Family Medicine Commons^™

The Pattern Of Admission, Clinical Characteristics, And Outcomes Among Patients Admitted To The Intensive Care Unit Of A Tertiary Hospital In Tanzania: A 5-Year Retrospective Review, Nadeem Kassam, Philip Adebayo, Iris Martin Matei, Eric Aghan, Samina Somji, Samwel Paul Kadelya, Yasson Abha, Frank Elton Swai, Mangaro Mabusi, Kamran Hamid

Internal Medicine, East Africa

Introduction: Despite the implementation of complex interventions, ICU mortality remains high and more so in developing countries. The demand for critical care in Sub-Saharan Africa is more than ever before as the region experiences a double burden of rising rates of non-communicable diseases (NCD) in the background battle of combating infectious diseases. Limited studies in Tanzania have reported varying factors associated with markedly high rates of ICU mortality. Investigating the burden of ICU care remains crucial in providing insights into the effectiveness and challenges of critical care delivery.

Material and Methods: A single-center retrospective study that reviewed records of all …

Outpatient Management Of Urinary Tract Infections By Medical Officers In Nairobi, Kenya: Lack Of Benefit From Audit And Feedback On Adherence To Treatment Guidelines, Florence Mbatia, James Orwa, Mary B. Adam, Gulnaz Mohamoud, Rodney Adam

Family Medicine, East Africa

Introduction: Acute uncomplicated urinary tract infections are common in outpatient settings but are not treated optimally. Few studies of the outpatient use of antibiotics for specifc diagnoses have been done in sub-Saharan Africa, so little is known about the prescribing patterns of medical ofcers in the region.

Methods: Aga Khan University has 16 outpatient clinics throughout the Nairobi metro area with a medical ofcer specifcally assigned to that clinic. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records in these clinics. Then the medical ofcer from each of the 16 clinics was recruited from …

Role Of Hospital Leadership In Pandemic Preparedness: Experience At A Tertiary Hospital In Kenya During The Covid-19 Pandemic, Lucy Mwangi, William Macharia, Benjamin Wachira, Jemimah Kimeu, Boniface Mativa, Lukoye Atwoli

Paediatrics and Child Health, East Africa

Introduction: Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis.

Objectives and methods: We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-forprofit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, …

Factors Associated With Depressive Symptoms In Patients With Benign Prostatic Enlargement, Husni Abdalla, Jasmit Shah, Tabitha A.N. Nyanja, Jacob Shabani

Family Medicine, East Africa

Background: Depression is a common condition that may lead to suicide at its worst. It is considered one of the primary causes of morbidity globally. Among the urological causes of depression is benign prostatic enlargement (BPE).

Aim: To determine the prevalence and factors associated with depressive symptoms among BPE patients.

Setting: This study was conducted in the Urology and Family Medicine Clinic at the Aga Khan University Hospital, Nairobi and Urology clinic at the Aga Khan Hospital Mombasa.

Methods: The study was a cross-sectional design recruiting 308 males above the age of 40. Patient Health Questionnaire-9 …

The Relation Of Abo Blood Group To The Severity Of Coronavirus Disease: A Cross-Sectional Study From A Tertiary Care Hospital In Karachi, Fazal Ur Rehman, Syed Furrukh Omair, Fatima Memon, Bakhtawar J. Rind, Danish Ahmed Memon, Syed Ahsan Ali, Bilal Ahmed, Naureen Ali

Section of Internal Medicine

Background: Blood groups are considered to have an impact on the occurrence and severity of coronavirus disease. While among Chinese and Caucasian, blood group O individuals were less and group A were more likely to have severe disease and mortality, data on South Asians aren’t available.
Objective: This study aimed to find out the association of disease severity with blood group among coronavirus disease 2019 (COVID-19) patients.
Materials and methodology: Data were collected on a predesigned questionnaire containing details of patient demographics, medical comorbidities, clinical presentation, and laboratory parameters. Multiple logistic regression was used to determine the association of the …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Ischemic Strokes: Observations From A Hospital Based Stroke Registry In Bangladesh., Nirmalenduk Bikash Bhowmik, Aamir Abbas, Mohammad Saifuddin, Md. Rashedul Islam, Rumana Habib, Aminur Rahman, Md. Amirul Haque,, Zahid Hassan, Mohammad Wasay

Department of Medicine

Background. Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh. Methods. Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded. Results. Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected …

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

Department of Medicine

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

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

Effect Of Nutritional Deficiency On The Efficacy Of The Polio Vaccines In Pakistan., Aamir Abbas, Romaina Iqbal

Department of Medicine

No abstract provided.

