Medical Specialties Commons^™

Errors In Surgical Pathology Reports: A Study From A Major Center In Pakistan, Zubair Ahmad, Romana Idrees, Nasir Uddin, Arsalan Ahmed, Saira Fatima

Department of Pathology and Laboratory Medicine

Background:
Errors in surgical pathology diagnosis can have serious consequences for the patient. Since the final product of a surgical pathology lab is the report, errors can be picked by reviewing reports of cases.AIM: To determine the frequency and types of error in surgical pathology reports of cases signed out in 2014 in a laboratory in Karachi, Pakistan.
Material and Methods:
All surgical pathology reports in which changes were made in the original report after sign out and an amended report was issued were included. Errors included: (1) misinterpretations; (2) missing critical information; (3) erroneous critical information; (4) misidentification; and …

International Consortium On Mammographic Density: Methodology And Population Diversity Captured Across 22 Countries, Valerie A. Mccormacka, Anya Burton, Isabel Dos-Santos-Silva, John H. Hipwell, Caroline Dickens, Dorria Salem, Rasha Kama, Mikael Hartman, Charmaine Pei Ling Lee, Kee-Seng Chia, Vahit Ozmen, Mustafa Erkin Aribal, Anath Arzee Flugelman, Martín Lajous, Ruy Lopez-Riduara, Megan Rice, Isabelle Romieu, Giske Ursin, Samera Qureshi, Huiyan Ma, Eunjung Lee, Carla H. Van Gils, Johanna O.P. Wanders, Sudhir Vinayak, Rose Ndumia, Steve Allen, Sarah Vinnicombe, Sue Moss, Jong Won Lee, Jisun Kim, Ana Pereira, Maria Luisa Garmendia, Reza Sirous, Mehri Sirous, Beata Peplonska, Agnieszka Bukowska, Rulla M. Tamimi, Kimberly Bertrand, Chisato Nagata, Ava Kwong, Celine Vachon, Christopher Scott, Beatriz Perez-Gomez, Marina Pollan, Gertraud Maskarinec, Graham Giles, John Hopper, Jennifer Stone, Nadia Rajaram, Soo-Hwang Teo, Shivaani Mariapun, Martin J. Yaffe, Joachim Schüz, Anna M. Chiarelli, Linda Linton, Norman F. Boyd

Imaging & Diagnostic Radiology, East Africa

Mammographic density (MD) is a quantitative trait, measurable in all women, and is among the strongest markers of breast cancer risk. The population-based epidemiology of MD has revealed genetic, lifestyle and societal/environmental determinants, but studies have largely been conducted in women with similar westernized lifestyles living in countries with high breast cancer incidence rates. To benefit from the heterogeneity in risk factors and their combinations worldwide, we created an International Consortium on Mammographic Density (ICMD) to pool individual-level epidemiological and MD data from general population studies worldwide. ICMD aims to characterize determinants of MD more precisely, and to evaluate whether …

Mycobacterium Tuberculosis Lineage 4 Comprises Globally Distributed And Geographically Restricted Sublineages, David Stucki, Daniela Brites, Leïla Jeljeli, Mireia Coscolla, Gunturu Revathi

Pathology, East Africa

Generalist and specialist species differ in the breadth of their ecological niches. Little is known about the niche width of obligate human pathogens. Here we analyzed a global collection of Mycobacterium tuberculosis lineage 4 clinical isolates, the most geographically widespread cause of human tuberculosis. We show that lineage 4 comprises globally distributed and geographically restricted sublineages, suggesting a distinction between generalists and specialists. Population genomic analyses showed that, whereas the majority of human T cell epitopes were conserved in all sublineages, the proportion of variable epitopes was higher in generalists. Our data further support a European origin for the most …

Implementation Of Hiv Drug Resistance Testing In Kenya, Horacio Duarte, Ingrid Beck, James Munyao, Molly Levine, Catherine Kiptinness, Bhavna Chohan, Samah Sakr, Michael Chung, Lisa Frenkel

