Medical Specialties Commons^™

Delivering Healthcare Services In Resource Constraint Countries Like Pakistan: Sustainable Options, Waris Qidwai

Department of Family Medicine

No abstract provided.

Prevalence Of Tobacco Use Among Women: A Cross Sectional Survey From A Squatter Settlement Of Karachi, Pakistan, Nousheen Iqbal, Muhammad Irfan, Nida Ashraf, Safia Awan, Javaid A. Khan

Section of Pulmonary & Critical Care

Background: While the prevalence of tobacco use has been slowly declining in the developed countries, rates have been steadily rising in the developing countries. This has led to a rapid rise in tobacco related lung diseases among women.

Objective: Determine the prevalence of tobacco use (both smoking and smokeless) among women in an urban squatter settlement (Orangi Town) in Karachi, Pakistan.

Methods: A cross-sectional survey was conducted on 19,325 females aged between 15 and 80 years in Orangi Town, an urban squatter settlement in Karachi, Pakistan. Modified questionnaire, developed by World Health Organization WHO and Global Adult …

Community-Based Perceptions Of Emergency Care In Kenya, Morgan C. Broccoli, Emilie J.B Calvello, Alexander P. Skog, Benjamin W. Wachira, Lee A. Wallis

Emergency Medicine, East Africa

Access to quality emergency services is an essential component of the human right to health, but barriers to emergency care are found throughout Africa and the wider world. Data to support the development of emergency care are essential to improve access to care and further infrastructure development. We undertook this study to understand the community's emergency care needs and the barriers they face when trying to access care and to engage community members with developing high impact solutions to expand access to essential emergency services.

To accomplish this, we used a qualitative research methodology to conduct 59 focus groups with …

Financing Early Childhood Education: An Investment Into The Future, Shelina Bhamani

Department of Obstetrics & Gynaecology

No abstract provided.

Urine Neutrophil Gelatinase-Associated Lipocalin In Asphyxiated Neonates: A Prospective Cohort Study, Farida Essajee, Fred Were, Bashir Admani

Paediatrics and Child Health, East Africa

Background: Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that urine neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI; yet, there is a paucity of data about its use in term neonates with perinatal asphyxia.

Methods: A prospective cohort study was conducted on 108 term babies in the new-born unit of Pumwani Maternity Hospital and Kenyatta National Hospital. Urine NGAL and serum creatinine were measured in 108 term asphyxiated neonates on days 1 and 3 of life.

Results: One-hundred and eight patients were recruited (male:female 1.4:1). At a cut-off of 250 …

Parenting Skills And Emotional Availability: An Rct, Aisha K. Yousafzai, Muneera A. Rasheed, Arjumand Rizvi, Robert Armstrong, Zulfiqar A. Bhutta

Paediatrics and Child Health, East Africa

Objective: To investigate whether a responsive stimulation intervention delivered to caregivers of young children either alone or integrated with nutrition interventions would benefit parenting skills and emotional availability to promote children’s development and growth compared with either a nutrition intervention alone or the usual standard of care.

Methods: A cluster randomized factorial effectiveness trial was implemented in an impoverished community in Pakistan. The 4 trial arms were control (usual standard of care), responsive stimulation (responsive care and stimulation), enhanced nutrition (education and multiple micronutrients), and a combination of both enriched interventions. The 4 intervention packages were delivered by community health …

World Allergy Organization-Mcmaster University Guidelines For Allergic Disease Prevention (Glad-P): Probiotics, Alessandro Fiocchi, Ruby Pawankar, Carlos Cuello-Garcia, Kangmo Ahn, Suleiman Al-Hammadi, Arnav Agarwal, Kirsten Beyer, Wesley Burks, Giorgio W. Canonica, Motohiro Ebisawa, Shreyas Gandhi, Rose Kamenwa, Bee Wah Lee, Haiqi Li, Susan Prescott, John J. Riva, Lanny Rosenwasser, Hugh Sampson, Michael Spigler, Luigi Terracciano, Andrea Vereda-Ortiz, Susan Waserman, Juan José Yepes-Nuñez, Jan L. Brożek, Holger J. Schünemann

Paediatrics and Child Health, East Africa

Background: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20–30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention.

Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy.

Methods: We identified the most relevant clinical questions and performed a systematic review …

Guidelines For The Initial Management Of Adults With Sepsis/Severe Sepsis/Septic Shock: 2015, Erfan Hussain, Bushra Jamil, Naseem Salahuddin

Department of Medicine

No abstract provided.

