Digital Commons Network^™

Communication Skills Of Family Physicians In A Doctor-Patient Consultation, Waris Qidwai, Si Karim, Fm. Irfan

Department of Family Medicine

No abstract provided.

Physical Exercise As A Key Health Determinant Among Patients, Waris Qidwai, Danish Saleheen, Sadia Saleem, Marie Andrades, Iqbal Azam

Department of Family Medicine

No abstract provided.

Patient Complaints Among Emergency Room Patients At A Teaching Hospital In Karachi, Waris Qidwai, Muhammad Baqir, Syed Sohail Ali, Semi Ayub

Department of Family Medicine

OBJECTIVES: To study the chief presenting complaints among patients presenting to the Emergency Medical services.
SETTING: This study was conducted at the Emergency Room of Aga Khan University Hospital, Karachi during March and April, 2003.
METHODS: A survey was carried out by the study investigators. This survey included patients who were not very sick and were selected at random. Demographic profiles of the respondents were noted. EPI-info and SPSS computer software programs were used for analysis of the results.
RESULTS: One hundred patients were surveyed. The majority was relatively young, married men and women, well educated and …

Perceptions On Bioethics Among Patients Presenting To Family Physicians At A Teaching Hospital In Karachi, Waris Qidwai, Hafeez Qureshi, Syed Sohail Ali, Mahboob Alam, Syed Lgbal Azam

Department of Family Medicine

Objective: To study the perceptions on bioethics among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan Study design: Questionnaire based cross sectional survey
Settings: The study was carried out at the family practice center, the Aga Khan University Hospital, Karachi Main outcome measures: Perceptions on the broad principles of bioethics
Results: Majority of the respondents were young and well educated and better placed socioeconomically. Respondents reported the moral duties of a physician and their reaction in the event of the death of a close relative due to a doctor`s negligence. The majority agreed …

Paternalistic Model Of Medical Practice, Waris Qidwai

Department of Family Medicine

No abstract provided.

Use Of Services Of Spiritual Healers Among Patients Presenting To Family Physicians At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai

Department of Family Medicine

Objective: To study the use of the services of spiritual healers, among patients visiting the family physicians, at a teaching hospital in, Karachi. Design: Cross-sectional survey
Place and Duration of Study: Family practice center, the Aga Khan University, Karachi, from February to June, 2001
Subjects and Methods: A total of 387 patients were surveyed. A questionnaire was developed and administered to collect information on the use of the services of spiritual healers among the respondents.
Results: Most of the respondents were young, well educated and better placed socio-economically. The use of the services of spiritual healers …

Implications For The Practice Of A Patient Expectation And Satisfaction Survey, At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, R. H. Dhanani, F. M. Khan

Department of Family Medicine

Objective: To study the expectations and satisfaction of patients visiting Family Practice Clinics, at the Aga Khan University Hospital, in Karachi, Pakistan. Methodology: A cross sectional survey of 316 patients was carried out. A questionnaire, based on the study objectives was developed and administered. The participating patient signed a consent form, after assurance of confidentiality was provided. Data on the demographic profile of the patients was collected.
Results: The mean age was 33.81 years, with 105 (33.2%) women, and 211 (66.8%) men. The majority were married, with education above intermediate level and were in private or government service or were …

Prevalence And Perceptions About Consanguineous Marriages Among Patients Presenting To Family Physicians, In 2001 At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, Iqbal Azam, Faisal M Khan

Department of Family Medicine

Aim: Consanguineous marriages are common in Pakistan despite their declining popularity in the developed world. In the present study, a questionnaire based survey was used to record the attitudes and perceptions of consanguineous marriages among the sample population.
Methods: A questionnaire was developed to collect information on the acceptability of, and perceptions about, consanguineous marriages among patients presenting to family physicians, at the Family Practice Center of the Aga Khan University Hospital in Karachi, Pakistan. Demographic data was collected as part of the questionnaire. Each participating patient signed a consent form after assurance of confidentiality was provided.
Results …

