Medical Specialties Commons^™

Uchunguzi (Journal Watch/Montre De Journal) June 2012, Benjamin Wachira

Family Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent.

Clinical Characteristics And Predictors Of Positive Stool Culture In Adult Patients With Acute Gastroenteritis, Muhammad Mehmood Riaz, Muhammad Junaid Patel, Muhammad Shoaib Khan, Muhammad Ali Anwar, M. Tariq, Harith Hilal, Safia Awan, Shahzad Razi

Section of Internal Medicine

OBJECTIVE: To identify the presenting features and spectrum of pathogens in adult patients with acute diarrhoea and to determine the predictors of stool culture positivity.

METHODS: A descriptive study was conducted in a tertiary care hospital from April 1, 2005 to March 31, 2006. Medical records of all consecutive adult patients with history of acute diarrhoea were reviewed between June 2006 to December 2006 for clinical characteristics and laboratory investigations.

RESULTS: A total of 454 patients were admitted from April 1, 2005 to March 31, 2006. Stool cultures were performed in 233 (50%) patients, 96 (42%) had positive results. Patients …

An Incidentally Discovered Asymptomatic Para-Aortic Paraganglioma With Peutz-Jeghers Syndrome, Nazish Butt, Mohammad Salih, Mohammad Rizwan Khan, Rashida Ahmed, Zishan Haider, Syed Hasnain Ali Shah

Section of Internal Medicine

Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal (GI) tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extraGI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers.We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was …

Community Based Weighing Of Newborns And Use Of Mobile Phones By Village Elders In Rural Settings In Kenya: A Decentralised Approach To Health Care Provision, Peter Gisore, Evelyn Shipala, Kevin Otieno, Betsy Rono, Irene Marete, Constance Tenge, Hillary Mabeya, Sherri Bucher, Janet Moore, Edward Liechty, Fabian Esamai

Paediatrics and Child Health, East Africa

Background: Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children’s Health study area in Kenya revealed that up to 70% of newborns did …

Influence Of Perceived Racial Discrimination On Health And Behaviour Of Immigrant Children In British Columbia, Anne George, Cherylynn Bassani, Robert Armstrong

Paediatrics and Child Health, East Africa

This study examines the influence of perceived discrimination on the health and behaviour of ethnic minority immigrant children in British Columbia, Canada. Using data from the New Canadian Children and Youth Study, we examine perceived discrimination experienced by the parent, family, and cultural group in Canada to test the influence of micro-, meso-, and macrolevels of discrimination on children. Families from 6 ethnic backgrounds participated in the study. Parents’ perceptions of the child’s health and six behavioral scales (hyperactivity, prosocial behaviour, emotional problems, aggression, indirect aggression, and a general combined behaviour scale) were examined as outcome variables. After controlling for …

Reminder Systems For Self Uterine Massage In The Prevention Of Postpartum Blood Loss, S. K. Ngichabe, B. W. Gatinu, M. A. Nyangore, R. Karuga, Sikolia Wanyonyi, Jn Kiarie

Obstetrics and Gynaecology, East Africa

Background: Uterine massage may significantly reduce post partum blood loss and could be patient-driven.

Objective: To assess the effectiveness of an alarm reminder system for self uterine massage in the prevention of post partum blood loss.

Design: A random controlled trial.

Setting: Meru District Hospital, Kenya.

Subjects: One hundred and twenty seven (127) women were randomly assigned to a 15 minute alarm reminder system (71) and non-alarm (56) control arm during the fourth stage of labour.

Results: Uterine massage compliance was better in the alarm group compared to the non-alarm group ( Average massage …

Risks To Early Childhood Health And Development In The Postconflict Transition Of Northern Uganda, Theresa A. Mcelroy, Stella Atim, Charles P. Larson, Robert Armstrong

Paediatrics and Child Health, East Africa

Research from numerous fields of science has documented the critical importance of nurturing environments in shaping young children’s future health and development. We studied the environments of early childhood (birth to 3 years) during postconflict, post displacement transition in northern Uganda. The aim was to better understand perceived needs and risks in order to recommend targeted policy and interventions. Methods. Applied ethnography (interview, focus group discussion, case study, observational methods, document review) in 3 sites over 1 year. Results. Transition was a prolonged and deeply challenging phase for families. Young children were exposed to a myriad of risk factors. Participants …

Imaging And Intervention For Coronary Artery Disease Following Irradiation Of Malignant Thymoma, Saulat H. Fatimi, Salima Ahmed Bhimani, Ranish Deedar-Ali- Khawaja, Ali Khawaja

