Medical Specialties Commons^™

Perceptions And Attitudes Of Physicians And Midwives Towards Patient Safety At The Maternity Department Of A Tertiary Teaching Hospital In Kenya: A Mixed Method Study, Albert Kiretia Gichuki

Master of Medicine in Obstetrics and Gynecology

Introduction: The maternal mortality ratio (MMR) has declined across the world over the last 17 years. This has been attributed to more women delivering in health facilities with trained birth attendants. Despite this there is still a high maternal mortality rate with over 86% of the mortalities occurring in Sub-Saharan Africa and South East Asia. This has led to increased focus on improving quality of care and patient safety in the health facilities. A positive safety culture, which is the product of individual and group values, attitudes, perceptions and patterns of behaviour that determine the commitment to an organization’s safety …

Renal Cell Carcinoma Of Pelvic Kidney With Atypical Nodal Metastasis: A Diagnostic Challenge, Roshan-E-Shahid Rana, Muhammad Hammad Ather

Section of Urology

Ectopic pelvic kidney is a known congenital anomaly; however, the presence of renal cell carcinoma (RCC) in an ectopic kidney is rare with the evidence available in the form of a few case reports only. In this case report, we present a case of metastatic RCC in the pelvic kidney which became a diagnostic challenge because of atypical contrast-enhanced computed tomographic (CT) characteristics and unusual pattern of lymph node involvement including cervical lymph node in the absence of visceral metastasis. Because of its unusual location and uncertain vascular anatomy, ectopic kidney poses a surgical challenge. Owing to the rarity of …

Obstetric Risk In Pregnancy Interacts With Hair Cortisone Levels To Reduce Gestational Length, Wangira Musana, Craig R. Cohen, Miriam Kuppermann, Roy Gerona, Anthony Wanyoro, David Aguilar, Nicole Santos, Sandra J. Weiss, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Maternal psychological stress has been linked to preterm birth. However, the dierential contribution of psychological stress versus stress hormones is not clear. Studies focus primarily on perceived stress and cortisol, with few assessing its inter-convertible hormone cortisone. Furthermore, little is known about the potential moderating roles of obstetric risk and fetal sex in the relationship between maternal stress and gestational length. This gap in knowledge is particularly evident for rural women who typically experience chronic multiple stressors during pregnancy. We explored the relationship of hormonal and psychological stress to gestational length and the eects of obstetric risks and …

Association Between Suicide Rate And Human Development Index, Income, And The Political System In 46 Muslim-Majority Countries: An Ecological Study, S. M. Yasir Arafat, Marthoenis Marthoenis, Murad Khan, Mohsen Rezaeian

Brain and Mind Institute

Very little has been researched assessing the relationship between the suicide rate and the ecological perspectives of the country, especially in the Muslim majority countries. We aimed to determine the association between suicide rate and the ecological parameters of 46 Muslim majority countries. We extracted the Muslim majority countries and their suicide rate, income distribution, distribution of the WHO region and continents, and Human Development Index (HDI). We assessed the correlation of the proportion of Muslim populations, the total population of the countries, number of suicides, continent, income group, political system, and HDI score with the suicide rate. The median …

The Association Of Age At Menarche And Adult Height With Mammographic Density In The International Consortium Of Mammographic Density, Sarah V. Ward, Anya Burton, Rulla M. Tamimi, Ana Pereira, Maria Luisa Garmendia, Marina Pollan, Norman Boyd, Isabel Dos-Santos-Silva, Sudhir Vinayak, Rose Ndumia

Imaging & Diagnostic Radiology, East Africa

Background: Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk.

