Medicine and Health Sciences Commons^™

Diagnosis, Treatment And Follow-Up In Four Children With Biotinidase Deficiency From Pakistan, Bushra Afroze, Mohammad Wasay

Department of Medicine

Biotinidase deficiency is an inherited disorder in which the vitamin biotin is not recycled. If untreated, affected individuals develop neurological and cutaneous symptoms. Untreated individuals with biotinidase deficiency either succumb to disease or are left with significant morbidity. We describe clinical course and follow-up of 4 children from Pakistan. All 4 presented with classical symptoms of biotinidase deficiency and responded dramatically to oral biotin within days to weeks. Biotinidase deficiency is reported in Pakistani children from different part of world, however; there is no such report from Pakistan. This highlights lack of awareness of biotinidase deficiency among physicians in Pakistan

A Descriptive Study To Find Possible Correlation Between Mri Findings Of Pituitary Gland And Serum Prolactin Level, Muhammad Azeemuddin, Rohana Naqi, Mohammad Wasay

Department of Medicine

Objective: To explore equation, if any, between findings of magnetic resonance imaging of pituitary gland and serum prolactin level.

Methods: The retrospective, descriptive study was conducted at the Department of Radiology, Aga Khan University Hospital, Karachi, and related to patients\' records from April 19, 2006 to April 23, 2009. Seventy patients underwent magnetic resonance imaging of brain for pituitary gland. Inclusion criteria were all patients referred with relevant clinical symptoms or deranged serum prolactin level. Patients who were claustrophobic or had a pacemaker, aneurysm clip, metallic foreign body in the orbit or with no laboratory investigation were excluded from the …

Biotinidase Deficiency In Pakistani Children; What Needs To Be Known And Done, Bushra Afroze, Mohammad Wasay

Department of Medicine

No abstract provided.

Can We Stop The Stroke Epidemic In Pakistan?, Ismail A. Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.

A Simple Method To Reduce Infection Of Ventriculoperitoneal Shunts Clinical Article, Atiq-Ur Rehman, Tausif-Ur Rehman, Hassaan H. Bashir, Vikas Gupta

Department of Medicine

Object: Postoperative shunt infection is the most common and feared complication of ventriculoperitoneal (VP) shunt placement for treatment of hydrocephalus. The rate of shunt infection is highest in the 1st postoperative month. The most common organisms responsible for shunt infection include coagulase-negative Staphylococcus and Staphylococcus aureus. This suggests a transfer of Patient's skin flora via the surgeons' glove as a possible means of infection. The authors conducted a study to determine if the rate of postoperative shunt infections could be reduced simply by changing gloves before handling the shunt catheter. Methods: A total of 111 neonates born with congenital hydrocephalus …

Growing Burden Of Neurological Diseases In Pakistan � Need For A National Health Survey, Mohammad Wasay, Shaukat Ali

Department of Medicine

No abstract provided.

Ischemic Stroke Care - Official Guidelines From The Pakistan Society Of Neurology, Ayeesha Kamran Kamal, Ahmed Itrat, Imama Naqvi, Maria Khan, Roomasa Channa, Ismail Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.

Asian Cerebral Venous Thrombosis Registry: Study Protocolv, Mohammad Wasay, Ayeesha Kamal, Bhojo Khealani

Department of Medicine

Introduction:

Cerebral venous thrombosis (CVT) is a well known but poorly reported entity. Most of the studies and registries related to CVT are reported from European countries. No large multi-center or multi- national data base or registry has been reported from Asian countries. CVT is not uncommon in Asia especially in south Asian subcontinent including India, Pakistan and Bangladesh. One study reported from India that CVT accounted for half of all strokes in the young and 40% of strokes in women. Review of CVT cases from Asian countries is suggestive of differences in risk factors profile and outcome in these …

Fight Against Chronic Diseases (High Blood Pressure, Stroke, Diabetes And Cancer) In Pakistan; Cost-Effective Interventions, Mohammad Wasay, Abdul Jabbar

Department of Medicine

No abstract provided.

