Digital Commons Network^™

Calcifying Fibrous Pseudotumor In Association With Hyaline Vascular Type Castleman's Disease., Muhammad Azam, Yousuf A Husen, Shahid Pervez

Department of Pathology and Laboratory Medicine

Calcifying fibrous pseudotumor is a recently described rare entity. It is considered as sclerosing end stage of inflammatory myofibroblastic tumor. An association with hyaline vascular type Castleman's disease has also been described. We report a case of a 13-year-old boy who presented with pain in epigastrium. Computed tomography scan of abdomen revealed a circumscribed mass arising from the gastric wall along the greater curvature. Histology revealed a tumor composed of spindle cells present within the dense hyalinized collagenous tissue. Lymphoplasmacytic infiltrate was seen along with lymphoid follicles, dystrophic and ossifying calcification. Tumor cells were focally positive for alpha smooth muscle …

Sirenomelia, The Mermaid Syndrome: Case Report And A Brief Review Of Literature, Rozina Sikandar, Shama Munim

Department of Obstetrics & Gynaecology

Sirenomelia, the Mermaid Syndrome is a rare and lethal congenital anomaly with an incidence of one in 60,000 to 70,000 pregnancies. Sirenomelia is characterized by complete fusion of the lower limbs, commonly associated with renal agenesis, absent external genitalia and other gastrointestinal defects. Another pathognomonic finding is the presence of single umbilical, persistent vitelline artery which is the chief distinguishing anatomic finding from Caudal Regression Syndrome. We report a case of termination of pregnancy done on the basis of ultrasound diagnosis of bilateral renal agenesis with no liquor volume. The foetus was identified to have characteristic features of Sirenomelia at …

Euroscore Predicts Postoperative Mortality, Certain Morbidities, And Recovery Time., Hitoshi Hirose, Hirotaka Inaba, Chiaki Noguchi, Keiichi Tambara, Taira Yamamoto, Motoshige Yamasaki, Keita Kikuchi, Atsushi Amano

Department of Surgery Faculty Papers

EuroSCORE (European System for Cardiac Operative Risk Evaluation) used for calculating the risk of the postoperative mortality rate for patients undergoing open-heart surgery may be able to predict postoperative complications as well. Consecutive cases of isolated on-pump coronary artery bypass grafting (CABG) (n=1552) performed between 1991 and 2006 at our hospital group were placed into a systematic database. Patients were stratified using additive EuroSCORE. Incidence of postoperative mortality, morbidity (bleeding, heart failure, mediastinitis, pneumonia, myocardial infarction, renal failure, and stroke), and recovery time (intubation time, ICU stay, and postoperative length of stay) was assessed in each EuroSCORE group. EuroSCORE was …

National Health Accounts: Lessons For Pakistan, Muhammad Ashar Malik

Community Health Sciences

No abstract provided.

Oculocardiac Reflex Elicited During Debridement Of An Empty Orbit, James C. Tsai, Md, James W. Heitz, Md, Edward H. Bedrossian Jr, Md Facs

Wills Eye Hospital Papers

87 yo male with history of hypertension and right periorbital basal cell carcinoma s/p previous right total ethmoidectomy, right maxillary antrostomy, and complete right orbital exenteration for basal cell carcinoma invading the right ethmoid sinus. Functional endoscopic sinus surgery and orbital exploration was scheduled for excision of recurrent basal cell carcinoma. Rapid sequence induction and intubation was uneventful. During right orbital base curettage, the patient experienced several precipitious episodes of profound bradycardia or brief asystole. After surgery, the patient denied cardiac symptoms, and cardiac enzymes were all normal. Oculocardiac-mediated bradyarrhythmias are rarely elicited from empty orbits.

How Early Do Antibiotics Have To Be To Impact Mortality In Severe Sepsis? A Prospective, Observational Study From An Emergency Department, Shahla Siddiqui, Nawal Salahuddin, Adeel Raza, Junaid Razzak

Department of Anaesthesia

BACKGROUND: The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization.

METHODS: Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values < 0.05 were considered significant.

