Medical Specialties Commons^™

Impact Of Cable Television On Lives Of Patients Visiting A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, Kashmira Nanji, Madeeha Anwar Adam

Department of Family Medicine

A cross sectional survey was conducted during August 2014 to October 2014, to identify the impact of cable television channels on lives of the people, in Karachi, Pakistan. Three hundred participants were selected through convenience sampling and a pre-tested structured questionnaire was used for data collection. Data was analyzed in SPSS version 19.0. About 15% of participants were more than 40 years. About 62% were females in the study sample. Regression analysis showed that viewing television at night impacts work performance (OR: 1.39; 95% CI: 0.81-2.37), sleep (OR: 1.07; 95% CI: 0.63-1.81), family life (OR: 1.52; 95% CI: 0.89-2.60) and …

Association Between Immediate Postnatal Anaemia And Risk Of Developing Postpartum Depression At The Aga Khan University Hospital: A Cohort Study, John Ndungu Kimani

Master of Medicine in Obstetrics and Gynecology

Introduction: Postpartum depression has significant burden on obstetric psychopathology. While risk factors for the same have been extensively studied, most of this studies have focused on the role of psychosocial factors. Data on the role of physiological variables such as anaemia and role of obstetric complications in postpartum depression is now emerging. There are still gaps in literature regarding the same in developing countries and in Africa. Primary Objective: To determine the association between low postnatal hemoglobin and postpartum depression Secondary Objective: To determine the association between obstetric complication specifically postpartum hemorrhage, operative delivery and NICU/NHDU admission and postpartum depression. …

Atresia Of The Descending Aorta In A Young Woman Requiring Bypass Graft, Ammarah Mashhood, Taimur Asif Ali, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Congenital aortic atresia is a malformation accounting for 4 - 6% of all congenital heart diseases in children. Left ventricular outflow obstruction due to atresia is common at the aortic valve but rarely has atresia been identified in the descending aorta. We report the case of a 25-year woman who was evaluated for headache and uncontrolled hypertension. CTscan chest showed a short atretic segment in the descending aorta at the isthmus, distal to the takeoff of the subclavian artery. She underwent surgery; a 22 mm Dacron graft was taken and jump graft was placed between the arch of the aorta …

Electrophysiological Changes In Patients With Liver Cirrhosis In A Tertiary Care Hospital In Karachi, Pakistan, Om Parkash, Ghulam Rehman Mohyuddin, Adil Ayub, Irfan Nazir, Arslan Arif Maan, Saeed Hamid

Section of Gastroenterology

Background: Electrophysiological changes in cirrhosis are well known but least investigated especially in our country hence we wanted to see electrophysiological changes especially QT interval in cirrhotic patients.

Methods: A cross-sectional study was conducted at Aga Khan University Hospital Karachi (AKUH) in which medical records (duration 2008-2010) of cirrhotic patients were reviewed.

Results: Three hundred and eighty cirrhotic patients' charts were studied, 227 (59.7 %) were male and mean age of this cohort was 52.8±12.6 years. The most common cause for CLD was Hepatitis C (CHC) in 260 (68.4%), NBNC in 56(14.7%) and HBV in 51 (13.4%). Only 225 …

The Impact Of The Introduction Of The Pecarn Head Ct Rules On The Utilisation Of Head Ct Scans For Children With Mild Head Injury At The Aga Khan University Hospital, Nairobi., Isaac Oluoch Kobe

Master of Medicine in General Surgery

Background: Head injury is the most common cause of childhood morbidity and mortality worldwide. Mild head injury comprises 90% of cases of head injury in children. Head CT scans are few, expensive and have the side effect of ionizing radiation whose effect is potentiated in children and also associated risk of sedation that is often required when doing CT scans in young children. The decision to order CT scans of the head is thus made on the basis of clinical decision rules of which the PECARN CT head rule has been found to be most sensitive and useful. Objectives: Primary: …

