Digital Commons Network^™

Perinatal Outcomes In Pregnancy With Asthma., Rashid Jooma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Department of Medicine

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort.

Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths.

Results: The mean age of asthmatics and nonasthmatics were 28.0±4.9 …

Effect Of Diclofenac Suppository On Tramadol Consumption In Posthysterectomy Pain, Aziza Mohammad Hussain, Fauzia A Khan, Lumaan Sheikh

Department of Anaesthesia

OBJECTIVE: To determine reduction in dose of tramadol and side effects in posthysterectomy patients on addition of diclofenac on rectal suppository.

STUDY DESIGN: Randomized double blinded placebo controlled study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, Pakistan, from August 2004 to January 2006. Methodology: Seventy ASA I and II females, aged 20 and above, who underwent elective abdominal hysterectomy, were included in this study. Patients received identical looking suppository of either 100 mg diclofenac sodium or placebo after induction of anaesthesia and then 12 hourly for 24 hours. General anaesthesia was standardized and tramadol was given …

Anaesthetic Management Of A Pregnant Patient For Aortic Valve Replacement, Khalid M Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Cardiac disease can be encountered during pregnancy with the frequency being 1% to 2% of all pregnant women. Because of the high foetal and relative maternal mortality during surgery, medical management is the first line of treatment. Nevertheless, when medical treatment fails, cardiac surgery becomes necessary. We present the anaesthetic management of a case of Aortic valve disease in a pregnant woman undergoing surgery.

Factor Xiii Deficiency In Children--Clinical Presentation And Outcome, Zehra Fadoo, Ali Faisal Saleem

Department of Paediatrics and Child Health

OBJECTIVE: To determine the demographic features and clinical outcome of children with Factor XIII deficiency.

STUDY DESIGN: Observational case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 1996 to December 2006.

METHODOLOGY: Records of all hospitalized pediatric patients with discharge diagnosis of FXIII D, on the basis of factor XIII assay 5 mol/L urea test were retrospectively reviewed and abstracted on a pre-specified proforma. Demographic features, coagulation profile, family history and outcomes were noted.

RESULTS: A total of 10 charts were reviewed. There were 5 boys and 5 girls. Almost all the children (9/10) …

Experimental Optic Neuritis Induced By A Demyelinating Strain Of Mouse Hepatitis Virus., Kenneth S. Shindler, Lawrence C. Kenyon, Mahasweta Dutt, Susan T. Hingley, Jayasri Das Sarma

Department of Neurology Faculty Papers

Optic neuritis (ON), an inflammatory demyelinating optic nerve disease, occurs in multiple sclerosis (MS). Pathological mechanisms and potential treatments for ON have been studied via experimental autoimmune MS models. However, evidence suggests that virus-induced inflammation is a likely etiology triggering MS and ON; experimental virus-induced ON models are therefore required. We demonstrate that MHV-A59, a mouse hepatitis virus (MHV) strain that causes brain and spinal cord inflammation and demyelination, induces ON by promoting mixed inflammatory cell infiltration. In contrast, MHV-2, a nondemyelinating MHV strain, does not induce ON. Results reveal a reproducible virus-induced ON model important for the evaluation of …

Characteristics Of Tia And Its Management In A Tertiary Care Hospital In Pakistan, Ayeesha Kamal, Farhad Khimani, Rushna Raza, Sahar Zafar, Salman Bandeali, Sayeedullah Jan

Section of Neurology

Background:Transient ischemic attack (TIA) is described as a brief episode of neurological dysfunction caused by focal brain ischemia, with clinical symptoms typically lasting less than an hour, and without evidence of acute infarction. Recent studies depict TIA as a particularly unstable condition. Risk of stroke is greater than 10% in the first 90 days after an index TIA. The presentation, prognosis and intervention for TIA have not been reported in South-Asians in a developing country. Method: A retrospective chart review was done for 158 Patients who were admitted with the diagnosis of TIA, as defined by ICD 9 code …

Misoprostol In Addition To Routine Treatment Of Postpartum Hemorrhage: A Hospital-Based Randomized-Controlled Trial In Karachi, Pakistan., N. F. Zuberi, Jill Durocher, Rozina Sikander, Neelofur Baber, Jennifer Blum, Gijs Walraven

Department of Obstetrics & Gynaecology

Background:Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment.

