Medicine and Health Sciences Commons^™

Menke's Kinky Hair Syndrome--A Rare Medical Condition., Yaseer Al-Bita, Azam J. Samdani, Tania Azam

Department of Medicine

The case of a 16-month-old boy is described who had typical clinical and radiological features and was proven biochemically to be a case of Menke's disease. Clinical manifestations began in the first few months with hypothermia, hypotonia, seizures and death occurring at the age of 18 months.

Characteristics Of Patients With Guillain Barre Syndrome At A Tertiary Care Centre In Pakistan, 1995-2003, Mohammad Yawar Yakoob, Aisha Rahman, Bushra Jamil, Nadir Ali Syed

Department of Medicine

Objective: To study the clinical presentation, hospital course and outcome of patients admitted with Guillain Barre Syndrome (GBS) to a tertiary care hospital in Karachi, Pakistan.
Methods: The charts of patients conforming to International Classification of Diseases (ICD) code 9.0, for GBS, from September 1995 to January 2003 were reviewed. Clinical data was recorded on a standardized questionnaire, which included patients' age, sex, antecedent events, neurological signs and symptoms and ventilation requirement. The hospital course was analyzed, including nosocomial infections, therapy given and the functional status of patients, using the Rankin scale (0-6). Standard SPSS 11.5 software (Windows) …

Autonomic Nervous System Dysfunction Predicts Poor Prognosis In Patients With Mild To Moderate Tetanus, Mohammad Wasay, Bhojo A. Khealani, Naasha Talati, Rohmah Shamsi, Nadir Ali Syed, Naseem Salahuddin

Department of Medicine

Background

Autonomic nervous system (ANS) dysfunction is present in up to one third of patients with tetanus. The prognostic value of ANS dysfunction is known in severe tetanus but its value is not well established in mild to moderate tetanus.

Methods

Medical records of all patients admitted with tetanus at two academic tertiary care centers in Karachi, Pakistan were reviewed. The demographic, clinical and laboratory data was recorded and analyzed. ANS dysfunction was defined as presence of labile or persistent hypertension or hypotension and sinus tachycardia, tachyarrythmia or bradycardia on EKG. Patients were divided into two groups based on presence …

Survival Of Patients Treated With Intra-Aortic Balloon Counterpulsation At A Tertiary Care Center In Pakistan - Patient Characteristics And Predictors Of In-Hospital Mortality., Fahim H. Jafary, Sohail A. Khan, Haresh Kumar, Numaan F. Malik, K. Kazmi, Sajid Dhakam, Azam Shafquat, Aamir Hameed, Javed Tai, Najaf Nadeem

Department of Medicine

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan.

METHODS: Hospital charts of 95 patients (mean age 58.8 (+/- 10.4) years; 78.9% male) undergoing IABC between 2000-2002 …

Cutaneous Manifestations Of Hyper-Ige Syndrome In Twins: A Case Report From Saudi Arabia., Azam J. Samdani, A. Tania

Department of Medicine

The hyper-IgE syndrome with recurrent infections is a rare immunodeficiency disorder characterized by very high levels of IgE in serum. It is inherited in most of the cases in a dominant fashion meaning that it can run in families with a high frequency. About 250 cases have been published in literature so far.

Bronchiolitis Obliterans Organizing Pneumonia Associated With Cytomegalovirus Infection In A Patient With Systemic Lupus Erythematosus., Muhammad Irfan, Ali Bin Sarwar Zubairi, S.J. Husain

Department of Medicine

No abstract provided.

Neurology In The 21st Century: Contemporary State Of Diagnostics And Therapeutics, Saad Shafqat, Mohammad Wasay

Department of Medicine

Although neurological disease has been recognized since antiquity, neurology as a systematic clinical discipline is less than 130 years old. Neurological practice has traditionally been constrained by the complexity of the human nervous system, which has been slow to yield its secrets. Over the last three decades, however, clinical neurology has been transformed in terms of both diagnostics and therapeutics and now marches in lockstep with the cutting edge of medicine. Efficacious treatments are now available for the majority of neurological diseases, including epilepsy, migraine, Guillain-Barre syndrome, Parkinson's disease, multiple sclerosis, and ischemic stroke. This neurological revolution has been enabled …

Pregnancy Dermatoses: A Three-Year Study, Azam J. Samdani

Department of Medicine

Objective: To determine the percentage occurrence, clinical features and the age distribution of pregnancy-related dermatoses in pregnant females who were referred from Maternity Hospital Makkah to dermatology department for management at King Abdul Aziz Hospital, Makkah, Saudi-Arabia.