Evidence And Evidence Gaps In Adolescent Health, George Patton, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The momentum to bring adolescents and young adults to center stage in global health and international development is palpable. Adolescents are increasingly seen as a crucial group for the success of the newly adopted Agenda for Sustainable Development [1]. Sitting within the Agenda for Sustainable Development framework, the 2030 Global Strategy for Women's, Children's and Adolescents' Health has extended the Every Woman, Every Child agenda to adolescence [2]. The strategy articulates the need for adolescent responsive health systems as well as social determinants, a focus that extends to legal and policy environments [3]. Countries seeking to adopt this more holistic …

Moving Towards The Goals Of Fp2020 — Classifying Contraceptives, Mario Philip R. Festin, James Kiarie, Julie Solo, Jeffrey Spieler, Shawn Malarcher, Paul F.A. Van Look, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

With the renewed focus on family planning, a clear and transparent understanding is needed for the consistent classification of contraceptives, especially in the commonly used modern/traditional system. The World Health Organization Department of Reproductive Health and Research and the United States Agency for International Development (USAID) therefore convened a technical consultation in January 2015 to address issues related to classifying contraceptives. The consultation defined modern contraceptive methods as having a sound basis in reproductive biology, a precise protocol for correct use and evidence of efficacy under various conditions based on appropriately designed studies. Methods in country programs like Fertility Awareness …

Eregistries: Electronic Registries For Maternal And Child Health, J. Frederik Frøen, Sonja L. Myhre, Michael J. Frost, Doris Chou, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women’s, Children’s and Adolescent’s Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to …

Vitamin D Levels In Black African Adults At The Aga Khan University Hospital Nairobi, Elizabeth Muringa Kagotho

Master of Medicine in Clinical Pathology

Introduction: Vitamin D has been known for centuries for its benefits in bone health. Recent observational studies have however demonstrated its benefits in infectious diseases such as tuberculosis and non-communicable diseases such as diabetes mellitus, cardiovascular diseases and cancer. This has led to a dramatic increase in testing among adults. The cut-offs for vitamin D deficiency have been debated for decades and the current cut off is derived from a Caucasian population. Studies done among black African adults in Africa are few and have shown that vitamin D deficiency ranges from 5-91%. In view of the difference in skin colour, …

Magnetic Resonance Cholangiopancreatography In Diagnosis Of Biliary Disorders In Children - Sharing Our Experience., Fahad Ali, Waseem Akhter, Muhammad Arshad

Department of Radiology

Abstract

OBJECTIVE:

To evaluate the role of Magnetic Resonance Cholangio-pancreatography in the diagnosis of biliary disorders in children.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data related to the period between August 2005 and December 2013. All children from age of 1 day to 17 years who had undergone Magnetic Rasonance Cholangio-pancreatography examination for suspected pancreaticobiliary disorders were included. Clinical presentation, Magnetic Rasonance Cholangio-pancreatography findings, operative findings and histopathological results were recorded. Sensitivity and specificity of Magnetic Rasonance Cholangio-pancreatography for different diseases was worked out.

RESULTS:

Of the 50 patients in the study, …

Omental Infarction In A Child, Saad Siddiqui, Anwar Ahmed, Naila Nadeem

Department of Radiology

Omental infarction is a rare cause of acute abdomen in children. Typical findings on imaging establish the diagnosis. We present case of a 7 years old boy who presented with acute right iliac fossa pain with diagnosis of omental infarction on imaging and findings confirmed on laparotomy. Sound knowledge regarding this infrequent cause of acute abdomen in children is necessary for timely diagnosis.

Comparison Of Risk Factors And Survival Of Type 1 And Type Ii Endometrial Cancers, Tahira Y. Malik, Uzma Chishti, Aliya Aziz, Irfan Sheikh

Department of Obstetrics & Gynaecology

Objective: To compare risk factors and progression free survival of type 1 & 2 endometrial cancers.
Methods: A retrospective analysis of 149 patients with early stage endometrial carcinoma treated between 1997 and 2012 in Aga Khan University Hospital, Karachi was performed.
Results: A total of 149 patients were analyzed. Type I tumors accounted for 92% of cases in the study while 8% were type II tumors. The mean age, BMI, parity, co-morbidities (hypertension & Diabetes), family history and history of polycystic disease were comparable in both groups. Overall better survival (113 Vs 24 months) was observed for type I endometrial …

