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Khan MD, Daniyal M, Abid K, Tawiah K, Tebha SS, Essar MY. Analysis of adolescents' perception and awareness level for Sexual and Reproductive Health Rights in Pakistan. Health Sci Rep 2022; 6:e982. [PMID: 36544620 PMCID: PMC9764813 DOI: 10.1002/hsr2.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background Awareness of rights is a precondition to establishing rule of law in society. Sexual and Reproductive Health and Rights (SRHR) are closely knitted in the human rights framework as they overlap with other human rights such as the right to health and life. However, awareness about these rights remains a challenge. Considering the importance of these rights this study has measured the awareness of adolescents about SRHR in Bahawalpur (Division) of Pakistan. Methodology We conducted a cross-sectional study in the Divison of Bahawalpur, Pakistan from October 2019 to December 2019. The study included a sample size of 500 respondents which included 250 young females of age 15-19 and 250 their parents (mother). The reasoning behind including only females in this study was the increased vulnerability and greater impact of SRHR in their life compared to males. The age range 15-19 was primarily selected as females this age will better understand and respond to the questionnaire compared to females in their early adolescent years. The quantitative research was conducted using two-stage cluster sampling. Detailed structured questionnaires were distributed among the respondents to obtain their points of view on the awareness of SRHR. The population was divided into multi-clusters with 25 households comprising 250 households for the division of Bahawalpur. The information was also gathered from the doctors and the teachers through interviews. The data were analyzed using SPSS version 21. Results The study explored the knowledge and understanding of adolescent SRHR thereby highlighting the key restrictions in Bahawalpur, Pakistan, which prohibit adolescents from gaining access to SRHR and exercising it. There is a significant portion of adolescents who strongly agreed with the importance and awareness level and think they should be more aware of information regarding SRHR. However, they are of the view that they are less independent in practicing them. Conclusion The study found a low level of awareness about SRHR among young female and their parents in Bahawalpur, Pakistan. It is a need of time and responsibility of the local government of the Bahawalpur region to devise clear and proper policies which give access to these rights. This can be done by including the information on these rights in the course curriculum and teachers keeping in view the cultural and regional restrictions that guide the young female about SRHR.
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Affiliation(s)
| | - Muhammad Daniyal
- Department of StatisticsTheIslamia University of BahawalpurBahawalpurPakistan
| | | | - Kassim Tawiah
- Department of Mathematics and StatisticsUniversity of Energy and Natural ResourcesSunyaniGhana
| | - Sameer Saleem Tebha
- Department of Neurosurgery and NeurologyJinnah Medical and Dental CollegeKarachiPakistan
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Khan MD. Access to COVID-19 vaccination for transgender community in Multan, Punjab, Pakistan. Health Care Women Int 2022:1-14. [PMID: 35147488 DOI: 10.1080/07399332.2022.2029864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given the discrimination, harassment, and lack of adequate healthcare facilities, the transgender community members find it hard to access the COVID-19 vaccination. The COVID-19 pandemic has exacerbated the disparities in access to healthcare for the transgender community. In November 2020, on the topic of 'COVID-19 and Disaster Vulnerability in Pakistan: A Human Rights Based Analysis', a co-published report from the UNDP and Ministry of Human Rights Pakistan, reflected concerns on the challenges of access to healthcare for the transgender community in Pakistan. The report demanded the government to amplify its response to further protect the transgender community. In this paper, I aim at developing a theoretical framework for providing indiscriminate access to the COVID-19 vaccination for the transgender community as a part of right to health by reporting the first-hand knowledge about the challenges of access to vaccination facilities using qualitative research methods.