Methods: Patients who attended the dermatology clinic at King Abdul Aziz Hospital, Makkah were examined clinically and appropriate laboratory evaluation was done to facilitate diagnosis. These cases were managed till the termination of pregnancy and 10 weeks follow up in the puerperium. This study lasted for a period of 03 calendar years.

Results: A total of 47 females were seen, with polymorphic …

Hepatic Steatosis And Hepatitis C., Faisal Wasim Ismail, Saeed Hamid

Department of Medicine

No abstract provided.

Motor Neuronopathy Associated With Adenocarcinoma Of Esophagus, Bhojo A Khealani, R. Qureshi, Mohammad Wasay

Department of Medicine

Neurologic paraneoplastic syndromes (NPS) are remote neurologic effects, except metastasis, of systemic cancers. These are a rare group of disorders, commonly associated with small cell lung carcinoma (SCLC).1 Various NPS have been described, including motor neuronopathy. The motor neuronopathy has commonly been described with small cell carcinoma of lung, breast cancer and lymphoproliferative disorders.2,3 We report a case of motor neuronopathy in association with large cell adenocarcinoma of esophagus. To our knowledge this is the first reported case of motor neuronopathy associated with adenocarcinoma of the esophagus.

Prognostic Indicators In Patients With Intracranial Tuberculoma: A Review Of 102 Cases, Mohammad Wasay, M. K. Moolani, J. Zaheer, Bhojo A. Khealani, R. A. Smego, A. R. Sarwari

Department of Medicine

Objective:

To see the characteristics, course and outcome of patients suffering from intracranial tuberculoma.

Methods:

Retrospective review of 102 patients diagnosed as intracranial tuberculoma at a tertiary care center over 10 years.

Results:

A total of 102 cases were seen with an age range of 1 to 75 years (mean, 30 years). Predisposing factors included Diabetes mellitus (8 patients) and pregnancy or puerperium (7 patients). Five pediatric patients had tuberculoma despite documented BCG vaccination. Fever (59%), headache (57%), meningeal irritation (36%) were the commonest presenting features; one-third of patients were drowsy or comatosed at presentation. Cerebrospinal fluid analysis was performed …

Banti's Syndrome: Case Report And Review Of Literature., Waqar, S.N., S. Jindhani, N. S. . Baig, M. A. Waqar, Faisal Wasim Ismail, Muhammad Tariq

Department of Medicine

No abstract provided.

Boerhaave's Syndrome: A Diagnostic Dilemma In The Emergency Room, Ab Zubairi, I Khalid, Saulat H. Fatimi, J Hussain, N Salahuddin

Department of Medicine

Boerhaave's syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations. All clinicians need to be aware of this lethal disease, its frequent unusual presentations and the importance of early diagnosis.

Ischemic Stroke Subtypes In Pakistan: The Aga Khan University Stroke Data Bank, N. A. Syed, B. A. Khealani, S. Ali, A. Hasan, H. Brohi, T. Mozaffar, N. Ahmed, A. Hameed, S. M. Baig, M. Wasay

Department of Medicine

Objective: Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital.

Methods: We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi.

Results: A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 …

Spectrum Of Complications And Mortality Of Bacterial Meningitis: An Experience From A Developing Country, M. A. Rabbani, A. A. Khan, S. S. Ali, B. Ahmad, Mohammad Asim Beg, M. A. Khan, Mohammad Wasay

Department of Medicine

Objective:

The aim of this study was to obtain data on predisposing factors, causative organisms and their associated mortality and complications related to acute bacterial meningitis.

Methods:

The chart review of all patients in whom acute bacterial meningitis was diagnosed at The Aga Khan University Hospital from January 1995 through December 2001.

