Medicine and Health Sciences Commons^™

View Box Case--4 Left Sided Tuberculous Autonephrectomy, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Latent Activity Of Curcumin Against Leishmaniasis In Vitro, Danish Saleheen, Syed Atif Ali, Khalid Ashfaq, Anwar Ali Siddiqui, Ajmal Agha, Muhammad Masoom Yasinzai

Department of Biological & Biomedical Sciences

In this study the anti-proliferative effect of curcumin (curcuma longa) that is the active ingredient of ground dried rhizome has been studied against three local and three reference leishmanial strains, Leishmania major, Leishmania tropica and Leishmania infantum (Pakistani isolate). Curcumin has shown an average IC50 of 5.3mM against promastigotes of various leishmanial strains which is much lower as compared with pentamidine that is one of the basic treatments against leishmaniasis. The main draw back attributed to these assays performed on promastigotes is the heterogeneity of results compared with those obtained with intracellular amastigotes or with in vivo effect. We also …

Predictors Of Mortality In Brain Abscess, H U. Qureshi, A A. Habib, A A. Siddiqui, T Mozaffar, A R. Sarwari

Section of Neurosurgery

Objective: Brain abscess carries significant morbidity and mortality. Our objective was to elucidate the clinical presentation of brain abscess and to assess predictors of mortality in these patients.
Methods: All patients with a brain abscess presenting to the Aga Khan University Hospital, a tertiary care referral center in Karachi, Pakistan, were studied retrospectively. Statistical analysis involved univariate analysis and a logistic regression model.
Results: Among the 66 patients analyzed, a distant metastatic focus of infection was the most commonly identified predisposing factor (29%). Otogenic infection was the commonest contiguous source and sinusitis was noticeably absent. Multiple abscesses were frequent (35%). …

View Box Case--3 Hepatic Hemangioma, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Epidermal Growth Factor Receptor (Egfr) As A Prognostic Marker: An Immunohistochemical Study On 315 Consecutive Breast Carcinoma Patients, S. A. Aziz, Shahid Pervez, N. Kayani, M. H. Rahbar, S. Khan

Department of Pathology and Laboratory Medicine

Objective: To assess the independent and interdependent prognostic value of epidermal growth factor receptor (EGFR) in carcinoma of breast in female population. The Type I family of growth factor receptors includes epidermal growth factor receptor (EGFR also known as EGFRI).

Methods: The expression of EGFR protein was analysed immunohistochemically on 315 tumour specimens of infiltrating ductal carcinoma of breast. These patients also had axillary lymph nodes sampling.

Results: Overexpression and/or amplification of EGFR was observed in 70 (22.00%) tumours. Eleven (16%) were grade I, 43 (61%) grade II and 16 (23%) grade Ill tumours. Axillary lymph node metastasis had significant …

View Box Case--2 Mid-Colic Intussusception, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Prostatic Carcinoma With Emphasis On Gleason’S Grading: An Institution Based Experience., Zaid Ahmed, Suhail Muzaffar

Department of Pathology and Laboratory Medicine

Abstract

Objective:To grade prostatic carcinomas according to the Gleason’s Grading System and see whether the frequency of incidental carcinoma is significant. Method:Retrospective study of all consecutive cases of prostatic adenocarcinoma diagnosed at Aga Khan University Hospital (AKUH) between January 1st, 1996 and December 31st, 1999. Setting:The histopathology section of AKUH, Karachi. Observation:Prostatic adenocarcinomas comprised 14.2% of all prostate specimens. There were 3 types of specimens i.e. transurethral resection, suprapubic prostatectomies and core bIopsies. The mean age was 72.1 years; 68.1% patients were 65 years or older. The majority of the tumours were moderately differentiated (Gleason’s scores 5,6 or 7). Grading …

Determination Of Alpha-I Antitrypsin Genetic Deficiency In Duodenal Ulcer By Polymerase Chain Reaction, A Shahid, H Qureshi, S J. Zuberi, Anwar Ali Siddiqui, T Sultana, M A. Waqar

Department of Biological & Biomedical Sciences

Objective: To confirm alpha-I-AT deficiency status in duodenal ulcer using a combination of PCR and restricted enzyme digestion.

