Medicine and Health Sciences Commons^™

A Simple Method To Reduce Infection Of Ventriculoperitoneal Shunts Clinical Article, Atiq-Ur Rehman, Tausif-Ur Rehman, Hassaan H. Bashir, Vikas Gupta

Department of Medicine

Object: Postoperative shunt infection is the most common and feared complication of ventriculoperitoneal (VP) shunt placement for treatment of hydrocephalus. The rate of shunt infection is highest in the 1st postoperative month. The most common organisms responsible for shunt infection include coagulase-negative Staphylococcus and Staphylococcus aureus. This suggests a transfer of Patient's skin flora via the surgeons' glove as a possible means of infection. The authors conducted a study to determine if the rate of postoperative shunt infections could be reduced simply by changing gloves before handling the shunt catheter. Methods: A total of 111 neonates born with congenital hydrocephalus …

What Are The Current Therapeutic Options For Haemorrhagic Strokes?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Controversies Of Treatment Modalities For Cerebral Venous Thrombosis, Maria Khan, Ayeesha Kamran Kamal, Mohammad Wasay

Department of Medicine

Cerebral vein thrombosis has been well recognized for nearly two centuries. However, therapeutic options for the condition are limited due to lack of large randomized trials. The various modalities reportedly used include antiplatelets, anticoagulation, fibrinolysis, and mechanical thrombectomy. Of these, antiplatelets are the least studied, and there are only anecdotal reports of aspirin use. Anticoagulation is the most widely used and accepted modality with favorable outcomes documented in two randomized controlled trials. Various fibrinolytic agents have also been tried. Local infusions have shown more promise compared to systemic agents. Similarly, mechanical thrombectomy has been used to augment the effects of …

Homozygous Frame Shift Mutation In Ecm1 Gene In Two Siblings With Lipoid Proteinosis., Azam J. Samdani, Abid Azhar, Syed M. Shahid, Syeda N. . Nawab, Rozeena Shaikh, Shah A. Qader, Qaisar Mansoor, Bahram K. Khoso, Muhammad Ismail

Department of Medicine

Background: The extracellular matrix protein 1 (ECM1) is a glycoprotein, expressed in skin and other tissues. Loss-of-function mutation in ECM1 causes a rare autosomal recessive disorder called lipoid proteinosis. Lipoid proteinosis is presented by varying degrees of skin scars, beaded papules along the eyelid margins, variable signs of hoarseness of voice and respiratory disorders. More than 250 cases of this disorder have been described in the literature, but occurrence of lipoid proteinosis in siblings is very rare. This study was designed to investigate the possible mutation causing lipoid proteinosis in a Pakistani family and to elaborate the scope of possible …

Acute Administration Of Rt-Pa For Acute Stroke In Pakistani Patients--What Does The Available Evidence Teach Us?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

What Is The Best First Agent To Give To A Patient With Acute Ischaemic Stroke? Aspirin, Heparin, Clopidogrel, Cilostazol Or Dipyridamole?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Molecular Studies Of Ichthyosis Vulgaris In Pakistani Families., Azam J. Samdani, Naghma Naz, Nuzhat Ahmed

Department of Medicine

Objective: To target and amplify a 1.5 kb FLG gene fragment known to carry R501X mutation responsible for causing ichthyosis vulgaris.

Study Design: A case series.

Place and Duration of Study: Centre for Molecular Genetics, University of Karachi and Dermatology Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from October 2007 to December 2008.

Methodology: Clinically examined seven ichthyosis vulgaris families were included in this study. The 1.5 kb FLG gene fragment was located in the genomic DNA of both the affected (patients) and unaffected (normal, controls) members of the families by PCR amplification using known primers FilF3 and RPTIP6.

Results: …

Antibiotic Susceptibility Patterns Of Helicobacter Pylori And Triple Therapy In A High-Prevalence Area, Javed Yakoob, Shahab Abid, Z. Abbas, S. N. W. Jafri

Department of Medicine

This study aims to determine primary Helicobacter pylori resistance and its effect on eradication of the organism. Ninety-two Patients with dyspeptic symptoms were enrolled. H. pylori was cultured and antibiotic sensitivity was determined by the Epsilometer test (Etest) for clarithromycin (CLR), amoxicillin (AMX) and metronidazole (MTR). 23S ribosomal RNA (rRNA) point mutations associated with clarithromycin resistance were also detected. Patients were treated with omeprazole (40 mg daily), CLR (500 mg) and AMX (1g twice a day) for 14 days. A (14)C-urea breath test ((14)C-UBT) was repeated four weeks after completion of treatment to confirm eradication. Triple therapy failure was seen …

What Is The Best Antiplatelet Agent For Prevention Of Recurrent Stroke In Pakistani Patients? Do Combinations Offer Significant Advantages In The South Asian Context?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Contrast-Induced Nephropathy In Patients Undergoing Percutaneous Coronary Intervention, Sajid H. Dhakam, Saqib A Gowani, Asif Jafferani, Sajid H Dhakam

Department of Medicine

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose Patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk Patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been …

How Should Physicians Practically Approach Symptomatic And Asymptomatic Carotid Stenosis?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