Animal Anti-Apoptotic Genes Ameliorate The Loss Of Turgor In Water-Stressed Transgenic Tobacco, Tala Awada, D. D. Dunigan, M. B. Dickman

Nebraska Center for Virology: Faculty Publications

Nicotiana tabacum L. ‘Glurk’ plants were transformed with antiapoptotic animal genes [chicken Bcl-xl; nematode CED-9; chicken Bcl-xl(GA) a mutant of Bcl-xl; and a 3’ non-coding region of human Bcl-2, referred to as 161-1]. Our objectives were to determine whether plant transformation with anti-apoptotic genes ameliorates drought tolerance in tobacco plants by subjecting the plants to a dry-down period. The non-transformed Glurk and the transgenic Glurk harboring G115, which expresses β-glucuronidase, served as controls. Transformation of tobacco plants with animal anti-apoptotic genes significantly impacted the rates of photosynthesis (A) and stomatal conductance (g_s), but not to the same extent …

Identification Of Novel Domains Within Sox-2 And Sox-11 Involved In Autoinhibition Of Dna Binding And Partnership Specificity, Matthew S. Wiebe, Tamara K. Nowling, Angie Rizzino

Nebraska Center for Virology: Faculty Publications

Sox transcription factors play key regulatory roles throughout development, binding DNA through a consensus (A/T)(A/T)CAA(A/T)G sequence. Although many different Sox proteins bind to this se-quence, it has been observed that gene regulatory elements are commonly responsive to only a small subset of the entire family, implying that regulatory mechanisms exist to permit selective DNA bind-ing and/or transactivation by Sox family members. To identify and explore the mechanisms modu-lating gene activation by Sox proteins further, we compared the function of Sox-2 and Sox-11. This led to the discovery that Sox proteins are regulated differentially at multiple levels, including trans-activation, protein partnerships …

Saru, A Sara Homolog, Is Repressed By Sart And Regulates Virulence Genes In Staphylococcus Aureus, Adhar C. Manna, Ambrose L. Cheung

Dartmouth Scholarship

In searching the Staphylococcus aureus genome, we previously identified sarT, a homolog of sarA, which encodes a repressor for alpha-hemolysin synthesis. Adjacent but transcribed divergently to sarT is sarU, which encodes a 247-residue polypeptide, almost twice the length of SarA. Sequence alignment disclosed that SarU, like SarS, which is another SarA homolog, could be envisioned as a molecule with two halves, with each half being homologous to SarA. SarU, as a member of the SarA family proteins, disclosed conservation of basic residues within the helix-turn-helix motif and within the beta hairpin loop, two putative DNA binding domains within this protein …

Prenatal Chromosomal Diversification Of Leukemia In Monozygotic Twins, Helena Kempski, Karen A. Mensa- Bonsu, Lyndal Kearney, G. Reza Jalali, Ian Hann, Mohammad Khurshid, Mel Greaves

Section of Haematology/Oncology

Previous studies on concordant acute lymphoblastic leukemia (ALL) in identical twins have identified the leukemia as monoclonal with MLL or ETV6-RUNX1 gene fusion as early or initiating events in utero. In the latter case, postnatal latency is associated with secondary genetic events such as ETV6 deletion. We describe here a pair of infant twins with concordant acute monoblastic leukemia (AML). They are a unique pair in that their leukemia blasts display extensive intraclonal chromosomal diversity. Comparison of the leukemic cells between the two twins by karyotype and fluorescence in situ hybridization identifies a common or shared stem line …

Hyalgan® Has A Dose-Dependent Differential Effect On Macrophage Proliferation And Cell Death, Kyle M. Sheehan, Lindsey B. Delott, Susan M. Day, David H. Deheer

University Faculty Publications and Creative Works

The intra-articular injection of high molecular weight hyaluronic acid (HA) has been reported to be an effective treatment for pain of osteoarthritis of the knee. However, the mechanism by which HA exerts its effect is unknown. To explore HA's influence on the growth of U937 human macrophages, cells were incubated for 168 h with three concentrations, 1, 0.1 and 0.01 mg/mL, of Hyalgan®, a high molecular weight HA preparation. At 24-h increments, the cells were examined for proliferation, cell cycle distribution as well as the number of apoptotic and dead cells. Exposing macrophages to 1 mg/mL Hyalgan® significantly reduced the …

