Saad Siddiqui

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

BackgroundThere is a strong association between stillbirth and fetal growth restriction. Early detection and management of IUGR can lead to reduce related morbidity and mortality. In this paper we have reviewed effectiveness of fetal movement monitoring and Doppler velocimetry for the detection and surveillance of high risk pregnancies and the effect of this on prevention of stillbirths. We have also reviewed effect of maternal body mass index (BMI) screening, symphysial-fundal height measurement and targeted ultrasound in detection and triage of IUGR in the community.MethodsWe systematically reviewed all published literature to identify studies related to our interventions. We searched PubMed, Cochrane Library, and all World Health Organization Regional Databases and included publications in any language. Quality of available evidence was assessed using GRADE criteria. Recommendations were made for the Lives Saved Tool (LiST) based on rules developed by the Child Health Epidemiology Group. Given the paucity of evidence related to the effect of detection and management of IUGR on stillbirths, we undertook Delphi based evaluation from experts in the field.ResultsThere was insufficient evidence to recommend against or in favor of routine use of fetal movement monitoring for fetal well being. (1) Detection and triage of IUGR with the help of (1a) maternal BMI screening, (1b) symphysial-fundal height measurement and (1c) targeted ultrasound can be an effective method of reducing IUGR related perinatal morbidity and mortality. Pooled results from sixteen studies shows that Doppler velocimetry of umbilical and fetal arteries in ‘high risk’ pregnancies, coupled with the appropriate intervention, can reduce perinatal mortality by 29 % [RR 0.71, 95 % CI 0.52-0.98]. Pooled results for impact on stillbirth showed a reduction of 35 % [RR 0.65, 95 % CI 0.41-1.04]; however, the results did not reach the conventional limits of statistical significance. This intervention could be potentially recommended for high income settings or middle income countries with improving rates and standards of facility based care. Based on the Delphi, a combination of screening with maternal BMI, Symphysis fundal height and targeted ultrasound followed by the appropriate management could potentially reduce antepartum and intrapartum stillbirth by 20% respectively. This estimate is presently being recommended for inclusion in the LiST.ConclusionThere is insufficient evidence to recommend in favor or against fetal movement counting for routine use for testing fetal well being. Doppler velocimetry of umbilical and fetal arteries and appropriate intervention is associated with 29 % (95 % CI 2% to 48 %) reduction in perinatal mortality. Expert opinion suggests that detection and management of IUGR with the help of maternal BMI, symphysial-fundal height measurement and targeted ultrasound could be effective in reducing IUGR related stillbirths by 20%.

Computed Tomography Signs in Acute Cholecystitis

Background: Acute cholecystitis remains to be a frequent presentation in emergency rooms worldwide. Role of ultrasound in evaluation of acute cholecystitis is well established however, Computed Tomography (CT) is still under evaluated as a diagnostic modality for detection of acute cholecystitis. In this work we describe frequencies of various CT signs in pathologically proven cases of cholecystitis. Methods: Retrospective review of CT images of 120 patients with cholecystitis for identifying signs of cholecystitis and their relative frequencies. Results: Pericholecystic inflammatory changes with or without fluid collection was the most common CT sign followed in order by; gall bladder distention, wall thickening, mucosal enhancement, visualization of calculi, tensile fundus sign and reactive hepatic hyperemia. Conclusion: An understanding of CT signs in diagnosis of cholecystitis will help improve the diagnostic confidence as well as ensure prompt diagnosis of cholecystitis. To cite this article [Siddiqui, S., Sayani, R., Khan, D. B., Saeed, M. A., & Afzal, A. (2017). Computed Tomography Signs in Acute Cholecystitis. The Journal of Middle East and North Africa Sciences, 3(8), 33-36]. (P-ISSN 24129763) (e-ISSN 24128937). www.jomenas.org. 4

Is Eating Out Really Safe : Assessing Attitudes and Practices of Street Vendors’ in Peshawar, Pakistan

Background: Street food consumption is a common occurrence in public places, particularly in cities where it often fulfills a basic need to the urban inhabitants. Street food vendors prepare food in informal settings and are thus exposed to climate and temperature changes, poor sanitation and unsafe water supply. This aim of this study was to assess knowledge, attitudes and practices of food vendors in preparation of food, its storage and dispensing. Objective: The aim of the current study was to assess knowledge, attitudes and practices of food vendors in preparation of food, its storage and dispensing. Materials and Methods: Cross sectional survey conducted by interviewing 120 street food vendors in two towns of the city of Peshawar. Results: Only fifty percent of participants reported hand washing before and after handling of food. More than half disagreed with the fact that street food can lead to outbreaks. Only 18 % thought that the proper training was needed to improve their practices regarding food handling despite the majority of them accepting that safe food handling as part of their responsibility. A good financial return and self-dependency were viewed as encouraging points for opting this profession. Conclusions: Street vendors form a significant source of food consumption, requiring education and interventions in order to prevent outbreaks. To cite this article [Ayub, R., Siddiqui, S., & Inamullah, M. (2017). Is Eating Out Really Safe: Assessing Attitudes and Practices of Street Vendors’ in Peshawar, Pakistan. The Journal of Middle East and North Africa Sciences, 3(2), 21-24]. (P-ISSN 24129763) (e-ISSN 2412-8937). www.jomenas.org. 3

An overview of smoking practices in Pakistan

Smoking remains a major player in morbidity and mortality worldwide. It is a matter of immense public health importance as single leading cause of preventable deaths. The aim of this study was to assess smoking practices that prevail across Pakistan & Attitude of people towards this issue. We conducted an extensive search on major databases as well as search of bibliography of published literature for studies assessing Attitudes and Practices of tobacco smoking that prevail across Pakistan. Data from available studies was abstracted and utilized in preparation of this manuscript. After screening of 613 articles, we were able to identify 22 studies matching our criteria for inclusion. Majority of studies reported adolescence as time of initiation. Average national prevalence was 21.6%. A significant portion of smokers comprised of females. The prevalence of smoking in healthcare professionals ranged from 32 – 37%. Passive smoking was a major contributor of tobacco exposure. Prevalence of ‘Shisha’ use was 33%. Smoking continues to be a major Public Health issue in Pakistan. The prevalence in healthcare professionals and adolescents is alarming. Adequate measures need to be taken to ensure its control.