Methods: Participants were 10,681 breast‐cancer‐free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemio‐ logic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi‐level linear regression models estimated changes in square‐root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult …

A Retrospective Cross Sectional Study Assessing Factors Associated With Retention And Non-Viral Suppression Among Hiv Positive Fsws Receiving Antiretroviral Therapy From Primary Health Care Facilities In Kampala, Uganda, Lydia Atuhaire, Constance Shumba, Lovemore Mapahla, Peter S. Nyasulu

School of Nursing & Midwifery, East Africa

Background: Patient retention in care and sustained viral load suppression are a cornerstone to improved health and quality of life, among people living with HIV. However, challenges of retention on ART remain among female sex workers (FSWs). We report lost to follow up (LTFU), viral load suppression, and the associated factors among FSWs that access HIV treatment at primary health care facilities in Kampala.

Methods: We retrospectively abstracted and analysed patient management data of HIV positive FSWs who enrolled in care between January 2018 to December 2020. LTFU was defined as failure of a FSW to return for …

Promoting Best Practice In Cancer Care In Sub Saharan Africa, Karishma Sharma, Shahin Sayed, Mansoor Saleh

Internal Medicine, East Africa

Promoting best practice in the management of a cancer patient is rooted in the application of new knowledge derived through various sources including population science, laboratory advances, and translational research. Ultimately, the impact of these advances depends on their application at the patient’s bedside. A close collaboration between the oncologist and the pathologist is critical in underwriting progress in the management of the cancer patient. Recent advancements have shown that more granular characteristics of the tumor and themicroenvironment are defining determinants when it comes to disease course and overall outcome. Whereas, histologic features and basic immunohistochemical characterization were previously adequate …

A Qualitative Inquiry On Smokers’ Perceptions Of Smoking Cessation During Covid-19, Sajid Iqbal, Rubina Barolia, Kiran Iftikhar, Pammla Petrucka, Jeniefer Anastasi, Faris Farooq Saeed Khan, Naheed Feroz Ali

School of Nursing & Midwifery

Background: This qualitative exploratory study explores smokers’ perspectives regarding smoking cessation processes amid the COVID-19 pandemic.
Methods: Purposive sampling was employed to conduct semi-structured interviews with cigarette smokers visiting cardiac and pulmonary clinics at a tertiary care hospital in Karachi, Pakistan. Thematic analysis was performed to identify themes from the participants’ responses.
Results: Three themes emerged from the thematic analysis. These were smoking cessation facilitators, smoking cessation barriers, and COVID-19 impacts on smoking cessation. Awareness and education, threat of acquiring health problems, religious beliefs and family or support system behave as smoking cessation facilitators. While, role modeling, associating smoking to …

Viral Infections In Pakistan: Prevalence, Factors Affecting Spread, And Recommendations For Control, Zehra Naseem, Maaha Ayub, Sharaf Ali Shah, Syed Asad Ali, Syed Hani Abidi

Medical College Documents

Pakistan is endemic to a number of viral infections, owing to its humid climate, topographical variation, soaring population, and lack of education and awareness. These viruses may have several different modes of transmission, including respiratory or airborne transmission, sexual transmission, blood-borne, fecal-oral transmission, vector-borne transmission, and transmission following an organ transplant. Although several different microorganisms are responsible for causing these infections, a few viruses are found more commonly in Pakistan and are primarily responsible for causing infections. In this study, we present a review of the most recent studies on different viruses, transmitted through various transmission routes, found commonly in …

Role Of Lipid-Lowering Therapy In Peripheral Artery Disease, Agastya Deepak Belur, Aangi J. Shah, Salim S. Virani, Mounica Vorla, Dinesh K. Kalra

Office of the Provost

Atherosclerosis is a multifactorial, lipoprotein-driven condition that leads to plaque formation within the arterial tree, leading to subsequent arterial stenosis and thrombosis that accounts for a large burden of cardiovascular morbidity and mortality globally. Atherosclerosis of the lower extremities is called peripheral artery disease and is a major cause of loss in mobility, amputation, and critical limb ischemia. Peripheral artery disease is a common condition with a gamut of clinical manifestations that affects an estimated 10 million people in the United States of America and 200 million people worldwide. The role of apolipoprotein B-containing lipoproteins, such as LDL and remnant …

