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Fiberoptic Intubation In A Paediatric Patient With Severe Temporomandibular Joint (Tmj) Ankylosis, Ali Asghar, Faisal Shamim, Asiyah Aman

Department of Anaesthesia

Craniofacial abnormalities are associated with mandibular hypoplasia, reduced mandibular space with overcrowding of soft tissues and maxillary hypoplasia. Decreased mouth opening and limitation in jaw protrusion are independent predictors of difficult airway in such patients. The relative difficult problem becomes even graver in the paediatric age group because of their small mouth opening and un-cooperativeness. A child with severe temporomandibular joint (TMJ) ankylosis presented with negligible mouth opening and required surgical correction under general anaesthesia. Successful intubation was performed with endotracheal tube size 5.5 mm using an adult 4.3 mm fiberoptic bronchoscope under inhalational as well as topical anaesthesia.

Radiation Exposure In Interventional Procedures, G. K. Korir, B. O. Ochieng, J. S. Wambani, I. K. Korir, C. Y. Jowi

Imaging & Diagnostic Radiology, East Africa

The aim of this study was to estimate radiation doses patients and staff are exposed to during interventional procedures (IPs), compare them with the international diagnostic reference levels and to develop initial National Diagnostic Reference Levels. The IP survey was undertaken as the initial task of which, retrospective data were collected from the only four Kenyan hospitals carrying out interventional radiology and cardiology procedures at the time of the study. Real-time measurement of radiation dose to patients and staff during these procedures was done. To the patients, kerma-area product (KAP) and fluoroscopy time measurements were done using an in-built KAP …

Prevalence Of Body-Focused Repetitive Behaviors In Three Large Medical Colleges Of Karachi: A Cross-Sectional Study., Efaza Umar Siddiqui, Syed Saad Naeem, Haider Naqv, Bilal Ahmed

Department of Medicine

Background: Body-focused repetitive behaviors (BFRBs) that include skin picking (dermatillomania), hair pulling (trichotillomania) and nail biting (onychophagia), lead to harmful physical and psychological sequelae. The objective was to determine the prevalence of BFRBs among students attending three large medical colleges of Karachi. It is imperative to come up with frequency to design strategies to decrease the burden and adverse effects associated with BFRBs among medical students.

Methods: A cross-sectional study was conducted among 210 students attending Aga Khan University, Dow Medical College and Sind Medical College, Karachi, in equal proportion. Data were collected using a pre tested tool, “Habit Questionnaire”. …

Comparison Of Upper Lip Bite Test With Mallampati Test In The Prediction Of Difficult Intubation At A Tertiary Care Hospital Of Pakistan, Muhammad Asghar Ali, Muhammad Qamar-Ul-Hoda, Khalid Samad

Department of Anaesthesia

Objective: To determine the accuracy of the Upper lip bite test and Mallampati test in predicting difficult endotracheal intubation.Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, a tertiary care facility in Karachi, Pakistan. Between June 1,2007 and May 31, 2008, 324 adult patients undergoing elective surgeries requiring general anaesthesia with endotracheal intubations were enrolled. Pre-operatively upper lip bite test and Mallampati test were performed for the assessment of airway by a specifically trained observer. Laryngoscopic view was rated by using Cormack and Lehane laryngoscopic grading once the patient was fully anaesthetised using standard anaesthesia technique. Completed …

Epidemiological Ins And Outs Of Helicobacter Pylori: A Review, Jibran Sualeh Muhammad, Syed Faisal Zaidi, Toshiro Sugiyama

Department of Biological & Biomedical Sciences

Helicobacter pylori infection is now recognised as a worldwide problem. It is the most common cause of chronic gastritis, and is strongly linked to peptic ulcer disease and gastric cancer. A comprehensive understanding of epidemiological ins and outs of H. pylori infection is very important in solving the patho-physiological enigma and might help in leading towards better management and prognosis of infection. This article presents a review of the literature on the epidemiology of H. pylori infection from 2006 to 2011. The authors used Medical Subject Heading (MeSH) terms 'Helicobacter' with 'epidemiology,' 'transmission' or 'risk factor' to search PubMed database. …

Socio-Economic Determinants Of Out-Of-Pocket Payments On Healthcare In Pakistan, Ashar Muhammad Malik, Syed Iqbal Azam Shah

Community Health Sciences

BACKGROUND:

Out-of-pocket (OOP) payment on healthcare is dominant mode of financing in developing countries. In Pakistan it is 67% of total expenditure on healthcare. Analysis of determinants of OOP health expenditure is a key aspect of equity in healthcare financing. It helps to formulate an effective health policy. Evidence on OOP in Pakistan is sparse. This paper attempts to fill this research gap.