Methods: Fifty patients with endoscopically proven duodenal ulcer and hundred controls with no signs of the disease were included. Alpha-i-AT phenotypes were confirmed by polymerase chain reaction followed by restriction enzyme digestion.

Results:Alpha-I-AT concentration in duodenal ulcer patients showed a mean value of 2.12 ± 0.11g/1 (range: 0.52-3.95 g/1, p

Conclusion: Alpha-1 AT deficiency was found in 10% of duodenal ulcer patients. DNA analysis more accurately resolved the phenotypes as S and Z mutations (JPMA 52:545; 2002).

Communicating About Aids-Changes In Understanding And Coping With Help Of Language In Urban Kagera, Tanzania, Aldin Mutembei, Maria Emmelin, Joe Lugalla, Lars Dahlgren

Institute for Educational Development, East Africa

Faced with the problems of HIV/AIDS, people have to find ways to communicate around them. The aim of this paper is to mirror changes over time in the Kagera people's social cognition regarding HIV/AIDS, using their own language as a tracer of this process. Focus group discussions and personal and group interviews conducted during 1992 to 1995 in urban Bukoba, Kagera, constitute the basis for an analysis of metaphorical expressions in use since 1985. Pronounced uncertainty is later transformed into a deeper understanding of the pandemic and an increased disposition to cope with the situation. Knowledge about the socio-linguistic expressions …

Ischemic Monomelic Neuropathy: A Complication Of Vascular Access Procedure, Malik Anas Rabbani, Aasim Ahmad, Syed Mansoor Ahmed Shah, Tahseen Mozzaffar, Mahesh Moolani, Syed Sohail Ali

Section of Nephrology

Ischemic monomelic neuropathy (IMN) is an infrequently recognized type of ischemic neuropathy produced by shunting blood or acute occlusion of a major proximal artery in the extremities. IMN predominantly occurs in diabetic patients with evidence of peripheral atherosclerotic vascular disease and neuropathy. We report a case of ischemic monomelic neuropathy occurring in a diabetic patient with end-stage renal disease following the placement of polytetrafluoroethylene (PTFE) graft as a vascular access in the proximal upper arm for chronic hemodialysis.

Defining The Cultural Milieu For Implementing Faculty Practice In Pakistan, Michele J. Upvall, Zeenatkhanu Kanji, Salma Jaffer, Khurshid Khowaja, Rubina Barolia, Yasmin Amarsi

School of Nursing & Midwifery, East Africa

Faculty practice can promote a collaborative partnership mutually beneficial to both nursing education and service. However, little is known about its implementation in developing countries. The purpose of this study was to explore the potential for introducing faculty practice within the cultural milieu of Karachi, Pakistan. Focus groups of nursing faculty, staff and students were conducted in various settings: government, semi government and private institutions to elicit the data. Data analysis revealed that a more comprehensive definition of faculty practice is needed that will provide the foundation for a culturally acceptable model of faculty practice in Pakistan. Hierarchy dominates the …

Psychiatric Morbidity And Perceptions On Psychiatric Illness Among Patients Presenting To Family Physicians, In April 2001 At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, Iqbal Azam

Department of Family Medicine

Objective: To assess psychiatric morbidity and the perceptions about psychiatric illness, among patients presenting to family physicians, at a teaching hospital in Karachi, Pakistan.
Methods: A questionnaire based survey was developed to collect demographic data, information on psychiatric morbidity and perceptions on psychiatric illness. It was administered to 400 patients, against a sample size of 347. The study objective was explained, written consent was taken and confidentiality was assured.
Results: There were more women then men in the study, with a mean age of 37 years. The majority was married, better educated and socioeconomically placed then the rest …