Internal Medicine, East Africa

Background: Testing for HIV drug resistance prior to antiretroviral therapy (ART) is standard of care in the United States but is rarely performed in Africa due to its high cost. The prevalence of HIV drug resistance is increasing in resource-limited settings (RLS). An affordable and feasible strategy is needed in RLS to identify individuals with drug resistance and prescribe effective ART. Our group developed a low-cost oligonucleotide ligation assay (OLA) that detects mutations conferring resistance. Little data exists on implementing HIV drug resistance testing in RLS. Here, we describe the implementation of OLA in one laboratory in Kenya and discuss …

Frequency, Indications And Complications Of Pulmonary Artery Catheter Insertion In Adult Open-Heart Surgery Patients Of A Tertiary Care Hospital, Syed Shabbir Ahmed, Mohammad Irfan Akhtar, Rehana Kamal

Department of Anaesthesia

Background: Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients.Methods: A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital …

A Case Of Refractory Thrombotic Thrombocytopenic Purpura Treated With Plasmapheresis And Rituximab, Nicholas Kirui, Ahmed Sokwala

Internal Medicine, East Africa

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder with no prevalence or incidence studies in sub-Saharan Africa. Acquired TTP has several causes, all of which lead to decreased activity of von Willebrand factor cleaving protease (ADAMTS13) due to autoantibodies that are directed towards ADAMTS13. We report a case of a 46-year-old man who presented with most of the classic clinical manifestations of TTP.

Short Communication: Analysis Of Minor Populations Of Human Immunodeficiency Virus By Primer Identification And Insertion-Deletion And Carry Forward Correction Pipelines, Paul Hughes, Wenjie Deng, Scott C. Olson, Robert W. Coombs, Michael Chung, Lisa M. Frenkel

Internal Medicine, East Africa

Accurate analysis of minor populations of drug-resistant HIV requires analysis of a sufficient number of viral templates. We assessed the effect of experimental conditions on the analysis of HIV pol 454 pyrosequences generated from plasma using (1) the ‘‘Insertion-deletion (indel) and Carry Forward Correction’’ (ICC) pipeline, which clusters sequence reads using a nonsubstitution approach and can correct for indels and carry forward errors, and (2) the ‘‘Primer Identification (ID)’’ method, which facilitates construction of a consensus sequence to correct for sequencing errors and allelic skewing. The Primer ID and ICC methods produced similar estimates of viral diversity, but differed in …

Symptoms In Women With Peripartum Cardiomyopathy: A Mixed Method Study, Harshida Patel, Marie Berg, Anders Barasa, Cecily Begley, Maria Schaufelberger

Internal Medicine, East Africa

Objective: Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women's experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and descirbe women’s experiences of symptoms in Peripartum Cardiomyopathy.

Design: A triangulation of methods with individual interviews and data from medical records.

Setting: Mothers with Peripartum Cardiomyopathy diagnosis were …

A Global Reference For Caesarean Section Rates (C‐Model): A Multicountry Cross‐Sectional Study, J. P. Souza, A. P. Betran, A. Dumont, B De Mucio, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To generate a global reference for caesarean section (CS) rates at health facilities. Design Cross-sectional study.

Setting: Health facilities from 43 countries. Population/Sample Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing.

Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: …

Effects Of The Copper Intrauterine Device Versus Injectable Progestin Contraception On Pregnancy Rates And Method Discontinuation Among Women Attending Termination Of Pregnancy Services In South Africa: A Pragmatic Randomized Controlled Trial, G. Justus Hofmeyr, Mandisa Singata-Madliki, Theresa A. Lawrie, Eduardo Bergel, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The copper intrauterine device (IUD) is under-utilised in South Africa, where injectable progestin contraception (IPC) dominates contraception usage. There is a lack of robust comparative data on these contraceptive options to inform policy, programs, clinical counseling, and women’s choices.

Methods: Within the context of a South African program to increase women’s access to the IUD, we conducted a pragmatic, open-label, parallel-arm, randomised controlled trial of the IUD versus IPC at two South African hospitals. The target sample size was 7,000 women and the randomisation ratio was 1:1. The random sequence was computer-generated and group allocation was concealed in sealed, …

Contraceptive Method Choice Among Women In Slum And Non-Slum Communities In Nairobi, Kenya, Rhoune Ochako, Chimaraoke Izugbara, Jerry Okal, Ian Askew, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Understanding women’s contraceptive method choices is key to enhancing family planning services provision and programming. Currently however, very little research has addressed inter and intra-regional disparities in women’s contraceptive method choice. Using data from slum and non-slum contexts in Nairobi, Kenya, the current study investigates the prevalence of and factors associated with contraceptive method choice among women.