RESULTS: One hundred and eleven patients …

Foxp3-Expressing T Regulatory Cells (T-Regs) Increase With The Severity Of Active Disease In Chronic Hepatitis C, Adam D. Toll, Md, John L. Farber, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The hepatitis C virus (HCV) leads to chronic disease in 80% of those infected and is associated with a chronic inflammatory response that is mediated by both cytokine producing (CD4+) and cytotoxic T cells (CD8+). FoxP3-expressing, CD4+, CD25+T cells (T-regs) are a subset of T lymphocytes that inhibit immune responsiveness and thereby control immunological reactions. Whether FoxP3+ T regulatory cell-mediated suppression is a factor in HCV persistence and/or the course of chronic liver injury has not been defined. In order to assess the association between these T regulatory cells and the severity of chronic hepatitis C, we evaluated liver biopsies …

Educational Opportunities In Integrative Medicine: The A-To-Z Healing Arts Guide And Professional Resource Directory, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Determination Of Complication Rate Of Picc Lines In Oncological Patients, Ghulam Haider, Shiyam Kumar, Basit Salam, Nehal Masood, Asim Jamal, Yasmeen Abdul Rasheed

Department of Radiation Oncology

OBJECTIVE: To determine the complication rate of (PICCs) peripherally inserted central catheters in cancer patients with a 1 year prospective cohort study.

METHODS: All PICCs inserted in adult cancer patients in Radiology Department of The Aga Khan University Hospital were followed prospectively till removed or patient expired and pattern of complications noted.

RESULTS: One hundred and fourty six PICCs were inserted over a period of 1 year and followed for a total of 3329 catheter-days; median placement, 14 days: range 3-218 days. Of these 67 (32.8%) PICCs were complicated and removed earlier, for a rate of 14.4/1000 PICC-days. Patients with …

Ethnic Differences In Do-Not-Resuscitate Orders After Intracerebral Hemorrhage, Darin B Zahuranec, Devin L Brown, Lynda D Lisabeth, Nicole R Gonzales, Paxton J Longwell, Melinda A Smith, Nelda M Garcia, Lewis B Morgenstern

Faculty, Staff and Student Publications

OBJECTIVE: To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.

DESIGN: Population-based surveillance.

SETTING: Corpus Christi, Texas.

PATIENTS: All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for do-not-resuscitate orders. Unadjusted and multivariable logistic regression were used to test for associations between ethnicity and do-not-resuscitate orders, both overall ("any do-not-resuscitate") and within 24 hrs of presentation ("early do-not-resuscitate"), adjusted for age, gender, Glasgow Coma Scale, intracerebral hemorrhage volume, intraventricular hemorrhage, infratentorial hemorrhage, …

Labrad : Vol 34, Issue 3 - October 2009, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Detection of Amoebic Meningitis by Wet Film of Cerebrospinal Fluid (CSF)
• Biochemical Tests in the Diagnosis of Anaemia
• Pathophysiology and Laboratory Investigation in Anaemia of Chronic Disease
• Haematogones: A pitfall in the Diagnosis of Leukemias/Lymphoma in Children
• Porphyria: The Mysterious Disease
• Imaging Features of Thalassaemia and Sickle Cell Anaemia
• N-Terminal Pro-BNP for Rapid Diagnosis of Heart Failure
• Frozen Section: A Rapid Diagnostic Tool
• Prenatal Diagnosis of ß-Thalassaemia
• Farewell to Administrative Director, Mr Sajid Khan

Venoarterial Pco2 Difference: A Marker Of Postoperative Cardiac Output In Children With Congenital Heart Disease, Muhammad Furqan, Fahad Hashmat, Munir Amanullah, Mansoor Khan, Hina K Durani, Anwarul Haque

Department of Paediatrics and Child Health

OBJECTIVE: To determine the relationship between venoarterial carbon dioxide gradient (DeltapCO2) and central venous oxygen saturation (ScvO2) in children after cardiac surgery.

STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: The Paediatric cardiac intensive care unit of the Aga Khan University Hospital, Karachi, from June 2006 to May 2007.