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Affiliation(s)
- Muhammad Danyal Khan
- Faculty of Commerce Law and Business Administration, Bahauddin Zakariya University, Multan, Pakistan
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Wali A, Safdar N, Manair R, Khan MD, Khan A, Kurd SA, Khalil L. Early TB case detection by community-based mobile X-ray screening and Xpert testing in Balochistan. Public Health Action 2021; 11:174-179. [PMID: 34956844 PMCID: PMC8680181 DOI: 10.5588/pha.21.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/26/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING This survey was conducted at 35 sites of 20 cities in 15 districts with low programmatic TB case notifications in the past years in Balochistan. OBJECTIVE To assess the effectiveness of the systemic community-based screening and diagnosis for early detection of TB; and 2) to describe the characteristics and understand the strengths and weaknesses of the intervention in Balochistan, and sociodemographic factors associated with it. DESIGN This cross-sectional descriptive study was conducted using a mobile van equipped with a digital X-ray machine with computer-aided detection for TB (CAD4TB) software for screening, followed by confirmatory high sensitivity Xpert® MTB/RIF assay testing. RESULTS A total of 236 (3.4%) TB cases was detected out of 6,899 screened. About 1,168 (17%) presumptive TB cases were identified and 1,065 (91%) sputum samples were tested on Xpert. Among those diagnosed, 166 (70%) were Mycobacterium tuberculosis-positive and 70 (30%) were with clinical suspicion. Of the sputum samples tested, 87% (923/1065) had a probability score of >70 on CAD4TB. CONCLUSION Community-based screening with innovative activities, comprising sensitive screening and diagnostic tools, effectively improves TB case detection, which might suffice to reduce the prevalence of TB and break the chain of infection transmission in the at-risk population.
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Affiliation(s)
- A Wali
- Department of Primary and Secondary Healthcare, Government of Balochistan, Quetta, Pakistan
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - N Safdar
- Interactive Research and Development, Singapore
| | - R Manair
- Interactive Research and Development, Karachi, Pakistan
| | - M D Khan
- Provincial AIDS Control Programme, Department of Primary and Secondary Healthcare, Government of Balochistan, Quetta, Pakistan
| | - A Khan
- Planning and Development Department, Government of Balochistan, Quetta, Pakistan
| | - S A Kurd
- Vector-Borne Disease Control Programme, Department of Primary and Secondary Healthcare, Government of Balochistan, Quetta, Pakistan
| | - L Khalil
- Human Resource Development, Department of Primary and Secondary Healthcare, Government of Balochistan, Quetta, Pakistan
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Khan MD. Toward creating equity in access to COVID-19 vaccination for female population in Multan, Punjab, Pakistan. Health Care Women Int 2021:1-10. [PMID: 34686113 DOI: 10.1080/07399332.2021.1988952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
The researchers examined the access to the COVID-19 vaccine among 32 females in Multan, Punjab, Pakistan. The aim of the study is to access the independence of decision-making among female participants to vaccinate themselves against the COVID-19. Participants of the study belong to Multan, a city of Southern Punjab. The researchers adopt a qualitative research design, using in-depth interviews, repeated open-ended questions, and local languages. Among general conclusions of this study are, female dependence on male members to get the vaccination, limited control on deciding the need for vaccination, and patriarchal decision to vaccinate the family. The aim of the researchers is to contribute toward an effective COVID-19 vaccination campaign by minimizing discrimination against women in accessing the vaccine.
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Affiliation(s)
- Muhammad Danyal Khan
- Faculty of Commerce Law and Business Administration, Bahauddin Zakariya University, Multan, Pakistan
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Younus S, Maqsood H, Awais R, Gulraiz A, Khan MD. Prognostication of the abdominal aortic aneurysm with a novel three-dimensional ultrasonographic analysis system and its comparison with computed tomography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Self
Introduction
An abdominal aortic aneurysm is a life-threatening condition and the risk of rupture is higher with the increased maximum diameter (Dmax) and expansion rate. Therefore, AAAs require regular monitoring of Dmax. The most commonly used imaging technique for measuring AAA size is two-dimensional ultrasonography (2-D US), closely followed by computed tomography (CT).
Purpose :
This study sought to evaluate the accuracy of a novel semi-automated 3-D ultrasonography (3-D US) system and its comparison CT as a reference.
Methods :
A total of 66 patients with abdominal aortic aneurysm were prospectively recruited in an outpatient setting. Two-dimensional ultrasonography (2-D US) and 3-D US images were attained with a single-sweep volumetric transducer. Dmax and the vessel area of the Dmax slice were measured with 2-D US, 3-D US, and CT. The vessel, lumen, and thrombus areas of the Dmax slice were also measured using 3-D US and CT.