Methods: Data were from a cross-sectional quantitative study conducted among a random sample of 1,873 women (aged 15–49 years) in two non-slum and two slum settlement areas in Nairobi, Kenya. The study locations were purposively sampled by virtue of being part of …

Assessing Women's Satisfaction With Family Planning Services In Mozambique, Leonardo Chavane, Martinho Dgedge, Patricia Bailey, Osvaldo Loquiha, Marc Aerts, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The contraceptive prevalence rate in Mozambique was estimated as 11.3% in the last Demographic and Health Survey. The impact of family planning (FP) on women’s health and on the reduction of maternal mortality is well known.

Methods: Acknowledging the importance of user satisfaction in the utilisation of health services, exit interviews were used to assess women’s satisfaction with FP services in Mozambique. The survey, conducted in 174 health facilities, was representative at the national level, covered all provinces, and both urban and rural areas.

Results: Overall, 86% of respondents were satisfied with FP services, but issues such as insufficient …

Scientific Basis For Standardization Of Fetal Head Measurements By Ultrasound: A Reproducibility Study, R. Napolitano, V. Donadono, E. O. Ohuma, C. L. Knight, Sikolia Wanyonyi, B. Kemp, T. Norris, A. T. Papageorghiou

Obstetrics and Gynaecology, East Africa

Objective: To compare the standard methods for ultrasound measurement of fetal head circumference (HC) and biparietal diameter (BPD) (outer-to-outer (BPDoo) vs outer-to-inner (BPDoi) caliper placement), and compare acquisition of these measurements in transthalamic (TT) vs transventricular (TV) planes.

Methods: This study utilized ultrasound images acquired from women participating in the Oxford arm of the INTERGROWTH-21st Project. In the first phase of the study, BPDoo and BPDoi were measured on stored images. In the second phase, real-time measurements of BPD, occipitofrontal diameter (OFD) and HC in TT and TV planes were obtained by pairs of sonographers. Reproducibility of measurements made by …

Prevalence And Determinants Of Postpartum Depression In A Tertiary Care Hospital, Shiyam Sunder Tikmani, Tufail Soomro, Prashant Tikmani

Community Health Sciences

Purpose: Postpartum depression is one of the common complication of postpartum period and a major public health issue. It adversely affects the mother, her child, and the family. To determine the prevalence and determinants of postpartum depression in women delivered in a tertiary hospital Karachi.
Methods: This was a cross-sectional study carried out in a private hospital of Karachi, from 1^st February 2014 to 31^st January 2016. All women having age between 20-49 years between 4-6 weeks postpartum period consented to participate were included. Women with pre-existing co-morbid like diabetes mellitus, hypertension, physical and psychiatric illnesses, having multigestation …

Frequency Of Retinopathy Of Prematurity In A Tertiary Care Hospital, Shiyam Sunder Tikmani, Tufail Soomro, Prashant Tikmani

Community Health Sciences

Introduction: Retinopathy of prematurity (ROP) is one of a preventable cause of blindness in neonates. Screening of preterm infants for ROP in Pakistan is currently under-recognized. The aim of this study was to determine the frequency of retinopathy of prematurity (ROP) in premature and very low birth weight neonates (birth weight ≤ 1500 g and gestational age ≤ 32 weeks) in a tertiary care hospital, Karachi, Pakistan.
Methods: This was a cross-sectional study carried out in the neonatal intensive care unit (NICU) of Civil Hospital Sukkur from 1st June 2014 to 17th June 2015. Preterm neonates with birth weight ≤ …

Hyperlactetemia And Its Trends In Critically Ill Children Admitted In Pediatric Intensive Care Unit Of A Developing Country, Qalab Abbas, Muhammad Tariq Jamil, Leena Jafri, Anwar Ul Haque, Vivek Khetpal