A Non-Randomized Study Of Safety And Efficacy Of Heparin For Dvt Prophylaxis In Intracerebral Haemorrhage, Mohammad Wasay, Saqibuddin Khan, Khawaja S. Zaki, Bhojo A. Khealani, Ayeesha Kamal, Iqbal Azam, Ismail A. Khatri

Department of Medicine

Objective: To evaluate the safety and efficacy of subcutaneous heparin for deep venous thrombosis (DVT) prophylaxis in patients with intracerebral haemorrhage (ICH) during acute phase in comparison to elastic stockings.

Methods: The diagnosis of ICH was based on imaging (CT or MRI) and DVT was based on Doppler ultrasound.

Results: A total of 458 patients were identified over a period of 5 years (1997-2001). Median age was 59 years (range:12-99 years). Two hundred (44%) patients received heparin (heparin group) in addition to elastic stockings and 258 (56%) patients were only given elastic stockings (stockings group). These two groups were not …

Idiopathic Epilepsy Of Childhood And Potassium Ion Channels, Alper I. Dai, Mohammad Wasay

Department of Medicine

Potassium can affect the development of common seizure type and can be defined seizure susceptibility allele. The existence of inward-rectifying potassium (Kir) channels was first recognized half a century ago. The biophysical fingerprint of Kir channels is inward rectification in the current-voltage relationship , which limits potassium efflux at depolarizing membrane potentials. Kir channels are essential in the control of resting membrane potential, coupling of the metabolic cellular state with membrane excitability, and maintenance of potassium homeostasis. The critical interval contains several candidate genes, one of which, KCNJ10, exhibits a potentially important polymorphism with regard to fundamental aspects of seizure …

Acute Stroke Secondary To Internal Carotid Artery Pseudoaneurysm: Mri Findingsand Treatment With Endovascularcoiling, Mohammad Wasay, Alper Dai, Neeraj Dubey, Saadat Kamran

Department of Medicine

Internal carotid artery pseudoaneurysms are uncommon. We report a young man with history of trivialtrauma who presented with middle cerebral artery stroke.Head CT scan revealed a right parapharyngeal mass. MRI confirmed the diagnosis of internal carotidpseudoaneurysm. Cerebral angiogram showed dissection of internal carotid artery with a large pseudoaneurysm and almost complete occlusion of vessel distal to aneurysm.Vessel was obliterated by fibercoiling and gluing byendovascular technique to diminish risk of furthere mbolization. MRI characteristics of carotid pseudoaneurysms and role of endovascular treatment arediscussed.

Cerebral Venous Thrombosis: Recent Advances And Need For An Asian Registry, Mohammad Wasay, Ayeesha K. Kamal

Department of Medicine

No abstract provided.

Mechanism Of Neuronal Injury In Cerebral Venous Thrombosis, Uzma Usman, Mohammad Wasay

Department of Medicine

The impact of CVT on the brain is wide spectrum, ranging from completely normal parenchyma to brain oedema and/or haemorrhage. Multiple factors relate to neuronal injury in CVT including; dural sinus pressure, increased venous flow velocities, collateralization of venous channels, rate of occlusion, development of cytotoxic and vasogenic oedema, recanalization and accelerated myelination. It is suggested that recanalization of occluded vein, as well as, the presence or absence and the efficiency of intracranial venous collaterals, may have an impact on the extent of brain tissue damage and hence the prognosis of acute CVT.

Botulinum Toxin Type-A In The Management Of Cerebral Palsy: Low Or High Dose?, Alper I. Dai, Mohammad Wasay

Department of Medicine

Cerebral palsy is the most common cause of severe physical disability in childhood. Spasticity is a common and disabling symptom for many patients with cerebral palsy. Therapy for spasticity is symptomatic with the aim of increasing functional capacity and relieving discomfort. Spasticity treatment by orally administered drugs and intramuscular chemodenervation agents has become more frequent. Most oral medications to treat spasticity have been inadequately studied in children, especially those with cerebral palsy. Since its first use in pediatric patients, reported in 1993, botulinum toxin (BTX-A), a relatively recent addition to the available medical interventions for children with cerebral palsy, has …