Successful Management Of A Stab Wound To The Left Ventricle, Jaleed Ahmad Gillani, Hamza Ar Khan, Omar Irfan, Saulat H. Fatimi

Section of Cardiothoracic Surgery

A 24 year old male presented to the emergency room with a 2 hour history of knife stab wound. He was haemodynamically stable with good bilateral air entry. However on X-ray an enlarged cardiac silhouette was seen. The patient suddenly became hypotensive and on suspicion of cardiac tamponade a catheter was introduced in pericardial space, but the measure was unsuccessful and he was rushed to the Operating Room. During the surgery a 2 cm long laceration was identified in the mid-left ventricular (LV) wall less than 1mm away from the Left Anterior Descending (LAD) Artery. The Left Anterior Descending Vein …

Myxoid Liposarcoma Originating In The Anterior Mediastinum, Mohammad Harisullah Khan, Ramsha Kashif, Hamza Abdur Rahim Khan, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Myxoidliposarcomas ofthe head and neck aremostly metastaticin nature, with the primarylesion usually in lower extremities or retroperitoneum. Primary mediastinal liposarcomas are even rare Although there have been previous cases reporting their incidence, there is no evidence of any case comprising of both the neck and the mediastinal region yet. We here present a case of a 43 year old male with a primary liposarcoma of the myxoid subtype originating in the anterior mediastinumThis is the first time such a case haspres ented in literature. The patient presented with a right sided neck swelling associated with pain and shortness of breath …

Low Self-Esteem Leads To Depression Among Elderly: Case Study Of Nursing Home, Savera Aziz Ali, Nadir Suhail, Sumera Aziz Ali

School of Nursing & Midwifery

Background: Self-esteem is defined as “how we value our self”; it affects our trust and relationships in every part of life. Person with low self-esteem may feel powerless and incompetent about himself/herself. Moreover, low self-esteem operates as a risk factor for depression, which is most common disorder among elderly people both in developed and developing countries, causing multiple behavioral changes as well as may increase the chances of depression and suicide among the elderly people. Objective: The objective of this case study was to understand the problems faced by elderly people in the nursing home and to relate the self-esteem …

Diagnostic Accuracy Of Ct Scan In Staging Resectable Esophageal Cancer, Rizwan Sultan, Zishan Haider, Tabish Chawla

Department of Surgery Docs

Abstract

INTRODUCTION:

CT scan is an important tool in staging of esophageal cancer. Survival can be improved by providing neoadjuvant treatment which depends on stage of esophageal cancer. So it is very important to stage the disease accurately.

METHODS:

The objective of this study is to determine diagnostic accuracy of CT scan to stage esophageal cancer. Ct scans of 62 patients included in the study were reviewed by a Consultant radiologist who was blinded to the final stage of tumour. Diagnosticaccuracy measured by comparing with histopathological staging.

RESULTS:

Accuracy, sensitivity and specificity of CT for T2 and T3 are 66%, …

Success Of Bubble Cpap In Treatment Of Respiratory Distress Syndrome In Preterm Infants, Tufail Soomro, Shiyam Sunder Tikmani

Community Health Sciences

Background: To observe the survival of preterm infants with respiratory distress syndrome treated with bubble CPAP in a tertiary care hospital.
Methods: This prospective observational study was conducted in the NICU of Civil hospital Sukkur from 1st July 2013 to 18th August 2015. All consecutively born preterm neonates with gestational age between 27 weeks to 36 weeks of gestation, admitted to the neonatal intensive care unit with respiratory distress are included in the study.These neonates were managed by Bubble continuous positive airway pressure (bCPAP) in combination with surfactant (bovine derivative) via intubation, Surfactant replacement, extubation (INSURE) protocol Success was considered …

Critical Need Of Osteoporosis Risk Assessment Tool For Pakistan, Lena Jafri, Romaina Iqbal, Aysha Habib Khan

Community Health Sciences

No abstract provided.

