Medicine and Health Sciences Commons^™

Angiokeratoma Of Tongue:A Series Of 14 Cases, Nausheen Yaqoob, Aamir Ahsan, Zubair Ahmed, Akhter Husain, Rashid Ahmed, Naila Kayani, Shahid Pervez, Sheema Hassan

Department of Pathology and Laboratory Medicine

Angiokeratomas (AC) are vascular lesions which are defined histologically as one or more dilated blood vessels lying directly subepidermal and showing an epidermal proliferative reaction with ectatic capillaries in the papillary dermis. Only three other cases of isolated mucosal angiokeratoma have been reported in the indexed literature. We reviewed all cases of angiokeratoma located on the tongue, diagnosed in our department during a study period of 10 years (1995-2005). Histologically all 14 cases showed dilated and congested blood vessels in the upper papillary dermis. They lack deep dermal involvement. Hyperkeratosis and acanthosis were also seen in most of the cases. …

Bronchoscopic Study On Aetiology Of Chronic Cough In Hiv-Infected Adults With Negative Sputum Smears For Mycobacterium Tuberculosis At Kenyatta National Hospital, Nairobi, A. M. Siika, J. M. Chakaya, Gunturu Revathi, S. S. Mohamed, K.M .. Bhatt

Pathology, East Africa

Objective: To establish the aetiology of chronic cough in HIV-infected patients with negative sputum smears for Acid Fast Bacilli (AFB).

Design: A cross-sectional descriptive study.

Setting: Kenyatta National Hospital, a tertiary referral centre in Kenya

Subjects: Sixty five HIV-infected adults presenting with chronic cough and negative sputum smears for AFBs.

Results: Sixty-two patients were included in the final analysis. Aetiology of chronic cough was established in 42 (68%) patients. Pneumocystis jiroveci, bacterial pneumonia and Mycobacterium tuberculosis were diagnosed in 22 (35.5%),17 (27.4%) and 14 (22.5%) patients respectively. Majority (98%) of patients with a diagnosis had multiple causes established …

Evaluation Of Erectile Dysfunction With Color Doppler Sonography, Vaqar Bari, M Nadeem Ahmed, M Zafar Rafique, Kashif Ashraf, Waseem Ahmad Memon, M Uzair Usman

Department of Radiology

Objective: To assess the role of Color Doppler Sonography in the evaluation of erectile dysfunction.Methods: A cross-sectional study was conducted at the Radiology Department, Aga Khan University Hospital Karachi from 5-6-2002 to 2-9-2003. All consecutive patients presenting with erectile dysfunction and undergoing penile color Doppler evaluation with injection PGE1 20 mcg were included in this study.Results: A total of 70 patients with an age range of 24-70 years (mean 41 +/- 12.25 years) were included in the study. A normal response was noted in 45 (psychogenic) cases. Vasculogenic causes were observed in 23 patients, 12 with arterial insufficiency and 11 …

Abdominal Pain With Rigidity Secondary To The Anti-Emetic Drug Metoclopramide, Nadeem Ullah Khan, Junaid A. Razzak

Department of Emergency Medicine

We report a case of abdominal pain with rigidity, mimicking an acute abdomen, caused by metoclopramide, a common anti-emetic drug. Extrapyramidal symptoms are commonly reported side-effects of this medication. They generally include involuntary movements of limbs, torticollis, oculogyric crisis, rhythmic protrusion of tongue, trismus, or dystonic reactions resembling tetanus, etc. Abdominal rigidity due to this medication, resembling an acute abdomen, has not been reported previously. This case report illustrates the importance of considering medication side-effects when evaluating a patient with abdominal pain and rigidity.

Frequency Of Nsaid Induced Peptic Ulcer Disease, Saeed Hamid, Javed Yakoob, Wasim Jafri, Shanul Islam, Shahab Abid, Muhammad Islam

Section of Gastroenterology

Objective:

To determine the frequency of peptic ulcer disease in patients on nonsteroidal anti-inflammatory drugs (NSAID).

Methods:

Record of eight hundred and twenty consecutive patients undergoing upper gastrointestinal (GI) endoscopy; from January 1998 to December 2000 were reviewed. The endoscopic diagnosis varied from gastritis, peptic ulcer to duodenitis. The use of NSAID was documented by reviewing medical records of patients with peptic ulcer.