Central Nervous System Involvement In Dengue Viral Infection, Romasa Channa, Mohammad Wasay

Department of Medicine

Neurological manifestations of dengue infection are rare. This review includes data regarding the epidemiology of the disease, neurological manifestations,pathogenesis, diagnosis and prognosis. It is based on 9 original articles and 10 case reports, adding up to 200 cases of dengue fever with neurological manifestations. Relevant cases have been reported from Asia, the Pacific rim, the Americas, the Mediterranean region, and Africa. A wide range of neurological manifestations has been reported. Altered consciousness and seizure are among the more common manifestations. The exact pathogenesis of this disease has not yet been established. However, recent studies hypothesize that the virus is neurotropic. …

Wernekink Comissure Syndrome: A Rare Midbrain Syndrome Secondary To Stroke, Alper I. Dai, Mohammad Wasay

Department of Medicine

Wernekink commissure involves the decussation of superior cerebellar peduncle (SCP) in midbrain. We report an elderly hypertensive, diabetic man who developed slurred speech, ataxia, and internuclear ophthalmoplegia. MRI examination revealed an unusual ischemic stroke involving Wernekink commissure. This rare stroke pattern involving decussation of SCP occurs in the setting of small arterial disease. The association between the anatomic location of the stroke and clinical findings is noteworthy.

Neuroleptic Malignant Syndrome: Need For Early Diagnosis And Therapy, Humaira M. Khan, Nadir A. Syed, Mughis Sheerani, Bhojo Khealani, Ayeesha Kamal, Mohammad Wasay

Department of Medicine

Background: Neuroleptic Malignant Syndrome (NMS) is a medical entity that has received little attention in the clinical settings in Pakistan. The aim of our study was to review the predisposing factors, outcomes and characteristics of in-patients diagnosed with NMS.

Methods: We performed a retrospective chart review of all cases (age > 15 years) at a tertiary care center in Karachi between January 01, 1990 and November 30, 2001, diagnosed using ICD 10 coding. Data was collected using a standardized data entry form and statistical analysis was performed using Epi Info 6, Version 6.02.

Results: There were a total of 20 patients …

Prognostic Indicators In Patients With Primary Intraventricular Haemorrhage, Bilal Hameed, Bhojo A. Khealani, Tahseen Mozzafar, Mohammad Wasay

Department of Medicine

Objectives: Primary intraventricular haemorrhage (PIVH) is a rare clinical entity. We sought to evaluate risk factors, clinical and radiological features, and outcome of patients with PIVH.

Materials and Methods: Cases of PIVH were identified from cohort of patients with non traumatic intracerebral haemorrhage (ICH) by reviewing the radiological data. Their charts were reviewed and demographic, clinical, radiological and laboratory data was recorded and analyzed. Chi square and t test were used to determine predictors of poor outcome.

Results: Fifteen of 677 (2%) patients with ICH had PIVH. Nine (60%) were men. Median age was 56 years. Predisposing factors included hypertension …

Rapidly Developing Optic Neuritis Secondary To Ethambutol: Possible Mechanism Of Injury, Sajjad Ali, Uzma Usman, Mohammad Wasay

Department of Medicine

Optic neuritis has been described among the toxic effects of Ethambutol. This side effect is dose related. The mean duration of Ethambutol induced optic neuritis (EON) is three months. We report a case of EON after few days of exposure to Ethambutol and the symptoms resolved after discontinuation of Ethambutol. This most likely represents an idiosyncratic reaction which is different as compared to dose related optic neuritis.

Autonomic Nervous System Dysfunction Predicts Poor Prognosis In Patients With Mild To Moderate Tetanus, Mohammad Wasay, Bhojo A. Khealani, Naasha Talati, Rohmah Shamsi, Nadir Ali Syed, Naseem Salahuddin

Department of Medicine

Background

Autonomic nervous system (ANS) dysfunction is present in up to one third of patients with tetanus. The prognostic value of ANS dysfunction is known in severe tetanus but its value is not well established in mild to moderate tetanus.