Diagnosis And Management Of Preeclampsia In Community Settings In Low And Middle-Income Countries, Rehana A. Salam, Jai K. Das, Anum Ali, Soumyadeep Bhaumik, Zohra S. Lassi

Department of Paediatrics and Child Health

Hypertensive disorders of pregnancy contribute significantly to maternal mortality and morbidity. Preeclampsia belongs to the spectrum of hypertensive disorders of pregnancy and if undiagnosed and/or untreated leads to fatal consequences for both the mother and the baby. Early detection and prevention of preeclampsia is limited by uncertainty in the knowledge about its etiopathogenesis. While much work has been done in establishing clinical guidelines for management of preeclampsia in the hospital or tertiary care settings, there is considerable lack of work in the domain of evidence-based guidelines for screening, identification and management of preeclampsia at the community-level. The article reviews these …

Bilateral Choroidal Neovascularization After Pegylated Interferon Therapy, Pir Salim Mahar, Abdul Sami Memon

Section of Ophthalmology

A 30-year-old male presented with gradual decrease in vision in his both eyes after the use of interferon alpha for his hepatitis-C. Ocular examination of patient included, Best Corrected Visual Acuity (BCVA), fundus photographs, Fundus Fluorescein Angiography (FFA) and Optical Coherence Tomography (OCT). His BCVA was recorded as 6/18 in the right eye and 6/12 in the left eye. The anterior segments were unremarkable, with normal intraocular Pressure (IOP) in his both eyes. Both fundi revealed the presence of bilateral Choroidal Neovascularization (CNV), confirmed on FFA and OCT. To the best of authors' knowledge, simultaneous presence of CNV in both …

Ceftriaxone-Resistant Salmonella Enterica Serotype Typhimurium Sequence Type 313 From Kenyan Patients Is Associated With The Blactx-M-15 Gene On A Novel Inchi2 Plasmid, Samuel Kariuki, Chinyere Okoro, John Kiiru, Samuel Njoroge, Geoffrey Omuse, Gemma Langridge, Robert A. Kingsley, Gordon Dougan, Gunturu Revathi

Pathology, East Africa

Multidrug-resistant bacteria pose a major challenge to the clinical management of infections in resource-poor settings. Although nontyphoidal Salmonella (NTS) bacteria cause predominantly enteric self-limiting illness in developed countries, NTS is responsible for a huge burden of life-threatening bloodstream infections in sub-Saharan Africa. Here, we characterized nine S. Typhimurium isolates from an outbreak involving patients who initially failed to respond to ceftriaxone treatment at a referral hospital in Kenya. These Salmonella enterica serotype Typhimurium isolates were resistant to ampicillin, chloramphenicol, cefuroxime, ceftriaxone, aztreonam, cefepime, sulfamethoxazole-trimethoprim, and cefpodoxime. Resistance to β-lactams, including to ceftriaxone, was associated with carriage of a combination …

Proceedings Of The African Pathologists Summit; March 22-23, 2013; Dakar, Senegal: A Summary, Shahin Sayed

Pathology, East Africa

Context: This report presents the proceedings of the African Pathologists Summit, held under the auspices of the African Organization for Research and Training in Cancer.

Objectives: To deliberate on the challenges and constraints of the practice of pathology in Sub-Saharan Africa and the avenues for addressing them.

Participants: Collaborating organizations included the American Society for Clinical Pathology; Association of Pathologists of Nigeria; British Division of the International Academy of Pathology; College of Pathologists of East, Central and Southern Africa; East African Division of the International Academy of Pathology; Friends of Africa-United States and Canadian Academy of Pathology Initiative; International Academy …

Impact Of Service Provision Platforms On Maternal And Newborn Health In Conflict Areas And Their Acceptability In Pakistan: A Systematic Review, Zohra S. Lassi, Wafa Aftab, Shabina Ariff, Rohail Kumar, Imtiaz Hussain, Nabiha Musavi, Zahid Memon, Sajid B. Soofi, Zulfiqar A. Bhutta

Woman and Child Health

Various models and strategies have been implemented over the years in different parts of the world to improve maternal and newborn health (MNH) in conflict affected areas. These strategies are based on specific needs and acceptability of local communities. This paper has undertaken a systematic review of global and local (Pakistan) information from conflict areas on platforms of health service provision in the last 10 years and information on acceptability from local stakeholders on effective models of service delivery; and drafted key recommendations for improving coverage of health services in conflict affected areas.

