Medicine and Health Sciences Commons^™

Ganglioneuroblastoma Of The Posterior Mediastinum: A Case Report., Saulat Fatimi, Samira A Bawany, Awais Ashfaq

Section of Cardiothoracic Surgery

Introduction:Ganglioneuroblastoma is a rare peripheral neuroblastic tumor that is derived from developing neuronal cells of the sympathetic nervous system, and is found mostly, but not exclusively, in babies and young children.

Case Presentation:

To the best of our knowledge, there have been no previously reported cases of ganglioneuroblastoma of the mediastinum from Pakistan. We present a case of ganglioneuroblastoma in an eight-year-old Pakistani Sindhi boy incidentally found to have a large posterior mediastinal mass that on biopsy initially looked like ganglioneuroma. He underwent successful excision of the mediastinal mass and remained stable post-operatively. Final pathology findings showed a ganglioneuroblastoma. …

Comparison Of Stereotactic Core Breast Biopsy And Open Surgical Biopsy Results At A Tertiary Care Hospital In Pakistan., Imrana Masroor, Shaista Afzal, Gulnaz Shafqat, Yasir Jamil Khattak

Department of Radiology

Background:The Purpose of this study was to determine the yield of stereotactic core breast biopsy and its cost-saving potential.

Methods:

This observational study was conducted at the Department of Radiology at Aga Khan Hospital in Karachi. All female Patients (n = 84) undergoing stereotactic core breast biopsy under mammographic guidance from January 2005 to May 2010 were included. Stereotactic core biopsy was performed on a dedicated mammography unit employing a 14-gauge needle with an automated biopsy device. Ten Patients with incomplete medical records were excluded. All breast biopsy results were either compared with surgical findings in cases of malignant …

The Hirsch Index - A Play On Numbers Or A True Appraisal Of Academic Output?, Taimur Saleem

Medical College Documents

Citation metrics have rapidly gained importance in today's landscape and are being increasingly utilized as a yardstick in making several important decisions regarding academic funding and appointments. The impact factor has traditionally been the metric most often employed in this regard. However, the emergence of the Hirsch index has provided an alternative to the impact factor. The h-index, despite its flaws, continues to gain acceptance and popularity in the medical community. Several medical journals have evaluated and endorsed the use of the h-index. However, it must be interpreted with all of its limitations in mind.

Intracranial Atherosclerotic Disease, Maria Khan, Imama Naqvi, Asha Bansari, Ayeesha Kamran Kamal

Department of Medicine

Intracranial atherosclerotic disease (ICAD) is the most common proximate mechanism of ischemic stroke worldwide. Approximately half of those affected are Asians. For diagnosis of ICAD, intra-arterial angiography is the gold standard to identify extent of stenosis. However, noninvasive techniques including transcranial ultrasound and MRA are now emerging as reliable modalities to exclude moderate to severe (50%-99%) stenosis. Little is known about measures for primary prevention of the disease. In terms of secondary prevention of stroke due to intracranial atherosclerotic stenosis, aspirin continues to be the preferred antiplatelet agent although clopidogrel along with aspirin has shown promise in the acute phase. …

Pharmacy Newsletter : July 2011, Pharmacy Department

Pharmacy Newsletter

Content:

• E-Call logging system at Drug and Poison Information Centre
• Computerised Physician Order Entery System (CPOE) featured with more robust allergies information
• Initiation of Point of Care Clinical Pharmacy in Paeds Oncology
• Sulfa Allergy: Myths and Realities
• Drug Safety Updates

Disclosure Of Medical Error, Kiran Shaikh, Sharifa Bashir Lalani

School of Nursing & Midwifery

With the advancement of medical sciences, lives are being prolonged and practice of medicine is considered an art and no longer as science. ‘To Err is Human Report’ has been released and gives data of medical errors in United States which opened people’s eyes but there is grieving need that health professional in Pakistan also report the medical errors. Medical errors are common, costly, and often preventable. This could only happen when health professional are trained and made aware to report the errors. Evidences shows that full and honest disclosure of error and restitution are factors that may lead to …

Application Of Geographical Information System (Gis) For Mapping Road Traffic Injuries Using Existing Source Of Data In Karachi, Pakistan--A Pilot Study, Junsid Razzak, Uzma R. Khan, Sabeena Jalal

Department of Emergency Medicine

OBJECTIVE: To assess the feasibility of using Geographical Information System for mapping of road traffic injuries with an existing data source in a developing country.

METHODS: The study was a retrospectives case series of road traffic injury cases registered with the medico-legal office located in the three major trauma centers in Karachi for the period of January 1, 2004 till December 31st, 2004. Spatial data analysis was performed using ARCVIEW 3.1.