Methods: A randomized controlled trial was conducted in four Karachi hospitals from December 2005 - April 2007 to assess the benefit of a …

Staphylococcus Aureus Pbp4 Is Essential For Β-Lactam Resistance In Community-Acquired Methicillin-Resistant Strains, G Memmi, S R. Filipe, M G. Pinho, Z Fu, Ambrose Cheung

Dartmouth Scholarship

Recent cases of infections caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA) (CA-MRSA) strains in healthy individuals have raised concerns worldwide. CA-MRSA strains differ from hospital-acquired MRSAs by virtue of their genomic background and increased virulence in animal models.

Association Between Antipsychotics And Weight Gain Among Psychiatric Outpatients In Pakistan: A Retrospective Cohort Study., Syed Ahmer, Rashid A. M Khan, Saleem Perwaiz Iqbal

Department of Psychiatry

Background: It has been known for a long time that use of antipsychotics, particularly atypical antipsychotics, is associated with weight gain and increase in risk of metabolic disturbances. In this study we have tried to find out if use of antipsychotics is associated with increase in weight and body mass index (BMI) in the Pakistani population. Methods: We performed a case note review of all Patients who had been prescribed antipsychotic medication at the psychiatry outPatient clinic of a tertiary care university hospital in Pakistan over a 4-year period. Results: A total of 50% of Patients had a BMI in …

Reuters Health: Factor Vii Curbs Bleeding In Non-Hemophiliac Trauma, Surgical Patients

Data and Test Instruments

Use of recombinant activated factor VII (rFVIIa) reduces the need for blood transfusion in patients without hemophilia and may also reduce mortality, according to pooled data from randomized placebo-controlled trials involving more than 3000 participants, Canadian researchers report. "I had found it to be effective in some combat situations in Afghanistan," senior investigator Dr. Vivian C. McAlister told Reuters Health.

Characterizing And Inhibiting Two Pathways Activated In Glioblastoma Multiforme, Andrea Jydstrup, Sheri L. Holmen

Undergraduate Research Opportunities Program (UROP)

Despite major improvements in imaging, radiation, and surgery, the prognosis for patients with Glioblastoma multiforme (GBM) remains clinically challenging. New treatment strategies are badly needed to reduce the mortality and morbidity associated with this disease. The resistance of these tumors to conventional treatments makes GBM patients ideal candidates for molecularly targeted therapies and several agents are currently being developed(1). Because GBM is genetically heterogeneous, combination therapies or the use of multikinase inhibitors are more likely to achieve the greatest therapeutic benefit(2,3). However, genes that can be productively targeted for effective therapies in patients remain to be identified. The overall objective …

Relationship Of Lactobacillus Casei To Prevention Of Antibiotic Associated Diarrhea Due To Clostridium Difficile, Kayal K. Chandramohan

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this research was to study the effectiveness of Lactobacillus casei in preventing the occurrence of antibiotic associated diarrhea related to Clostridium difficile. Twenty-six patients, above the age of sixty years, who were prescribed antibiotic therapy and admitted to the Rehabilitation or Orthopedics Units at Union Hospital and who met the eligibility criteria were recruited for the study. Equal numbers of patients (13 in each group) were assigned to the Control and the Experimental group based on their admission date to the hospital and their willingness to consume a probiotic yogurt type drink. The patients in the experimental …

Hyponatraemia: Etiology, Management And Outcome, Aasima Yawar, Abdul Jabbar, Naeem Ul Haque, Lubna M Zuberi, Najmul Islam, Jaweed Akhtar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To determine the etiology of hyponatraemia, the treatment instituted and the outcome of treatment in a tertiary care hospital setting.

STUDY DESIGN: Case series.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, between January and June 2004.

