The Aga Khan University 8th Health Sciences Research Assembly 2013 i The Aga Khan University 8th Health Sciences Research Assembly 2013 8th Health Sciences Research Assembly December 11 & 12, 2013 INAUGURAL SESSION Wednesday, December 11, 2013 | 8:30 – 9:30 • Tilawat • Introduction Dr Hammad Ather, Chair Organising, Committee, 8th HSRA • Remarks by Dr Keith Cash, Dean, School of Nursing & Midwifery • Remarks by Dr Farhat Abbas, Dean, Medical College • Remarks by Dr El-Nasir Lalani, Dean of Research & Graduate Studies • Vote of thanks Shela Hirani, Co-Chair, 8th HSRA • Inauguration of Scientific Exhibition (Posters) i The Aga Khan University 8th Health Sciences Research Assembly 2013 Message from Chair/Co-Chair, Organising Committee Health Sciences Research Assembly is an essential milestone of Aga Khan University. It is an avenue where faculty, fellows, residents, nurses, students, and alumni of Aga Khan University unite at one platform. The gathering helps to disseminate research and share research ideas with the interdisciplinary and multidisciplinary group of health care professionals. HSRA not only plays a pivotal to promote research culture within the university but also encourage the novice researchers to flourish their research career, come up with innovative researches, and recognize the power of collaborative researches. We are hopeful that in coming year we all will recognize the impact of such events beyond the boundaries of AKU. Considering the impact of past years’ HSRAs, one can say it with conviction that this platform will strengthen the research capacities of many novice researchers to an extent that in coming years they can better serve this society and bring positive changes in the health indicators worldwide. We congratulate each one of you for your attendance and active participation in this year’s research assembly. Best wishes, Dr Hammad Ather Shela Hirani Chair, Organising Committee Co-Chair, Organising Committee 8th HSRA 8th HSRA ii The Aga Khan University 8th Health Sciences Research Assembly 2013 Message from Dean, School of Nursing and Midwifery These days knowledge is not confined to the narrow boundaries of individual disciplines. On the contrary, for a university to be active in the creation of new knowledge and the application of existing knowledge, we need cross-fertilization between disciplines. A good example is the collaboration of a physicist and a biologist, using the findings of a crystallographer and competing with a chemist, that lead to the modeling of DNA by Crick and Watson. This way of working is not easy and needs structures that can support it, as well as the will to work in this way. One way of encouraging and supporting it comes from meetings like the 8th Health Sciences Research Assembly, which lets faculty and students share their work and ideas in a collegial environment where connections can be made and new ideas emerge. Collaboration needs the opportunity to meet and talk. The organizers of this celebration of the exciting research culture in AKU are to be congratulated on their work and their initiative in creating this event. Dr Keith Cash Dean and Professor School of Nursing and Midwifery Aga Khan University ii The Aga Khan University 8th Health Sciences Research Assembly 2013 Message from Dean, Medical College As scholarship and discovery continue to take on increasing importance for all leading academic institutions the world over, the Aga Khan University-in its pursuit of making AKU a truly research-led institution of the 21st century-continues to foster and underpin its research culture while forging new multi- and interdisciplinary collaborations. AKU’s first Health Sciences Research Assembly was held in 2005 and was amongst the first steps towards making research the cornerstone of AKU’s existence. Over the last eight years the Health Sciences Research Assembly has become an integral component of AKU’s academic and scholarly activities with abstract submission and participation surpassing expectations year after year. To continue this exchange and dissemination of learning, ideas and work, both completed and in progress, to provide greater opportunities for collegial efforts across disciplines and specialties, we announce the 8th Health Sciences Research Assembly, as a two-day event on December 11 and 12, 2013. I encourage all faculty, fellows, residents and students to actively participate in the event, in an effort to make meaningful contributions to the contemporary knowledge-based society and for making a sustainable impact on the intellectual landscape. I take this opportunity to convey my appreciation to Dr. Hammad Ather and the Organizing Committee of the 8th Health Sciences Research Assembly. I wish you all the best and hope the event meets unprecedented success. Dr Farhat Abbas Dean, Medical College Aga Khan University iii The Aga Khan University 8th Health Sciences Research Assembly 2013 Message from Dean of Research and Graduate Studies The Aga Khan University is committed to innovative trans/multi-disciplinary undergraduate and postgraduate education, and research. The University aims to achieve this by offering students a rich educational experience, an experience connecting individual curiosity, intellectual rigor and trans-disciplinary breath. Research is an integral and essential part of this experience. The thematic research focus of the Faculty of Health Sciences is “Social and Economic Determinants of Health” with six sub-themes: a. Maternal, Newborn & Child Health; b. Non-Communicable Diseases; c. Infection, Immunity and Inflammation; d. Human Development; e. Neurosciences and f. Stem Cell Research. These sub-themes are underpinned by the drive and intellectual inquisitiveness of individuals who