The literature search revealed ten studies that …

Metastatic Pancreatic Carcinoma And Experience With Folfirinox - A Cross Sectional Analysis From A Developing Country, Muhammad Nauman Zahir, Adnan Abdul Jabbar

Department of Radiation Oncology

Background: Pancreatic cancer is the fourth leading cause of cancer related death with median survival ranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatment in advanced stage and has evolved over time. Data pertaining to the disease are scarce from our part of the world where treatment poses a significant challenge due to lack of resources.MATERIALS AND Methods: A retrospective chart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary care hospital in Karachi, Pakistan between January 2008 and December 2012. Data were collected using a …

Prevalence And Risk Factors For Active Convulsive Epilepsy In Kintampo, Ghana, Kenneth Ayuurebobi Ae-Ngibise, Bright Akpalu, Anthony Ngugi, Albert Akpalu, Francis Agbokey, Patrick Adjei, Damien Punguyire, Christian Bottomley, Charles Newton, Seth Owusu-Agyei

Family Medicine, East Africa

Introduction: epilepsy is common in sub-Saharan Africa, but there is little data in West Africa, to develop public health measures for epilepsy in this region.

Methods: we conducted a three-stage cross-sectional survey to determine the prevalence and risk factors for active convulsive epilepsy (ACE), and estimated the treatment gap in Kintampo situated in the middle of Ghana.

Results: 249 people with ACE were identified in a study population of 113,796 individuals. After adjusting for attrition and the sensitivity of the screening method, the prevalence of ACE was 10.1/1000 (95% Confidence Interval (95%CI) 9.5-10.7). In children aged <18 years, risk factors for ACE were: family history of seizures (OR=3.31; 95%CI: 1.83-5.96), abnormal delivery (OR=2.99; 95%CI: 1.07-8.34), problems after birth (OR=3.51; 95%CI: 1.02-12.06), and exposure to Onchocerca volvulus (OR=2.32; 95%CI: 1.12-4.78). In adults, a family history of seizures (OR=1.83; 95%CI: 1.05-3.20), never attended school (OR=11.68; 95%CI: 4.80-28.40), cassava consumption (OR=3.92; 95%CI: 1.14-13.54), pork consumption (OR=1.68; 95%CI: 1.09-2.58), history of snoring at least 3 nights per week (OR=3.40: 95%CI: 1.56-7.41), exposure to Toxoplasma gondii (OR=1.99; 95%CI: 1.15-3.45) and Onchocerca volvulus (OR=2.09: 95%CI: 1.29-3.40) were significant risk factors for the development of ACE. The self-reported treatment gap was 86.9% (95%CI: 83.5%-90.3%).

Conclusion: ACE is common …

Fortifying The External Peer Review: An Editorial Perspective, Saba Sohail

Department of Radiology

No abstract provided.

Diagnostic Performance Of Breast Mri In The Evaluation Of Contralateral Breast In Patients With Diagnosed Breast Cancer, Shaista Afzal Saeed, Imrana Masroor, Madiha Beg, Romana Idress

Department of Radiology

AIMS: The purpose of our study was to evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in the evaluation of contralateral breast in patients with diagnosed breast cancer. A secondary objective was to determine accuracy of breast MRI in diagnosing multi-focal and multicentric lesions in the ipsilateral breast.MATERIALS AND Methods: Using a non-probability convenience sampling technique, patients with histopathologically diagnosed breast cancer with MRI of breast performed to exclude additional lesions were included. MRI findings were correlated with histopathology. In addition, follow-up imaging with mammography and ultrasound was also assessed for establishing stability of negative findings and for …

Fmic Annual Report 2015 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Cutaneous Ulcers As Initial Presentation Of Localized Granulomatosis With Polyangiitis: A Case Report And Review Of The Literature, Noreen Nasir, Syed Ahsan Ali, Hafiz Mohammed Mehmood Riaz

Section of Internal Medicine

Background. Granulomatosis with polyangiitis (GPA) is an ANCA associated small vessel vasculitis characterized by necrotizing granulomatous inflammation involving the upper and the lower respiratory tract and the kidneys. The disease has a broad clinical spectrum that ranges from limited/localized involvement of a single organ system to a generalized systemic vasculitis that affects several organs with evidence of end organ damage. Atypical forms of the disease have been recognized with or without respiratory tract involvement with a long protracted course before manifesting as generalized disease.