Primary Healthcare Policy Implementation In South Asia, Chris Van Weel, Ryuki Kassai, Waris Qidwai, Raman Kumar, Kanu Bala, Pramendra Prasad Gupta, Ruvaiz Haniffa Haniffa, Neelamani Rajapaksa Hewageegana, Thusara Ranasinghe, Michael Kidd, Amanda Howe

Department of Family Medicine

Primary healthcare is considered an essential feature of health systems to secure population health and contain costs of healthcare while universal health coverage forms a key to secure access to care. This paper is based on a workshop at the 2016 World Organization of Family Doctors (WONCA) South Asia regional conference, where the health systems of Bangladesh, India, Nepal, Pakistan and Sri Lanka were presented in relation to their provision of primary healthcare. The five countries have in recent years improved the health of their populations, but currently face the challenges of non-communicable diseases and ageing populations. Primary healthcare should …

Present And Future Of Neurology In Pakistan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Neurology started as a department in early nineteen sixties in Dow Medical College and King Edward Medical College and initially having a separate department of neurology was not mandated in medical colleges by Pakistan Medical and Dental Council¹. Some neurology training programs do not give exposure to subspecialties and training is focused on adult neurology². From 2015 to 2016, several conferences were held on neurology including an Annual Meeting in Quetta, movement disorder conference in Lahore.

Acute Childhood Ischemic Stroke: A Pakistani Tertiary Care Hospital Experience, Prem Chand, Shahnaz Ibrahim, Muhammad Matloob Alam, Fazal Arain, Bhojo Khealani

Pakistan Journal of Neurological Sciences (PJNS)

Stroke in pediatric population is increasingly recognized and has diverse clinical presentation and risk factor profile. Majority of patients survive acute stroke but remain disabled. The reported literature on the subject from our part of world is scarce.Methods:A retrospective chart review was carried out for stroke patients between 1 month and 14 years of age, admitted between January 2009 and January 2015. Their demographic, clinical and radiological data was collected and analyzed.Results:Twenty nine patients were admitted with stroke over 5 years. Their mean age was 5.7 ±11.7 and male to female ratio was 3:1. The most common clinical features reported …

Factors Influencing Antiepileptic Drug Non-Compliance In Epileptic Patients Of Pakistan, Safia Bano, Ahsan Numanb

Pakistan Journal of Neurological Sciences (PJNS)

Failure to comply with drug regimes is prevalent amongst patients with epilepsy and the consequence of this is often an increased risk of further seizures and other associated harms including increased health care costs. Contributing factors leading to non-compliance of anti-epileptic drugs has not been examined in Pakistan. We investigated the factors influencing non-compliance to prescribed antiepileptic drugs (AEDs). A cross-sectional study was employed for a total of 53 epileptic patients with non-compliance of anti-epileptic drugs. The data-collection tools were a questionnaire and structured interview for this study. Results showed that males were more liable to non-compliance of AEDs as …

Socio-Demographic Risk Factors For Hemorrhagic And Ischemic Stroke: A Study In Tertiary Care Hospital Of Hyderabad, Tariq Feroz Memon, Manzoor Ali Lakhair, Muzaffar Shaikh, Abeer Raque, Muhammad Saleem Rind

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a common neurological disorder and major cause of death and disability worldwide. Stroke is a second leading cause of death after cancer and ischemic heart disease. Incidence of stroke has not been well studied in Pakistan but it is estimated that 350,000 cases of stroke occur per year. Objective: To determine the frequencies and Socio-demographic features of Hemorrhagic and Ischemic strokes among stroke patients in tertiary care hospital.Material & method:This cross-sectional study was carried out at department of medicine Liaquat university hospital Hyderabad from June to September 2010, Patients were included in study according to inclusion and exclusion …

Neurocutanoussarcoidosis: A Rare Entity, Muslim Ali Lakhiar, Manzoor Lakhiar, Abdul Hafeez Bughio

Pakistan Journal of Neurological Sciences (PJNS)