METHODOLOGY: All children admitted in the paediatric cardiac intensive care after complete repair of congenital heart defect using cardiopulmonary bypass were included in the study. Simultaneous arterial and central venous blood gas samples were obtained from a catheter placed in the artery (either radial or femoral) and superior vena …

Methods And Animal Model For Analyzing Age-Related Macular Degeneration, Jayakrishna Ambati

Ophthalmology and Visual Science Faculty Patents

Methods for testing candidate drugs for treatment of age-related macular degeneration are provided. Ccl2-deficient, and Ccr2-deficient mice are used to determine the effect of candidate drugs and treatments on development of age-related macular degeneration. Also provided is a Ccl2-deficient, Ccr2-deficient dual knockout mouse, which is a useful animal model for age-related macular degeneration.

Long-Term Immunity To Lethal Acute Or Chronic Type Ii Toxoplasma Gondii Infection Is Effectively Induced In Genetically Susceptible C57bl/6 Mice By Immunization With An Attenuated Type I Vaccine Strain, Jason P. Gigley, Barbara A. Fox, David J. Bzik

Dartmouth Scholarship

C57BL/6 (B6) mice are genetically highly susceptible to chronic type II Toxoplasma gondii infections that invariably cause lethal toxoplasmic encephalitis. We examined the ability of an attenuated type I vaccine strain to elicit long-term immunity to lethal acute or chronic type II infections in susceptible B6 mice. Mice immunized with the type I cps1-1 vaccine strain were not susceptible to a lethal (100-cyst) challenge with the type II strain ME49. Immunized mice challenged with 10 ME49 cysts exhibited significant reductions in brain cyst and parasite burdens compared to naive mice, regardless of the route of challenge infection. Remarkably, cps1-1 strain-immunized …

Orbital Aspergillus Infection Mimicking A Tumour: A Case Report, Muhammad Ahsan Zafar, Syeda Sidra Waheed, Ather Enam

Section of Neurosurgery

A 14-year-old male presented to the neurosurgical clinic with swelling just above the right eye which had been growing slowly for the last eight years. The swelling first appeared following a non-penetrating trauma eight years ago. On examination it was a non-tender, non-erythematous, firm, round swelling causing marked proptosis and diplopia on downward gaze only. The visual acuity was intact. MRI showed an intraorbital, extraconal mass isointense on T1 and hypointense on T2 imaging. A diagnosis of orbital tumor was made. A white, friable mass consistent with meningioma was resected. However histopathology report later showed it to be an Aspergilloma. …

The Otto Aufranc Award Identification Of A 4 Mb Region On Chromosome 17q21 Linked To Developmental Dysplasia Of The Hip In One 18-Member, Multigeneration Family, George Feldman, Chelsea Dalsey, Kasia Fertala, David Azimi, Paolo Fortina, Marcella Devoto, Maurizio Pacifici, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Developmental dysplasia of the hip (DDH) is a disabling condition of the hip that, depending on geography, can afflict between 20-80% of patients with end-stage arthritis of the hip. Despite its prevalence, the etiology of this disease remains unknown. DDH is a complex disorder with both environmental and genetic causes.. Based on the literature, the candidate genes for the disease are HOXB9, collagen type I α1, and DLX 3. The purpose of our study was to map and characterize the gene or genes responsible for this disorder by family linkage analysis. We recruited one 18-member, multigeneration affected family to provide …

Giant Adrenal Endothelial Cyst Associated With Acute And Chronic Morbidity In A Young Female: A Case Report., Muhammad Rizwan Khan, Saad Ajmal, Taimur Saleem

Department of Surgery Docs

Adrenal cysts are rare clinical entities that can present as acute abdomen through rupture and internal hemorrhage as well as chronic symptoms such as gastrointestinal disturbances. A 20-year-old girl presented to our hospital with a 4-years history of abdominal pain and diarrhea. Ultrasound of the abdomen revealed a cystic area measuring 10 x 10 cm between the spleen and left kidney. Computed tomography scan showed a large cystic, homogeneous mass measuring 12.8 x 9.5 x 9.4 cm in the left hypochondrium with most likely origin from the left adrenal gland. Limited work up for hormone hypersecretion was negative. The Patient …

Impairments In Attention In Occasionally Snoring Children: An Event-Related Potential Study., Maria E. Barnes, Elizabeth A. Huss, Krista N. Garrod, Eric Van Ray, Ehab Dayyat, David Gozal, Dennis L. Molfese

