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Bhutta Z.A.,Aga Khan University | Hafeez A.,Health Services Academy | Rizvi A.,Aga Khan University | Ali N.,John Snow | And 6 more authors.
The Lancet | Year: 2013

Globally, Pakistan has the third highest burden of maternal, fetal, and child mortality. It has made slow progress in achieving the Millennium Development Goals (MDGs) 4 and 5 and in addressing common social determinants of health. The country also has huge challenges of political fragility, complex security issues, and natural disasters. We undertook an in-depth analysis of Pakistan's progress towards MDGs 4 and 5 and the principal determinants of health in relation to reproductive, maternal, newborn, and child health and nutrition. We reviewed progress in relation to new and existing public sector programmes and the challenges posed by devolution in Pakistan. Notwithstanding the urgent need to tackle social determinants such as girls' education, empowerment, and nutrition in Pakistan, we assessed the Effect of systematically increasing coverage of various evidence-based interventions on populations at risk (by residence or poverty indices). We specifi cally focused on scaling up interventions using delivery platforms to reach poor and rural populations through community-based strategies. Our model indicates that with successful implementation of these strategies, 58% of an estimated 367 900 deaths (15 900 maternal, 169 000 newborn, 183 000 child deaths) and 49% of an estimated 180 000 stillbirths could be prevented in 2015.


Saeed M.A.,Foundation University | Irshad M.,Pakistan Institute of Medical science
Journal of the College of Physicians and Surgeons Pakistan | Year: 2010

Objective: To determine the demographic characteristics of gender, age, involvement of hand/hands and seasonal distribution in patients with a neurophysiological diagnosis of carpal tunnel syndrome (CTS). Study Design: An observational study. Place and Duration of Study: Department of Neurology, Fauji Foundation Hospital, Rawalpindi and PIMS, Islamabad, during December 2006 to July 2009. Methodology: Cases reported in the months of December and January (winter group) and those reported in the months of June and July (summer group), of any age and gender with electrophysiological confirmation of CTS were included. Those having median neuropathy in the region of elbow, brachial plexopathy and cervical radiculopathy (C6-7) or polyneuropathy were excluded. Nerve conduction study was done in Median nerve. Statistical significance between the two groups (summer and winter) was calculated. Results: Among the 213 patients (320 hands) of CTS, 70 (105 hands) were in summer group and 143 (215 hands) were in winter group. There were 15 (21.43%) males and 55 (78.57%) females in summer group and 22 (15.38%) males and 121 (84.62%) females in winter group. The female hands were 83 (79.05%) and 182 (84.65%) and male hands were 22 (20.95%) and 33 (15.35%), respectively in summer and winter group. Mean age was 44.38 years and 45.16 years. The right hand was affected in 64 (60.95%) and 121 (56.28%); and the left hand was affected in 41 (39.05%) and 94 (43.72%) in summer and winter groups respectively. Half of the patients had bilateral involvement. The p-values for the NCS variables were not statistically significant. Conclusion: Presentation with CTS was more common in winter at the study centre. Female gender and dominant hand was affected more frequently. There were no significant changes in NCS parameters among the two groups.


Nasir S.,Pakistan Council for Science and Technology | Jamila B.,Pakistan Council for Science and Technology | Khaleeq S.,Pakistan Institute of Medical science
Asian Pacific Journal of Cancer Prevention | Year: 2010

The aim of present study was to determine the relative frequency of primary brain tumors among children under 14 years of age in Pakistan. A retrospective review of pediatric primary brain tumors, encountered over 13 years (January 1998 through July 2010) at the Neurosurgical Unit of the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan, was made covering 231 cases, 142 (61.5%) males and 89 (38.5%) females, with a male to female ratio of 1.69:1. The cases were divided into 5 age groups each covering three years of life (0-2, 3-5, 6-8,9-11 and 12-14 years), with the greatest number in age group 3 i.e. 6-8 years (32%) and the least number of patients in age groups 1 and 5 (10.3% each). The 231 malignancies were categorized by site into two groups, supratentorial (83 cases; 35.9%) and infratentorial (148 cases; 64.1%). The morphological distribution was medulloblastoma (33.3%), astrocytoma (24.7%), mixed gliomas (14.7%), craniopharyngioma (11.7%), ependymoma (8.7%), PNET (6.1%) and pineal tumor (0.9%). Since only a single institution was studied, cautious interpretation is needed. Ideally, a population-based approach would be adopted to determine the cancer burden due to pediatric malignancies of the brain in this population and for their morphological categorization in Pakistan.