Results:

One hundred ninety-four patients were included in study. There were 146 males and 48 females. The mean age of our study population was 41±12.3 years. One hundred and ninety (97.9%) patients had community acquired meningitis; only 4 (2.0%) patients developed meningitis nosocomially. The two most common predisposing …

Neurological Care In Pakistan: Actions Are Needed, M. Wasay

Department of Medicine

No abstract provided.

Should Carotid Endarterectomy Be Performed For Symptomatic Carotid Stenosis Pakistan?, N. A. Syed, A. Zakaria, B. A. Khealani, M. Wasay, S. M. Baig, Z. Sophie

Department of Medicine

Objective: The risk of stroke and death associated with carotid endarterctomy is operator dependant. Data regarding risks of this procedure are not available in Pakistan and therefore it is difficult to make accurate risk benefit analysis for individual patients. Our objective was to determine safety of carotid endarterectomy at an academic tertiary care center in Pakistan.

Methods: Patients who underwent carotid endarterectomy (CEA) at our hospital during a ten-year period were identified through ICD-9 coding system of the hospital medical records. Demographic features. associated medical problems and immediate postoperative complications were recorded and analyzed.

Results: Sixty-three carotid endarterectomies were performed …

The Effect Of Proteinases (Keratinases) In The Pathogenesis Of Dermatophyte Infection Using Scanning Electron Microscope, Azam J. Samdani, Yaseer Al-Bitar

Department of Medicine

Objective: To study the inter-relationship between the stratum corneum of host and the fungal microorganisms using scanning electron microscopy for a complete understanding of the host parasite relationship.

Setting: The patients attended the outpatients of Department of Dermatology, King Abdul Aziz Hospital Makkah. The isolation & identification was carried out at the Department of Mycology University Hospital of Wales, Cardiff, U.K.

Material and Methods: Skin surface biopsies were obtained from two patients suffering from tinea cruris infection. One patient was infected with Trichophyton rubrum and the other with Epidermophyton floccosum strains.

Results: The scanning electron microphotographs obtained from two patients …

Current Treatments Of Vitiligo, Azam J. Samdani

Department of Medicine

No abstract provided.

Abscesses In The Liver: Amoebic Or Pyogenic?, Bushra Jamil, Saeed Hamid

Department of Medicine

No abstract provided.

Development And Testing Of An Assessment Tool For Integrated Learning, Z. Naqvi, R. Ahmed, Bushra Jamil

Department of Medicine

Objective: Development of integrated questions for undergraduate medical students and assessing students’ capability to retain and apply basic concepts in an integrated way.
Method: Multiple choice questions, attempting to probe understanding and application of different concepts, affiliated with different subjects and topics, were developed. As a pilot these were administered to the students of third year and final year at the end of their certifying examinations as a mock test. The following year these questions were introduced in the continuous assessments and subsequently the certifying examinations (in third year) as 33% of the whole examination. Difficult indices, item analysis and …

The Spectrum Of Bacterial Infections In Febrile Neutropenic Patients: Effect On Empiric Antibiotic Therapy, Ikram A. Burney, Tariq Siddiqui, Badar J. Farooqui, Mohammad Khurshid

Department of Medicine

The aim of this retrospective analysis was to look at the spectrum of bacterial isolates and their resistance patterns to the commonly used antIbiotics in the settmg of febrile neutropenia. A total of 127 bacteria were isolated from patients with acute leukemias, lymphoproliferative disorders, aplastic anaemia and various solid tumours. Fifty-four percent organisms were gram negative; while the rest were gram positive. E. coli, pseudomónas aeruginosa, staphylococcus aureus, enterococcus and streptococci were the commonly isolated organisms. Forty-eight percent organisms were isolated from blood, 16% from urine, 13% from wounds and superficial abscesses and 11% from respiratory tract. E. coli exhibited …

Thrombolytic Therapy In Acute Myocardial Infarction In Pakistan., M. Asad Karim, Ata Ata-Ur- Rehman Qureshi, Syed Faisal Mahmood, J. Akhter