Antipyretic, Parasitologic, And Immunologic Effects Of Combining Sulfadoxine/Pyrimethamine With Chloroquine Or Paracetamol For Treating Uncomplicated Plasmodium Falciparum Malaria, E. Hugosson, D. Tarimo, M. Troye-Blomberg, S.M. Montgomery, Zul Premji, A. Bjorkman

Pathology, East Africa

Sulfadoxine/pyrimethamine (SP) is increasingly used against malaria in sub-Saharan Africa because of chloroquine resistance. However, chloroquine may have a beneficial antipyretic effect. We therefore compared the combination of SP plus chloroquine, chloroquine alone, SP alone, and SP plus paracetamol in the treatment of uncomplicated Plasmodium falciparum malaria in 175 Tanzanian children (1-4 years old) in a randomized trial. Outcome variables were axillary temperatures every six hours, daily parasitemias, and serum levels of IgG antibodies to P. falciparum. Lower mean temperatures (6-48 hours) were achieved with SP plus chloroquine or paracetamol than with SP alone (P < 0.001) or chloroquine alone (P < 0.05). All three SP-treated groups showed high and similar parasite reduction (0-48 hours), whereas treatment with chloroquine alone was much less effective. Levels of IgG antibodies to P. falciparum increased significantly (P < 0.001) and similarly in the four treatment groups between days 0, 2. and 3. Thus, the addition of chloroquine or paracetamol to SP improved the clinical outcome, but did not affect the parasitologic response or antibody production.

Enhancement Of Disease And Pathology By Synergy Of Trichuris Suis And Campylobacter Jejuni In The Colon Of Immunologically Naive Swine, Linda S. Mansfield, David T. Gauthier, Sheila R. Abner, Kathryn M. Jones, Stacey R. Wilder, Joseph F. Urban

Biological Sciences Faculty Publications

Campylobacter jejuni, a leading cause of bacterial gastroenteritis, has different age distribution and disease expression in developing and developed countries, which may be due to the endemnicity of infection and the age of acquisition of immunity. Differences in disease expression are not solely dependent on the C jejuni strain or virulence attributes. Another modulating factor in developing countries may be endemic nematode infections such as Trichuris, which drive type 2 cytokine responses and down-regulate type I immune responses. In this study, three-day-old germfree pigs given dual infections with Trichuris suis and C jejuni had more frequent, more severe …

Role Of Neuropoietic Cytokines In Development And Progression Of Diabetic Polyneuropathy: From Glucose Metabolism To Neurodegeneration, Dusanka S. Skundric, Robert P. Lisak

Neurology Faculty Publications

Diabetic neuropathy develops as a result of hyperglycemia- induced local metabolic and microvascular changes in both type I and type II diabetes mellitus. Diabetic neuropathy shows slower impulse conduction, axonal degeneration, and impaired regeneration. Diabetic neuropathy affects peripheral, central, and visceral sensorimotor and motor nerves, causing improper locomotor and visceral organ dysfunctions. The pathogenesis of diabetic neuropathy is complex and involves multiple pathways. Lack of success in preventing neuropathy, even with successful treatment of hyperglycemia, suggests the presence of early mediators between hyperglycemia-induced metabolic and enzymatic changes and functional and structural properties of Schwann cells (SCs) and axons. It is …

Needed: Urologic Nursing Mentors For New Grads, Karen A. Karlowicz

Ellmer School of Nursing Faculty Publications

Presents the accomplishment felt after a completion of intense course of study. Inundation of nursing graduates; Assessment of nursing education programs; Tips to develop the role as urologic nurse.

Embryo And Gamete Development Upon Exposure To Cca Components: Cro3, Cuo, And As2o5, Nerbana Talaat-Elsebaei Mahmoud

Theses and Dissertations in Biomedical Sciences

Production of functional gametes and healthy embryos is essential for proliferation of all vertebrates, especially humans. Many compounds have toxic effects on developing gametes and embryos among which are chromium trioxide (CrO₃), cupric oxide (CuO) and arsenic pentaoxide (As₂O₅) as a mixture (CCA) or individually. Controversy surrounding the safety of CCA-treated wood centers primarily on the toxicity of its components and the potential for these metals to be released from the wood.