Faculty and Staff Scholarship

Objective: To determine whether minimal snoring is benign in children. Procedure: 22 rarely snoring children (mean age = 6.9 years, 11 females) and age- and sex-matched controls participated in an auditory oddball task wearing 128-electrode nets. Parents completed the Conners Parent Rating Scales–Revised Long (CPRS–R:L). Results: Snorers scored significantly higher on four CPRS-R:L subscales. Stepwise regression indicated that two ERP variables from a region of the ERP that peaked at 844 msec post-stimulus onset predicted CPRS-R:L Attention Deficit Hyperactivity Disorder (ADHD) Index scores. Conclusions: Occasional snorers, according to parental report, do exhibit ADHD-like behaviors. Basic sensory processing is longer than …

Geographic Variation And Environmental Conditions As Cofactors In Chlamydia Psittaci Association With Ocular Adnexal Lymphomas: A Comparison Between Italian And African Samples, Alessandro Carugi, Anna Onnis, Giuseppina Antonicelli, Benedetta Rossi, Susanna Mannucci, Anna Luzzi, Stefano Lazzi, Cristiana Cristiana Bellan, Gian Marco Tosi, Shahin Sayed, Giulia De Falco, Lorenzo Leoncini

Pathology, East Africa

A particular extra-nodal lymphoma type arises from B cells of the marginal zone (MZ) of mucosa-associated lymphoid tissue (MALT). The aetiology ofMZ lymphomas suggests that they are associated with chronic antigenic stimulation by microbial pathogens, among which Helicobacter pylori-associated gastricMALT lymphoma is the best studied. Recently, MALT lymphomas have been described in the context of chronic conjunctivitis, which can be associated with Chlamydia spp. infection. Studies from Italy showed the presence of Chlamydia psittaci in 87% of ocular adnexal lymphomas (OAL), and C. psittaci has been described in a large part of samples from Austria and Korea as well. However, …

Medical Education Digest, Vol. 11 No. 5 (September/October 2009), Nova Southeastern University

Medical Education Digest

No abstract provided.

Effects Of Genistein Following Fractionated Lung Irradiation In Mice., Andrea E Para, Andrea Bezjak, Ivan W T Yeung, Jacob Van Dyk, Richard P Hill

Oncology Publications

BACKGROUND AND PURPOSE: This study investigated protection of lung injury by genistein following fractionated doses of radiation and its effect on tumor response.

MATERIAL AND METHODS: C3H/HeJ mice were irradiated (100 kVp X-rays) with 9 fractions of 3.1 Gy over 30 days (approximately equivalent to 10 Gy single dose) and were maintained on a genistein diet ( approximately 10mg/kg). Damage was assessed over 28 weeks in lung cells by a cytokinesis block micronucleus (MN) assay and by changes in breathing rate and histology. Tumor protection was assessed using a colony assay to determine cell survival following in situ irradiation of …

Lymphangiosarcoma Of The Arm Presenting With Lymphedema In A Woman 16 Years After Mastectomy: A Case Report, Yasir J. Sepah, Masood Umer, Asim Qureshi, Shaista Khan

Section of Orthopaedic Surgery

Lymphangiosarcoma following breast cancer is a relatively rare entity, with around 300 cases so far reported worldwide. Affecting the long term survivors of breast cancer, lymphangiosarcoma (Stewart-Traves Syndrome) has a high mortality rate. Since lympedema following radical mastectomy or axillary clearance and radiotherapy seems to be the main predisposing factor, further research regarding modifications in the surgical technique of axillary nodes dissection as well as the development of new chemotherapeutic agents effective in lymphangiosarcoma are required.

Contraception, Synergies And Options, Rashid Jooma, Adnan A. Khan

Section of Neurosurgery

No abstract provided.

Utilization Of Dantrolene In Stiff-Person Syndrome: A Case Report, John M. Vasudevan, Md, S. Kamal Fetouh, Md,, Nethra S. Ankam, Md, Adam L. Schreiber, Do, Ma

Department of Rehabilitation Medicine Faculty Papers

Setting: University hospital-based acute rehabilitation.

Patient: 75-year-old woman with Stiff-Person Syndrome (SPS) with a recent fall and Colles fracture.