Results :
It was found that the Dmax values from the 3-D US demonstrate better agreement (R2 = 0.971) with the CT values than with the 2-D US values (R2 = 0.929). Overall, 2-D US underestimated Dmax compared with 3-D US (30.8 ± 13.1mm vs. 34.4 ± 11.6 mm). The vessel, lumen, and thrombus areas all demonstrated better agreement with CT than with 2-D US (R2 = 0.988 vs. 0.961 for the vessel, R2 = 0.879 vs. 0.829 for the lumen, and R2 = 0.963 vs. 0.849 for the thrombus).
Conclusion :
Our study concludes that our novel semi-automated 3-D US analysis system provides more accurate Dmax values and volumetric data as compared to the 2-D US. The application of the semi-automated 3-D US analysis system in an abdominal aorta assessment is easy and accurate.
Abstract Figure. Comparison of AAA on three modalities
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Affiliation(s)
- S Younus
- Nishtar Medical University, Multan, Pakistan
| | - H Maqsood
- Nishtar Medical University, Multan, Pakistan
| | - R Awais
- Nishtar Medical University, Multan, Pakistan
| | - A Gulraiz
- Nishtar Medical University, Multan, Pakistan
| | - MD Khan
- Nishtar Medical University, Multan, Pakistan
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Younus S, Maqsood H, Gulraiz A, Khan MD, Awais R. Identification and prognostication of the substrate of ventricular arrhythmia with cardiac magnetic resonance (CMR) imaging in patients with normal echocardiography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Self
Introduction
Malignant ventricular arrhythmia contributes to approximately half of the sudden cardiac deaths. In common practice, echocardiography is used to identify structural heart diseases that are the most frequent substrate of VA. Identification and prognostication of structural heart diseases are very important as they are the main determinant of poor prognosis of ventricular arrhythmia.
Purpose :
The objective of this study is to determine whether cardiac magnetic resonance (CMR) may identify structural heart disease (SHD) in patients with ventricular arrhythmia who had no pathology observed on echocardiography.
Methods :
A total of 864 consecutive patients were enrolled in this single-center prospective study with significant ventricular arrhythmia. VA was characterized as >1000 ventricular ectopic beats per 24 hours, non-sustained ventricular arrhythmia, sustained ventricular arrhythmia, and no pathological lesion on echocardiography. The primary endpoint was the detection of SHD with CMR. Secondary endpoints were a composite of CMR detection of SHD and abnormal findings not specific for a definite SHD diagnosis.
Results :
CMR studies were used to diagnose SHD in 212 patients (24.5%) and abnormal findings not specific for a definite SHD diagnosis in 153 patients (17.7%). Myocarditis (n = 84) was the more frequent disease, followed by arrhythmogenic cardiomyopathy (n = 51), ischemic heart disease (n = 32), dilated cardiomyopathy (n = 17), hypertrophic cardiomyopathy (n = 12), congenital cardiac disease (n = 08), left ventricle noncompaction (n = 5), and pericarditis (n = 3). The strongest univariate and multivariate predictors of SHD on CMR images were chest pain (odds ratios [OR]: 2.5 and 2.33, respectively) and sustained ventricular tachycardia (ORs: 2.62 and 2.21, respectively).
Conclusion : Our study concludes that SHD was able to be identified on CMR imaging in a significant number of patients with malignant VA and completely normal echocardiography. Chest pain and sustained ventricular tachycardia were the two strongest predictors of positive CMR imaging results.