Section of Cardiothoracic Surgery

Thymomas are rare malignant epithelial growths, constituting 20% of mediastinal tumours. Resection followed by irradiation may be employed in all thymomas except for stage 1 thymomas. Mediastinal irradiation is associated with coronary artery disease. The mean duration of presentation of post-irradiation coronary artery disease is 16 years (range 3-29 years). In our patient coronary artery disease was found only a year post irradiation. A 55 year old male who presented with complaints of dyspnoea, retrosternal chest pain and heaviness since one year underwent resection for malignant thymoma followed by radiotherapy. He presented with coronary artery disease a year after undergoing …

Factors Associated With Failed Induction Of Labour In A Secondary Care Hospital, Neelofur Babar Khan, Iffat Ahmed, Ayesha Malik, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: To assess the factors associated with failed induction of labour (IOL) in a secondary care hospital.
Method: This is a retrospective cross sectional study on women admitted for labour induction in Aga Khan Hospital for women Karimabad from 1st Jan, 2009 to 31st Dec, 2009. Induction was considered successful if the patient delivered vaginally and failed if it ended up in Caesarean Section.
Result: Eighteen percent of our pregnant population who underwent induction of labour failed to deliver vaginally. About 25% of 328 nulliparous women had failed induction. With a Bishop score of <5 in 84.3%. In 28.2% with prolonged latent phase of more than 20 hours in Caesarean section had to be performed.
Conclusion: Nulliparity, poor Bishop score and …

Conduct Problems In Children Attending Pre-Primary Schools In Rural Areas Of Pakistan, Shelina Bhamani, Nadia Ayub

Department of Obstetrics & Gynaecology

The aim of this study was to explore the conduct problems faced by school going children in the rural areas of Pakistan. Two hypotheses were formulated to explore the significant differences between the intervention and non-intervention groups and gender on the variables of conduct and internalization. The data ofa total 386 young children were collected from three different regions, who were enrolled in government pre-primary classes. The children under study comprised two kinds of schools: intervention schools that had early childhood interventions, and non-intervention schools. The data analysis revealed no significant difference between children in intervention and non-intervention schools. However; …

Does The Afferent Tubular Segment In An Orthotopic Bladder Substitution Compromise Ureteric Antireflux Properties? An Experimental Study In Dogs, Hassan Abol- Enein, Nuzhat Faruqui, Nashwa Barakat, Ahmed A. Shokeir

Section of Urology

Objective: To study the effects of a short ureter on renal function and histology in an orthotopic bladder substitution model using a long afferent limb, in a canine model.
Materials and methods: The study included nine adult mongrel dogs. A 40-cm segment of ileum was isolated, the distal half detubularized, configured into a U-shape and sutured to form a flat plate; this was then used to augment the bladder. The proximal half of the isolated ileum remained in continuity with the enterocystoplasty to form an isoperistaltic ileal ‘chimney’. The left ureter was divided at its lumbar part and …

Conscientious Objection And Reproductive Health Service Delivery In Sub-Saharan Africa, V. M. Lema

Obstetrics and Gynaecology, East Africa

Lack of access to quality reproductive health services is the main contributor to the high maternal mortality and morbidity in sub-Saharan Africa (SSA). This is partly due to a shortage of qualified and experienced health care providers. However conscientious objection amongst the available few is a hitherto undocumented potential factor influencing access to health care in SSA. Provision of certain reproductive health services goes counter to some individual’s religious and moral beliefs and practices. Health providers sometimes refuse to participate in or provide such services to clients/patients on moral and/or religious grounds. While the rights to do so are protected …

Idiopathic Adult Ileoileal And Ileocolic Intussusception In Situs Inversus Totalis: A Rare Coincidence, Nazish Butt, Syed H Shah, Abdul R. Alvi, Saba Hassan

Section of Gastroenterology

Situs inversus totalis is a rare autosomal recessive congenital anomaly that is characterized by mirror image anatomy of the abdominal and thoracic organs. We report a case of a 28-year-old male with situs inversus totalis, who developed an idiopathic ileoileal and ileocolic intussusception, which was diagnosed on computed tomography scan. Patient underwent successfully ileal resection and side-to-side functional anastomosis of ileum 12 cms from ileocecal junction. Postoperative course was uneventful. To the best of our knowledge, this is the first case of idiopathic adult intussusception with situs inversus totalis in the literature.