The aim of this research is to test the hypothesis that CCA components have deleterious effects on embryo development, oocyte maturation and …

Prostate Cancer: Some Clinical And Scientific Dilemmas., Paul D. Abel, El-Nasir Lalani

Department of Pathology and Laboratory Medicine

No abstract provided.

Use Of Intravenous Anti-D In Patients With Refractory And Relapsed Immune Thrombocytopenic Purpura, R. Sajid, Salman Adil, Z. Fadoo, S. Sabir, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To determine the response to IV anti-D and its comparison with splenectomy as second line therapy in refractory and relapsed cases of ITP, in the Aga Khan University Hospital, Karachi.
Methods: A total of 23 patients with chronic ITP were treated with either anti-D or splenectomy as second line treatment. The patients were assessed for time to achieve a response to second line treatment, duration ofresponse and adverse events.
Results: There were 12 patients in the anti-D group and 11 in the splenectomy group. The mean platelet count at presentation was 9,000/cumm. The mean age was 8.9 …

Fludarabine Induced Immune Thrombocytopenia In A Patient With Cd5 Positive B Cell Chronic Lymphocytic Leukemia, M. Usman, Salman Adil, R. Sajid, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Fludarabine is a purine nucleoside analogue, which inhibits DNA synthesis by inhibiting DNA polymerase and ribonucleoside reductase.1 It affects both dividing and non- dividing cells.2 Fludarabine possesses proven efficacy in the treatment of a variety of indolent B cell lymphoproliferative disorders including chronic lymphocytic leukemia3, low-grade non-Hodgkin's lymphoma4 and Waldenstrom macroglobulinemia.5 It is also a part of conditioning regimes in non-myeloablative bone marrow transplantation.6 The common side effects include myelosuppression, immunosuppression, and neurologic toxicity.7 The rare side effects are immune mediated hemolytic anemia8 and thrombocytopenia.9 Here we describe a case of a middle-aged lady who was diagnosed as B cell …

Cyclosporin Induced Fatal Rhabdomyolysis In A Young Patient With Acquired Aplastic Anemia: A Case Report, M. Usman, S. N. Adil, G. N. Kakepoto, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Cyclosporin is used as an immunosuppressive agent in the management of a variety of autoimmune disorders1 and in patients of organ transplant to suppress host immunity and prevent rejection.2 It is now well established that acquired aplastic anemia is secondary to immune mediated destruction of stem cells in the bone marrow3 and hence Cyclosporin is used as a first line immunosuppressive drug alone or in combination with anti lymphocyte globulin in the management of aplastic anemia.1 Rhabdomyolysis is a rare side effect of Cyclosporin.4 Here we describe a case of fatal rhabdomyolysis in a young patient who received cyclosporin for …

Chromosomal Abnormalities As A Cause Of Recurrent Abortions: A Hospital Experience, M. Azim, A.H. Khan, Z.L. Khilji, J.A. Pal, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To analyze the chromosomal abnormalities in couples with history of recurrent abortions.
Design: Retrospective study.
Setting: Cytogenetic section, Department of Pathology at the Aga Khan University Hospital. Karachi, Pakistan. Patients: Three hundred couples with history of recurrent abortions. Main outcome measure: Structural chromosomal abnormalities in carrier couples.
Results: G-banded chromosomes were analyzed from both partners of 300 couples who had had two or more spontaneous abortions. Sixteen (5.3%) couples showed a chromosomal aberration in one of the partners. Seven translocations, 5 inversions, 2 deletions and 2 sex chromosomal abnormalities were identified. There was an increase in …

Brainstem Encephalitis With Kikuchi-Fujimoto Disease, Saad Shafqat, Saima Bano Memon, Shiraz Hyder, Sheema H Hasan, Raymond A Smego

Section of Neurology

A case of young woman is described who developed clinical and MRI features of brainstem encephalitis in the setting of fever and cervical lymphadenopathy. Lymph node biopsy revealed histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease), which may reflect host response to an unspecified immune insult.