Does Individualized Guided Selection Of Antiplatelet Therapy Improve Outcomes After Percutaneous Coronary Intervention? A Systematic Review And Meta-Analysis, Naser Yamani, Samuel Unzek, Muhammad Hasnain Mankani, Talal Almas, Adeena Musheer, Humera Qamar, Shausha Farooq, Waqas Shahnawaz, Kaneez Fatima, Vincent Figueredo

Department of Medicine

Background: The potential benefits of individualized guided selection of antiplatelet therapy over standard antiplatelet therapy in improving outcomes in patients undergoing percutaneous coronary intervention (PCI) have not been established. Therefore, we pooled evidence from available clinical trials to assess the effectiveness by comparing the two regimens in patients undergoing PCI.
Methods: We queried two electronic databases, MEDLINE and Cochrane CENTRAL, from their inception to April 20, 2021 for published randomized controlled trials in any language that compared guided antiplatelet therapy, using either genetic testing or platelet function testing, versus standard antiplatelet therapy in patients undergoing PCI. The results from trials …

Pneumococcal Carriage In Infants Post-Pcv10 Introduction In Pakistan: Results From Serial Cross-Sectional Surveys, Shahira Shahid, Amala Khan, Muhammad Imran Nisar, Farah Khalid, Muhammad Farrukh Qazi, Sheraz Ahmed, Furqan Kabir, Aneeta Hotwani, Sahrish Muneer, Syed Asad Ali, Anita K. M. Zaidi, Fyezah Jehan

Department of Paediatrics and Child Health

The 10-valent pneumococcal vaccine was introduced in Pakistan's Expanded Program on Immunization (EPI) in 2013 as a 3 + 0 schedule without catchup. We conducted three annual cross-sectional surveys from 2014-2016 to measure vaccine-type (VT) carriage in infants from a rural part of Pakistan. Nasopharyngeal specimens were collected by random sampling of infants from two union councils of Matiari. Samples were then transported to the Infectious Disease Research Laboratory (IDRL) at the Aga Khan University within 6-8 h of collection. Serotypes were established using sequential multiplex PCR. Of the 665 children enrolled across three surveys, 547 were culture-positive for pneumococcus. …

Experience Of Telemedicine In Gastroenterology Out-Patient Practice During The Covid-19 Pandemic: Experiences From A Tertiary-Care Hospital In A Developing Country, Anjiya Shaikh, Maria Khan, Faisal Wasim Ismail

Department of Medicine

Objective: Telemedicine is being widely implemented in the COVID-19 pandemic to avoid infection risk. However, its effectiveness has not been evaluated, especially in developing countries, where it is invaluable for healthcare access. This study assesses physicians' and patients' perspectives of the usefulness and challenges of telemedicine in the gastroenterology department to identify its pitfalls.
Methods: A cross-sectional telephonic survey was conducted on patients presenting to the gastroenterology department at a tertiary care hospital in Pakistan. An online survey was sent to physicians in the department.
Results: A total of 160 patients participated, with a mean age 49.8 years, and 42.8% …

Potential Impact Of 2017 American College Of Cardiology/American Heart Association Hypertension Guideline On Contemporary Practice: A Cross-Sectional Analysis From Ncdr Pinnacle Registry, Aliza Hussain, Salim S. Virani, Luke Zheng, Ty J. Gluckman, William B. Borden, Frederick A. Masoudi, Thomas M. Maddox

Office of the Provost

Background Clinical implications of change in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the diagnosis and management of hypertension, compared with recommendations by 2014 expert panel and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), are not known. Methods and Results Using data from the NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence) Registry (January 2013-Decemver 2016), we compared the proportion and clinical characteristics of patients seen in cardiology practices diagnosed with hypertension, recommended antihypertensive treatment, and achieving blood pressure (BP) goals …

Rural-Urban Trends In Congenital Heart Disease-Related Mortality In The United States, 1999 To 2019, Abdul Mannan Khan Minhas, Rachel A. Wyand, Robert W. Ariss, Salik Nazir, Vardhmaan Jain, Sadeer G. Al-Kindi, Michael D. Shapiro, William Campbell, Laurence Sperling, Salim S. Virani

Office of the Provost

No abstract provided.