Department of Paediatrics and Child Health

Background: There is increasing evidence that in setting of critical ailments clinical signs lag biomarkers like Lactate and hyperlactetemia can be the only marker for this disorder. This study was conducted to describe the incidence of hyperlactatemia in critically ill children and its association with outcome.Methods: Retrospective review of medical records of all children who had their lactic acid (LA) levels measured during their admission in PICU from January 2014 to December 2015 was done. Demographic and clinical variables were recorded along with PICU therapies, outcome (Survived or expired) and development of multi-organ dysfunction. Results are presented as frequency with …

Telephone Versus Face To Face Palliative Care Consults During Referral, John Weru

Internal Medicine, East Africa

Introduction: Palliative care aims at ameliorating patients and families suffering when they are faced with life-limiting illnesses. It involves symptoms management as well as psychosocial, spiritual support. As such, proper communication between clinicians taking care of the patient is an important aspect of this care. Studies have shown that errors in communication are common and relevant in palliative care as they negatively impact on the quality of care provided. The service at Aga Khan University Hospital, Nairobi (AKUHN) provides both in and out patient consult services. Primary physicians to patients consult the palliative care team via telephone models as well …

Fmic Annual Report 2016 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Results From The Survey Of Antibiotic Resistance (Soar) 2011-14 In The Democratic Republic Of Congo, Ivory Coast, Republic Of Senegal And Kenya, A. Kacou-Ndouba, Gunturu Revathi, P. Mwathi, A. Seck, A. Diop, M. J. Kabedi-Bajani, W. Mwiti, M. J. Anguibi-Pokou, I. Morrissey, D. Torumkuney

Pathology, East Africa

Objectives: To assess antibiotic susceptibility of community-acquired respiratory tract isolates from Ivory Coast, Kenya, Democratic Republic of Congo (DRC) and Senegal in 2011–14.

Methods: Bacterial isolates were collected and MICs determined using Etest^® for all antibiotics except erythromycin, for which testing was by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. For macrolide interpretation, CLSI breakpoints were adjusted for incubation in CO₂.

Results: Susceptibility to penicillin (using CLSI oral or EUCAST breakpoints) was low among isolates of Streptococcus pneumoniae from the DRC and Kenya (17.4% and 19%, respectively) but higher among isolates from …

Adding A Single Low-Dose Of Primaquine (0.25 Mg/Kg) To Artemether-Lumefantrine Did Not Compromise Treatment Outcome Of Uncomplicated Plasmodium Falciparum Malaria In Tanzania: A Randomized, Single-Blinded Clinical Trial, Richard Mwaiswelo, Billy Ngasala, Irina Jovel, Berit Aydin‑Schmidt, Roland Gosling, Zul Premji, Bruno Mmbando, Anders Björkman, Andreas Mårtensson

Pathology, East Africa

Background: The World Health Organization (WHO) recently recommended the addition of a single low-dose of the gametocytocidal drug primaquine (PQ) to artemisinin-based combination therapy (ACT) in low transmission set‑ tings as a component of pre-elimination or elimination programmes. However, it is unclear whether that influences the ACT cure rate. The study assessed treatment outcome of artemether-lumefantrine (AL) plus a single PQ dose (0.25 mg/kg) versus standard AL regimen for treatment of acute uncomplicated Plasmodium falciparum malaria in Tanzania.

Methods: A randomized, single-blinded, clinical trial was conducted in Yombo, Bagamoyo district, Tanzania. Acute uncomplicated P. falciparum malaria patients aged ≥1 year, …

Safety Of A Single Low-Dose Of Primaquine In Addition To Standard Artemether-Lumefantrine Regimen For Treatment Of Acute Uncomplicated Plasmodium Falciparum Malaria In Tanzania, Richard Mwaiswelo, Billy Ngasala, Irina Jovel, Roland Gosling, Zul Premji, Eugenie Poirot, Bruno Mmbando, Anders Björkman, Andreas Mårtensson

Pathology, East Africa

Background: This study assessed the safety of the new World Health Organization (WHO) recommendation of adding a single low-dose of primaquine (PQ) to standard artemisinin-based combination therapy (ACT), regardless of individual glucose-6-phosphate dehydrogenase (G6PD) status, for treatment of acute uncomplicated Plasmodium falciparum malaria in Tanzania.