METHODOLOGY: Case records of 220 patients admitted to the medical service were identified through computerized hospital patients' data. All patients (3) 15 years with a sodium level on admission of (2) 130 mmol/litre were included. The records of those patients were reviewed for relevant demographic, clinical and laboratory data, in addition to the diagnosis, treatment and outcome of hospitalization. The …

Factors Associated With Non-Adherence Among Psychiatric Patients At A Tertiary Care Hospital, Karachi, Pakistan: A Questionnaire Based Cross-Sectional Study, Fawad Taj, Mansoor Tanwir, Zarmeneh Aly, Ameer Ali Khowajah, Asma Tariq, Fahd Khalid Syed, Fahd Waqar, Khezar Shahzada

Department of Psychiatry

OBJECTIVE: To elucidate predictors of non-adherence among psychiatric patients presenting at a tertiary care hospital of Pakistan, for follow-up with consultant psychiatrist.

METHODS: A convenient sampleof psychiatric patients from Aga Khan University Hospital was enrolled between April and May, 2005. An interviewer assisted, standardized questionnaire was used for data collection. Patients with cognitive deficit or psychosis and those presenting for the first time were not included in the study.

RESULTS: Out of 128 patients, those with co-morbidity (32.81%) were less adherent than those without comorbidity (p-value:0.002). Adherence among depressed was 61.53%; psychotic was 58.82%; bipolar disorder was 73.91%. Reasons for …

Migraine And Patent Foramen Ovale: Exploring The Association And A Possible Treatment Option, Muhammed Yaser Hasan

Department of Biological & Biomedical Sciences

Migraine is a very common type of headache. With a prevalence of 10-12%, migraine ranks 19th among diseases causing worldwide morbidity. Number of studies have shown a high prevalence of patent foramen ovale (PFO) in patients with migraine, especially migraine with aura. The right to left shunting of blood in a PFO could serve as a conduit for chemicals that would exert a trigger effect on hyper excitable neurons leading to the development of migraine. Furthermore patients with PFO and migraine also show a marked improvement in their symptoms after percutaneous closure of the PFO. This review is a close …

Enterocutaneous Fistulae In Children - A Management Challenge, Ali Imran Amjad, Saqib Hamid Qazi, Zafar Nazir

Department of Biological & Biomedical Sciences

No abstract provided.

Vital Signs, Fall 2008, Boonshoft School Of Medicine

Vital Signs

A fifty-five page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, a research spotlight, and more.

Clinical Outcomes Of Sirolimus With Eluting Stent Implantation In Coronary Artery Disease, Munsif Ali, Syed Mumtaz Ali Shah, Zaman Shah, Islam Hussain, Khezar Shahzada Syed, Hadi Mohammad Khan

Section of Cardiology

OBJECTIVE: To evaluate the immediate post procedure, thirty-days, and six-months clinical outcomes of sirolimus-eluting stents (SES) implantation in patients with single and multivessel coronary artery disease (CAD).

METHODS: A case series of all consecutive patients undergoing percutaneous coronary interventions (PCI) with SES implantation at Shifa International Hospital, Islamabad, were evaluated at early post-procedure, 30-days and six-months clinical follow-up for the incidence of major adverse cardiac event (MACE). This included death, nonfatal myocardial infarction (MI) and repeat revascularization.

RESULTS: Out of 206 consecutive patients, 324 had SES implanted. Cumulative MACE rate was 2.93% and 6% at 30-days and six-months follow-ups respectively. …

99mtc-Nannocolloid Localization Of Lymphorenal Fistula Causing Chyluria, Maseeh Uz Zaman, Riffat Parveen Hussain, Khalil Ahmed Khan, Gufran Khan, M. Nadeem Ahmad

Department of Radiology

Chyluria is an abnormal condition in which chyle appears in the urine because of a fistulous communication between the lymphatics and the urinary tract. It is not life-threatening and spontaneous regression is reported in 50% of cases. Lymphangiography has been the main imaging modality for localization of the site of fistula, but it is invasive and requires expertise. Lymphoscintigraphy using Tc-99m labelled colloid is a safe, non-invasive, reproducible technique, which bears less radiation exposure. A 67-year-old male presented with 7-month history of chyluria following a spinal surgery. Bilateral lower limb lymphoscintigram revealed sluggish lymph flow in the left lower limb …