Prevalence & Factors Associated With Acute Kidney Injury In Patients Undergoing Percutaneous Coronary Intervention At A Tertiary Healthcare Facility In Tanzania, Faisal Hooda

Master of Medicine in Internal Medicine

Background: Acute kidney injury is a potentially fatal but preventable outcome of percutaneous coronary intervention: the most plausible cause being radiocontrast-induced nephropathy; others include: pre-existing renal insufficiency from underlying illnesses and also acute renal insult caused by hypoperfusion from cardiac causes. The prevalence, associated risk factors and outcomes of AKI post-PCI are unclear and unexplored in our setting. Objectives: The study sought to determine the prevalence of acute kidney injury post-percutaneous coronary intervention at The Aga Khan Hospital, Dar es Salaam, Tanzania. Secondary objectives included: factors associated, with and outcomes of acute kidney injury (AKI) post percutaneous coronary intervention (PCI). …

Churg Strauss Syndrome With Neuropathy: A Case Report, Zaid Waqar

Pakistan Journal of Neurological Sciences (PJNS)

A 24 years old man with known history of asthma came with acute presentation of ascending weakness for four days following flu like symptoms and worsening of asthma. His complete blood counts showed elevated eosinophil count. Nerve conduction showed neuropathy. He was diagnosed as Churg Strauss syndrome due to presence of asthma, eosinophilia, neuropathy and pulmonary infiltrates. Churg Strauss is a systemic eosinophilic vasculitis involving multiple organ systems that may present with neuropathy, as in this case.

Post Covid-19 Vaccine (Sinovac) Cerebral Venous Sinus Thrombosis, Soban Khan, Maryam Khalil, Zaid Waqar

Pakistan Journal of Neurological Sciences (PJNS)

SINOVAC is an inactivated virus COVID 19 vaccine given emergency authorization for COVID-19 Pandemic. Different adverse reactions have been seen in after-marketing of COVID-19 vaccines. Here we present a case of patient who developed cerebral venous sinus thrombosis two weeks after the first dose of SINOVAC vaccine.

Molecular Analyses Of Phenylketonuria In The Intellectually Disabled Children From Faisalabad, Punjab, Pakistan, Habiba Hussain, Muhammad Wasim, Haq Nawaz Khan, Hina Ayesha, Fazli Rabbi Awan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and Objective: Phenylketonuria (PKU) is a rare inherited metabolic disorder, caused by mutations in the phenylalanine hydroxylase (PAH). It is a treatable disorder if diagnosed earlier in life. The objective was to identify PKU patient(s) amongst the intellectually disabled children. Methods: Blood samples (n=100) were collected from intellectually disabled children from Faisalabad, Pakistan. Screening was performed on plasma samples through High Performance Liquid Chromatography (HPLC), and DNA samples were examined for mutation analysis of PAH through direct PCR and SSCP analyses. Results: In the current study, 85% consanguinity rate was observed, with the average BMI (16.15 kg/m2) and …

Prevalence Of Depression In Caregivers Of Stroke Patients In Karachi, Pakistan, Marium Mansoor, Shahina Pirani, Rabeeka Aftab, Tania Nadeem

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and Objective: Caregivers of patients with chronic debilitating illnesses are at risk of developing mental health problems. The objective of this study is to determine the frequency of depression in caregivers of stroke patients at a tertiary care teaching hospital in Karachi, Pakistan. Methods: A cross-sectional study was conducted among caregivers of stroke, who were recruited from the Aga Khan University Hospital between January 2018 to October 2018. Data was collected through the Urdu Hamilton rating scale for depression (HAM-D-U) and it was analyzed using descriptive and inferential statistics. Results: A total of 136 caregivers participated in the …