Perceptions On Bioethics Among General Practitioners In Karachi, Pakistan, Waris Qidwai, Hafeez Qureshi, Iqbal Azam, Syed Sohail Ali, Semi Ayub

Department of Family Medicine

Objective: To study the perceptions on bioethics among general practitioners in Karachi, Pakistan.
Design: A questionnaire based cross sectional survey. Settings: 85 general practitioners in Karachi were surveyed at their clinic premises. Main outcome measures: Perceptions on the broad principles of bioethics.
Results: The majority of general practitioners were males, with mean age of 36.3 years, had minimal postgraduate qualifications and continuing medical education. They reported the top five moral duties of a physician and their reaction in the event of the death of a close relative due to a doctor's negligence. A significant number of respondents agreed …

Patterns Of Use And Non-Use Of The Services Of Hakim Practitioners Among Patients In Karachi, Waris Qidwai

Department of Family Medicine

Objective: To study the pattern of use and non-use of the services of hakim practitioners, among patients visiting the Family Physicians, at a teaching hospital in Karachi.
Design: Cross-sectional survey
Place and Duration of Study: Family practice centre, The Aga Khan University, Karachi, from March to June, 2001.
Methods: A total of 387 patients were surveyed against an estimated sample size of 347. A questionnaire was developed and administered to collect information on the patterns of the use and non-use of the services of hakim practitioners among the respondents.
Results: The majority of the respondents were young, well-educated …

The Utilization Of Services Of Health Care Providers Among Patients Presenting To Family Physicians At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, Iqbal Azam, S. S. Ali, S. Ayub

Department of Family Medicine

Objective: To study the utilization of services of Health care providers among patients presenting to Family Physicians in a teaching hospital in Karachi.
Methodology: It was a cross sectional study. A questionnaire was developed to collect patient’s utilization of services of health care providers. The investigators administered the questionnaire to 387 patients, after purpose of the study was explained, written consent was taken and confidentiality was assured.
Results: The study population included more females than males, with average age of 32.6 years. The majority were married, well educated, in private and government service, were students or housewives. …

Myths Regarding Treatment Of Hepatitis: The Vicious Cycle Of Increasing Morbidity, Waris Qidwai, Naureen Alim, Iqbal Azam

Department of Family Medicine

Viral hepatitis has high prevalence rates in Pakistan. It is a potentially serious condition with associated high morbidity and mortality. Studies from neighboring regions document significant utilization of the services of faith healers for the treatment of patients with hepatitis. This article is a short communication

Abscesses In The Liver: Amoebic Or Pyogenic?, Bushra Jamil, Saeed Hamid

Department of Medicine

No abstract provided.

Early Surgical Results With Intent To Treat By Radical Retropubic Prostatectomy For Clinically Localized Prostate Cancer, Farhat Abbas, Kamran Siddiqui, Syed R. Biyabani, Jamsheer J. Talati, S. H. Hasan

Section of Urology

Aims: To evaluate the early cancer control rates, morbidity and mortality in men undergoing radical retropubic prostatectomy (RRP) for clinicallylocalized adenocarcinoma prostate.
Methods: Patient's characteristics, operative data, progressive-free survival rates, morbidity and mortality were analyzed for 23 men with clinical T1-2 prostate cancer who underwent surgery with an intent to treat by RRP between December 1997 to July 2001.
Results: Patient's mean age was 63 +/- 6.2 years (range 51 to 76 years) with American Society of Anesthesiology (ASA) status I in 4%, II in 65% and III in 31%. Two third of the patients had lower urinary tract obstructive …

Acridine Orange For Malaria Diagnosis: Its Diagnostic Performance, Its Promotion And Implementation In Tanzania, And The Implications For Malaria Control, J. Keiser, J. Utzinger, Zul Premji, Y. Yamagata, B.H. Singer