Abstract Figure. Distribution of different SHD
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Affiliation(s)
- S Younus
- Nishtar Medical University, Multan, Pakistan
| | - H Maqsood
- Nishtar Medical University, Multan, Pakistan
| | - A Gulraiz
- Nishtar Medical University, Multan, Pakistan
| | - MD Khan
- Nishtar Medical University, Multan, Pakistan
| | - R Awais
- Nishtar Medical University, Multan, Pakistan
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Daniyal M, Ogundokun RO, Abid K, Khan MD, Ogundokun OE. Predictive modeling of COVID-19 death cases in Pakistan. Infect Dis Model 2020; 5:897-904. [PMID: 33195884 PMCID: PMC7647892 DOI: 10.1016/j.idm.2020.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2020] [Accepted: 10/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The world is presently facing the challenges posed by COVID-19 (2019-nCoV), especially in the public health sector, and these challenges are dangerous to both health and life. The disease results in an acute respiratory infection that may result in pain and death. In Pakistan, the disease curve shows a vertical trend by almost 256K established cases of the diseases and 6035 documented death cases till August 5, 2020. OBJECTIVE The primary purpose of this study is to provide the statistical model to predict the trend of COVID-19 death cases in Pakistan. The age and gender of COVID-19 victims were represented using a descriptive study. METHOD ology: Three regression models, which include Linear, logarithmic, and quadratic, were employed in this study for the modelling of COVID-19 death cases in Pakistan. These three models were compared based on R2, Adjusted R2, AIC, and BIC criterions. The data utilized for the modelling was obtained from the National Institute of Health of Pakistan from February 26, 2020 to August 5, 2020. CONCLUSION The finding deduced after the prediction modelling is that the rate of mortality would decrease by the end of October. The total number of deaths will reach its maximum point; then, it will gradually decrease. This indicates that the curve of total deaths will continue to be flat, i.e., it will shift to be constant, which is also the upper bound of the underlying function of absolute death.
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Affiliation(s)
- Muhammad Daniyal
- Department of Statistics, Islamia University of Bahawalpur, Pakistan
| | | | - Khadijah Abid
- Research Evaluation Unit, College of Physicians & Surgeons, Pakistan
| | | | - Opeyemi Eyitayo Ogundokun
- Directoriate Department, Audit Section, Agricultural and Rural Management Training Institute, Ilorin, Nigeria
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Anwer AH, Khan MD, Khan N, Nizami AS, Rehan M, Khan MZ. Development of novel MnO 2 coated carbon felt cathode for microbial electroreduction of CO 2 to biofuels. J Environ Manage 2019; 249:109376. [PMID: 31437708 DOI: 10.1016/j.jenvman.2019.109376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Abstract
Fabrication of superior and cost-effective cathodic materials is vital in manufacturing sustainable microbial electrolysis cells (MECs) for biofuels production. In the present study, a novel manganese dioxide (MnO2) coated felt cathode (Mn/CF) has been developed for MECs using electrodeposition method via potentiostat. MnO2 is considered to encourage exogenous electron exchange and, in this way, improves the reduction of carbon dioxide (CO2). MnO2, as a cathodic catalyst, enhances the rate of biofuel production, electron transfer, and significantly reduces the cost of MECs. A maximum stabilized current density of 3.70 ± 0.5 mA/m2 was obtained in case of MnO2-coated Mn/CF based MEC, which was more than double the non-coated carbon felt (CF) cathode (1.70 ± 0.5 mA/m2). The dual chamber Mn/CF-MEC achieved the highest production rate of acetic acid (37.9 mmol/L) that was significantly higher (43.0%) in comparison to the non-coated CF-MEC. The cyclic voltammograms further verified the substantial enhancement in the electron transfer between the MnO2 coated cathode and microbes. The obtained results demonstrate that MnO2 interacted electrochemically with microbial cells and enhanced the extracellular electron transfer, therefore validating its potential role in biofuel production. The MnO2 coated CF further offered higher electrode surface area and better electron transfer efficiency, suggesting its applicability in the large-scale MECs.
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Affiliation(s)
- A H Anwer
- Environmental Research Laboratory, Department of Chemistry, Faculty of Sciences, Aligarh Muslim University, Aligarh, 202002, India
| | - M D Khan
- Environmental Research Laboratory, Department of Chemistry, Faculty of Sciences, Aligarh Muslim University, Aligarh, 202002, India; School of Engineering and Advanced Materials, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - N Khan
- Environmental Research Laboratory, Department of Chemistry, Faculty of Sciences, Aligarh Muslim University, Aligarh, 202002, India
| | - A S Nizami
- Centre of Excellence in Environmental Studies (CEES), King Abdulaziz University, Jeddah, Saudi Arabia.
| | - M Rehan
- Centre of Excellence in Environmental Studies (CEES), King Abdulaziz University, Jeddah, Saudi Arabia
| | - M Z Khan
- Environmental Research Laboratory, Department of Chemistry, Faculty of Sciences, Aligarh Muslim University, Aligarh, 202002, India.