Infectious Keratitis Associated With Contact Lens Use, Misty Dawn Harvey

All-Inclusive List of Electronic Theses and Dissertations

In March 2006, ophthalmologists noticed increased Fusarium keratitis in patients wearing soft contact lenses; the etiology was that of Fusarium solani. By May of 2006, CDC reported receiving a total of 130 confirmed cases of Fusarium keratitis across 26 states and one territory; of the 118 who could identify the lens solution they had used, 64% reported using Bausch & Lomb's ReNu with Moistureloc ©,while 18% reported using only non-Bausch & Lomb products. The association between Fusarium keratitis and ReNu with Moistureloc was not clear. Nevertheless, Bausch & Lomb withdrew Moistureloc solutions worldwide. In earlier laboratory tests using standard methods …

Molecular Ablation Of Transforming Growth Factor Beta Signaling Pathways By Tyrosine Kinase Inhibition: The Coming Of A Promising New Era In The Treatment Of Tissue Fibrosis., Joel Rosenbloom, Sergio A. Jimenez

Department of Medicine Faculty Papers

No abstract provided.

Effects Of Hypoxic-Ischemic Encephalopathy And Whole-Body Hypothermia On Neonatal Auditory Function: A Pilot Study, Ulrike Mietzsch, Nehal A Parikh, Amber L Williams, Seetha Shankaran, Robert E Lasky

Faculty, Staff and Student Publications

We assessed the effects of hypoxic-ischemic encephalopathy (HIE) and whole-body hypothermia therapy on auditory brain stem evoked responses (ABRs) and distortion product otoacoustic emissions (DPOAEs). We performed serial assessments of ABRs and DPOAEs in newborns with moderate or severe HIE, randomized to hypothermia ( N = 4) or usual care ( N = 5). Participants were five boys and four girls with mean gestational age (standard deviation) of 38.9 (1.8) weeks. During the first week of life, peripheral auditory function, as measured by the DPOAEs, was disrupted in all nine subjects. ABRs were delayed but central transmission was intact, suggesting …

Digest Of The Philadelphia College Of Osteopathic Medicine (Fall 2008), Philadelphia College Of Osteopathic Medicine

Digest

The Fall 2008 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Opening Remarks
• PCOM Updates and Kudos
• Development News
• Global Warming’s Health Crisis
• Weather Disasters
• Emerging Infectious Diseases
• What Can Be Done?
• Water-Borne Diseases
• Heat Related Illnesses
• Heat Intensifies Air Pollution
• What Can Health Professionals Do?
• Extreme Climate Events and Mental Health Disorders
• Common Goals
• Medical Marriages
• Starting Out
• Practicing Together
• Military Match
• A Family Tradition
• Research: Fruit of the Vine May Combat Prostrate Cancer
• Class Notes
• In Memoriam
• My Turn Essay
• PCOM Events

Pegylated Interferon 2a And 2b In Combination With Ribavirin For The Treatment Of Chronic Hepatitis C In Hiv Infected Patients., Ravinder Dhillon, Simona Rossi, Steven K Herrine

Department of Medicine Faculty Papers

Coinfection with hepatitis C virus (HCV) and HIV is an increasingly recognized clinical dilemma, particularly since the advent of highly active antiretroviral therapy. Several studies of this population have demonstrated both more rapid progression of liver disease and poorer overall prognosis compared to HCV monoinfected patients. Consensus guidelines, based primarily on the results of 4 major randomized trials, recommend treatment with peginterferon and ribavirin for 48 weeks in coinfected patients. However, this current standard of care is associated with lower response rates to therapy than those seen in monoinfected patients. Important predictors of response include HCV genotype, pretreatment HCV RNA …

Characterization Of Kaposi's Sarcoma-Associated Herpesvirus Orf11 As A Possible Dutpase, Christina N. Ramirez

Seton Hall University Dissertations and Theses (ETDs)

A dUTPase is a crucial enzyme that hydrolyzes dUTP to dUMP. This reaction prevents the mutagenic or lethal misincorporation of uracil into DNA. For that reason, the enzyme is required for efficient DNA replication. Previous studies have shown that has ORFl l dUTPase-like motifs and thus may be a dUTPase. Generally, gammaherpesviruses contain six characteristic dUTPase motifs. In particular ORFl 1 and contains motifs 1, 2, 4, 6. While the characteristic motifs of gamroaberpesviruses include motifs 1, 2, 3, 4, 5, and 6, the number of dUTPase-like motifs in ORFl 1 's protein sequence is substantial. Thus, ORFl 1 may …