Case Description: Four months prior to admission, the patient was diagnosed with SPS, negative for anti-GAD antibodies. Diagnosis was based on a 3-year history of progressive rigidity leading to frequent falls and fractures. Anxiety and fear of falling limited her mobility, and she sustained a sacral pressure ulcer during acute hospitalization. On admission, history was remarkable for unsteady gait and muscle cramps exacerbated when startled or excited. Examination was remarkable for rigidity in her axial and limb muscles. She presented …

Human Amniotic Fluid Stem Cells Do Not Differentiate Into Dopamine Neurons In Vitro Or After Transplantation In Vivo., Angela E Donaldson, Jingli Cai, Ming Yang, Lorraine Iacovitti

Farber Institute for Neuroscience Faculty Papers

Although embryonic stem (ES) cells can generate dopamine (DA) neurons that are potentially useful as a cell replacement therapy in Parkinson's disease (PD), associated ethical and practical concerns remain major stumbling blocks to their eventual use in humans. In this study, we examined human amniotic fluid stem (hAFS) cells derived from routine amniocenteses for their potential to give rise to DA neurons in vitro and following transplantation into the 6-hydroxydopamine-lesioned rat brain. We show that undifferentiated hAFS cells constitutively expressed mRNAs and proteins typical of stem cells but also cell derivatives of all three germ layers, including neural progenitors/neurons (nestin, …

Chinese Coal Mines--The Industrial Death Trap, Amber Mehmood

Department of Emergency Medicine

No abstract provided.

Early And Late Treatment Of Migraine With Dhe Ns (Migranal®), Meryl Latsko, Md, Mph, Stephen D. Silberstein, Md

Department of Jefferson Headache Center Papers and Presentations

To examine the use of DHE NS (Migranal®) in the early and late treatment of migraine in subjects with a history of cutaneous allodynia.

Staging Of Endometrial Carcinoma By Magnetic Resonance Imaging: Correlation With Surgery And Histopathology, Fatima Mubarak, Mirza Waseem Akhtar, Gul-E-Khanda, Yusuf A Husen

Department of Radiology

OBJECTIVE: To evaluate the accuracy of MRI in staging of endometrial carcinoma, and comparison with surgery and histopathological findings.

METHODS: A one year prospective cross-sectional study was conducted from 10/3/2005 to 31/5/2006, at the Radiology department, Aga Khan University Hospital (AKUH) Karachi. Fifty two patients with diagnosis of endometrial carcinoma, referred to radiology department for preoperative staging by MRI and had undergone surgery were included.

RESULTS: MRI was found to be 79% sensitive, 85% specific and 80% accurate for staging endometrial carcinoma while PPV and NPV were 97% and 66% respectively.

CONCLUSION: Magnetic resonance imaging is a good, safe, accurate …

Obesity And Cancer, Rickie Brawer, Phd, Mph, Nancy Brisbon, Md, James Plumb, Md

Department of Family & Community Medicine Faculty Papers

Obesity has become the second leading preventable cause of disease and death in the United States, trailing only tobacco use. Weight control, dietary choices, and levels of physical activity are important modifiable determinants of cancer risk. If multi-factorial approaches to prevention and management are not implemented, obesity will likely become the leading modifiable cause of death in the coming years. Physicians have a key role in integrating these approaches into clinical care and advocating for systemic prevention efforts. This article provides: 1) an introduction to the epidemiology and magnitude of childhood and adult obesity; 2) the relationship of overweight/obesity to …

Transverse Myelitis In Pregnancy: A Case Report, Brian P. Mcdonald, Do, Nethra S. Ankam, Md

Department of Rehabilitation Medicine Faculty Papers

Objective: Describe the clinical course and treatment of a patient with paraplegia secondary to transverse myelitis during her pregnancy.

Setting: Acute Inpatient Rehabilitation Unit, University Hospital.

Participant: 36 year old Caucasian woman at 18 weeks gestation.

Interventions: Provided education and training on basic childcare tasks at a wheelchair level, and on how to obtain wheelchair accessible baby furniture. Provided availability of a peer who sustained a spinal cord injury prior to pregnancy. Maintained a close working relationship with maternal fetal health department regarding management of nausea and pain management, and educated team members about the possibility of autonomic …