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Abstract
PURPOSE Pakistan, like many other developing countries, is caught in the vicious cycle of poverty, illiteracy, violence, and disease. Right from its inception, it has been facing serious challenges of fast growing population, longevity, unemployment, wars, floods, double burden of diseases including blindness, as well as earthquakes, insurgencies, and political instability. Despite such challenges, the country has managed to reduce the burden of blindness from 1.78% in 1987-88 to 0.9% in 2003.This paper will highlight the methods used to achieve such a difficult goal. METHODS The country used the report of the World Health Organization (WHO) temporary consultant as the initial tool for advocacy to obtain political and professional commitment. Results from the first National Blindness Survey 1987-1990 were used as baseline for development of the programme. Under the Ministry of Health, national and provincial committees with respective coordinators were constituted. To ensure access and equity, the national programme was developed on the basis of district comprehensive eye care services. The concept was carefully tested in a laboratory and then piloted in a real district before it was rolled over to the country. Strong national institutes for human resource development, research and development, and service delivery were established. A strong network of high-quality national institutes was set up and run by powerful national non-governmental organizations. The second National Blindness Survey evaluated the achievements of the programme in 2001-2003. CONCLUSION National prevalence of blindness was reduced by 100% by improving the uptake of services at the district level, especially by females.
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Affiliation(s)
- M D Khan
- CHEF International, Khyber Pakhtunkhwa, Pakistan.
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10
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Abstract
BACKGROUND Many cases of post-operative and posttraumatic endophthalmitis are being managed at the Khyber Institute of Ophthalmic Medical Sciences, Peshawar in Pakistan but no study has been done to ascertain the magnitude of the disease and to also evaluate the visual outcome after management. METHODS The case notes of 39 patients diagnosed with posttraumatic and postoperative endophthalmitis between May 2006 and April 2007 were analyzed and clinical characteristics obtained were documented and tabulated. RESULTS During the study period, 2474 patients were admitted in both the male and female wards. Of these, 39 (1.6%) had endophthalmitis due to surgical and traumatic complications. In all, 6 (12.4%) patients had evisceration, while 21 (53.8%) patients who had topical antibiotics consisting of ofloxacin, 0.1% corticosteroids, fortified cetazoline and 1% atropine along with intravitreal antibiotics, a combination of 0.1 mg vancomycin and 0.4 mg amikacin, were discharged home with a visual acuity of counting fingers to light perception. CONCLUSION Endophthalmitis is a serious ocular complication of open globe injury and intraocular surgery. The frequency in this center has been noted to be very high as compared to other places. Its management is very challenging and often leads to devastating structural and functional damage to the eye; causing severe frustration to both the patient and the attending physician. Efforts must be made to prevent the condition.
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Affiliation(s)
- P D Wade
- Department of Ophthalmology, Jos University Teaching Hospital, Jos, Nigeria.
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Zaman M, Hussain M, Babar TF, Wade PD, Shah AA, Khan MD. A review of 50 cases of aphakic detachment in Peshawar, North West Frontier Province of Pakistan. Niger J Med 2010; 18:263-7. [PMID: 20120642 DOI: 10.4314/njm.v18i3.51174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This prospective study was conducted at Khyber Teaching Hospital Peshawar, North West Frontier Province (NWFP) of Pakistan over the period of 16 months. It was to assess the demographic pattern, mode of presentation, treatment modalities and postoperative result of aphakic retinal detachment. This study also compared the incidence of aphakic retinal detachment in intracapsular versus extracapsular cataract extraction as well as the duration between cataract surgery and retinal detachment. PATIENTS AND METHOD A total of 50 patients were recruited in this prospective study. A Proforma was specially designed for this purpose. Detailed history with reference to age, sex, presenting complaints, spectacle wear, previous ocular surgery, duration of surgery/laser treatment, systemic and family history was taken. All patients had detailed ophthalmic examination, underwent conventional retinal reattachment surgery, and were followed up for 6 months. RESULTS Of the total number studied, 86% of the patients were males; only 14% were females, with a mean age of 58 years. The overall anatomical success was achieved in 40 (80%) eyes. The visual acuity of 6/12 and better was achieved in 8 (16%) eyes. 20 (40%) eyes attained a vision of 6/18 to 6/36. 12 (24%) eyes had a vision between 6/60 to CF 3m. The vision could not be improved beyond CF 3m in 10 (20%) eyes. CONCLUSION Vitreous loss during cataract surgery is the most common cause of aphakic retinal detachment. The risk is maximal in the first and second year. The overall anatomical attachment achieved through conventional retinal detachment surgery is 80%.