Neurosarcoidosis is a granulomatous disorder considered to be a great imitator. We report a case of young lady who presented with gradual onset flexed posturing of fingers of left hand for four years, followed by similar pattern of weakness involving the right hand for three years along with slipping of slippers for one year. Neurologic examination showed distal wasting & weakness in upper limbs with normal jerks and sensory impairment in gloves and stocking distribution. On skin examination there were hypopigmented macules over face, neck and back. Electro diagnostic studies showed sensory motor axonal polyneuropathy, while skin biopsy reported as …

Mental Health Is Not A Luxury In Pakistan, Salma Kerai

Pakistan Journal of Neurological Sciences (PJNS)

A day with a fever is taken serious enough to get off from work in contrast to a day with emotional distress. World health organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. However, mental health is not seen as an integral part of overall well-being in many cultures.

Spontaneous Intracranial Hypotension; Three Case Reports With Similar Clinical Manifestations, Treated Successfully Using Different Management Techniques., Ali Ilyas, Wasim Tariq, Anam Abrar, Muhammad Amjad, Muhammad Azhar Saeed, Inayatullah Khan

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous Intracranial hypotension (SIH) is a rare neurological disorder, characterized by orthostatic headaches. Due to the complicity of its diagnosis and lack of awareness amongst physicians, SIH remains an under-diagnosed disease and its true prevalence remains unknown. It is a reversible condition, if diagnosed early. Delay in diagnosis can result in life threatening complications.Case Reports:We present a case series of three patients who presented with typical symptoms of SIH. But management course of each patient varied. The first patient responded well to the EBP (epidural blood patch) while the second improved with conventional symptomatic treatment. The third patient needed a …

An Unusual Presentation Of Gbs: Case Report And Literature Review, Sadaf Khattak, Sumaira Nabi, Irfan Khattak, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS), also known as Landry paralysis is an acute idiopathic polyneuritis, believed to be immunologically mediated. It usually presents as a demyelinating neuropathy with ascending weakness, however, many clinical variants have been well documented in the medical literature, and variants involving the cranial nerves or pure motor involvement with axonal injury have also been described. We report a case of a 50 year old patient who initially presented to the ER with hemiparesis and cranial nerve palsies simulating a cerebrovascular event. Based on neurological examination, CSF analysis and needle EMG finding a diagnosis of GBS was made.

From Tip To Tpa, Shaista A Siddiqi, Syed Habibullah Kamran, Abubaker A Almadni

Pakistan Journal of Neurological Sciences (PJNS)

We present the case of a 50 year old lady who presented with sudden onset altered sensorium, anarthria, right hemianopia, ophthalmoplegia, quadriparesis and abnormal posturing of upper limbs for 4 hours. The NIHSS score was 31. The CT brain showed early ischemic changes in left posterior cerebral artery territory. The CT cerebral angiogram showed occlusion of the tip of basilar artery. Intravenous thrombolysis with rtPA resulted in remarkable recovery and NIHSS improved to 3 within 6 hours. In view of expected severe disability associated with tip of basilar artery syndrome, intravenous thrombolysis can be rewarding even in patients with high …

T-Tube Placement As A Method For Treating Penetrating Oesophageal Injuries, Roger Gill, K. M. Inam Pal, Fatima Mannan, Amber Bawa, Saulat H. Fatimi

Department of Surgery Docs

Introduction: Penetrating oesophageal injuries are extremely rare. Their timely recognition can be difficult and optimal treatment remains controversial. Early recognition of injury is possible with the help of a high index of suspicion and early radiological and endoscopic examinations. Prompt surgical intervention with primary repair of injury, should be the goal.
Presentation of cases: We describe two cases of penetrating oesophageal trauma where T-Tube placement through the oesophageal defect, was successfully employed. Both cases proved to be challenging due to time lapse after injury and anatomical location.
Discussion: Penetrating injuries to the Oesophagus are rare with a reported …

An Unusual Case Of Cauda Equina Secondary To Spinal Metastasis Of Thyroid Cancer, Shabbir Akhtar, Mohammad Adeel

Department of Surgery Docs

Abstract

INTRODUCTION:

Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity.

CASE REPORT:

We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of …