Methods

Medical records of all patients admitted with tetanus at two academic tertiary care centers in Karachi, Pakistan were reviewed. The demographic, clinical and laboratory data was recorded and analyzed. ANS dysfunction was defined as presence of labile or persistent hypertension or hypotension and sinus tachycardia, tachyarrythmia or bradycardia on EKG. Patients were divided into two groups based on presence …

Neurology In The 21st Century: Contemporary State Of Diagnostics And Therapeutics, Saad Shafqat, Mohammad Wasay

Department of Medicine

Although neurological disease has been recognized since antiquity, neurology as a systematic clinical discipline is less than 130 years old. Neurological practice has traditionally been constrained by the complexity of the human nervous system, which has been slow to yield its secrets. Over the last three decades, however, clinical neurology has been transformed in terms of both diagnostics and therapeutics and now marches in lockstep with the cutting edge of medicine. Efficacious treatments are now available for the majority of neurological diseases, including epilepsy, migraine, Guillain-Barre syndrome, Parkinson's disease, multiple sclerosis, and ischemic stroke. This neurological revolution has been enabled …

Motor Neuronopathy Associated With Adenocarcinoma Of Esophagus, Bhojo A Khealani, R. Qureshi, Mohammad Wasay

Department of Medicine

Neurologic paraneoplastic syndromes (NPS) are remote neurologic effects, except metastasis, of systemic cancers. These are a rare group of disorders, commonly associated with small cell lung carcinoma (SCLC).1 Various NPS have been described, including motor neuronopathy. The motor neuronopathy has commonly been described with small cell carcinoma of lung, breast cancer and lymphoproliferative disorders.2,3 We report a case of motor neuronopathy in association with large cell adenocarcinoma of esophagus. To our knowledge this is the first reported case of motor neuronopathy associated with adenocarcinoma of the esophagus.

Prognostic Indicators In Patients With Intracranial Tuberculoma: A Review Of 102 Cases, Mohammad Wasay, M. K. Moolani, J. Zaheer, Bhojo A. Khealani, R. A. Smego, A. R. Sarwari

Department of Medicine

Objective:

To see the characteristics, course and outcome of patients suffering from intracranial tuberculoma.

Methods:

Retrospective review of 102 patients diagnosed as intracranial tuberculoma at a tertiary care center over 10 years.

Results:

A total of 102 cases were seen with an age range of 1 to 75 years (mean, 30 years). Predisposing factors included Diabetes mellitus (8 patients) and pregnancy or puerperium (7 patients). Five pediatric patients had tuberculoma despite documented BCG vaccination. Fever (59%), headache (57%), meningeal irritation (36%) were the commonest presenting features; one-third of patients were drowsy or comatosed at presentation. Cerebrospinal fluid analysis was performed …

Should Carotid Endarterectomy Be Performed For Symptomatic Carotid Stenosis Pakistan?, N. A. Syed, A. Zakaria, B. A. Khealani, M. Wasay, S. M. Baig, Z. Sophie

Department of Medicine

Objective: The risk of stroke and death associated with carotid endarterctomy is operator dependant. Data regarding risks of this procedure are not available in Pakistan and therefore it is difficult to make accurate risk benefit analysis for individual patients. Our objective was to determine safety of carotid endarterectomy at an academic tertiary care center in Pakistan.

Methods: Patients who underwent carotid endarterectomy (CEA) at our hospital during a ten-year period were identified through ICD-9 coding system of the hospital medical records. Demographic features. associated medical problems and immediate postoperative complications were recorded and analyzed.

Results: Sixty-three carotid endarterectomies were performed …

Neurological Care In Pakistan: Actions Are Needed, M. Wasay

Department of Medicine

No abstract provided.

Ischemic Stroke Subtypes In Pakistan: The Aga Khan University Stroke Data Bank, N. A. Syed, B. A. Khealani, S. Ali, A. Hasan, H. Brohi, T. Mozaffar, N. Ahmed, A. Hameed, S. M. Baig, M. Wasay

Department of Medicine

Objective: Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital.

Methods: We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi.

Results: A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 …