Pathology, East Africa

One hundred years ago, Giemsa's stain was employed for the first time for malaria diagnosis. Giemsa staining continues to be the method of choice in most malarious countries, although, in the recent past, several alternatives have been developed that exhibit some advantages. Considerable progress has been made with fluorescent dyes, particularly with Acridine Orange (AO). The literature on the discovery, development and validation of the AO method for malaria diagnosis is reviewed here. Compared with conventional Giemsa staining, AO shows a good diagnostic performance, with sensitivities of 81.3%-100% and specificities of 86.4%-100%. However, sensitivities decrease with lower parasite densities, and …

Effect Of Zinc On The Treatment Of Plasmodium Falciparum Malaria In Children: A Randomized Controlled Trial, F. Sempertegui, B. Estrella, F.R. Toapanta, D.S. Torres, D.E. Calahorrano, K. Yeboah-Antwi, E. Addo-Yobo, P. Arthur, S. Newton, Zul Premji, M. Hubert, C.S. Makwaya, F. Ssengooba, J. Konde-Lule, E. Mukisa, D.H. Hamer, W. Macleod, C. Duggan, W. Fawzi, J. Simon, V. Mwanakasale, M. Mulenga, T. Sukwa, J. Tshiula

Pathology, East Africa

Background: Zinc supplementation in young children has been associated with reductions in the incidence and severity of diarrheal diseases, acute respiratory infections, and malaria.

Objective: The objective was to evaluate the potential role of zinc as an adjunct in the treatment of acute, uncomplicated falciparum malaria; a multicenter, double-blind, randomized placebo-controlled clinical trial was undertaken.

Design: Children (n = 1087) aged 6 mo to 5 y were enrolled at sites in Ecuador, Ghana, Tanzania, Uganda, and Zambia. Children with fever and ≥ 2000 asexual forms of Plasmodium falciparum/μL in a thick blood smear received chloroquine and were randomly assigned to …

A Point Mutation In Codon 76 Of Pfcrt Of P. Falciparum Is Positively Selected For By Chloroquine Treatment In Tanzania, A.G. Schneider, Zul Premji, I. Felger, T. Smith, S. Abdulla, H.-P. Beck, H. Mshinda

Pathology, East Africa

This study was undertaken to validate the relevance of Chloroquine (CQ) resistance markers pfert76 and pfmdrl86 in an endemic area in Tanzania. After treatment with CQ, recrudescence was distinguished from new infection by msp2 genotyping, and the number of concurrent infection was also determined. The rate of children with recrudescent parasites at day 7 and/or day 14 amounted to a parasitological failure rate of 22.4% using PCR. The mean multiplicity of infection at day 0 was 3.2 (n = 71). The allelic frequencies of the mutated pfert76 and pfmdrl86 were estimated to be 92 and 77%, respectively. Both values exceeded …

Health-Seeking Behavior Of Karachi Women With Reproductive Tract Infections, Lubna Ishaq Bhatti, Fariyal F. Fikree

Community Health Sciences

To explore the contextual factors influencing health-seeking behavior of women in Karachi regarding reproductive tract infections, 18 women with reproductive tract infections from different clinics and community settings were identified and in-depth interviews were conducted. Physicians in our study diagnosed a woman to have lower reproductive tract infection if she complained of malodorous vaginal discharge with or without perineal itching; and to have pelvic inflammatory disease or upper reproductive tract infection if she had any two of the following complaints: malodorous vaginal discharge, menstrual irregularities, lower abdominal pain or dyspareunia. Women consulted a variety of healthcare providers in their pursuit …

A Hospital Based Preliminary Report On Sleep Disordered Breathing In Pakistani Population, R Haqqee, S F. Hussain, M Mujib, H R. Ahmad

Section of Pulmonary & Critical Care

Background: Sleep Disordered Breathing is an important medical condition leading to significant morbidity and mortality. Western studies have shown its prevalence in middle age to be 9% in women and 24% in men. The aim of this study was to have a preliminary assessment on the frequency of Sleep Disordered Breathing in Pakistani subjects.