Methods: Men and non-pregnant, non-lactating women aged ≥1 year with uncomplicated P. falciparum malaria were enrolled and randomized to either standard artemether-lumefantrine (AL) regimen alone or with a 0.25 mg/kg single-dose of PQ. PQ was administered concomitantly with the first AL dose. All drug doses were supervised. Safety was evaluated between days 0 and 28. …

Childhood Obesity, A Public Health Crisis: Narrative Review Of Public Health Interventions For Childhood Obesity, Sumera Aziz Ali, Savera Aziz Ali, Nadir Suhail, Shiyam Sunder Tikmani, Gulshan Bano

Community Health Sciences

Introduction: Child obesity is the major pediatric public health crisis of the current century and its trend is increasing in the developing countries due to nutrition and epidemiologic transition. Considering the burden of childhood obesity and its associated outcomes need for obesity prevention in children has become priority both for government and researchers.
Objective: The objective of this review is to provide the updated knowledge and evidence from various research studies, designed to provide interventions either in school or at home.
Methodology: Electronic databases like Google scholar, PubMed and Sciencedirect were used as search engines. Key terms used during the …

Clinico-Pathological Profile And Outcomes Of Patients With Polycythaemia Vera, Essential Thrombocythaemia And Idiopathic Myelofibrosis: A Tertiary Care Center Experience From Southern Pakistan, Muhammad Shariq Shaikh, Mohammad Usman Shaikh, Salman Naseem Adil, Mohammad Khurshid, Zeeshan Ansar Ahmed

Department of Pathology and Laboratory Medicine

Background: The “Philadelphia Negative Classic Myeloproliferative Neoplasms” include polycythaemia vera (PV), essential thrombocythaemia (ET) andidiopathic myelofibrosis (IMF). These three disorders share several clinical and laboratory features including JAK2 V617F mutation. Our objectives were to determine the clinicoat hological profile and outcomes of Pakistani patients with polycythaemia vera (PV), essential thrombocythaemia (ET) and idiopathic myelofibrosis (IMF) in order to have an insight regarding behaviour of these conditions.
Methods: A retrospective analysis of all the cases of PV, ET and IMF diagnosed at our institute from January 1995 to December 2013 was performed.Age, gender, clinical presentation, laboratory investigations, treatment provided and …

Central, Extraventricular And Atypical Neurocytomas: A Clinicopathologic Study Of 35 Cases From Pakistan Plus A Detailed Review Of The Published Literature, Zubair Ahmad, Nasir Ud Din, Aisha Memon, Mohammad Usman Tariq, Romana Idrees, Sheema Hasan

Department of Pathology and Laboratory Medicine

Background: Central neurocytomas are rare neuronal neoplasms with a favorable prognosis. They are typically located in the lateral ventricles of the brain and mostly histologically correspond to WHO grade II with a Mib 1 labelling index of 2 % and are designated as "atypical neurocytomas.AIM: The aim of our study was to describe the common as well as unusual morphologic features and the role of various immunohistochemical stains in the diagnosis of these rare tumors.MATERIALS AND Methods: We retrieved and reviewed 35 cases diagnosed between 2001 and 2015.Results: Sixty percent of patients were males, and the mean age was 26 …

Sporadic Early Onset Colorectal Cancer In Pakistan: A Case- Control Analysis Of Microsatellite Instability, Sabeehuddin Siddique, Kanwal Tariq, Sobia Rafiq, Ahmed Raheem, Rashida Ahmed, Munira Shabbir-Moosajee, Kulsoom Ghias

Department of Pathology and Laboratory Medicine

Background: Early onset sporadic colorectal cancer (CRC) is a biologically and clinically distinct entity hypothesized to exhibit differences in histological features and microsatellite instability (MSI) as compared to typical onset CRC. This study compared the MSI status, mismatch repair enzyme deficiency and clinicopathological features of early onset (aged ≤45 years) with controls (>45 years).
Materials and Methods: A total of 30 cases and 30 controls were analyzed for MSI status using the Bethesda marker panel. Using antibodies against hMLH1, hMSH2 and hMSH6, mismatch repair protein expression was assessed by immunohistochemistry. Molecular characteristics were correlated with clinicopathological features.
Results: …

Naegleria Fowleri Meningoencephalitis Associated With Public Water Supply, Pakistan, 2014, Najia Ghanchi, Erum Khan, Azam Khan, Wali Muhammad, Faisal Riaz Malik, Afia Zafar

Department of Pathology and Laboratory Medicine

No abstract provided.