The Learners' Perspective On Internal Medicine Ward Rounds: A Cross-Sectional Study, M. Tariq, Afaq Motiwala, Syed Umer Ali, Mehmood Riaz, Safia Awan, Jaweed Akhter

Department of Medicine

Background: Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees' opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates. Methods: A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory …

Effects Of A Perindopril-Based Blood-Pressure-Lowering Regimen In Patients With Previous Stroke Or Transient Ischaemic Attack (Progress). How Do The Results Affect Practice In Pakistan?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Surgical Interventions For Malignant Middle Cerebral Infarction--Saving Lives And Functionality Or Increasing Disabled Survivors?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Severity Of Acute Hepatitis And Its Outcome In Patients With Dengue Fever In A Tertiary Care Hospital Karachi, Pakistan (South Asia), Om Parkash, Aysha Almas, Wasim Jafri, Saeed Hamid, J. Akhter, Syed H Shah

Department of Medicine

Background: Liver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC) and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications) between patients of Dengue who have mild/moderate (ALT 23-300 IU/L) v/s severe acute hepatitis (ALT > 300 IU/L).

Methods: A Cohort study of inpatients with dengue viral infection done at Aga Khan University Hospital Karachi. All patients (≥ 14 yrs age) admitted with diagnosis of Dengue …

Crimean-Congo Hemorrhagic Fever In A Dengue-Endemic Region: Lessons For The Future., Farheen Ali, Taimur Saleem, Umair Khalid, Syed Faisal Mahmood, Bushra Jamil

Department of Medicine

Crimean-Congo hemorrhagic fever and dengue hemorrhagic fever are endemic in Pakistan. However, the overlap of geographic distribution and early clinical features between the two conditions make a reliable diagnosis difficult in the initial stage of illness. A 16-year-old boy presented with a history of hematemesis and high-grade fever. A preliminary diagnosis of dengue hemorrhagic fever was made and supportive treatment was instituted; however, the patient continued to deteriorate clinically. Dengue IgM antibody testing was negative on the third day of admission. Qualitative polymerase chain reaction test for Crimean-Congo hemorrhagic fever viral RNA was sent but the patient expired shortly after …

Growing Burden Of Neurological Diseases In Pakistan � Need For A National Health Survey, Mohammad Wasay, Shaukat Ali

Department of Medicine

No abstract provided.

Qrs Duration And Echocardiographic Evidence Of Left Ventricular Dyssynchrony In Patients With Left Ventricular Systolic Dysfunction., Hafeez Ahmed, Javed Majid Tai, Sohail Abrar Khan, Muniza Yousuf

Department of Medicine

Objective: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.

Study Design: A cross-sectional study.

Place and Duration of Study: The Aga Khan University, Karachi, from June to September 2007.

Methodology: All patients with LVEF < 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer’s exact test was used to determine the association between QRS duration and left ventricular dyssynchrony.

Results: A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference …

Hepatitis D: Scenario In The Asia-Pacific Region, Z Abbas, Wasim Jafri, Sajjad Raza

Department of Medicine

Hepatitis D virus (HDV) infection is present worldwide and affects all age groups. Around 18 million people are estimated to be infected with HDV. An important trend in HDV infection is global decline. HDV prevalence has decreased significantly in Europe since the 1970s and 1980s when it was first reported. The Asia-Pacific region now seems to be where HDV is a major health concern. There is a lack of available data from most of the countries from this region, hence, the true status of HDV cannot be determined. In South Asia, most of the countries have conditions that are favorable …

Emergency Evaluation Of Acute Chest Pain., Aysha Almas, Om Parkash, Aamir Hameed, Muhammad Islam

Department of Medicine

Objective: To determine the sensitivity and specificity of initial clinical assessment about the diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain by a cardiology resident in the emergency room and assess the 30-day outcome of patients with ACS and non ACS.

Study Design: Cohort study.

Place and Duration of Study: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.

Methodology: A total of 202 patients, who presented to the emergency room with chest pain, were given an initial ECG and troponin check. Patients were assigned …

H1n1 2009 In Karachi: A Situational Analysis, Bushra Jamil, Syed Faisal Mahmood

Department of Medicine

No abstract provided.

Ischemic Stroke Care - Official Guidelines From The Pakistan Society Of Neurology, Ayeesha Kamran Kamal, Ahmed Itrat, Imama Naqvi, Maria Khan, Roomasa Channa, Ismail Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.

Variables Predictive Of Outcome In Patients With Acute Hypercapneic Respiratory Failure Treated With Noninvasive Ventilation., Nawal Salahuddin, Muhammad Irfan, Shereen Khan, Muhammad Naeem, Ahmad Suleman Haque, Shahid Javed Husain, Nisar Rao, Ali Bin Sarwar Zubairi, Javaid Khan

Department of Medicine

Objective: To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors.

Methods: This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of < 0.05 was considered statistically significant. Software used was SPSS 14.

Results: Total numbers of patients included were 119; 52.9% were males. Mean age was 63.4 ± 11.9 years. Overall Survival …

Future Prospects For The Utility Of Interferon Assays In Tuberculosis Diagnosis, Taimur Saleem, Madiha Syed, Bushra Jamil

Department of Medicine

No abstract provided.