METHOD: Patients attending a medical clinic were surveyed. A sleep questionnaire elicited information about snoring, witnessed apnea, nocturnal choking and excessive daytime sleepiness. Data were recorded for age, height, collar size and weight. Epworth Sleepiness Scale was used to assess excessive daytime sleepiness. Statistical analysis …

Acute Lung Injury/Acute Respiratory Distress Syndrome, Fazal Hameed Khan

Department of Anaesthesia

Reports of pulmonary physiopathological insults following severe trauma resulting in respiratory failure are not new in medical literature^1,2. In 1967 Ashbaugh and colleagues described a syndrome of acute respiratory distress following a variety of precipitating conditions³. Severe hypoxemia, diffuse pulmonary infiltrates, poor lung compliance and absence of left heart failure characterize this condition. Ashbaugh et al⁴ subsequently named it as adult respiratory distress syndrome to differentiate it from infant respiratory distress syndrome. It was proposed at that time that both conditions manifest similar physiopathological changes. It was also referred to as “traumatic wet lung”, “congestive …

Long-Term Outcomes Of Acute Myeloid Leukemia In Adults In Pakistan, G. N. Kakepoto, S. N. Adil, Mohammad Khurshid, I. A. Bumey, S. Zaki

Department of Pathology and Laboratory Medicine

Objective: To describe the long-term outcomes of Acute Myeloid Leukemia (AML) and to study clinico­pathological features at presentation, morphological subtypesand remission rates.
Methods: Demographic information, response to therapy and survival of patients (>14 years of age) admitted between January 1988 to August 1996 with acute myeloid leukaemia was retrieved and analysed.
Results: Seventy-four patients were admitted with a diagnosis of AML during the study period. There were 43 males and 31 females. Age ranged between 15 and 70 years with a mean age of 38 years. The most common presenting feature was fever (67.5%) and the …

Acute Myeloid Leukemia In Children In Pakistan: An Audit, S. Zaki, I. A. Burney, Mohammad Khurshid

Section of Haematology/Oncology

Objective: To see the clinical features and treatment of children with Acute Myeloid Leukemia (AML) in Pakistan. Setting: Tertiary referral at a specialist Hematology/Oncology center.
Methods: Retrospective, chart-based review of children (less than 14 years) admitted to the hospital with a diagnosis of AML between January 1987 and August 1997.
Results: A total of 23 patients were admitted. There were 18 males and 5 females. The mean age was 8 5 years. M3 was the commonest morphological subtype (43%). Twenty- two percent of the patients presented with hyperleucocytosis (TLC> 100 x i09 /L) and 95% with an elevated …

Knowledge About Sexually Transmitted Infections Among Young Pakistani Men, Waris Qidwai

Department of Family Medicine

Prevalence of Human Immuno-deficiency Virus (HIV) infection is still believed to be low in Pakistan. However, because of its location in South Asia and the presence of high risk group for the disease, it is likely that Pakistan would experience diffusion of HIV1. We therefore decided to cany out this study to access the understanding of young Pakistani men about sexually transmitted infections (STI s).

Lack Of Benefit Of Granulocyte Macrophage Or Granulocyte Colony Stimulating Factor In Patients With Febrile Neutropenia, T. Siddiqui, I. A. Burney, A. Salam, G. N. Kakepoto, Mohammad Khurshid, R. A. Smego

Section of Haematology/Oncology

Objectives: To compare the clinical benefits of granulocyte-colony stimulating factor (G-CSF) or granulocyte macrophage-colony stimulating factor (GM-CSF) plus standard supportive care to supportive care alone among cancer patients with febrile neutropenia.
Methods: Clinical data were collected retrospectively from 148 consecutive cancer patients with neutropenia and fever. Patients had hematologic (i.e., acute leukemias or lymphoproliferative disorders) or non-hematologic malignancies (i.e., solid tumors including carcinoma of breast, lung, or colon). Clinical variables analyzed included: age and sex; underlying malignancies; chemotherapy regimens; symptoms at time of presentation; duration of fever prior to study enrollment; days from chemotherapy until administration of GM-CSF or …