Department of Medicine

To characterize features of acute myocardial infarction (AMI) in a Pakistani population, and assess the role of thrombolysis in our country, we studied 194 consecutive admitted patients with enzyme positive AMI. Males were affected three times more frequently; women, although affected less, had a higher incidence of complications than men. Premature coronary artery disease (CAD) was present in 50% patients presenting with AMI. An unusually high incidence of anterior wall myocardial infarction (39%) was seen. Complications were frequent with a predominance of LV failure symptoms. Cardiogenic shock was associated with a very high mortality, in excess of 93%. Streptokinase (SK) …

Severe Thrombocytopenia In A Man With Prostatic Cancer, Saeed Hamid, Ata Khan, Haleem Khan, Roger Sutton, Ikram A. Burney, Mohammad Khurshid

Department of Medicine

A 66 year old gentleman was diagnosed to have metastatic adenocarcinoma of the prostate in 1990, following a CT scan of the abdomen and trans-uretheral resection of prostate (TLJRP). He was started on estrogen therapy (Fos­festerol sodium). Two years later he presented to the emer­gency room with breathlessness and edema of the left ann of a week’s duration. He admitted to persistence of symptoms of pmstatism and was found to have bilateral axillary lymphade­nopathy and pitting edema of the left arm. A doppler scan revealed left subclavian vein thrombosis. The patient was started on i.v. heparin and was maintained on …

Pneumonia Caused By Nocardia Caviae In A Healthy Neonate, Perween Mufti, Bushra Jamil

Department of Medicine

Nocardia infections have been associated with patients of Aids, chronic granulomatous disease, recipient of organ transplant and malignancy Pulmonary nocardiosis in neo­nates is an unusual infection. A case of neonatal pulmonary nocardiosis mimicking miliaiy tuberculosis has been reported in the past. We report another case of pulmonary nocardiosis in a neonate presenting as consolidation with pleural effusion and cavitation.

Prognostic Factors In Ganglionic And Thalamic Haemorrhages: A Clinical And Radiological Study., Aziz Sonawalla, Z Abbas, Mohammed Ataullah Khan

Department of Medicine

Clinical and radiological features of 43 patients admitted for ganglionic (21) and thalamic (22) haemorrhages were studied to ascertain the factors that would determine prognosis in the acute stage of the illness. Nineteen patients died, 16 of them in the first week. The adverse clinical factors were an altered state of consciousness, decorticate/decerebrate posturing, ataxic respiration, abnormalities of gaze and presence of bilateral Babinski's sign. Adverse radiological factors were the presence of thalamic haemorrhage of 3 cm or more, intraventricular spread of the haemorrhage and midline shift of 0.5 cm of more. The significance of these findings is discussed.

Radiation Induced Tumor Lysis Syndrome In Patients With Leukemia, Imtiaz A. Malik, Paul Vellozo, Mohammad Khurshid, M. Ata Khan

Department of Medicine

Tumour lysis syndrome is a catastrophic complica­lion of treatment of certain neoplasms. It is usually seen with the tumours that have high growth fractions, increased bulk and extreme sensitivity to cytotoxic therapy. Most commonly it occurs in association with hematologic malignancies such as lymphomas and leukaemias. Rarely it has been observed with solid tumours like small cell lung cancer, seminoma and carcinoma of the breast. The syndrome develops due to massive cell lysis occurring within a few hours to a few days of starting the cytotoxic therapy. It is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcaemia. Acute renal failure, cardiac …

Serum Cholesterol In Neonates And Their Mothers. A Pilot Study, S.H. Badruddin, R. Lalani, Mohammad Khurshid, A. Molla, R. Qureshi, M.A. Khan

Department of Medicine

Reports from the Aga Khan University indicate that 58% of 400 school children studied had undesirably high serum cholesterol levels. The present study was undertaken to determine whether the high cholesterol levels are present at birth and to determine the relationship between cord blood, maternal blood cholesterol and maternal diet. Cord blood from 58 neonates and fasting venous blood form 45 mothers were analyzed for total serum cholesterol. Mothers were interviewed regarding their usual diet during pregnancy. Mean cord blood cholesterol was 56.90 mg/dl (range 26 to 123 mg/dI). Mean maternal blood cholesterol was 232.4mg/dl (range 141-382 mg/dl). Mean maternal …