RESULTS: Out of 3650 of all road traffic injury, only 3% had locations detailed and accurate enough allowing mapping on a GIS map in the first attempt. Even after …

Non-Traumatic Coma In Paediatric Patients: Etiology And Predictors Of Outcome, Saba Ahmed, Kiran Ejaz, Muhammad Shahzad Shamim, Maimoona Azhar Salim, Muhammad Umer Rais Khan

Department of Emergency Medicine

Objective: To determine the common etiological features of non-traumatic coma in children and evaluate possible predictors of morbidity and mortality in these patients.
Method: A cross sectional study was carried out at the Paediatric Department of Civil Hospital Karachi from February 2008 to February 2009. In total 100 children, up to 14 years of age having history of non-traumatic coma were included. At the time of enrolment demographic data, clinical features, laboratory parameters and radiological workup were recorded. Data was entered and analyzed with SPSS version 16. Descriptive statistics were generated for all variables. Relationships between categorical variables were evaluated …

Cranial Reconstruction After Decompressive Craniectomy: Prediction Of Complications Using Fuzzy Logic, Saniya Siraj Godil, Muhammad Shahzad Shamim, Ather Enam, Uvais Qidwai, Mohsin Qadeer, Zain A. Sobani

Section of Neurosurgery

Introduction: Cranial reconstruction after decompressive craniectomy (DC) has been shown to be associated with a relatively high complication rate (16.4%-34%) compared with standard neurosurgical procedures (2%-5%). Most studies that have previously attempted to formulate a multivariate model for identifying factors predictive of postoperative complications of cranioplasty either were unsuccessful or yielded conflicting results. Therefore, fuzzy logic-based fuzzy inference system (FIS), which has proven to be a useful tool for risk prediction in medical and surgical conditions, was used in this study to identify predictors of complications of cranioplasty.
Methods: A retrospective chart review of all the patients who underwent DC …

Management Of Penetrating Brain Injury, Syed Faraz Kazim, Muhammad Shahzad Shamim, Muhammad Zubair Tahir, Ather Enam, Shahan Waheed

Section of Neurosurgery

Penetrating brain injury (PBI), though less prevalent than closed head trauma, carries a worse prognosis. The publication of Guidelines for the Management of Penetrating Brain Injury in 2001, attempted to standardize the management of PBI. This paper provides a precise and updated account of the medical and surgical management of these unique injuries which still present a significant challenge to practicing neurosurgeons worldwide. The management algorithms presented in this document are based on Guidelines for the Management of Penetrating Brain Injury and the recommendations are from literature published after 2001. Optimum management of PBI requires adequate comprehension of mechanism and …

Malignant Peripheral Nerve Sheath Tumour Of Maxilla, Naeem Sultan Ali, Montasir Junaid, Kanwal Aftab

Section of Otolaryngology, Head & Neck Surgery

Malignant peripheral nerve sheath tumour (MPNST) is a very rare entity in head and neck with high rate of recurrences and local invasiveness. This tumour is usually found in lower extremities and only 10-12% occur in head and neck region. The diagnosis is considered as the most elusive and difficult among soft tissue sarcomas because of its non specific presentation, both clinically as well as pathologically. This difficulty has now been overcome by immunohistochemistry. We report here a case of MPNST in a 50 years old male with a localized right maxillary growth.

Treatment Outcome Of Multi-Drug Resistant Tuberculosis Treated As Outpatient In A Tertiary Care Center, Zeeshan Waheed, Muhammad Irfan, Ahmed Suleman Haque, Muhammad Owais Khan, Atif Zubairi, Noor Ul Ain, Javaid A. Khan

Section of Pulmonary & Critical Care

INTRODUCTION: Community-based out-patient treatment for multidrug-resistant tuberculosis (MDR TB) is relatively new concept with reported successful outcomes.

OBJECTIVE: To assess the treatment outcomes of HIV negative multidrug-resistant tuberculosis (MDR TB) patients treated as outpatient at a tertiary care center in Karachi, Pakistan.

METHODS: A retrospective observational study of 53 consecutive, culture proven HIV negative MDR TB patients (resistant at least to both Isoniazid (H) and Rifampin(R) treated at Aga Khan University Hospital, Karachi between August 1999 and March 2007. Data were collected on predesigned performa regarding patient’s demography, clinical features, radiological findings, drug sensitivity, treatment and outcome.

