Medical Specialties Commons^™

Key Opinion Leaders' Views Regarding Emergency Contraception In India, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief explores the views of key opinion leaders (KOLs) in the field of reproductive health and family welfare on provision of emergency contraception (ECPs). The study’s objective was to gain a better understanding of how the attitudes and beliefs of KOLs might influence policy and program implementation, either encouraging or opposing ECP promotion and service delivery. Results suggest strong support by the majority of KOLs to continue the sale of ECP as an over-the-counter drug. KOLs also emphasized the importance of comprehending and addressing the main barriers to ECP provision and use: poor knowledge, lack of training, moral …

Providers' Attitudes And Practices Regarding Emergency Contraception In India: Key Findings, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief reports key findings of a study in India that explored providers’ knowledge of how emergency contraception (ECP) works and its safety and effectiveness, their perceptions of the frequency of repeat use, their provision of ECP, and their attitudes toward women who seek it. Many of the findings of this study are encouraging. Most providers believed that ECP is an effective and safe method to prevent pregnancy and that it cannot induce abortion, and half supported the over-the-counter provision of ECP. Nevertheless, the study revealed many biases and gaps in knowledge. Recommendations include a number of ways to …

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …

Providers' And Key Opinion Leaders' Attitudes And Practices Regarding Emergency Contraception In Senegal: Key Findings, Babacar Mane, Martha Brady, Saumya Ramarao, Fatou Bintou Mbow

Reproductive Health

This study examines providers’ and key opinion leaders’ knowledge, attitudes, and practices regarding the emergency contraceptive pill (ECP) in Senegal, and synthesizes the findings to suggest program and policy recommendations. Analysis of providers’ opinions and beliefs reveals that although many providers believe ECP is a safe product, persistent negative views remain. KOLs and providers recognize the importance of ECP for preventing unintended pregnancy and are supportive of the integration of ECP into national guidelines. They note, however, the need to improve accessibility and quality of provision. Given the magnitude of sexual violence and abuse, considerable interest exists in devising strategies …

Attitudes, Croyances Et Pratiques Des Leaders D'Opinion Clés (Loc) Et Des Prestataires Sur La Contraception D'Urgence (Cu) Au Sénégal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In Senegal, initiatives for mainstreaming the emergency contraceptive pill (ECP) in the family planning program are fairly recent. Service statistics indicate, however, that ECP distribution through the public sector is very low. While most users access ECPs through the private sector, the volume of sales is not clear, due to the absence of an operational information system of EC distribution through pharmacies. In an effort to strengthen EC provision in Senegal and reposition EC within the FP program, the Population Council conducted a study in collaboration with the Reproductive Health Division of the Ministry of Health, Senegal to document the …

Critical Issues For Integrating Srh And Hiv/Aids Services To Provide Dual Protection Against Unintended Pregnancy And Hiv/Sti Acquisition, Population Council

Reproductive Health

This document reports on a one-day symposium that was held by the STEP UP (Strengthening Evidence for Programming on Unintended Pregnancy) Research Program Consortium, coordinated by the Population Council. STEP UP generates policy-relevant research to promote an evidence-based approach for improving access to family planning and safe abortion in Bangladesh, Ghana, India, Kenya, and Senegal. The symposium’s objectives were to review and discuss critical and emerging issues around integrating SRH and HIV and AIDS services to enable dual protection, including new directions in dual protection technology and behaviour change interventions. The meeting also provided an opportunity to discuss the programmatic …

Replication Of The Community Mobilization For Postabortion Care (Commpac) Model In Naivasha District, Rift Valley Province, Kenya: An Evaluation Report, Chi-Chi Undie, Francis Obare, Saumya Ramarao

Reproductive Health

The Population Council’s RESPOND project worked with districts and communities in Kenya to: strengthen service delivery points to provide postabortion care (PAC) services; conduct community mobilization to improve involvement in and knowledge of the prevention and treatment of postabortion complications; build community capacity to address needs related to PAC; and encourage involvement in community action of those most marginalized and most affected by postabortion complications. The program succeeded at increasing knowledge of critical danger signs; enabling providers to effectively offer PAC services; and raising awareness of PAC, among other goals. The intervention was less successful in increasing FP knowledge, current …

Birth Spacing And Family Planning Uptake In Pakistan: Evidence From Falah, Arshad Mahmood

Reproductive Health

The Population Council was the lead implementing agency for the Family Advancement for Life and Health (FALAH) project in Pakistan. The project’s main objectives were to achieve a 10 percent increase in the use of moden contraceptives, to equip 80 service delivery points to provide family planning services, and to ensure birth-spacing understanding and ways to achieve it by three-quarters of the target population. The main conclusion of this research is that a sharp uptake of family planning is possible in a relatively short time, if certain investments are made to ensure better communication and greater access to quality family …