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Affiliation(s)
- M Zaman
- Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, Pakistan
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Gilbert CE, Shah SP, Jadoon MZ, Bourne R, Dineen B, Khan MA, Johnson GJ, Khan MD. Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey. BMJ 2008; 336:29-32. [PMID: 18087076 PMCID: PMC2174750 DOI: 10.1136/bmj.39395.500046.ae] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the association between blindness and deprivation in a nationally representative sample of adults in Pakistan. DESIGN Cross sectional population based survey. SETTING 221 rural and urban clusters selected randomly throughout Pakistan. PARTICIPANTS Nationally representative sample of 16 507 adults aged 30 or above (95.3% response rate). MAIN OUTCOME MEASURES Associations between visual impairment and poverty assessed by a cluster level deprivation index and a household level poverty indicator; prevalence and causes of blindness; measures of the rate of uptake and quality of eye care services. RESULTS 561 blind participants (<3/60 in the better eye) were identified during the survey. Clusters in urban Sindh province were the most affluent, whereas rural areas in Balochistan were the poorest. The prevalence of blindness in adults living in affluent clusters was 2.2%, compared with 3.7% in medium clusters and 3.9% in poor clusters (P<0.001 for affluent v poor). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in poor clusters than in affluent clusters (0.24% v 0.07%, P<0.001). The prevalences of blindness caused by cataract, glaucoma, and corneal opacity were lower in affluent clusters and households. Reflecting access to eye care services, cataract surgical coverage was higher in affluent clusters (80.6%) than in medium (76.8%) and poor areas (75.1%). Intraocular lens implantation rates were significantly lower in participants from poorer households. 10.2% of adults living in affluent clusters presented to the examination station wearing spectacles, compared with 6.7% in medium clusters and 4.4% in poor cluster areas. Spectacle coverage in affluent areas was more than double that in poor clusters (23.5% v 11.1%, P<0.001). CONCLUSION Blindness is associated with poverty in Pakistan; lower access to eye care services was one contributory factor. To reduce blindness, strategies targeting poor people will be needed. These interventions may have an impact on deprivation in Pakistan.
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Affiliation(s)
- Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
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Mudhar HS, Sethuraman C, Khan MD, Jan SU. Intracular, pan-uveal intravascular large B-cell lymphoma associated with choroidal infarction and choroidal tri-lineage extramedullary haemtopoiesis. Histopathology 2007; 51:275-9. [PMID: 17593210 DOI: 10.1111/j.1365-2559.2007.02750.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jadoon Z, Shah SP, Bourne R, Dineen B, Khan MA, Gilbert CE, Foster A, Khan MD. Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey. Br J Ophthalmol 2007; 91:1269-73. [PMID: 17556430 PMCID: PMC2001008 DOI: 10.1136/bjo.2006.106914] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged >or=30 years in Pakistan. METHODS Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers. RESULTS 16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery. CONCLUSION Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3,560000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified.