Effects Of Polypharmacy On Adverse Drug Reactions Among Geriatric Outpatients At A Tertiary Care Hospital In Karachi: A Prospective Cohort Study., Bilal Ahmed, Kashmira Nanji, Rakshinda Mujeeb, Muhammad Junaid Patel

Department of Medicine

Background: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication’’. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center.

Methods: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University …

Clinical, Lifestyle, Socioeconomic Determinants And Rate Of Asymptomatic Intracranial Atherosclerosis In Stroke Free Pakistanis., Ayeesha Kamran Kamal, Farzin Majeed, Omrana Pasha, Hasan Rehman, Muhammad Islam, Iqbal Azam Syed, Muhammad Saleem Ilyas, Munawar Hussain, Kamran Masood, Bilal Ahmed, Sumaira Nazir, Zafar Sajjad, Scott E. Kasner

Department of Medicine

Background: Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region.

Methods: The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used …

Illuminating The Dark Side--Vitamin D Status In Different Localities Of Karachi., Romaina Iqbal, Lena Jafri, Ali Haroon, Aysha Habib

Department of Medicine

This study was conducted to determine the association between place of residence (grouped into neighbourhoods), and 25-hydroxy D (25[OH]D) levels of individuals of Karachi. Addresses of 4788 individuals tested for 25[OH]D at the clinical laboratory of the Aga Khan University (AKU), Karachi, from January 2007 to June 2008 were reviewed. The neighbourhoods were categorized into ten, based on locality attributes. A high overall prevalence (74%) of vitamin D deficiency (VDD) was observed. There was a significant difference (p-value < 0.01) between mean log 25[OH]D levels amongst neighbourhoods grouped according to distinct housing structure attributes and localities. A high frequency of VDD in all the studied localities of an urban city warrant dietary vitamin D supplementation and food fortification.

Unintentional Childhood Poisoning, Epidemiology And Strategies For The Prevention And Policy Change In Pakistan, Omer Ul Hassan, Hasana Qadri, Umer Mir, Bilal Ahmed

Department of Medicine

Poisoning is the fifth leading cause of unintentional injuries among young children. Agents most commonly ingested by young children include medicines, cleaning substances, hydrocarbons, pesticides and cosmetics. Children with less educated fathers, living in more crowded conditions and from lower income families are more predisposed to unintentional poisoning. Unsafe storage of medicines, chemicals and other hazardous substances is one of the leading reasons for childhood poisoning. Knowledge of parents and caregivers about prevention of poisoning may be the basis to prevent subsequent injuries. This paper is a review of the epidemiology of unintentional poisonings among young children (less than five …

Self-Perceived Health Among School Going Adolescents In Pakistan: Influence Of Individual, Parental And Life Style Factors?, Asad Ali Khan Afridi, Komal Motwani, Saleem Khawaja, Adeel Khoja, Zafar Fatmi, Iqbal Azam Syed, Muhammad Masood Kadir

Department of Medicine

BACKGROUND: Adolescents are at substantial risk of acquiring behaviors which might influence their health status. This study was aimed to assess the proportion of school going adolescents (both males and females) with poor self-perceived health and its associated factors.

METHODOLOGY: A cross-sectional study was conducted in three major cities of Pakistan i.e. Karachi, Lahore and Quetta. From each city, six (6) secondary schools were randomly selected (3 public and 3 private). Pre-tested, self-administered questionnaire was distributed to students. Binary logistic regression analysis was conducted to determine independent factors associated with poor self-perceived health.

RESULTS: Approximately 29% adolescents (119/414) reported poor …

Preventable Lifestyle Risk Factors For Non-Communicable Diseases In The Pakistan Adolescents Schools Study 1 (Pass-1)., Ali Khan Khuwaja, Saleem Khawaja, Komal Motwani, Adeel Khoja, Iqbal Azam Syed, Zafar Fatmi, Badar Sabir Ali, Muhammad Masood Kadir

Department of Medicine

Objectives: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents.

Methods: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis.

Results: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% …

Survival Of Patients Treated With Intra-Aortic Balloon Counterpulsation At A Tertiary Care Center In Pakistan - Patient Characteristics And Predictors Of In-Hospital Mortality., Fahim H. Jafary, Sohail A. Khan, Haresh Kumar, Numaan F. Malik, K. Kazmi, Sajid Dhakam, Azam Shafquat, Aamir Hameed, Javed Tai, Najaf Nadeem

Department of Medicine

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan.

METHODS: Hospital charts of 95 patients (mean age 58.8 (+/- 10.4) years; 78.9% male) undergoing IABC between 2000-2002 …