RESULTS: A total …

Preventable Lifestyle Risk Factors For Non-Communicable Diseases In The Pakistan Adolescents Schools Study 1 (Pass-1)., Ali Khan Khuwaja, Saleem Khawaja, Komal Motwani, Adeel Khoja, Iqbal Azam Syed, Zafar Fatmi, Badar Sabir Ali, Muhammad Masood Kadir

Department of Medicine

Objectives: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents.

Methods: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis.

Results: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% …

Factors Predicting The Recurrence Of Spontaneous Bacterial Peritonitis In Patients With Cirrhosis, Sajjad Jamil, Shahid Ahmed, Adil Memon, Sara Masood, Syed H Shah, Saeed Sadiq Hamid, Wasim Jafri

Department of Medicine

Objective: To evaluate the frequency of recurrence of spontaneous bacterial peritonitis (SBP) in patients with end stage liver disease and the factors responsible for it.

Study Design: Descriptive study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from November 2008 till November 2009.

Methodology: Patients with cirrhosis who were admitted at AKUH with diagnosis of SBP during the study period were included. Any episode of SBP after resolution of the first index case of SBP within one year was considered as recurrence.

Results: Out of 238 cirrhotic patients, 157 (66%) had single, while 81 (34%) had recurrent …

Juvenile Dermatomyositis, Sidra Ishaque, Shakeel Ahmed, Rehan Ali, Khurram Minhas

Section of Internal Medicine

Juvenile dermatomyositis (JDM) is an important subtype of dermatomyositis characterized by inflammation of muscle, skin and gastrointestinal tract. A 14-year-old girl, with a history of fever, joint pain, easy fatigability and a rash since the age of 3 years is described. Physical examination, laboratory evaluation, electromyography (EMG) and muscle biopsy were suggestive of a chronic inflammatory process involving the muscles, most likely dermatomyositis. The report highlights the importance of a muscle biopsy as the gold standard for diagnosing dermatomyositis.

Cerebral Nocardiosis, Rohana Naqi, Humera Ahsan, Muhammad Azeemuddin

Department of Radiology

Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The most common disease sites include lung, skin and central nervous system. We report a case of 73 years old man who is a known case of rheumatoid arthritis for more than 15 years and was on Methotrexate and Prednisolone. Now presented with generalized tonic clonic seizures. His Magnetic Resonace Imaging (MRI) scan showed a ring enhancing lesion with mild surrounding oedema in right posterior parietal cortex. Based on the finding, the most probable diagnosis of cerebral abscess …

18 Years Old – Time For National Identification, I.A. Khatri

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pre- And Post-Radiotherapy Predictors Of Functional Outcome And Survival In Metastatic Spinal Cord Compression, Mutahir A. Tunio, Altaf Hashmi

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Brain Abscess Complicating Hemorrhagic Contusion In A Case Of Closed Head Injury, A.A. Wani, Altaf U Ramzan, Nayil K Malik, Furqan A Nizami, Anil Dhar, Ashish Kumar, M A Wani

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

A Rare Case Of Candidal Meningitis In Immuna Competent Host, M. Mittal, Deepak Goel, Garima Mittal, Krishan K. Bansal

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pakistan Society For Neurology Conference Abstracts

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pakistan Society Of Neurosurgeons Neurotrauma Karachi 2011

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Comparison Of Chromogenic Urinary Tract Infection Medium With Cysteine Lactose Electrolyte Deficient Media In A Resource Limited Setting, Saba Qaiser, Muhammad Zeeshan, Kausar Jabeen, Tanwir Ahsan, Afia Zafar

Department of Pathology and Laboratory Medicine

OBJECTIVES: To compare the chromogenic UTI medium (CUM) with cysteine lactose electrolyte deficient medium (CLED) in terms of isolation of uropathogens, turnaround time and cost.

METHODS: A total of 251 urine samples were selected and inoculated on both CLED and CUM, growth was observed after 24 and 48 hours of incubation. Isolates were identified by colony's colour and biochemical tests. Turnaround time for identification and cost was calculated till final identification of microorganisms.