Case Presentation. We describe a 57-year-old woman who presented with recurrent fever and cutaneous ulcers on …

Sexual Onset And Contraceptive Use Among Adolescents From Poor Neighbourhoods In Managua, Nicaragua, Peter Decat, Sara De Meyer, Lina Jaruseviciene, Miguel Orozco, Marcia Ibarra, Zoyla Segura, Bernardo Vega, Kristien Michielsen, Marleen Temmerman, Olivier Degomme

Obstetrics and Gynaecology, East Africa

Background and objectives: The prevalence of teenage pregnancies in Nicaragua is the highest in Latin-America. This study aimed to gain insight into factors which determine the sexual behaviours concerned.

Methods: From July until August 2011, a door-to-door survey was conducted among adolescents living in randomly selected poor neighbourhoods of Managua. Logistic regression was used to analyse factors related to sexual onset and contraceptive use.

Results: Data from 2803 adolescents were analysed. Of the 475 and 299 sexually active boys and girls, 43% and 54%, respectively, reported contraceptive use. Sexual onset was positively related to increasing age, male sex, alcohol consumption …

Intravenous Tranexamic Acid As An Adjunct Haemostat To Ornipressin During Open Myomectomy. A Randomized Double Blind Placebo Controlled Trial, Sammy Ngichabe, Timona Obura, William Stones

Obstetrics and Gynaecology, East Africa

Background: Myomectomy is a surgical technique used for removal of uterine fibroids and historically hysterectomy has represented the mainstay of treatment. The options of conservative surgical approaches mainly aim at retention of fertility but have to be balanced against potential risks such as haemorrhage; blood loss at myomectomy still remains troublesome with use of various pharmacologic agents yielding inconclusive results. This trial aimed to explore the benefit of combining ornipressin and tranexamic acid during open myomectomy.

Study design: A randomized double blind placebo controlled trial.

Methods: Women who satisfied eligibility criteria were enrolled into the study and randomized into one …

A Review Of Factors Associated With The Utilization Of Healthcare Services And Strategies For Improving Postpartum Care In Africa, Danielle Yugbare Belemsaga, Anne Goujon, Joel A. Kiendrebeogo, Els Duysburgh, Seni Kouanda, Olivier Degomme, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Reducing maternal mortality continues to be a major challenge for African countries. We conducted a literature review to identify the factors associated with the utilization of maternal and child healthcare services during the postpartum period and the strategies for strengthening postpartum healthcare in Africa. We carried out an electronic search in several databases of texts published between 1995 and 2012 related to maternal and child health. Seventy-five publications fitted the eligibility criteria. Our analysis shows that to a large extent the socio-economic context was dominant among the factors associated with the quality and utilization of postpartum services. The best interventions …

Underuse Of Modern Methods Of Contraception: Underlying Causes And Consequent Undesired Pregnancies In 35 Low- And Middle-Income Countries, Saverio Bellizzi, Howard L. Sobel, Hiromi Obara, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Study question: What is the contribution of the underuse of modern methods (MM) of contraception to the annual undesired pregnancies in 35 low- and middle-income countries?

Summary answer: Fifteen million out of 16.7 million undesired pregnancies occurring annually in 35 countries could have been prevented with the optimal use of MM of contraception.

What is known already: Every year, 87 million women worldwide become pregnant unintentionally because of the underuse of MM of contraception.

Study design, size, duration: Demographic and health surveys (DHS) of 35 countries, conducted between 2005 and 2012, were analysed.

Participants/materials, setting, methods: Contraceptive use of 12 …

Sexual And Reproductive Health Knowledge, Contraception Uptake, And Factors Associated With Unmet Need For Modern Contraception Among Adolescent Female Sex Workers In China, Megan S. C. Lim, Xu-Dong Zhang, Elissa Kennedy, Yan Li, Yin Yang, Lin Li, Yun-Xia Li, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Objective: In China, policy and social taboo prevent unmarried adolescents from accessing sexual and reproductive health (SRH) services. Research is needed to determine the SRH needs of highly disadvantaged groups, such as adolescent female sex workers (FSWs). This study describes SRH knowledge, contraception use, pregnancy, and factors associated with unmet need for modern contraception among adolescent FSWs in Kunming, China.