Country Mapping: Kenya, Francis Obare, Wilson Liambila, Harriet Birungi, Eseoise Itombra, Heather Clark, Saumya Ramarao

Reproductive Health

The Population Council embarked on a three-year project to explore the acceptability of the progesterone vaginal ring (PVR) among women in sub-Saharan Africa and to develop a strategic plan for its introduction. This technical report presents the findings of the assessments in Kenya with specific focus on: (1) the country’s demographic profile; (2) the health systems, health policy, and family planning program context; and (3) stakeholder perspectives regarding the PVR. The findings suggest that the introduction of the PVR would fill a gap in the family planning needs of breastfeeding women in Kenya, and there is strong support from stakeholders …

Country Mapping: Nigeria, Salisu Mohammed Ishaku, Saumya Ramarao

Reproductive Health

The Population Council conducted a three-year acceptability study of the progesterone vaginal ring (PVR) in three sub-Saharan African countries. This technical report presents results from Nigeria, laying out the country’s demographics and high fertility rates; describing the family planning program and policy context; and, finally, revealing the stakeholder support thus far with a discussion on how best to proceed with introduction activities. This country mapping confirms the likelihood that the PVR would be well received in Nigeria and fill a large need in family planning. The PVR is a safe, long-acting, user-controlled product that can be easily inserted and removed …

Country Mapping: Senegal, Babacar Mane, Nafissatou Diop, Nancy Termini Lachance, Saumya Ramarao, Heather Clark

Reproductive Health

The Population Council embarked on a three-year project to explore the acceptability of the progesterone vaginal ring (PVR) among women in sub-Saharan Africa and its potential introduction. This technical report presents results from assessments undertaken to map the existing landscape of family planning programs and new contraceptive technologies in Senegal in an effort to identify national priorities and assess the level of interest in the PVR among stakeholders and to design appropriate preintroductory activities. This country mapping exercise confirms that Senegal is a promising context for the introduction of the PVR: the government is committed to repositioning family planning and …

Contraceptive Use Dynamics In Pakistan 2008-09, Arshad Mahmood, Syeda Saman Naz

Reproductive Health

This report looks at contraceptive use dynamics in Pakistan, focusing on contraceptive discontinuation, method failure, and contraceptive switching, as well as the reasons for discontinuation. The study found that almost one-third of discontinuations were due to side effects followed by one-fifth of them by the method failure. Side effects were the most common reason for discontinuing modern methods (IUDs and hormonal methods), while failure was the most common reasons for discontinuing barrier and traditional methods (condom, rhythm, withdrawal). Based on the findings of this study, this report suggests that better training of health providers and better information and counseling of …

Attitudes, Beliefs, And Practices Of Key Opinion Leaders (Kol) And Providers About Emergency Contraception (Ec) In Senegal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In 2010, the Reproductive Health Division in Senegal, with support from Population Council, performed an assessment of the emergency contraception (EC) integration process into the national health system through a national forum on EC. This forum revealed that there was a real promotional problem regarding EC in the national health system despite the efforts made. There was widespread lack of public awareness of the product, rumors concerning EC due to the sensitive nature of the product, low inclusion of EC in routine service delivery, especially during initial counseling in family planning awareness campaigns , and a better method of keeping …

Bellagio Consensus: Recommendations For Action To Increase Access To Highly Effective, Long-Acting, Reversible Contraception, Population Council

Reproductive Health

This brief and statement offers recommendations for action to increase access to highly effective, long-acting, reversible contraception (LARCs) and accelerate progress toward meeting the Millennium Development Goal of universal access to reproductive health services.

Situation Analysis Of Health Facilities With Special Reference To Family Planning Services In Pakistan, Arshad Mahmood, Muhammad Jamil Arshad, Maqsood Sadiq

Reproductive Health

The FALAH project, launched in 2007, funded by USAID and implemented by a consortium of partners led by The Population Council, sought to shift family planning (FP) perception. This report details the findings of an assessment of FALAH’s FP and birth spacing impact. The study assessed public health facility readiness for offering FP and birth spacing services by interviewing in-charges and providers, as well as assessing the types of services provided and service providers’ characteristics. The study also examined the facilities’ quality of care through observing client and provider interactions, while client satisfaction was assessed in exit interviews. FALAH’s objective …

Community Health Workers For Maternal And Child Health, Leah Jarvis, Nancy Termini Lachance

Reproductive Health

In this factsheet, the Population Council notes the shortage of trained health professionals in the developing world; virtually all of sub-Saharan Africa stands below the critical threshold of 2.3 doctors, nurses, and midwives per thousand people. Doctors are especially unevenly distributed between urban and rural areas, with shortages being even more acute in rural communities. This document summarizes the important role of community health workers (CHWs) who can considerably increase coverage where access to health facilities is difficult and service utilization is already low. CHWs can play a vital role in increasing access to family planning and work within a …

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. …

Teamstepps™ And Narrative Medicine: Towards An Increased Awareness Of “Teamwork” On The Obgyn Third Year Clinical Rotation---A Pilot Study, Kristin Friel Md, Krista Hirschmann Phd

Department of Obstetrics & Gynecology

No abstract provided.