Prevalence Of Non Helicobacter Pylori Species In Patients Presenting With Dyspepsia., Javed Yakoob, Z Abbas, Rustam Khan, Chagufta Naz, Zubair Ahmad, Muhammad Islam, Safia Awan, Fatima Jafri, Wasim Jafri

Section of Gastroenterology

BACKGROUND:

Helicobacter species associated with human infection include Helicobacter pylori, Helicobacter heilmannii and Helicobacter felis among others. In this study we determined the prevalence of H. pylori and non-Helicobacter pylori organisms H. felis and H. heilmannii and analyzed the association between coinfection with these organisms and gastric pathology in patients presenting with dyspepsia. Biopsy specimens were obtained from patients with dyspepsia on esophagogastroduodenoscopy (EGD) for rapid urease test, histology and PCR examination for Helicobacter genus specific 16S rDNA, H. pylori phosphoglucosamine mutase (glmM) and urease B (ureB) gene of H. heilmannii and H. felis. Sequencing of PCR products of H. …

Contegra Valved Conduit In The Paediatric Population: An Exciting Prospect For Right Ventricle To Pulmonary Artery Reconstruction; Experience And Outcomes At Aga Khan University, Maria Tariq Siddiqui, Asif Hasan, Shazia Mohsin, Mohammad Hamid, Muneer Amanullah

Department of Anaesthesia

Objective: The focus of this study is to share the experience and outcomes of Contegra graft implantation in the paediatric and adult population in Pakistan. Methods: Between May 2007 and July 2011, 16 patients, underwent implantation of a Contegra valved conduit. All operations were performed through a median sternotomy with cardiopulmonary bypass. Indications included: Pulmonary atresia with ventricular septal defect (n=11), Tetralogy of Fallot with absent Pulmonary Valve (PV) syndrome (n=2), double outlet right ventricle, transposition of great arteries and pulmonary stenosis (n=1), isolated aortic valve disease (n=1) and a pseudo-aneurysm with infective endocarditis (n=1).Conduit sizes varied between 16-22 mm. …

Breast Imaging Reports For Malignant Lesions: Are We Maintaining Recommended Bi-Rads® Lexicon Standards, Imrana Masroor, Muhammad Azeemuddin, Saima Sakhawat, Madiha Hashmi, Saba Sohail, Rashid Ahmed, M Irfan Ul Haq, Javed Mehboob

Department of Radiology

Background: The purpose of this study was to evaluate mammography reports for diagnosed breast cancer cases in major government and private centers in Karachi, Pakistan, with respect to concordance with the Breast Imaging Reports And Data System (BI-RADS®) lexicon.
Methods: A prospective, descriptive, multicenter study was conducted in the radiology sections of the Aga Khan University Hospital, Pakistan Naval Station Shifa Hospital, Advanced Radiology Clinic, Karachi Institute of Radiotherapy and Nuclear Medicine, and Civil Hospital Karachi between May and October 2010 after approval from the ethical review committee of Aga Khan University. Mammograms reported as BI-RADS category 4 and 5 …

Usefulness Of Hook Wire Localization Biopsy Under Imaging Guidance For Nonpalpable Breast Lesions Detected Radiologically, Imrana Masroor, Shaista Afzal, Gulnaz Shafqat, Hasan Rehman

Department of Radiology

Background: The purpose of this study was to evaluate the usefulness of hook wire localization biopsy under imaging guidance for nonpalpable breast lesions detected radiologically.Methods: This was a descriptive study conducted at the Department of Radiology, Aga Khan University Hospital, Karachi. All patients undergoing needle localization biopsy of a nonpalpable breast lesion under mammographic or ultrasound guidance between January 2009 to December 2010 were included in the study. Patients with incomplete medical records were excluded. All patients' mammograms or ultrasound were categorized using BI-RADS() assessment categories. The percentages of benign and malignant lesions were determined by pathological examination of surgically …

How Vats Has Changed The Management Of Spontaneous Pneumothorax In The 21st Century, Saulat H. Fatimi, Hashim Muhammad Hanif, Sana Mansoor, Marium Muzaffar

Section of Cardiothoracic Surgery

Objective: To determine the outcome of patients having undergone Video Assisted Thoracoscopic Surgery (VATS) for spontaneous pneumothrox in terms of hospital stay, complications and recurrence.
Methods: The netrospective study included the review of 39 cases who had presented with spontaneous pneumothorax at the Aga Khan University Hospital, Karachi, Pakistan, between January 2001 to November 2008 and had undergone video assisted thoracoscopic surgery (VATS).
Results: The duration of hospital stay (had a range of 3 to 9 days), and the length of chest tube in place (a range of 2 to 8 days), 2 (5.1%) patients developed recurrence after VATS while …

Dextrocardia With Situs Inversus Totalis: Coronary Artery Bypass Grafting, Salila Hashmi, Mariam Anis, Umer Darr

Section of Cardiothoracic Surgery

Dextrocardia with situs inversus is a rare congenital abnormality involving a left-handed mal rotation of the visceral organs. The incidence of coronary artery disease is the same as that in the general population. Performing coronary artery bypass surgery on patients with dextrocardia poses a more challenging task. It is recommended that the right internal mammary artery be the first choice of graft for the anterior descending artery for a "situs inversus" situation. We report 2 cases of patients with Dextrocardia who developed coronary artery disease and underwent coronary artery bypass grafting. Also mentioned is the slight difference in our technique.