Practical Measures For Disabled’S Empowerment-Time For Economic Growth!, Mahnoor Hafeez

Pakistan Journal of Neurological Sciences (PJNS)

The objective of this article is to advocate for persons with disabilities’ (PWD) rights, to discuss issues solutions, social awareness and to promote diversity and inclusion. The word ‘Disability’ covers a wide range of irreversible permanent impairments including physical and mobility difficulties, hearing, visual impairment, specific learning disabilities including dyslexia, medical conditions and mental health problems that may hinder their full and effective participation in society on an equal basis with others.1 Handicap is the condition of being unable to perform due to physical or mental unfitness.

Epilepsy Research In Africa: A Scoping Review By The Ilae Pediatric Commission Research Advocacy Task Force, Pauline Samia, Jane Hassell, Jessica Hudson, Azim Ahmed, Jasmit Shah, Charles Hammond, Edward Kija, Stéphane Auvin, Jo Wilmshurst

Paediatrics and Child Health, East Africa

Objective: Despite the high prevalence of epilepsy in Africa, evaluation of epi- lepsy research trends on the continent is lacking. Without establishing effective research, improvement in care for people with epilepsy cannot be effectively strategized or targeted.

Methods: A scoping review of the peer-reviewed literature on epilepsy from Africa (1989–2019) was conducted. The aim was to understand from this what areas are well researched versus underresearched based on published epilepsy topics.

Results: A total of 1227 publications were identified and assessed. A significant increase in publications occurred over the 30 years assessed. African author lead- ership was …

A Pilot Study Comparing Pre-Analytic Tissue Processes Before And After Implementation Of A Quality Improvement Program For Handling Breast Cancer Specimens, Joseph Gatheru Macharia

Master of Medicine in Anatomic Pathology

Background: Breast cancer as the most frequently occurring cancer in women is highly heterogeneous in its pathological characteristics. Assessment of tumor biologic characteristics including hormone receptor profile and growth factor receptor activity is important in characterizing the pathologic nature of such cancers. Tumor biomarker activity plays a big role in diagnosis and management of invasive breast cancer (IBC). Biological specimens are the primary sources of this molecular information. Optimal handling of the specimen through the various analytic phases assures of the validity of the final pathologic diagnosis. Objective: To assess the feasibility of implementing an intervention plan to improve specific …

Authorship Representation In Global Emergency Medicine: A Bibliometric Analysis From 2016 To 2020, Stephanie Chow Garbern, Gimbo Hyuha, Catalina González Marqués, Noor Baig, Jennifer L. Chan, Sanjukta Dutta, Masuma A. Gulamhussein, Gloria Paulina López Terán, Hussein Karim Manji, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field.

Methods: We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors' affiliations and funding sources. We compared the …

Clinical Skills Of General Practitioners In Nairobi, Kenya: A Cross-Sectional Study, Gulnaz Mohamoud, Robert Mash

Family Medicine, East Africa

Background: Quality service delivery in primary care requires motivated and competent health professionals. In the Kenyan private sector, GPs with no postgraduate training in family medicine offer primary care. There is a paucity of evidence on the ability of primary care providers to deliver comprehensive care and no such evidence is available for GPs practising in the private sector in Kenya.

Aim: To evaluate GPs’ training and experience in the skills required for comprehensive primary care.

Design and setting: A cross-sectional descriptive survey in 13 primary care clinics in the private sector of Nairobi, Kenya.

Method: A questionnaire, …

Shortness Of Breath In A Young Lady, Rare Case Report Of Thoracic Endometriosis, Willbroad Kyejo, Ally Zain Ismail, Davis Rubagumya, Rahma Bakari, Munawar Kaguta, Nancy Matillya

Family Medicine, East Africa

Introduction and importance: Endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The clinical presentation is depends on site of implantation. Complications include pneumothorax, pneumohemothorax or hemothorax.