Predictive Model Of Blood Transfusion During Cabg Surgery In Pakistan, Sana Shoukat, Saqib A Gowani, Farhad Khimani, Faraz A Khan, Mohammad Zaman, Hasanat Sharif

Section of Cardiothoracic Surgery

OBJECTIVE: To determine predictors of need for transfusion of blood and blood products and create a clinical predictive model to reduce indiscriminate use of blood products during surgery.

METHOD: We conducted a retrospective chart review of 485 patients who underwent coronary artery bypass surgery from January 2004 to December 2004 at a Tertiary Care Hospital in Karachi, Pakistan. Independent predictors associated with transfusion were identified and a clinical prediction model developed.

RESULTS: The transfusion rate was 37.1%. A predictive model was created based on the presence of pulmonary disease, diabetes mellitus, low ejection fraction and recent/ongoing myocardial infarction.

CONCLUSION: The …

The Minimally Invasive Treatment Of Ureteropelvic Junction Obstruction: A Review Of Our Experience During The Last Decade., Brent V. Yanke, Costas D. Lallas, Christopher Pagnani, David E. Mcginnis, Demetrius H. Bagley

Department of Urology Faculty Papers

PURPOSE: The minimally invasive treatment of ureteropelvic junction obstruction has evolved during the last decade from endoscopic to laparoscopic and robotic. We review our 10-year experience with ureteropelvic junction obstruction, and report on our experience and followup.

MATERIALS AND METHODS: We reviewed all patients treated during the last 10 years. There were 294 procedures performed with complete records on 273 patients including 128 retrograde endopyelotomies, 116 laparoscopic pyeloplasties and 29 robotic pyeloplasties. Technique for each procedure is reviewed. Statistical analysis was performed on all results. Variables evaluated were gender, age (younger than 41 vs 41 years or older), …

Frequency And Clinical Spectrum Of Rare Inherited Coagulopathies--A Tricenter Study, Safoorah Khalid, Fareena Bilwani, Salman Naseem Adil, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the frequency of rare inherited coagulopathies at three centers of haematology in Karachi and to study the clinical spectrum and laboratory data of these coagulopathies.

METHODS: This was a descriptive study conducted from September 2003 to December 2004 on subjects from Aga Khan University Hospital, Husaini Blood Bank and Fatimid Blood Transfusion Centre. All the subjects with bleeding tendency without any acquired causes of bleeding were selected for further investigation, and were asked relevant questions as present in the questionnaire. Screening tests including platelet count, PT, APTT and bleeding time were performed on all patients and subsequently, …

A Case Of Histoplasmosis Mimicking Tuberculosis, Asim Qureshi

Department of Pathology and Laboratory Medicine

Drug resistance to Tuberculosis is an emerging problem but proper exhaustive workup needs to be done before confirming the diagnosis. The case of a 5 year old male child who presented with low grade fever and lymphadenopathy and was being treated with anti TB drugs with no satisfactory response is presented. A detail workup including a biopsy gave the diagnosis of histoplasmosis.

Reducing The Rate Of Primary Caesarean Sections--An Audit, Lumaan Sheikh, Sara Tehseen, Saqib Ali Gowani, Hadi Bhurgri, Javed Rizvi, S Kagazwala

Department of Obstetrics & Gynaecology

Objective: To evaluate how the implementation of universally acceptable standards affects rates for primary caesarean sections, without compromising maternal or foetal safety.

Method: A complete audit cycle of all the primary caesarean sections performed in the maternity unit of Aga Khan University was conducted from 1st January to 31st March during years 2003 and 2004. New labour management guidelines were implemented after the first audit (appendix). The rates of caesarean section, induction of labour, failed induction, and maternal and foetal outcomes were compared before and after the implementation of the guidelines.

Results: Primary emergency caesarean section rate decreased from 16% …