METHODS:

We estimated determinants of OOP payments on healthcare in Pakistan. We used data sets of Pakistan Household Integrated Economic Survey (HIES) and Pakistan Standard of Living Measurement (PSLM) Survey for the year 2004-05. We developed a …

Observer Variation In Mri Evaluation Of Patients With Suspected Lumbar Disc Herniation And Nerve Root Compression: Comparison Of Neuroradiologist And Neurosurgeon's Interpretations, Imaad-Ur Rehman, Rana Shoaib Hamid, Waseem Akhtar, Muhammad Shahzad Shamim, Rohana Naqi, Haji Ismail Siddiq

Department of Radiology

Objective: To analyse inter-observer variation between a neuroradiologist and neurosurgeon in the MRI diagnosis of lumbar nerve root compression. Although lumbar MFI is primarily analyzed and reported by a radiologist, neurosurgeons often analyse it independently as they have sufficient clinical background as well as radiological expertise to diagnose most spinal pathologies on Magnetic Resonance Imaging (MRI).
Methods: Retrospective analysis was carried out for images of 54 patients who underwent MRI between March and July 2010 of lumbar spine with suspected lumbar disc herniation and nerve root compression, at Aga Khan Hospital, Karachi, Pakistan. One fellowship trained neuroradiologist and one neurosurgeon …

Post-Traumatic Apexogenesis Of Immature Non-Vital Permanent Incisors, Robia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Injury to an immature permanent tooth may result in cessation of dentin deposition and root maturation leaving an open root apex and thin dentinal walls that are prone to fracture. Endodontic treatment is often complicated and protracted with an uncertain prognosis frequently resulting in pre-mature tooth loss. There are several advantages of promoting apexogenesis in immature teeth with open apices. It encourages a longer and thicker root to develop thus decreasing the propensity of long term root fracture. This case report highlights the role of Hertwig root sheath and dental papilla in continued root formation of immature permanent tooth, even …

Beta2-Adrenoceptor Agonists For Dysmenorrhoea, Zbys Fedorowicz, Mona Nasser, Vanitha A. Jagannath, Jessica H. Beaman, Kiran Ejaz, Esther J. Van Zuuren

Department of Emergency Medicine

Background:Dysmenorrhoea is a common gynaecological complaint that can affect as many as 50% of premenopausal women, 10% of whom suffer severely enough to be rendered incapacitated for one to three days during each menstrual cycle. Primary dysmenorrhoea is where women suffer from menstrual pain but lack any pathology in their pelvic anatomy. Beta2-adrenoceptor agonists have been used in the treatment of women with primary dysmenorrhoea but their effects are unclear.
Objectives:To determine the effectiveness and safety of beta2-adrenoceptor agonists in the treatment of primary dysmenorrhoea. Search methods: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, …

Comparison Of Different Craniofacial Patterns With Pharyngeal Widths, Sarwat Memon, Mubassar Fida, Attiya Shaikh

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare different craniofacial patterns with pharyngeal widths.

STUDY DESIGN: Cross-sectional analytical study.

PLACE AND DURATION OF STUDY: Orthodontic Clinic at the Aga Khan University Hospital, Karachi, from June 2002 to June 2010.

METHODOLOGY: Data were collected using pre-treatment records including orthodontic files and pre-treatment lateral cephalographs of 360 orthodontic patients. The inclusion criteria were subjects of Pakistani origin, aged between 14-20 years and having no pharyngeal pathology or complaints of nasal obstruction at the initial visit. The sample comprised a total of 360 subjects divided into 2 groups: skeletal Class I (n=180) and skeletal Class II (n=180) subdivided …

Effectiveness Of Premedication At The Time Of Separation From Parent And Mask Induction In Paediatric Patients Coming For Congenital Heart Disease Surgery, Mohammad Hamid, Mansoor Ahmed Khan, Aftab Khatri, Irfan Akhtar

Department of Anaesthesia

OBJECTIVE: To compare the effectiveness of oral midazolam and chloral hydrate on anxiety and sedation at various stages of pre-operative period in congenital heart surgery patients.

STUDY DESIGN: Cross-sectional comparative study.

PLACE AND DURATION OF STUDY: Operating rooms of The Aga Khan University Hospital, Karachi, from October 2009 to December 2010.

METHODOLOGY: Sixty-six patients between the ages of 6 months and 6 years received either chloral hydrate (Group C) or midazolam (Group M) pre-operatively. All congenital heart disease patients coming for cardiac surgeries were included while cases of emergency surgery and those patients in whom premedication was not given were …

Problems And Issues In Implementing Innovative Curriculum In The Developing Countries: The Pakistani Experience, Syeda Kauser Ali, Lubna A. Baig

Department for Educational Development

Background: The Government of Pakistan identified 4 medical Colleges for introduction of COME, one from each province. Curriculum was prepared by the faculty of these colleges and launched in 2001 and despite concerted efforts could not be implemented. The purpose of this research was to identify the reasons for delay in implementation of the COME curriculum and to assess the understanding of the stakeholders about COME.

Methods: Mixed methods study design was used for data collection. In-depth interviews, mail-in survey questionnaire, and focus group discussions were held with the representatives of federal and provincial governments, Principals of medical colleges, faculty …

Impact Of Structured Meetings On The Learning Of Faculty Members, Ambreen Usmani, Rehana Rehman, Shazia Babar, Azam Afzal

Department of Continuing Professional Education

Objective: To determine impact of structured meetings on learning and faculty development
Methodology: The observational cross sectional study was conducted at Bahria University Medical &
Dental College from October 2010 to March 2011. Feed back of all faculty members of university was
acquired on weekly structured meeting (with alternating theme of journal club and problem based scenario
presentation) by a self reported questionnaire. The responses obtained on a 5-point Likert scale were
divided into two groups; I, senior faculty (professors, associates and assistants) II, junior faculty
(lecturers). Chi square test was applied to compare categorical variables and results considered significant …

A Comparative Analysis Of Toluidine Blue With Frozen Section In Oral Squamous Cell Carcinoma, Montasir Junaid, Moaz M. Choudhary, Zain A. Sobani, Ghulam Murtaza, Sadaf Qadeer, Naeem S. Ali, Mumtaz J. Khan, Anwar Suhail

Department of Surgery

Background:Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins.

Methods:

After obtaining clearance from the in-house ethical …

Water Pipe Smoking Amongst The University And College Students Of Karachi, Pakistan, Shehla Batool Jaffri, Aisha Yousuf, Waris Qidwai

Department of Family Medicine

Background:

An extensive literature search revealed that water pipe smoking is an emerging health risk and deserves the attention of health professionals. This study was therefore undertaken to determine the frequency of water pipe smoking among students in college and universities of Pakistan and to assess the practices, knowledge and attitude towards water pipe smoking among them.

Method:

A cross sectional survey was conducted in the College and Universities of Karachi, Pakistan from April 2009 to October 2009. Students were selected through non probability sampling and given self administered questionnaire after the informed consent.

Result:

A total …

Microaesthetics Of The Smile: Extraction Vs. Non-Extraction, Sanam Tauheed, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare microaesthetics in pre- and post-orthodontic cases, treated with non-extraction and extraction treatment and assessed whether the achieved microaesthetic parameters are comparable to the proposed norms.

STUDY DESIGN: Quasi-experimental study.

PLACE AND DURATION OF STUDY: Orthodontic Clinic, the Aga Khan University Hospital, Karachi, from January 2005 to December 2009.

METHODOLOGY: Orthodontic records of 31 cases treated with non-extraction therapy and 26 cases treated with extraction of upper first premolars were selected. Patients were of Pakistani origin, aged between 12 to 30 years. Microaesthetics was assessed by measuring maxillary central incisor crown width-height ratio, connectors between the maxillary anterior …

Physician Satisfaction Survey On Continuing Medical Education, Farhan Vakani, Wasim Jafri, Nizar Bhulani, Mughis Sheerani, Fatima Jafri

Department of Continuing Professional Education

No abstract provided.

Rapidly Progressive Periodontal Disease Associated With Human Immunodeficiency Virus, Khalid Al Hezaimi, Fawad Javed, Tazeen S. Ali, Mansour Al Askar, Abdulaziz Al Rasheed

School of Nursing & Midwifery

Severe periodontal inflammation with generalized dental plaque accumulation, spontaneous and severe gingival bleeding, fungal infection, and interdental papillae necrosis are presented in a patient infected with human immunodeficiency virus (HIV). Bite-wing radiographs revealed a generalized horizontal alveolar bone loss of 7-8 millimetres in both arches. Erythematous patches were noted on the gingival mucosa in both jaws. DNA testing was performed to indentify the periodontopathogens. The patient had no signs or symptoms of acquired immunodeficiency syndrome. This case-report presents the massive periodontal destruction that occurred in a patient infected with HIV. Therefore, it is highly recommended that patients infected with HIV …

Sindh Health Sector Strategy 2012 – 2020, Shehla Zaidi

Community Health Sciences

No abstract provided.

Dentoalveolar Heights In Skeletal Class I Normodivergent Facial Patterns, Zafar-Ul-Islam, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To determine the dentoalveolar heights (mm) in skeletal class I normodivergent facial pattern and compare the same heights in male and female subjects.

STUDY DESIGN: Cross-sectional observational study.

PLACE AND DURATION OF STUDY: Orthodontics Clinic, The Aga Khan University Hospital, Karachi, from July to October 2009.

METHODOLOGY: Eighty one subjects were selected from the orthodontic record at the Aga Khan University Hospital Karachi. The inclusion criteria were an age range of 12 to 30 years and skeletal class I normodivergent facial pattern with exclusion criteria of prior orthodontic treatment, restored teeth and craniofacial anomalies/syndromes. The pre-treatment cephalographs of the …

The Genetics Of Neuroendocrine Prostate Cancers: A Review Of Current And Emerging Candidates, M Hammad Ather, Tahmeena Siddiqui

Department of Surgery

Prostate cancer (PC) displays a strong familial link and genetic factors; genes regulating inflammation may have a pivotal role in the disease. Epigenetic changes control chromosomal integrity, gene functions, and, ultimately, carcinogenesis. The most widely studied epigenetic event in PC is aberrant DNA methylation (hypo- and hypermethylation); besides this, chromatin remodeling and micro RNA (miRNA) are other studied alterations in PC. These all lead to genomic instability and inappropriate gene expression. Causative dysfunction of histone modifying enzymes results in generic and locus-specific changes in chromatin remodeling. miRNA deregulation also contributes to prostate carcinogenesis, including interference with androgen-receptor signaling and apoptosis. …

Outcome Of Match Related Allogeneic Stem Cell Transplantation Procedures Performed From 2004 Till 2011, Natasha Ali, Salman Naseem Adil, Mohammad Usman Shaikh, Munira Moosajee, Nehal Masood

Department of Pathology and Laboratory Medicine

We present our initial experience of allogeneic stem cell transplant procedure performed between April 2004 and August 2011 for various haematological disorders. All patients with non-malignant and malignant haematological disorders with HLA matched donors were selected after pre-transplant workup. Ninety seven patients underwent the procedure. Most common indications for transplant were aplastic anaemia in n=34 (35%), followed by beta-Thalassemia major in n=21 (21.6%) and chronic myeloid leukemia in n=11 patients (11.3%). Primary graft failure present was present in 2.06%. Incidence of graft versus host disease (GvHD) in our patients was 34%. After median follow-up of five years the overall survival …