Results:

Peptic ulcers were found in 43% (353/820) patients. NSAID associated peptic ulcers were identified in 14.7% (52/353) patients. Diclofenac and aspirin were most common NSAIDs associated with peptic ulcers in 32.7% (17/52) and 30.7% (16/52) patients, …

Do Clinical Manifestations Of Systemic Lupus Erythematosus In Pakistan Correlate With Rest Of Asia?, Malik Anas Rabbani, Bilal Karim Siddiqui, Muhammad Hammad Tahir, Bushra Ahmad, A Shamim, Shahid Majid, Syed Sohail Ali, Syed Mansoor Ahmed Shah, Aasim Ahmad

Section of Nephrology

Objective: Systemic Lupus Erythematosus (SLE) is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data.Methods: Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University …

Hypertension And Kidney Disease In Asia, Tazeen H. Jafar

Section of Nephrology

PURPOSE OF REVIEW: Communicable diseases were traditionally the major cause of public health concern in Asian countries, most of which were less developed. With industrialization and associated lifestyle changes during the past few decades, however, noncommunicable diseases similar to those that affect Western societies have emerged in Asian countries. The purpose of the review was to examine recent evidence about the burden and factors associated with hypertension and chronic kidney disease (CKD) in Asian countries.RECENT FINDINGS: Hypertension has become one of the leading causes of mortality in Asia. Although its prevalence continues to rise, it remains under-diagnosed and under-treated. CKD …

Foreign Body Aspiration In Adults., Ali Bin Sarwar Zubairi, Haque A. S, Husain S. J, Javaid Khan

Department of Medicine

Foreign body aspiration is not an uncommon problem, particularly in children, the elderly, and those with predisposing factors like neurological impairment. In adults, regional differences exist in the type of foreign body aspirated. We report four cases of foreign body aspiration in South Asian adults, three of which were related to the widespread habit of chewing stimulant seeds such as betel nuts (two) and tamarind seed (one). It is important for clinicians to maintain a high index of suspicion for the diagnosis of foreign body inhalation in the appropriate clinical setting. Bronchoscopy is necessary not only for the diagnosis but …

Berneese Periacetabular Osteotomy For Residual Hip Dysplasia In Adults - A Case Report And Review Of Literature, Izhar Kashif, Masood Umer, Haroon Rashid

Department of Surgery

Abstract

Pelvic osteotomy for acetabular dysplasia has been introduced to improve acetabular coverage of the femoral head and reduce the risk of secondary osteoarthrosis. Several surgical methods for acetabular reorientation have been proposed for this purpose by reorientation of the acetabulum single, double, triple, spherical and periacetabular osteotomies. We report our first experience with periacetabulur berneese osteotomy described by Prof. R. Ganz and now the procedure of choice in appropriately selected patients. Fifteen years old boy who presented with complaints of fall and pain in the right gluteal region for 5 days duration that increased with walking. Examination revealed an …

Ms In Asian Countries, M Wasay, I A. Khatri, B Khealani, M Sheerani

Section of Neurology

This paper reviews all available English language literature on MS from Asian countries published between 1970 and 2005. Although limited data are available, the review reveals that western Asia--including the Middle East--has the highest prevalence of MS across the continent, and that MS in Asia largely resembles conventional MS in western countries. Opticospinal MS (a distinct clinical entity from conventional MS) is more common in eastern Asian regions. Larger epidemiological and genetic studies, with more complete ascertainment in various Asian populations, are needed so that we can understand the diversity of Asian MS.

Knowledge, Attitude And Misconceptions Regarding Tuberculosis In Pakistani Patients, Javaid Ahmed Khan, Muhammad Irfan, Amna Zaki, Madiha Beg, Syed Fayyaz Hussain, Nadeem Rizvi

Section of Pulmonary & Critical Care

Objective:

To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB.

Methods:

A cross sectional study was conducted at Out-patient clinics of two teaching hospitals (private and public) in Karachi, Pakistan. A questionnaire was filled for the purpose.

Results:

A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease. Contaminated food was considered the …

The Burden Of Anxiety And Depression Among Patients With Chronic Rheumatologic Disorders At A Tertiary Care Hospital Clinic In Karachi, Pakistan, Abdul Waheed, Kamran Hameed, Abdul Moiz Khan, Junaid Ali Syed, Ahmed Iqbal Mirza

Medical College Documents

Objectives: To study the burden of anxiety and depression as a comorbid among patients of chronic rheumatological disorders and to investigate possible determinants of depression and anxiety.Methods: It was a cross-sectional study conducted at the rheumatology clinic of The Aga Khan University Hospital (AKUH) Karachi, Pakistan. With convenient sampling, 111 patients who fulfilled inclusion/exclusion criteria were screened for anxiety and depression with help of Aga Khan University Anxiety and Depression Scale (AKUADS). The data was entered and analyzed by Statistical Package for Social Sciences (Version 10.0).Results: The population consisted mainly of middle aged (mean age 41) females (80.2%). The most …

Role Of Focused Appendiceal Computed Tomography In Clinically Equivocal Acute Appendicitis, Kashif Ashraf, Omer Ashraf, Vaqar Bari, Muhammad Zafar Rafique, Muhammad Uzair Usman, Ishtiaq Chisti