RESULTS: A discrepancy in isolation was observed in seven samples with growth on CUM in 24 hours while in 48 hours on CLED. There was 100% agreement …

Cytological Diagnosis Of Typical Carcinoid On Bronchoscopic Brush Smears In An Hiv-Positive Patient, Neeta Kumar, Shahin Sayed, Swati Das

Internal Medicine, East Africa

We report a case of typical carcinoid of the lung in a 60-year-old human immunodeficiency virus (HIV)-positive man diagnosed on brush cytology smears. Bronchial carcinoids are rare tumors, accounting for 1% to 2% of all lung tumors. Although the exact incidence in HIV-infected individuals is not known, the paucity of their documentation in the literature indicates that they may be equally rare. Cytological diagnosis on brush smears is rarely documented as the tumor is covered with mucosa and cellular yield is often not good. In this case, bronchial brushings showed distinctive cytological features of typical carcinoid. The awareness of its …

My Patient Just Had A Transient Ischaemic Attack. Can I Predict His Risk For Stroke? Is Stroke Inevitable Or Preventable?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Superficial Temporal Artery Calcification In Patients With End-Stage Renal Disease: Association With Vascular Risk Factors And Ischemic Cerebrovascular Disease, Zeeshan Anwar, Elcin Zan, Marco Carone, Arzu Ozturk, Stephen M Sozio, David M Yousem

Department of Medicine

Background And Purpose: Extracranial superficial temporal artery (STA) calcification is an unusual finding seen in Patients with chronic kidney disease and has unknown ramifications with respect to intracranial ischemic disease. We sought to determine the association between the risk factors for vascular calcification and this rare phenomenon, in Patients with chronic renal failure, and to assess the coexistence of cerebral ischemia. Materials And Methods: Medical records and laboratory data on risk factors for vascular calcification were retrospectively retrieved for 453 Patients with a discharge diagnosis of end-stage renal disease (ESRD). CT head examinations were reviewed to identify and associate STA …

My Patient Just Had A Transient Ischaemic Attack. Can I Predict His Risk For Stroke? Is Stroke Inevitable Or Preventable, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Real-World Comparison Of Two Molecular Methods For Detection Of Respiratory Viruses, Syed Asad Ali, James E. Gern, Tina V. Hartert, Kathryn M. Edwards, Marie R. Griffin, E Kathryn Mille, Tebeb Gebretsadik, Tressa Pappas, Wai Ming Lee, John V. Williams

Department of Paediatrics and Child Health

Background: Molecular polymerase chain reaction (PCR) based assays are increasingly used to diagnose viral respiratory infections and conduct epidemiology studies. Molecular assays have generally been evaluated by comparing them to conventional direct fluorescent antibody (DFA) or viral culture techniques, with few published direct comparisons between molecular methods or between institutions. We sought to perform a real-world comparison of two molecular respiratory viral diagnostic methods between two experienced respiratory virus research laboratories.
Methods: We tested nasal and throat swab specimens obtained from 225 infants with respiratory illness for 11 common respiratory viruses using both a multiplex assay (Respiratory MultiCode-PLx Assay [RMA]) …

Lymphomas In Sub-Saharan Africa - What Can We Learn And How Can We Help In Improving Diagnosis, Managing Patients And Fostering Translational Research?, Kikkeri N. Naresh, Martine Raphael, Leona Ayers, Nina Hurwitz, Valeria Calbi, Emily Rogena, Shahin Sayed, Omar Sherman, Hazem A.H. Ibrahim, Stefano Lazzi, Vasileios Mourmouras, Patricia Rince, Jessie Githanga, Bessie Byakika, Emma Moshi, Muheez Durosinmi, Babatunde J. Olasode, Olayiwola A. Oluwasola, Effiong E. Akang, Yetunde Akeno` Va,, Melissa Adde, Ian Magrath, Lorenzo Leoncini

Pathology, East Africa

Approximately 30 000 cases of non-Hodgkin lymphoma (NHL) occur in the equatorial belt of Africa each year. Apart from the fact that Burkitt lymphoma (BL) is very common among children and adolescents in Africa and that an epidemic of human immunodeficiency virus (HIV) infection is currently ongoing in this part of the world, very little is known about lymphomas in Africa. This review provides information regarding the current infrastructure for diagnostics in sub-Saharan Africa. The results on the diagnostic accuracy and on the distribution of different lymphoma subsets in sub-Saharan Africa were based on a review undertaken by a team …

Successful Management Of Aggressive Fibromatosis Of The Neck Using Wide Surgical Excision: A Case Report., Zain A. Sobani, Montasir Junaid, Mumtaz J Khan

Section of Otolaryngology, Head & Neck Surgery

Introduction:Aggressive fibromatosis is a benign tumor, thought to arise from deep musculoaponeurotic structures, rarely found in the head or neck. However, when it does occur in the head and neck region, it tends to be more aggressive and associated with significant morbidity, which may be attributed to the vital vascular, neurological or anatomical structures in close proximity. Case Presentation: We report the case of a 39-year-old Pakistani man who presented with a two-month history of a lump on the right side of his neck. The mass was excised and histopathological analysis revealed a case of aggressive fibromatosis.

Conclusions:

Due …