Methods: A cross-sectional study using a one-stage cluster sampling method was employed to recruit adolescents aged 15 to 20 years, and who self-reported having received money or gifts in exchange for sex in the past 6 months. A semi-structured questionnaire …

Temporal Trends In Results Of 9170 Myocardial Perfusion Imaging Studies (2004 To 2013)., Nosheen Fatima

Department of Surgery Docs

Abstract

BACKGROUND:

To assess the frequency of normal and abnormal myocardial perfusion imaging (MPI) in a consecutive cohort of patients from Pakistan over a period of 8.5 years.

MATERIAL AND METHODS:

We assessed 9170 patients who had undergone stress-rest MPI between January 2004 and June 2013. Patients were assessed for change in demographics, risk factors, and frequency of abnormal and normal MPI.

RESULTS:

Overall mean age and male predominance of studied cohort was ≈ 55 years and ≈ 55:45 (M:F), respectively, with no appreciable decline or rise. Marked decline in exercise as mode of stress (from 71% to 35%, p …

Pathogen Reduction Technology In Transfusion: Where Do We Stand?, Mohammad Khurshid, Bushra Moiz

Section of Haematology/Oncology

No abstract provided.

Frequency And Mortality Associated With Hyperglycemia In Critically Ill Children, Sabeen Abid Khan, Mohsina Noor Ibrahim, Anwarul Haque

Department of Paediatrics and Child Health

Objective: To determine the frequency of hyperglycemia in critically ill children admitted in PICU of a tertiary care hospital of Karachi and to compare the mortality of critically ill children with and without hyperglycemia.

Study Design: Cross-sectional study.

Place and Duration of Study: Paediatrics Intensive Care Unit (PICU) of National Institute of Child Health (NICH), Karachi, from November 2011 to April 2012.

Methodology: One hundred fifty critically ill children admitted to PICU were included. Patients who had fasting blood sugar levels more than 126 mg/dl within 48 hours of admission were included in the hyperglycemic group. The normoglycemic and hyperglycemic …

Diagnostic Accuracy Of Who Verbal Autopsy Tool For Ascertaining Causes Of Neonatal Deaths In The Urban Setting Of Pakistan: A Hospital-Based Prospective Study, Sajid Bashir Soofi, Shabina Ariff, Ubaidullah Khan, Ali Turab, Gul Nawaz Khan, Atif Habib, Kamran Sadiq, Zamir Suhag, Zaid Bhatti, Imran Ahmed, Rajiv Bhal, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Globally, clinical certification of the cause of neonatal death is not commonly available in developing countries. Under such circumstances it is imperative to use available WHO verbal autopsy tool to ascertain causes of death for strategic health planning in countries where resources are limited and the burden of neonatal death is high. The study explores the diagnostic accuracy of WHO revised verbal autopsy tool for ascertaining the causes of neonatal deaths against reference standard diagnosis obtained from standardized clinical and supportive hospital data.
Methods: All neonatal deaths were recruited between August 2006 –February 2008 from two tertiary teaching …

Abdominal Lymphonodular Cryptococcosis In An Immunocompetent Child, Mehjabeen Zaidi, Sonia Qureshi, Sadia Shakoor, Saira Fatima, Fatima Mir

Department of Paediatrics and Child Health

We describe our experience with an apparently immunocompetent child presenting with pyrexia of unknown origin without focal signs. Investigations revealed lymphadenopathy at lung hila, mesentery, and porta hepatis. The child had received at least two months of empiric antituberculous therapy (ATT) before she came to us. A CT-guided biopsy revealed granulomatous inflammation. PAS stain showed yeasts which stained blue with Alcian blue, suggesting C. neoformans.

Can Routine Screening And Iron Supplementation For Iron Deficiency Anemia In Nonsymptomatic Pregnant Women Improve Maternal And Infant Health Outcomes?, Anoosh Moin, Zohra S. Lassi

Department of Paediatrics and Child Health

Pregnant women have an increased need for iron that might not be met with diet alone. Due to physiologic anemia and population differences, no set criteria for defining iron deficiency anemia (IDA) are available globally. Serum ferritin and transferrin levels are often used to guide therapy by clinicians. Studies have reported an association between poor iron status and negative health outcomes such as low birth weight, premature birth, and perinatal death for women and their infants, although the evidence is weak.