Subclavian Steal Syndrome Secondary To Subclavian Artery Thrombosis In A Patient With Homocysteinemia And Its Successful Treatment, Marium Muzaffar, Hashim Muhammed Hanif, Saulat H. Fatimi, M. Tariq

Section of Cardiothoracic Surgery

Subclavian steal syndrome (SSS) is a rare condition. It results from subclavian artery (SA) stenosis proximal to the origin of the vertebral artery. It is characterized by cerebral ischaemia with associated symptoms of vertebrobasilar hypoperfusion and/or symptoms of brainstem or arm ischaemia. We describe a case of a 35 year old male who presented with persistent vertigo for two months, blue discoloration and pain in the left fingers for two weeks. A diagnosis of SSS was made and patient was treated with a gortex graft from the arch of the aorta to the second portion of the left subclavian artery. …

Experience Of Devolution In District Health System Of Pakistan: Perspectives Regarding Needed Reforms, Shiraz Shaikh, Imran Naeem Abbasi, Asaad Ahmed Nafees, Aysha Zahidie, Zafar Fatmi, Ambreen Kazi

Community Health Sciences

Objective: To identify the strengths and weaknesses of the devolved district health system from the experiences of different stakeholders, and recommend direction for reforms in the existing system.
Methods: Using qualitative exploratory design, the study was conducted in 3 cities of the province of Sindh in Pakistan--Karachi, Khairpur and Larkana--from January to March 2010. Nine in-depth interviews were conducted with multiple stakeholders (District Coordination Officer, Executive District Officer, Medical Superintendent, Medical officers, Health system experts) of the district health system. Interviews included questions on autonomy in decision-making at the district level and the effectiveness of the devolved health system. Data …

Retrospective Analysis Of Metabolic Syndrome: Prevalence And Distribution In Executive Population In Urban Pakistan., Niloufer Sultan Ali, Ali Khan Khuwaja, Adnan Ur Rahman, Kashmira Nanji

Department of Family Medicine

Background. Metabolic Syndrome (MetS) is a major public health concern.

Objective. The aim of this study was to estimate the frequency of MetS, its components, and factors associated with MetS amongst apparently healthy individuals in Pakistan.

Methods. A retrospective cross-sectional study was conducted at the executive Clinics of Aga Khan Hospital, Pakistan. Medical records of patients aged ≥18 years visiting the clinics from July 2011 to December 2011 were consecutively reviewed. Records in which either MetS components data or 10% of overall data was missing were excluded. A total of 1329 participants’ records was included in final analysis. Data was …

Fiber And Bulking Agents For The Treatment Of Chronic Constipation, Kashmira Nanji, Bilal Ahmed, Safia Awan, Waris Qidwai, Saeed Hamid

Department of Family Medicine

No abstract provided.

Sigmoid Volvulus In Pregnancy And Puerperium: A Surgical And Obstetric Catastrophe Report Of A Case And Review Of The World Literature, Muhammad R. Khan, Sameer Ur Rehman

Department of Surgery Docs

Sigmoid volvulus is a rare surgical complication occurring in pregnancy and puerperium. Only 84 cases of sigmoid volvulus in pregnancy have been reported in the English literature so far. We have reviewed the available literature on this subject and present another case recently managed at our institution. The available literature suggests that over the years, there has been an improvement in the maternal and fetal outcome for this critical condition, but delay in presentation and a further delay in diagnosis remain a challenge for the treating physicians. Our patient was a 30-week pregnant lady, who presented late with 6days history …

Species Identification Of Invasive Yeasts Including Candida In Pakistan: Limitations Of Phenotypic Methods, Joveria Farooqi, Kauser Jabeen, Noureen Saeed, Afia Zafar, Mary Eleanor Brandt, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: To compare phenotypic and genotypic methods of yeast identification. Methods: The in-vitro cross-sectional study was conducted from January 2006 to May 2009. Invasive yeasts isolated at the clinical microbiology laboratory at the Aga Khan University (AKU), Karachi, Pakistan, were identified. Speciation by phenotypic and molecular methods was compared. All yeasts isolated during the study period from blood and other invasive sites were identified using standard methods. Isolates were shipped to Mycotic Diseases Branch, Centres for Disease Control and Prevention, Atlanta, Georgia, USA, for identification by Luminex flow cytometric multianalyte profiling (xMAP) system. Ribosomal ITS2 DNA sequencing was performed …