Mansoor Q.,Institute of Biomedical and Genetic Engineering | Javaid A.,Institute of Biomedical and Genetic Engineering | Bilal N.,Pakistan Institute of Medical science | Ismail M.,Institute of Biomedical and Genetic Engineering
Journal of Diabetes | Year: 2012

Background: Diabetic peripheral neuropathy (DPN) is one of the complications of type 2 diabetes mellitus (T2DM) that decreases the quality of life of T2DM patients. Very few studies have found an association between the development and progression of DPN in T2DM and angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms. Methods: Using gene-specific primers in a polymerase chain reaction, the presence of ACE I/D polymorphisms was screened for in 276 T2DM patients with DPN, 496 T2DM patients without DPN, and 331 control (non-diabetic) subjects. Results: The distribution of the I/D genotypes was in Hardy-Weinberg equilibrium. The II genotype was significantly more prevalent in T2DM patients without DPN than the DD genotype (P<0.05); however, there was no significant difference in the prevalence of the II and DD genotypes in T2DM patients with DPN (P=0.78). Conclusion: The II genotype of the ACE gene has a protective effect against the development of DPN in T2DM patients. This suggests a role for the renin-angiotensin system in modulating neuropathy in T2DM. © 2012 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.


Mahmood I.,Pakistan Institute of Medical science | Jamal M.,Pakistan Institute of Medical science | Khan N.,Pakistan Institute of Medical science
Journal of the College of Physicians and Surgeons Pakistan | Year: 2011

Objective: To evaluate the effect of mother-infant early skin-to-skin contact on breastfeeding behavior of infants. Study Design: A randomized controlled trial. Place and Duration of Study: The study was conducted in the Department of Obstetrics of Pakistan Institute of Medical Sciences, Islamabad, from November to December 2009. Methodology: Eligible mothers were assessed for the successful breastfeeding by using IBFAT tool. The time to initiate the first feed, time to effective breastfeeding, maternal satisfaction with the care provided, preference for the same care in future and level of exclusive breastfeeding at the age of one month were also noted. The data was compared by using X2 and t-test. Significant p-value was taken as < 0.05. Results: A total of 183 mother-infant pairs (92 in skin-to-skin care [SSC] group and 91 in conventional care [CC] group) were analyzed for breastfeeding behavior of the infants. The first breastfeed was 26.25% more successful in SSC group (58.8% in SSC group as compared to 32.5% in CC group with p-value of 0.001). In SSC group, the mean time to initiate first breastfeed was 61.6 minutes shorter than CC group (40.62 vs. 101.88; p < 0.001). Mean time to achieve effective breastfeeding was 207 minutes earlier in SSC group (149.69 vs. 357.50; p < 0.001). The level of satisfaction in the mothers of SSC group was significantly high as compared to controls (56% vs. 6.2%). Similarly, 53.8% mothers of SSC group showed preference for similar care in future as compared to 5% in CC group. In SSC group 85.3% infants were exclusively breastfed at one month as compared to 65.7% in CC group (p=0.025). Conclusion: Maternal-infant early skin-to-skin contact significantly enhanced the success of first breastfeed and continuation of exclusive breastfeeding till one month of age. It also reduced the time to initiate first feed and time to effective breastfeeding. © 2011. College of Physicians & Surgeons Pakistan.


Mazhar S.B.,Pakistan Institute of Medical science | Kanwal S.,Pakistan Institute of Medical science
Journal of the College of Physicians and Surgeons Pakistan | Year: 2010

Objective: To determine the frequency of twin birth weight discordance and compare the maternal characteristics and neonatal outcome in discordant and concordant twin gestations. Study Design: Cross-sectional comparative study. Place and Duration of Study: MCH Centre, Unit-II, Pakistan Institute of Medical Sciences, Islamabad, from January 2005 to December 2007. Methodology: All twin gestations delivered at > 28 weeks gestation were included. Birth weight discordance was defined as > 20% twin birth weight difference and two groups were developed accordingly. Prenatal complications, gestational age at delivery, mode of delivery and neonatal outcome were compared using chi-square and Fischer exact test with significance at p < 0.05. Results: Two hundred and fifty three pairs of twins were delivered during the three years. The frequency of birth weight discordance was 19% (48 verses 205 concordant twin pairs). Preterm delivery (68% vs. 25%), pre-labour rupture of membranes (33% vs. 9%) and pregnancy induced hypertension (22% vs. 12%) were significantly more frequent in birth weight discordant compared to concordant gestations. The cesarean section rate was 29% and 21% respectively. Twelve (12%) discordant and 29 (7%) concordant infants required NICU admission. There were 10 intrauterine deaths (10%) and one (1%) neonatal death among the discordant twins while 18 (4%) intrauterine deaths and 10 (2.4%) neonatal deaths occurred in concordant twins, resulting in uncorrected PNMR of 114.5 and 43.9 per 1000 births respectively. Conclusion: Twin pregnancies with birth weight discordance are at higher risk of prenatal complications and have less favourable perinatal outcome. Their timely antenatal detection is, therefore, important for closer surveillance and timely delivery.


Saaiq M.,Pakistan Institute of Medical science | Zaib S.,Pakistan Institute of Medical science | Ahmad S.,Pakistan Institute of Medical science
Annals of Burns and Fire Disasters | Year: 2012

This is a study of 120 patients of either sex and all ages who had sustained deep burns of up to 40% of the total body surface area. Half the patients underwent early excision and skin autografting (i.e., within 4-7 days of sustaining burn injury) while the rest underwent delayed excision and skin autografting (i.e., within 1-4 weeks post-burn). Significant differences were found in favour of the early excision and grafting group with regard to the various burn management outcome parameters taken into consideration, i.e. culture positivity of wounds, graft take, duration of post-graft hospitalization, and mortality.