Department of Radiology

Objective: To determine the accuracy of FACT (focused appendiceal computed tomography) in evaluation of acute appendicitis.Methods: The study was conducted in Aga Khan University Hospital, Karachi, over a period of one year. Sixty-three patients with clinically equivocal acute appendicitis underwent thin-section non-enhanced helical CT. Axial scans were obtained in a single breath hold from L2 vertebral level to the pubic symphysis with 5-mm collimation and a pitch of 1.5. All scans were obtained without oral, intravenous, or rectal contrast material. Criteria for diagnosis of acute appendicitis included an enlarged appendix (>6 mm diameter) and periappendiceal inflammation. Final diagnoses were …

Extra [Corrected] Pulmonary Uptake Of Tc-99m-Maa Perfusion Lung Scan As A Result Of Right To Left Intra Cardiac Shunt, Riffat Hussain, Maseeh-Uz-Zaman, Sohail Abrar Khan, M Nadeem Ahmad

Department of Radiology

Extra pulmonary accumulation of Tc-99m-macroaggregate of albumin (MAA) is rarely seen on perfusion lung scan, and has been reported in less than 4% of a study population of nearly 380 patients. It occurs when the agent bypasses the lungs due to a right to left (R-L) cardiac or pulmonary shunt, when it is shunted to the portal vein before reaching the right atrium and ventricle of the heart, and when the agent is degraded to a submicron particle size. When a pharmaceutical problem is excluded, extra-pulmonary uptake implies unusual hemodynamics with a shunt. A case is reported in which a …

Knowledge Of Modifiable Risk Factors Of Heart Disease Among Patients With Acute Myocardial Infarction In Karachi, Pakistan: A Cross Sectional Study, Muhammad S. Khan, Fahim H. Jafary, Tazeen H. Jafar, Azhar M. Faruqui, Syed I. Rasool, Juanita Hatcher, Nish Chaturvedi

Community Health Sciences

Background: Knowledge is an important pre-requisite for implementing both primary as well as secondary preventive strategies for cardiovascular disease (CVD). There are no estimates of the level of knowledge of risk factor of heart disease in patients with CVD. We estimated the level of knowledge of modifiable risk factors and determined the factors associated with good level of knowledge among patients presenting with their first acute myocardial infarction (AMI) in a tertiary care hospital in Karachi, Pakistan.Methods: A hospital based cross-sectional study was conducted at the National Institute of Cardiovascular Disease, a major tertiary care hospital in Karachi Pakistan. Patients …

Acute Health Effects Of The Tasman Spirit Oil Spill On Residents Of Karachi, Pakistan, Naveed Zafar Janjua, Pashtoon Murtaza Kasi, Haq Nawaz, Sadia Zohra Farooqui, Urooj Bakht Khuwaja, Najam-Ul-Hassan, Syed Nadim Jafri, Shahid Ali Lutfi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Background: On July 27 2003, a ship carrying crude oil ran aground near Karachi and after two weeks released 37,000 tons of its cargo into the sea. Oil on the coastal areas and fumes in air raised health concerns among people. We assessed the immediate health impact of oil spill from the tanker Tasman Spirit on residents of the affected coastline in Karachi, Pakistan.Methods: We conducted a study consisting of an exposed group including adults living in houses on the affected shoreline and two control groups (A and B) who lived at the distance of 2 km and 20 km …

Surgery For Prolactinomas, Ashfaq A. Razzaq, Rashid Jooma

Section of Neurosurgery

A large proportion of prolactin secreting tumours of the pituitary gland are treatable by dopamine agonist drugs. however certain subgroups of these patients are better managed by surgical excision. the indications for surgery in prolactinomas remain controversial and this paper attempts to clarify these with illustrative cases. the factors favouring a surgical approach include poor tolerance of long term medical therapy, progression of visual deficits or recurrence while on medical treatment, cystic change in the tumour with pressure effects, csf fistula secondary to tumour shrinkage and prophylactic surgery in tumours anticipated to cause csf leak following medical therapy. the size …

The Diagnostic Yield Of Various Tests For Helicobacter Pylori Infection In Patients On Acid Reducing Drugs, Javed Yakoob, Wasim Jafri, Z Abbas, Shahab Abid, Muhammad Islam, Saeed Hamid, Syed H Shah

Section of Gastroenterology

No abstract provided.