traverse departments, faculties and other AKU campuses. Their collective aim is to bring forth new knowledge and solutions addressing local challenges and to inform regarding policy and practices. AKU’s close collaborations with extraordinary external collaborators and university partners offer an added wealth of research options. The University’s efforts are supported through donations, gifts, extra and intramural competitive grants and international aid agencies. The concept of an annual research assembly was an important bold step that has become part of the University’s calendar. The 8th Health Sciences Research Assembly provides a unique forum for faculty, staff, and students at AKU to showcase their work, discuss ideas, and become informed of the diverse activities and opportunities. AKU’s research is not only about new knowledge or the application of it; but also about developing a steady stream of highly skilled individuals. It is a very tall order to organise an event on such a mammoth scale. The organisers have worked tirelessly over many months to put together this year’s assembly. I take this opportunity to recognise and thank them for their effort, creativity and passion. Congratulations. Dr El-Nasir Lalani Dean, Research & Graduate Studies and Professor, Molecular and Cellular Pathology iv The Aga Khan University 8th Health Sciences Research Assembly 2013 TABLE OF CONTENTS ID Theme Page 1.0 Bone and Joint Diseases/Orthopaedics 1 2.0 Cardiovascular Diseases 7 3.0 Clinical Trials 38 4.0 Dentistry/Orthodontics/Dental Surgery 42 5.0 Endocrinology/Diabetes 52 6.0 GI/Liver 64 7.0 Health Sciences Education 91 8.0 Hematologic and Oncologic Diseases 106 9.0 Infectious Diseases 156 10.0 Neurosciences/Mental Health 196 11.0 Miscellaneous Abstracts 215 12.0 Public Health 241 13.0 Renal/Urology 301 14.0 Techniques/Innovations 307 15.0 Women and Child Health 328 v The Aga Khan University 8th Health Sciences Research Assembly 2013 ABSTRACTS vi The Aga Khan University Bone & Joint Diseases 8th Health Sciences Research Assembly 2013 / Orthopaedics Bone and Joint Diseases / Orthopaedics 1 The Aga Khan University Bone & Joint Diseases 8th Health Sciences Research Assembly 2013 / Orthopaedics 1.1 1.2 JUDET’S QUADRICEPSPLASTY FOR KNEE A CASE OF LOWER LIMB REPLANTATION CONTRACTURES WITH A 12 YEARS FOLLOW UP Akbar Jaleel Zubairi, Haroon ur Rashid Akbar Jaleel Zubairi, Pervaiz Hashmi Department of Surgery, Aga Khan University, Department of Surgery, Aga Khan University, Karachi Karachi Background: Knee stiffness is seen after peri- Introduction: Replantation of the lower articular knee fractures or Ilizarov application. extremity has limited indications because Judet’s Quadricepsplasty has been used for over crushing and avulsion of the involved parts half a century to manage this debilitating make the procedure difficult to perform and the condition even so Literature from our region is results of modern prostheses are better than a limited. poorly functional replanted limb. Nevertheless Methods: We retrospectively reviewed the replantation may be considered in carefully results of 22 cases of knee contractures managed selected patients like children with distal with Judet’s quadricepsplasty during the last 5 amputations who make better functional years having a mean follow up of 15.4 months. recoveries and in whom stump revision and Degrees of flexion of the operated knees pre- frequent change of prosthesis is cumbersome. operatively and at last follow up were recorded Here we present a successful replantation in a 3 along with quadriceps strength, presence of year old boy who has made excellent recovery extension lag and complications. Outcomes were with no functional deficit evident at 12 years classified according to Judet’s criteria. follow up. Results: Ilizarov application was the cause of Case Description: A 3 year old boy, sustained a contracture in 13 patients (59.1%) followed by traumatic amputation of his left lower limb at internal fixation for peri-articular fractures in 5 the level of distal tibia when he fell of a ‘Qing patients (22.7%). The degree of flexion Qi’ (Motorcycle Rickshaw). Replantation was increased from 29 degrees (0-90 degrees) attempted at 8 hours cold ischemia time with the preoperatively to 85.7 degrees (20-150 degrees) tibia shortened 4 cm and all tendons, vessels and on last follow up showing a flexion gain of 56.6 nerves repaired. Patient required a second degrees. Quadriceps strength at follow up was procedure during the same hospital stay for skin 4.5 with extension lag present in only 2 patients coverage. Patient made good recovery with (9.1%). Superficial wound infection was seen in ambulation without support at 6 months, less 3 patients (13.6%) and 1 patient suffered from than 2 cm limb length discrepancy, plantar and reflex sympathetic dystrophy. The outcome dorsiflexion power 4/5 and recovery of sensation according to Judet’s criteria on last follow up over the foot. Now at 12 years of follow up was excellent in 7 patients (31.8%), good in 10 patient has a normal gait with 5/5 power of (45.5%), fair in 2 (9.1 %) and poor in 3 patients plantar and dorsiflexion and has integrated in to (13.6%). Female gender was significantly society with no functional deficit. Considering associated with a poor outcome (p value 0.039). the functional outcome of our case, replantation Conclusion: Judet’s quadricepsplasty is a useful should be attempted where possible and feasible procedure to increase the range of motion of especially in children. rigid knees. Our results are comparable to what have been reported in international literature. Keywords: Replantation, amputation, functional outcome Keywords: Judet's Quadricepsplasty, knee contracture, functional outcome 1