Case presentation: A 31 year old woman with history of infertility presented with shortness of breath and was found to have a significant right sided pneumohemothorax. Drainage was done followed by chemical pleurodesis using bleomycin with resolution of symptoms on her follow up.

Clinical discussion: Thoracic endometriosis tend to present with chronic or sub-acute symptoms which are nonspecific symptoms leading to late diagnosis. Video Assisted Thoracoscopic surgery offer both …

Labrad : Vol 47, Issue 1 - June 2022, Aga Khan University, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• From the Editor’s Desk
• LABRAD Star Contributors for the Year 2021
• Clinical Relevance of Measuring Thyroid Stimulating Hormone Receptor Antibodies in Pregnancy and Newborns
• Aromatic l-amino Acid Decarboxylase (AADC) Deficiency- An Ultra-rare and Underdiagnosed Neurometabolic Disorder
• Role of Flowcytometry & Kleihauer - Betke Test in Detection and Quantification of Fetomaternal Hemorrhage
• Gestational Trophoblastic Diseases: An Overview
• Acrania-Exencephaly-Anencephaly Sequence/ Spectrum: Radiological Features on Antenatal Screening
• Minimally Invasive Tissue Sampling (MITS) A New Way to Investigate Cause of Death In Resource-constrained Countries
• Laboratory Guideline for Detection, Interpretation and Reporting of Maternal Cell Contamination (MCC) in Prenatal Analysis
• Molecular Analysis of Alpha Thalassemia …

Evaluation Of Sibel’S Advanced Neonatal Epidermal (Anne) Wireless Continuous Physiological Monitor In Nairobi, Kenya, Jesse Coleman, Amy Sarah Ginsburg, William Macharia, Roseline Ochieng, Dorothy Chomba, Guohai Zhou, Dustin Dunsmuir, Shuai Xu, J. Mark Ansermino

Paediatrics and Child Health, East Africa

Background: Neonatal multiparameter continuous physiological monitoring (MCPM) technologies assist with early detection of preventable and treatable causes of neonatal mortality. Evaluating accuracy of novel MCPM technologies is critical for their appropriate use and adoption.

Methods: We prospectively compared the accuracy of Sibel’s Advanced Neonatal Epidermal (ANNE) technology with Masimo’s Rad-97 pulse CO-oximeter with capnography and Spengler’s Tempo Easy reference technologies during four evaluation rounds. We compared accuracy of heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂), and skin temperature using Bland-Altman plots and root-mean-square deviation analyses (RMSD). Sibel’s ANNE algorithms were optimized between each round. …

Post Covid-19 Vaccine Guillain Barre Syndrome, Soban Khan, Maryam Khalil, Zaid Waqar, Sajid Khan, Zakir Jan

Pakistan Journal of Neurological Sciences (PJNS)

The Guillain Barre Syndrome (GBS) is an acute immune-mediated progressive polyneuropathy having an acute monophasic illness leading to paralysis. The clinical features are progressive ascending symmetrical muscle weakness that may lead to respiratory failure. Diagnosis is based upon clinical presentation and is supported by a lumbar puncture with CSF analysis demonstrating albumin-cytological dissociation, and electrophysiological studies. Our patient presented to us with progressive ascending paralysis after receiving COVID 19 vaccine.

Succinic Semialdehyde Dehydrogenase Deficiency – A Rare Cause Of Metabolic Stroke, Areeba Wasim, Javeria Raza Alvi, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Succinic semialdehyde dehydrogenase (SSADH) deficiency is a rare neurometabolic disorder characterized by defective degradation of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter of the brain. Children with SSADH deficiency present with motor and mental delay, intractable seizures, infantile onset hypotonia, speech disturbances, extrapyramidal symptoms and ataxia. This wide spectrum results from increased accumulation of 4hydroxy butyric acid (4HBA) leading to down regulation of GABA receptors, which likely explain epileptogenesis but the pathophysiology of stroke in SSADH deficiency is not much elucidated. Here, we report an infant aged 11 months, product of consanguineous marriage with significant family history of motor delay …