Agreement Of Direct Antifungal Susceptibility Testing From Positive Blood Culture Bottles With The Conventional Method For Candida Species, Kauser Jabeen, Haresh Kumar, Joveria Farooqi, Raunaq Mehboob, Mary E. Brandt, Afia Zafar

Department of Pathology and Laboratory Medicine

Early availability of antifungal susceptibilities can ensure timely institution of targeted therapy in candidemia, which can improve patient outcomes. This study prospectively determines the agreement between the results of direct testing of antifungal susceptibilities from blood culture bottles by disk diffusion and Etest and the results of standardized susceptibility testing methods; direct testing would allow susceptibility results to be available 1 to 2 days earlier. A total of 104 blood cultures with different Candida species (28% C. albicans, 27% C. parapsilosis, 26% C. tropicalis, etc.) were evaluated between January 2012 and May 2013 for agreement of fluconazole, voriconazole, and amphotericin …

Carotid Intima Media Thickness Evaluation By Ultrasound Comparison Amongst Healthy, Diabetic And Hypertensive Pakistani Patients, Waseem Mirza, Vaqar Bari, Mirza Kazim, Kainat Fatima, Zafar Sajjad, Aziz Jiwani, Nadeem Ahmad, Mubashir Arain, Arif Ali

Department of Pathology and Laboratory Medicine

Objective: To compare carotid Intima media thickness and atherosclerosis burden amongst healthy, diabetic and hypertensive Pakistani patients.
Methods: A cross-sectional study was carried out at the Department of radiology and family medicine, Aga Khan University Hospital Karachi from April 2014 to July 2015. Bilateral carotid ultrasound was done in 133 healthy adults, 65 hypertensive, 31 type-2 diabetic and 37 hypertensive with type-2 diabetes patients. Normal adults were matched for age and gender. Mean intimal media thickness was measured for common and internal carotid arteries. Presence or absence of atherosclerotic plaque was also identified. Height, weight, ethnicity, socioeconomic status and other …

Clinical Practice Guidelines On The Management Of Variceal Bleeding, Javed Iqbal Farooqi, Hasnain Ali Shah, Anwaar A. Khan, Amjad Salamat, Altaf Alam, Abbas Khan Khattak, Nazish Butt, Muhammed Salih, Sher Sher Rehman, Arif Amir Nawaz, Nasir Khokhar, Ghias-Un-Nabi Tayyab, Javed Aslam Butt, Kashif Malik, Shakeel Ahmad Mirza, Mohammad Akram

Department of Medicine

Gastroesophageal variceal bleeding occurs in 30 - 50% of patients of liver cirrhosis with portal hypertension, with 20-70% mortality in one year. Therefore, it is essential to screen these patients for varices and prevent first episode of bleeding by treating them with β-blockers or endoscopic variceal band ligation. Ideally, the patients with variceal bleeding should be treated in a unit where the personnel are familiar with the management of such patients and where routine therapeutic interventions can be undertaken. Proper management of such patients include: initial assessment, resuscitation, blood volume replacement, vasoactive agents, prevention of associated complications such as bacterial …

Translating Knowledge For Action Against Stroke--Using 5-Minute Videos For Stroke Survivors And Caregivers To Improve Post-Stroke Outcomes: Study Protocol For A Randomized Controlled Trial (Movies4stroke)., Ayeesha Kamran Kamal, Adeel Khoja, Bushra Usmani, Nargis Asad, Asma Ahmed, Iqbal Azam, Sarah Saleem, Saleem Sayani

Department of Medicine

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.

Methods: Movies4Stroke will be a randomized control, outcome assessor …