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Affiliation(s)
- Z Jadoon
- Pakistan Institute of Community Ophthalmlogy, Kyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan
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Dineen B, Bourne RRA, Jadoon Z, Shah SP, Khan MA, Foster A, Gilbert CE, Khan MD. Causes of blindness and visual impairment in Pakistan. The Pakistan national blindness and visual impairment survey. Br J Ophthalmol 2007; 91:1005-10. [PMID: 17229806 PMCID: PMC1954803 DOI: 10.1136/bjo.2006.108035] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the causes of blindness and visual impairment in adults (> or =30 years old) in Pakistan, and to explore socio-demographic variations in cause. METHODS A multi-stage, stratified, cluster random sampling survey was used to select a nationally representative sample of adults. Each subject was interviewed, had their visual acuity measured and underwent autorefraction and fundus/optic disc examination. Those with a visual acuity of <6/12 in either eye underwent a more detailed ophthalmic examination. Causes of visual impairment were classified according to the accepted World Health Organization (WHO) methodology. An exploration of demographic variables was conducted using regression modeling. RESULTS A sample of 16 507 adults (95.5% of those enumerated) was examined. Cataract was the most common cause of blindness (51.5%; defined as <3/60 in the better eye on presentation) followed by corneal opacity (11.8%), uncorrected aphakia (8.6%) and glaucoma (7.1%). Posterior capsular opacification accounted for 3.6% of blindness. Among the moderately visually impaired (<6/18 to > or =6/60), refractive error was the most common cause (43%), followed by cataract (42%). Refractive error as a cause of severe visual impairment/blindness was significantly higher in rural dwellers than in urban dwellers (odds ratio (OR) 3.5, 95% CI 1.1 to 11.7). Significant provincial differences were also identified. Overall we estimate that 85.5% of causes were avoidable and that 904 000 adults in Pakistan have cataract (<6/60) requiring surgical intervention. CONCLUSIONS This comprehensive survey provides reliable estimates of the causes of blindness and visual impairment in Pakistan. Despite expanded surgical services, cataract still accounts for over half of the cases of blindness in Pakistan. One in eight blind adults has visual loss from sequelae of cataract surgery. Services for refractive errors need to be further expanded and integrated into eye care services, particularly those serving rural populations.
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Affiliation(s)
- B Dineen
- Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
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Anjum KM, Qureshi MB, Khan MA, Jan N, Ali A, Ahmad K, Khan MD. Cataract blindness and visual outcome of cataract surgery in a tribal area in Pakistan. Br J Ophthalmol 2006; 90:135-8. [PMID: 16424519 PMCID: PMC1860172 DOI: 10.1136/bjo.2005.078527] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To estimate the rates of cataract blindness and cataract surgical coverage and to assess the visual outcome of cataract surgery among individuals aged > or =50 years in Orakzai Agency, Pakistan. METHODS 1600 individuals aged > or =50 years were selected using probability proportional to size sampling. The main outcome measure was bilateral cataract blindness which was defined as visual acuity of <3/60 in the better eye with best available correction and with obvious central lens opacities/absence of red reflex in both eyes. RESULTS A total of 1549 people were examined; the coverage rate was 96.8%. Of individuals who were examined, 958 (61.8%) were men. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold greater prevalence of bilateral cataract blindness than men (7.1% (5.0% to 9.2%) v 3.4% (2.3% to 4.6%); p = <0.0001). However, cataract surgical coverage rates were lower for women than men. The overall quality of previous cataract surgery was poor: 43.1% eyes with cataract surgery had VA <6/60. 73.3% people with bilateral cataract blindness reported they could not undergo cataract surgery because they were too poor to afford its cost. CONCLUSION The unacceptably high rates of cataract blindness and poor affordability and visual outcome of cataract surgery calls for the establishment, in the agency, of static cataract surgical services that are high quality, affordable, and gender sensitive.