Rafiq M.F.,Pakistan Institute of Medical science
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2011

External ventricular drain involves catheter placement in ventricles of brain. It is used for various purposes. Basic theme is to drain cerebrospinal fluid so as to control intracranial pressure. This study was carried out to see the effect of tunnel length on rate of infection. This was a cross-sectional study carried out in Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad during 14 months from 1st December 2008 to 31 January 2010. External ventricular drain was placed in admitted patients after meticulous aseptic technique in operation theatre at right Kocher's point. It was carried out through a scalp tunnel and was connected to drainage bag through a drip set. Both long (> 5 Cm) and short (< 5 Cm) tunnels were randomly made. Infection rate was estimated in patients who had change of cerebrospinal fluid colour or developed fever (as per protocol to have minimum handling of drain). All patients received prophylactic Ceftriaxone. Among 76 patients long tunnel was made in 44 (57.9%) and short in 32 (42.1%). Three patients (3.9%) with long tunnel while 6 (7.9%) patients with short tunnel had infection. The overall infection was in 9 (11.8%) patients. External ventricular drain tunnel length strongly influences the rate of infection.


Raza M.,Pakistan Institute of Medical science
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2011

Many conditions affect renal size. To evaluate abnormalities in renal size, knowledge of standardised values for normal renal dimensions is essential as it shows variability in the values of normal renal size depending on body size, age and ethnicity. Ultrasound, being an easily available, noninvasive, safe and less expensive modality, is widely used for evaluation of renal dimensions and repeated follow-ups. The objectives of this study were to determine renal size by ultrasound in adults without any known renal disease, and to determine the relationship of renal size with body mass index. Study was conducted in the Department of Diagnostic Radiology, Shifa International Hospital and PIMS Islamabad. Renal size was assessed by ultrasound in 4,035 adult subjects with normal serum creatinine and without any known renal disease, between November 2002 and December 2010. Renal length, width, thickness and volume were obtained and mean renal length and volume were correlated with body mass index and other factors like age, side, gender, weight and height of the subjects. Mean renal length on right side was 101.6 +/- 8.9 mm, renal width 42.7 +/- 7.1 mm, and parenchymal thickness 14.4 +/- 2.9 mm. On left side, mean renal length was 102.7 +/- 9.2 mm, width 47.6 +/- 7.0) mm, and parenchymal thickness 15.1 +/- 3.1 mm. Mean renal volume on right was 99.8 +/- 37.2 cm3 and on left was 124.4 +/- 41.3 cm3. Left renal size was significantly larger than right in both genders. Relationship of mean renal length was significant when correlated with age, side, gender, height and weight, and body mass index. Renal volumes also showed a similar relationship with side, gender, height and weight, and body mass index; but with age such a relationship was seen only for left kidney. Pakistani population has mean renal size smaller than reference values available in international literature. Renal length and volume have a direct relationship with body mass index. Mean renal size is related to the side, age, gender, height and weight as well.


Rashid F.,Pakistan Institute of Medical science | Ul Haque A.,Pakistan Institute of Medical science
Annals of Diagnostic Pathology | Year: 2011

Diagnosis of prostate adenocarcinoma is primarily based on morphological analysis. Nucleomegaly, prominent nucleoli, and hyperchromasia constitute current nuclear diagnostic parameters but are seen in benign conditions, vary with Gleason grade, and pose diagnostic challenge in well-differentiated tumors with accompanying inflammation or equivocal architectural features. In such cases, other pleomorphic nuclear features such as variation in size and shape, irregular contours, nuclear membrane infoldings, and nonuniform chromatin, which are not incorporated in formal evaluation, may prove helpful. Our aim was to study different nuclear morphological features of prostate adenocarcinoma (including currently practiced ones) and highlight their variation with Gleason grades. We examined 84 cases of prostate adenocarcinoma using oil immersion microscopy where necessary. Commonest Gleason pattern observed was grade 4a accounting for 42.8% of cases. Nuclear enlargement (moderate to marked in 93.8%), nucleolar enlargement (62.1%), and nonuniform chromatin distribution (100%) could serve as useful diagnostic features but did not vary with tumor differentiation. Pleomorphism (moderate in 58.6%), nuclear overlapping (62.8%), nuclear membrane infoldings (66.2%), and irregular contours (frequent in 94.5%) were significant diagnostic features that increased in frequency and extent with increasing grade and could be used to differentiate low-grade from high-grade tumors. Worsening of nuclear morphology with advancing tumor grades indicated that nuclear anaplasia accompanies poor architectural differentiation. Coexistence of pale and dark nuclei signified variable chromatin density of no diagnostic significance. © 2011 Elsevier Inc. All rights reserved.

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