Is Nalidixic Acid Screening Still Valid For The Detection Of Reduced Susceptibility Of Fluoroquinolone With Salmonella Typhi?, Seema Irfan, Kauser Jabeen, Umair Anwar Jilani, Bushra Ahmed, Jaishri Mehraj, Tanwir Ahsan, Afia Zafar

Department of Pathology and Laboratory Medicine

Introduction: Considering the limitations of screening with nalidixic acid to detect reduced susceptibility to fluoroquinolones of Salmonella enterica serovar Typhi (S.Typhi) strains, we evaluated the use of a 30 µg nalidixic acid disc screening method in Pakistan.
Methodology: Non duplicate nalidixic acid susceptible S. Typhi isolates (246) from 2003-2008 were retrieved from the Salmonella strain bank. Minimum inhibitory concentrations of ciprofloxacin for all strains were determined by agar dilution and further rechecked by ciprofloxacin E-tests.E. coli ATCC 25922 was used as the control strain. The MIC data for ciprofloxacin were compared with nalidixic acid disk (30µg) zone diameters.
Results: …

Evaluation Of Elevated Alanine Aminotransferase And Hepatitis B Virus Dna In Healthy Seronegative Blood Donors, Natasha Ali, Bushra Moiz, Tariq Moatter

Department of Pathology and Laboratory Medicine

Background: Serum alanine transaminase (ALT) has been used as a surrogate marker for detection of hepatitis B and C in blood donors in Pakistan since 1985. Since the introduction of more sensitive assays the value of ALT became questionable but it was still used with subsequent wastage of blood units with raised ALT.
Finding: We conducted a study for a period of one year to evaluate the usefulness of ALT. During the study period, 25117 subjects donated blood. Eight hundred and seventy two donors (3.4%) were positive for one or more serological tests. ALT of all donors ranged from …

High Isoniazid Resistance Rates In Rifampicin Susceptible Mycobacterium Tuberculosis Pulmonary Isolates From Pakistan, Naima Fasih, Yasraba Rafiq, Kausar Jabeen, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:
Rapid new diagnostic methods (including Xpert MTB/RIF assay) use rifampicin resistance as a surrogate marker for multidrug resistant tuberculosis. Patients infected with rifampicin susceptible strains are prescribed first line anti-tuberculosis therapy. The roll out of such methods raises a concern that strains with resistance to other first line anti-tuberculosis drugs including isoniazid will be missed and inappropriate treatment given. To evaluate implications of using such methods review of resistance data from high burden settings such as ours is essential.
Objective:
To determine resistance to first line anti-tuberculosis drugs amongst rifampicin susceptible pulmonary Mycobacterium tuberculosis (MTB) isolates from Pakistan.
Material …

Lymphangioma Circumscriptum In The Scrotum: A Case Report, Saroona Haroon, Sheema H. Hasan

Department of Pathology and Laboratory Medicine

Introduction:
Lymphangioma circumscriptum is a rare benign skin disorder involving hamartomatous lymphatic malformation of deep dermal and subcutaneous lymphatic channels. It is a therapeutic challenge for the dermatologist when it occurs at common sites such as axilla, shoulder, groin and buttocks and a diagnostic challenge for the surgeon when it occurs at rare sites such as the scrotum. Surgical treatment is the most commonly used method to treat scrotal lymphangioma circumscriptum but there are high rates of recurrence.
Case Presentation:
We report the case of a 30-year-old Pakistani man who presented with scrotal swelling which was clinically misinterpreted as an …

Neonatal Hyperbilirubinemia In Infants With G6pd C563c > T Variant, Bushra Moiz, Amna Nasir, Sarosh Ahmed Khan, Saleema Amin Kherani, Maqbool Qadir

Department of Pathology and Laboratory Medicine

Background: There is a strong correlation between glucose-6-phosphate dehydrogenase (G6PD) deficiency and neonatal hyperbilirubinemia with a rare but potential threat of devastating acute bilirubin encephalopathy. G6PD deficiency was observed in 4–14% of hospitalized icteric neonates in Pakistan. G6PD c.563C > T is the most frequently reported variant in this population. The present study was aimed at evaluating the time to onset of hyperbilirubinemia and the postnatal bilirubin trajectory in infants having G6PD c.563C > T.
Methods: This was a case–control study conducted at The Aga Khan University, Pakistan during the year 2008. We studied 216 icteric male neonates who were re-admitted for …