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Affiliation(s)
- K M Anjum
- Pakistan Institute of Community Ophthalmology, Hayatabad Medical Complex, Hayatabad, Peshawar, Pakistan
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Abstract
BACKGROUND/AIMS Landmines have long been used in conventional warfare. These are antipersonnel mines which continue to injure people long after a ceasefire without differentiating between friend or foe, soldier or civilian, women or children. This study focuses on Afghan non-combatants engaged in mine clearing operations in Afghanistan in the aftermath of the Russo-Afghan war. The patterns and types of injuries seen are described and experiences in their management, ways, and means to prevent them, and recommendations for the rehabilitation of the affected individuals are given. METHODS It is a retrospective and analytical study of 84 patients aged 19-56 years who sustained mine blast injuries during mine clearing operations in Afghanistan from November 1992 to January 1996. The study was carried out at a military hospital with tertiary care facilities. The patients were divided into three groups on the basis of their injuries. Group 1 required only general surgical attention, group 2 sustained only ocular injuries, while group 3 had combined ocular and general injuries. Patients in groups 2 and 3 were treated in two phases. The first phase aimed at immediate restoration of the anatomy, while restoration of function wherever possible was done in subsequent surgical procedures in the second phase. RESULTS It was observed that 51 out of 84 patients (60.7%) had sustained ocular trauma of a variable degree as a result of the blasts. The mean age of the victims was 29 years and they were all male. A total of 91 eyes of 51 patients (89.2%) had been damaged. Bilaterality of damage was seen in 40 (78.4%) patients. Most, 34 (37.3%), eyes became totally blind (NPL). Only a few escaped with injury mild enough not to impair vision. Foreign bodies, small and multiple, were found in the majority of eyes; most, however, were found in the anterior segment, and posterior segment injuries were proportionally less. CONCLUSIONS The prevalence of blindness caused by mine blast injuries is quite high. The resulting psychosocial trauma to the patients and their families is tremendous and has not been adequately highlighted. These injuries are a great drain on the country's resources. Enforcement of preventive measures and the use of protective gear and sophisticated equipment by the mine clearing personnel would prove to be far more economical in terms of human life as well as medical and economic resources. There is also need for greater attention towards the establishment of support groups and rehabilitation programmes for these individuals.
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Affiliation(s)
- W Muzaffar
- Eye Department, Combined Military Hospital, Peshawar, Pakistan.
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Khan MA, Soni M, Khan MD. Development of primary eye care as an integrated part of comprehensive health care. Community Eye Health 1998; 11:24-6. [PMID: 17492028 PMCID: PMC1706055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- M A Khan
- Pakistan Institute of Community Ophthalmology, Hayatabad Medical Complex, Peshawar, North West Frontier Province, Pakistan
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Malik GM, Mubarik M, Khan MD, Lone BA, Kadla SA, Bhat FA. Laurence-Moon-Biedl-Bardet syndrome with chorea. J Assoc Physicians India 1995; 43:295-6. [PMID: 8713275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- G M Malik
- Department of Medicine, Government Medical College Associated, Srinagar, Kashmir
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Abstract
Five hundred and thirty cases of spring catarrh were studied at the Department of Ophthalmology, Khyber Hospital Peshawar, Pakistan. Corneal complications occurred in 259 patients, of which 48 cases were of keratoconus, consisting of 41 male and seven female patients. Most of the patients affected (37) were between the ages of 10 and 30 years. Six patients developed acute hydrops, which in one case affected both eyes, though after an interval of a few months. Keratoconus was progressive in many patients, resulting in gross visual loss, often not correctable with glasses or contact lenses and thus requiring keratoplasty. The importance of association of keratoconus with atopic disorders is discussed and its association with spring catarrh is stressed.
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Affiliation(s)
- M D Khan
- Lady Reading Hospital, Peshawar, Pakistan
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Khan MD, Kundi N, Mohammed Z, Nazeer AF. A 6 1/2-years survey of intraocular and intraorbital foreign bodies in the North-west Frontier Province, Pakistan. Br J Ophthalmol 1987; 71:716-9. [PMID: 3663566 PMCID: PMC1041281 DOI: 10.1136/bjo.71.9.716] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A survey of 198 patients (210 eyes) with intraocular or intraorbital foreign bodies is presented. Most were males between 16 and 30 years of age, and 6.1% of cases were bilateral. The commonest cause was a flying particle while using a hand hammer, followed by fragments of bomb and mine blasts. Intraorbital foreign bodies occurred in 78 eyes and intraocular foreign bodies in 132 eyes. Irreparable damage caused 13 eyes (6.2%) to be enucleated. Ten eyes developed severe endophthalmitis or panophthalmitis requiring evisceration. One hundred and thirty-four (63.8%) foreign bodies were removed, and 76 (36.2%) foreign bodies could not be removed. The causes of non-removal, the various complications, and the pattern of foreign bodies in the eye or orbit in Pakistan are discussed and compared with those of other regions.
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Affiliation(s)
- M D Khan
- Khyber Hospital, Peshawar, Pakistan
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