Clinical Practice Guidelines For The Management Of Ischemic Stroke In Pakistan, Saad Shafqat

Section of Neurology

Ischemic stroke represents a huge global burden, being the leading cause of physical disability and the third leading cause of death worldwide¹. Although rigorous epidemiological data from Pakistan are lacking, stroke is certainly the commonest reason for admission to a neurology ward in our part of the world, as elsewhere. Recent years have seen a number of new developments in the clinical approach to stroke, including in the areas of diagnostic work-up, acute treatment and secondary prevention. These developments enable the formulation of clinical practice guidelines for achieving standardized management of ischemic stroke, with the overall aini of …

Cost Of Acute Stroke Care At A Tertiary Care Hospital In Karachi, Pakistan, B. A. Khealani, Z. F. Javed, N. A. Syed, Saad Shafqat, Mohammad Wasay

Section of Neurology

Objective:To evaluate cost of acute stroke care and its determinants at a tertiary care hospital in Karachi and to find out predictors of high cost care. Acute stroke is a leading cause of morbidity and mortality. Cost of care is the single most important determinant in availability of acute stroke care at a tertiary care hospital in Pakistan.It is also an important factor in development of public health policies and medical insurance plans. Average nnual income in Pakistan is 4881 rupees (U$ 85).
Methods: Medical and billing records of 443 patients with acute stroke were retrospectively reviewed from …

Moyamoya Disease: An Elusive Diagnosis, K. B. Asumal, N. Akhtar, N. A. Syed, Saad Shafqat, S. M. Baig

Section of Neurology

Moyamoya disease is an idiopathic vasculopathy, affecting vessels of Circle of Willis.1 It usually manifests as stroke, but can also cause seizures and cognitive impairment.2 Ischemic strokes are common in children and hemorrhagic strokes in adults.1 We describe our experience with moyamoya disease in four patients who presented with ischemic strokes, at an academic tertiary care center and emphasize that this diagnosis should be considered in young patients, especially children, who present with stroke.

Current Treatments Of Vitiligo, Azam J. Samdani

Department of Medicine

No abstract provided.

Comparison Of Keorolac With Morphine For Intraoperative Analgesia In Patients Undergoing Total Abdominal Hysterectomy, S. S. Hasan, Fazal Hameed Khan, M. Ahmed

Department of Anaesthesia

Direct laryngoscopy and endotracheal intubation during anaesthesia and cutting, stretching and tissue manipulation during surgery is the most painful time for a patient undergoing surgery. The elicited pain during a surgical procedure is associated with significant hemodynamic changes including rise in blood pressure, heart rate, sweating, pupillary dilatation etc. These hemodynamic changes are not desirable and may produce deleterious effects in patients with hypertension, ischemic heart disease and cerebro-vascular disease and impose a great challenge for anaesthesiologist to maintain physiologic homeostasis during these periods of stress. Opioids are considered to be the corner stone in the management of intraoperative and …

Rac-1 And Iqgap Are Potential Regulators Of E-Cadherin-Catenin Interactions During Murine Preimplantation Development., David R Natale, Andrew J Watson

Obstetrics & Gynaecology Publications

Adherens junction formation is fundamental for compaction and trophectoderm differentiation during mammalian preimplantation development. We recently isolated an IQGAP-2 cDNA from a differential display-polymerase chain reaction screen of bovine preimplantation developmental stages. IQGAP-1 and -2 proteins mediate E-cadherin-based cell-to-cell adhesion through interactions with beta-catenin and the Rho GTPases, rac1 and cdc42. Our study demonstrates IQGAP-1,-2, rac-1 and cdc42 mRNAs are present throughout murine preimplantation development. IQGAP-1 and rac-1 protein distribution changes from predominantly plasma membrane associated to predominantly cytoplasmic as the embryo progresses through cleavage divisions and compaction to the blastocyst stage.