Cerebral Embolism: Distal Subclavian Disease As A Rare Etiology, Iram Naz, Ziad Sophie

Section of Cardiothoracic Surgery

Subclavian artery occlusive disease is usually secondary to persistent compression caused by thoracic outlet syndrome (TOS) and rarely due to focal atherosclerosis. Emboli from diseased vessel can flow retrograde to the vertebral or carotid arteries to produce ischemic infarct with or without neurological deficit. We are reporting two cases of distal subclavian artery disease presenting with cerebral embolization, an unusual manifestation. Such surgically correctable lesions producing cerebral emboli and stroke needs consideration while evaluating patients with unusual presentation to prevent further occurrence of stroke.

Colorectal Carcinoma, Preoperative Evaluation By Spiral Computed Tomography, Kashif Ashraf, Omer Ashraf, Zeeshan Haider, Zafar Rafique

Department of Radiology

Objectives: To assess the capability of spiral computed tomography (CT) scan in preoperative evaluation of colorectal carcinoma (CRC).Methods: A cross sectional study on 52 patients with recent histopathologic diagnosis of CRC was conducted over a period of one year at the Aga Khan University Hospital, Karachi. All these patients underwent spiral CT with oral and intravenous contrast administration. Surgery was subsequently done in all cases and surgical specimens were sent for detailed pathologic analysis. The radiologic findings on the CT scans were compared with the pathological findings.Results: The results proved that spiral CT had 60% sensitivity and 83% specificity for …

Phylloides Tumors In Adolescent Girls And Young Women In Pakistan., Naila Kayani, Amna Khurshid, Yasmin Bhurgri

Department of Pathology and Laboratory Medicine

Abstract The objective of this study was to determine the frequency of phylloides tumor (PT) in adolescent girls and youngwomen (less than and equal to 25 years of age) and to define the clinico-pathological features of PT in this unusualclinical setting. This descriptive study was carried out at the Aga Khan University Hospital (AKUH) pathologydepartment. All consecutive cases of PT diagnosed during the last sixteen years in the section of histopathology from1st January 1990 to 31st June 2005 were included. Selection of cases was restricted to patients up to 25 years of age.A total of 42 cases of PT in …

Incidence Of Acute Respiratory Infections In Children 2 Months To 5 Years Of Age In Periurban Communities In Karachi, Pakistan, Shaikh Qamaruddin Nizami, Zulfiqar Ahmed Bhutta, Rumina Hasan

Department of Paediatrics and Child Health

Objective: To measure the incidence of acute respiratory infections and burden of respiratory pathogens in children aged two months to five years.
Methods: Four periurban communities in Karachi were selected for the study. The children, identified with fever and cough during community surveillance at regular intervals, were referred to especially established study clinics. These children were diagnosed to have "no pneumonia", "pneumonia" and "severe pneumonia" as per IMCI guidelines. To identify the causative organisms, children with pneumonia and severe pneumonia were investigated with oropharyngeal swabs and blood culture.
Results: Acute respiratory infection was seen in 5884 children during 1st February …

Sentinel Lymph Node Scintigraphy And Radioguided Dissection In Breast Carcinoma: An Initial Experience At Aga Khan University Hospital, Maseeh Uz Zaman, Shaista Khan, Riffat Hussain, M Nadeem Ahmed

Department of Radiology

Objective: To evaluate the efficacy of SLN biopsy using imaging and gamma probe in breast cancer and to establish this technique at Aga Khan University Hospital.Methods: Thirty two patients (mean age 33-76 yrs) with operable breast carcinoma (4 with post-neo adjuvant therapy) with clinically negative axilla were studied. In 28 patients simultaneous axillary dissection was performed. Sentinel lymph nodes (SLN) scintigraphy was performed a day before surgery by injecting Tc-99m labeled nannocolloid sub-dermally in the peri-areolar region in 24 and peri-tumoral in remaining 8. First lymph node (LN) to appear to on the scan was labeled as SLN and marked …

Median Survival Time Of Patients After Transcatheter Chemo-Embolization For Hepatocellular Carcinoma, Zeeshan Haider, Haq Ul, Khalid Munir, M Uzair Usman, Muhammad Azeemuddin

Department of Radiology

Objective: To determine the effect on survival after transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC).Design: Longitudinal cohort study.PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Stadium Road, Karachi, from December 1997 to September 2005.PATIENTS AND Methods: Patients undergoing TACE procedure for HCC were prospectively followed. Fortythree patients were enrolled from December 1997 to March 2003 in the study and subjected to chemoembolization therapy. Eight out of 43 patients were excluded from the study, who lost to follow-up. All the patients were followed till their death. Median and mean survival were calculated.Results: The median …

Socio-Demographic Correlates Of Betel, Areca And Smokeless Tobacco Use As A High Risk Behavior For Head And Neck Cancers In A Squatter Settlement Of Karachi, Pakistan, Samia Mazahir, Rabia Malik, Maria Maqsood, Kanwal Aliraza Merchant, Farida Malik, Atif Majeed, Zafar Fatmi, