Medicine and Health Sciences Commons^™

Labrad : Vol 41, Issue 3 - December 2015, Aga Khan University Hospital, Karachi

LABRAD

• Overview on Approach to Inherited Bleeding Disorders
• Diagnostic Approach to Haemoglobinopathies
• Transient Abnormal Myelopoiesis
• Urinary Tract Infections (UTI) in Children
• Role of Histopathology in the Diagnosis of Paediatric Renal Tumours
• Role of Histopathology in the Diagnosis of Paediatric Bone and Soft Tissue Small Round Cell Tumours
• Evaluation of Inborn Errors of Metabolism (IEM) In a Nutshell
• An Update on Blood Lead Levels in Children
• Clinical Utility of Immature Platelet Fraction – An advanced 25 Parameter in Laboratory Hematology
• Meeting Report: “Les Confluences” The Society for the Study 30 of Inborn errors of Metabolism (SSIEM) Annual Symposium 2015 in Lyon, France

Effective Communication Of Critical Radiology Results: The Implementation Of Panic Alert Mechanism, Mumtaz Malik, Sidrah Nausheen

Department of Radiology

Objective: To establish an effective channel of timely communication of life-threatening emergencies to primary physicians by radiology team.Methods: The observational study was conducted at Aga Khan Hospital for Women and Children, Kharadar, Karachi. Data was collected from the log book from July 2012 to June 2013.Amultidisciplinary "Panic Alert" protocol was formulated and implemented in the Radiology unit. All radiological examinations were screened as soon as possible and panic alerts [provisional findings] were communicated to their primary care taker/relevant nursing staff, attendants within 30 minutes from the time of completion of examination. Complete log was maintained. Data was analysed on SPSS …

Frequency And Severity Of Acute Toxicity Of Pelvic Radiotherapy For Gynecological Cancer, Asim Hafiz, Ahmed Nadeem Abbasi, Nasir Ali, Khurshid Ahmed Khan, Bilal Mazhar Qureshi

Department of Radiation Oncology

Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer.STUDY Design: A case series.PLACE AND DURATION OF STUDY: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012.METHODOLOGY: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapys side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at …

Accreditation Of Healthcare Facilities: A Friend Or Foe?, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

The Specificity And Sensitivity Of Ultrasonography In The Diagnosis Of Acute Right Lower Quadrant Pain In Women Of Child Bearing Age, Shumaila Arooj, Arfanul Haq, Zafar Amin

Department of Radiology

Abstract

OBJECTIVE:

To assess the sensitivity and specificity of ultrasonography in differentiating causes of acute right lower quadrant pain in women of child-bearing age by taking surgical outcome as the gold standard.

METHODS:

The descriptive analytical study was conducted at PNS Shifa Hospital, Karachi, from July to December 2008, and comprised female patients of child-bearing age who presented with acute right lower quadrant pain and underwent surgery after ultrasonography. SPSS 10 was used for statistical analysis.

RESULTS:

Of the 75 patients, 54(72%) patients were symptomatically and sonographically positive to have either acutely inflamed non-compressible appendix or focal fluid collection in …

Targeted Ultrasound Of An Indeterminate Breast Lesion On Mammography: When Does It Influence Management?, Saba Sohail, Imrana Masroor, Shaista Afzal

Department of Radiology

Objective: To determine the change over mammographic diagnosis, BI-RADS category and management following targeted ultrasound of an indeterminate lesion seen on mammography and associated factors, if any.
Study design: Descriptive, analytical study.
Place and duration of study: Radiology Department, The Aga Khan University Hospital and Clifton Medical Services, Karachi, from April 2010 to May 2011.
Methodology: Patients referred for targeted breast ultrasound following X-ray mammography were selected regardless of age. Targeted Ultrasound (TUS) was defined as a limited ultrasound of a specific lesion or breast part as indicated by the referring source. Comparison was made between the post mammography and …

Labrad : Vol 41, Issue 2 - July 2015, Aga Khan Universiity Hospital, Karachi

LABRAD

• An Overview of Immunoglobulin G4-Related Disease
• Plasma Neutrophil Gelatinase Associated Lipocalin (NGAL) a Marker of Acute Kidney Injury
• Celiac Disease: Biomarkers for Diagnosis and Monitoring
• Pathophysiology of Paroxysmal Nocturnal Haemoglobinuria and Diagnosis by Flowcytommetry
• Pathological Changes in Renal Transplant Biopsies not Related to Allo-Immune Mechanisms
• Myelodysplastic Syndromes
• Fluorescent Optical Method for Platelet Estimation: An Advanced Clinical Parameter in Laboratory Hematology
• Introduction of Beta-D-Glucan and Galactomannan - Testing for Diagnosis of Invasive Fungal Infections
• Basic Concepts in Hematopoietic Stem Cell Transplantation

Thyroxine Replacement In Patients On Parenteral Nutrition: A Clinical Conundrum, Abdul Rehman, Noor Ul-Ain Baloch, Muhammad Awais

Department of Biological & Biomedical Sciences

No abstract provided.

Ultrasound Evaluation Of Umbilical Coiling Index In Second Trimester Of Gestation And Its Association With Small For Gestational Age Status At Birth, Josephine Mwikali Ndolo

Theses & Dissertations

Introduction: The degree of coiling of the umbilical cord, referred to as umbilical coiling index, has been shown to have an effect on perinatal adverse outcomes such as small for gestational age neonates, interventional delivery, meconium staining, low fetal pH and low Apgar score. This study proposes that the antenatal umbilical coiling index performed in the second trimester of pregnancy has a correlation with the gestation-specific birth weight and can therefore be used as a marker to predict small for gestational age neonates.

Objective: To determine the association between antenatal umbilical coiling index (aUCI) in the second trimester and small …

Prevalence Of Suspicious Ultrasound Findings In Patients With Mammographic Focal Asymmetry At Aga Khan University Hospital, Nairobi, Jacqueline Ndunge Mavuti

Theses & Dissertations

Background: Breast cancer has become the leading cancer in women in both economically developed and developing countries, accounting for 25% of all cancers diagnosed worldwide in 2012. The cornerstone of breast cancer control remains early detection in order to improve outcomes and survival. Thus far the only breast cancer screening method that has proved to be effective is mammography. Although mammography is the mainstay of early detection, a fundamental limitation is its low inherent contrast difference between the soft tissue structures in the breast. Mammographic specificity relies on the ability to distinguish benign from malignant breast lesions based on their …

Comparison Of Quantitative Analysis To Qualitative Analysis For Interpretation Of Lower Limb Lymphoscintigraphy, Edward Chege Nganga

Theses & Dissertations

Background: Lymphoscintigraphy is now the primary imaging modality used in determining a diagnosis in patients with suspected extremity lymphedema. However, analysis is mainly by visual qualitative analysis which is subjective and has a wide inter-observer variability. Subtle differences in ilioinguinal uptake between normal and abnormal limbs may be missed with visual qualitative analysis. This study seeks to compare quantitative analysis to qualitative analysis by computing percentage ilioinguinal nodes uptake at 1.5 hours.

Objectives: To compare quantitative analysis to qualitative analysis of lower limb lymphoscintigraphy in the diagnosis of lymphedema.

To determine the diagnostic accuracy of quantitative lymphoscintigraphy analysis.

Methodology: 52 …

Labrad : Vol 41, Issue 1 - March 2015, Aga Khan University Hospital, Karachi

LABRAD

• An Overview of Proficiency Testing
• Sources of Pre-analytical Variations
• Five Q-Framework for Implementing Total Quality Management in Laboratory
• Delta Check in Clinical Laboratory
• Indicators of Quality Improvement in Surgical Pathology
• Types of Analytical Errors
• Method Validation for Quantitative Tests: CAP Recommendations
• Levey Jenning Chart and a Guide to Use Westgard Rules
• Quality Control of Vitek-2 System
• Establishing Quality Control Values for Haematology Parameters

The Artificial Divide Between Biomedical Sciences And Clinical Medicine In Undergraduate Medical Education, Abdul Rehman, Noor Ul-Ain Baloch, Muhammad Awais

Department of Biological & Biomedical Sciences

No abstract provided.

Pseudo-Thyroid Lobe: A Diagnostic Conundrum Caused By Ossified Anterior Longitudinal Ligament On Bone Scan, Maseeh Uz Zaman, Nosheen Fatima, Zafar Sajjad, Unaiza Zaman, Areeba Zaman, Rabia Tahseen

Department of Radiology

Radionuclide bone imaging is one of the most commonly performed nuclear medicine procedure around the world and characterized by its high sensitivity and relatively low specificity. False positive findings on a bone scan are very common; however, dense uptake over unilateral ossified anterior longitudinal ligament appearing as single thyroid lobe on a bone scan has not been described in the literature.

Outcome And Cost Effectiveness Of Autobiographically Guided Surgical Clip Placement For Tumor Localization In Patients Undergoing Neo-Adjuvant Chemotherapy For Breast Cancer., Imrana Masroor, Sana Zeeshan, Shaista Afzal Saeed, Saira Naz, Madeeha Ali, Khabir Ahmad, Shaista Khan

Department of Surgery

Abstract

BACKGROUND:

To determine the outcome and cost saving by placing ultrasound guided surgical clips for tumor localization in patientsundergoing neo-adjuvant chemotherapy for breast cancer.

MATERIALS AND METHODS:

This retrospective cross sectional analytical study was conducted at the Department of Diagnostic Radiology, Aga Khan University Hospital, Karachi, Pakistan from January to December 2014. A sample of 25 women fulfilling our selection criteria was taken. All patients came to our department for ultrasound guided core biopsy of suspicious breast lesions and clip placement in the index lesion prior to neo-adjuvant chemotherapy. All the selected patients had biopsy proven breast cancer.

RESULTS: …

Metastatic Pancreatic Carcinoma And Experience With Folfirinox - A Cross Sectional Analysis From A Developing Country, Muhammad Nauman Zahir, Adnan Abdul Jabbar

Department of Radiation Oncology

Background: Pancreatic cancer is the fourth leading cause of cancer related death with median survival ranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatment in advanced stage and has evolved over time. Data pertaining to the disease are scarce from our part of the world where treatment poses a significant challenge due to lack of resources.MATERIALS AND Methods: A retrospective chart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary care hospital in Karachi, Pakistan between January 2008 and December 2012. Data were collected using a …

Plasmablastic Lymphoma Of The Oral Cavity With Breast Recurrence: A Case Report, Zarka Samoon, Romana Idrees, Nehal Masood, Tayyaba Zehra Ansari

Department of Radiation Oncology

Background: Plasmablastic lymphoma is an aggressive variant of diffuse large B cell lymphoma, mostly found in the oral cavity and associated with human immunodeficiency virus. There are no clear guidelines for its treatment. Therapies more intensive than cyclophosphamide, doxorubicin, vincristine, and prednisone are not associated with a prolonged survival. Lymphomas of the breast are rare, in one series representing 0.14% of all female breast malignancies, with diffuse large B cell lymphoma comprising up to 55% of all cases. Only one case of plasmablastic lymphoma involving the breast has been reported in the literature.CASE PRESENTATION: A 30 year old Pakistani woman, …

Temporal Trends In Results Of 9170 Myocardial Perfusion Imaging Studies (2004 To 2013)., Nosheen Fatima

Department of Surgery

Abstract

BACKGROUND:

To assess the frequency of normal and abnormal myocardial perfusion imaging (MPI) in a consecutive cohort of patients from Pakistan over a period of 8.5 years.

MATERIAL AND METHODS:

We assessed 9170 patients who had undergone stress-rest MPI between January 2004 and June 2013. Patients were assessed for change in demographics, risk factors, and frequency of abnormal and normal MPI.

RESULTS:

Overall mean age and male predominance of studied cohort was ≈ 55 years and ≈ 55:45 (M:F), respectively, with no appreciable decline or rise. Marked decline in exercise as mode of stress (from 71% to 35%, p …

Evaluation Of Common Risk Factors For Breast Carcinoma In Females: A Hospital Based Study In Karachi, Pakistan, Saira Naz Sufian, Imrana Masroor, Waseem Mirza, Sehrish Butt, Shaista Afzal, Zafar Sajjad

Department of Radiology

Background: Breast malignancies are one of the leading causes of deaths in females worldwide. There are a number of risk factors associated with breast cancer but in Karachi Pakistan there are insufficient data available.MATERIALS AND Methods: A case control study was conducted on females in age group between 30-80 years. This study was accomplished by retrospective data collection in Aga Khan University Hospital Karachi, Pakistan. A total of 108 females with primary malignancy of breast were included along with 108 matched controls. Relationship of various factors with disease was studied using logistic regression to calculate odds ratios with 95 % …

Comparison Of Microcoils And Polyvinyl Alcohol Particles In Selective Microcatheter Angioembolization Of Non Variceal Acute Gastrointestinal Hemorrhage, Tanveer-Ul-Haq, Muhammad Idris, Basit Salam, Waseem Akhtar, Yasir Jamil

Department of Radiology

Objectives: To compare the efficacy of polyvinyl alcohol (PVA) particles with microcoils in angiembolisation of non variceal acute gastrointestinal haemorrhage.Methods: This is a retrospective cross-sectional study of patients who underwent transcatheter angioembolization from January, 1995 to December, 2013 at Aga Khan University Hospital, Karachi. Patients were divided into two groups on basis of use of either microcoils or PVA particles and compared in terms of technical success, clinical success, re-bleeding and ischemic complication rates. Chi (chi(2)) square and Fisher's exact tests were applied and a P-value of less than 0.05 was considered statistically significant.Results: Fifty seven patients underwent angioembolization. Microcoil …

Uterine Fibroid Embolization For Symptomatic Fibroids: Study At A Teaching Hospital In Kenya, John Mutai, Sudhir Vinayak, William Stones, Nigel Hacking, Charles Mariara

Imaging & Diagnostic Radiology, East Africa

Objective: Characterization of magnetic (MRI) features in women undergoing uterine fibroid embolization (UFE) and identification of clinical correlates in an African population.

Materials and Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short-term imaging outcome, and mid-term symptom scores were analyzed for interval changes. Assessment of potential associations between short-term imaging features and mid-term symptom scores was also done.

Results: UFE resulted in statistically significant reduction (P < 0.001) of dominant fibroid, uterine volumes, and reduction of symptom severity scores, which were 43.7%, 40.1%, and 37.8%, respectively. Also, 59% of respondents had more than 10 fibroids. The predominant location of the dominant fibroid was intramural. No statistically significant association was found between clinical and radiological outcome.

Conclusion: The response of uterine fibroids to embolization in the African population is not different …

Fortifying The External Peer Review: An Editorial Perspective, Saba Sohail

Department of Radiology

No abstract provided.

Diagnostic Performance Of Breast Mri In The Evaluation Of Contralateral Breast In Patients With Diagnosed Breast Cancer, Shaista Afzal Saeed, Imrana Masroor, Madiha Beg, Romana Idress

Department of Radiology

AIMS: The purpose of our study was to evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in the evaluation of contralateral breast in patients with diagnosed breast cancer. A secondary objective was to determine accuracy of breast MRI in diagnosing multi-focal and multicentric lesions in the ipsilateral breast.MATERIALS AND Methods: Using a non-probability convenience sampling technique, patients with histopathologically diagnosed breast cancer with MRI of breast performed to exclude additional lesions were included. MRI findings were correlated with histopathology. In addition, follow-up imaging with mammography and ultrasound was also assessed for establishing stability of negative findings and for …

Fibrodysplasia Ossificans Progressiva Misdiagnosed As Cervical Exostosis, Muhammad Awais, Abdul Rehman, Noor Ul-Ain Baloch

Department of Radiology

No abstract provided.

Management Of Radioactive Spills In Nuclear Medicine; Teaching And Assessing With Objectively Structured Assessment Of Technical Skills, Riffat Parveen Hussain

Department of Radiology

Routine work in nuclear medicine requires the careful elution of radioactivity and its subsequent, storage and handling. Though all effort is maintained to prevent any "spill" of this radioactivity, accidents are bound to happen. The response to this spill is a methodically worked out a plan that is written and adopted as a "standard operating procedure." This protocol is taught to all involved in the area of working as a mock drill/apprenticeship model. No formal evaluation of learning is in place except for the mock drills. The objectively structured assessment of technical skills (OSATS) is a variation on the Objective …