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 …

Rapid Assessment Unit – The Difference At The Emergency Department Door, Diane Haines Msn, Rn, Cen

Patient Care Services / Nursing

No abstract provided.

Infectious Intracranial Aneurysms: Collaboration For Treatment Success, Erin M. Conahan Rn, Bsn, Cnrn

Patient Care Services / Nursing

No abstract provided.

A Networkwide, Multidisciplinary Approach To Improving Perioperative Medication Safety, Diane Kimsey Rn, Ms, Cnor, Jeanne P. Luke Msn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

Relationship Of Main Pulmonary Artery Diameter To Pulmonary Arterial Pressure In Scleroderma Patients With And Without Mild To Moderate Interstitial Fibrosis, Robert Kane Mccall

MUSC Theses and Dissertations

Purpose: To determine the validity of main pulmonary artery diameter (MPAD) as a marker of pulmonary hypertension in scleroderma patients with and without interstitial lung disease (lLD). Materials and Methods: We cross-referenced the radiologic database with medical records to identify patients with both computed tomography (CT) scans of the chest and right-heart catheterization separated by no more than six months. Computed tomography scans were reviewed to determine MPAD and extent of ILD for each patient. Ground glass opacity and fibrosis were individually scored by a single thoracic radiologist on a five-point scale. The same radiologist also determined the quality of …

Bnnt- Mediated Irreversible Electroporation: It's Potential On Cancer Cells, V. Raffa, C. Riggio, M. W. Smith, K. C. Jordon, W. Cao, A. Cuschieri

Applied Research Center Publications

Irreversible lethal electroporation (IRE) is a new non-thermal ablation modality that uses short pulses of high amplitude static electric fields (up 1000V/cm) to create irreversible pores in the cell membrane, thus, causing cell death. Recently, IRE has emerged as a promising clinical modality for cancer disease treatment. Here, we investigated the responses of tumour human He La cells when subjected to IRE in the presence of BNNTs. These consist of tiny tubes of B and N atoms (arranged in hexagons) with diameters ranging from a 1 to 3 nanometres and lengths <2 μm. BNNTs have attracted wide attention because of their unique electrical properties. We speculate that BNNTs, when interacting with cells exposed to static electrical fields, amplify locally the electric field, leading to cell death. In this work, electroporation assays were performed with a commercial electroporator using the cell-specific protocol suggested by the supplier (exponential decay wave, time constant 20ms) with the specific aim to compare IRE in absence and in presence of BNNTs. We observed that BNNTs have the capacity to decrease substantially the voltage required for IRE. When cells were pulsed at 800V/cm, we observed a 2,2-fold reduction in cell survival in the presence of BNNTs compared to controls. We conclude that the death of the tumour cells exposed to IRE is strongly enhanced in the presence of BNNTs, indicating their potential therapeutic application.

A Mathematical Model For Cell Cycle-Specific Cancer Virotherapy, Joanna R. Wares, Joseph J. Crivelli, Juraj Földes, Peter S. Kim

Department of Math & Statistics Faculty Publications

Oncolytic viruses preferentially infect and replicate in cancerous cells, leading to elimination of tumour populations, while sparing most healthy cells. Here, we study the cell cycle-specific activity of viruses such as vesicular stomatitis virus (VSV). In spite of its capacity as a robust cytolytic agent,VSVcannot effectively attack certain tumour cell types during the quiescent, or resting, phase of the cell cycle. In an effort to understand the interplay between the time course of the cell cycle and the specificity of VSV, we develop a mathematical model for cycle-specific virus therapeutics. We incorporate the minimum biologically required time spent in the …

Promoting Mitochondrial Biogenesis With The Sirti Activator Srt1720 To Improve Mitochondrial And Renal Function After Acute Kidney Injury, Jason Allen Funk

MUSC Theses and Dissertations

Mitochondrial dysfunction is a primary pathological consequence of acute kidney injury (AKI). Induction of mitochondrial biogenesis via the nuclear coactivator of transcription PPARγ-coactivator-1α (PGC-1α), the master regulator of mitochondrial biogenesis, rescues mitochondrial function in renal cells after oxidant injury. The primary goal of this project was to evaluate the recovery of mitochondrial function after in vivo AKI, and to determine the influence of mitochondrial biogenesis during the repair process. Deacetylation of PGC-1α by the class III HDAC SIRT1 produces a more active form of the protein and stimulates mitochondrial biogenesis. The potent SIRT1 activator SRT1720 induced deacetylation of PGC-1α, increased …

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 …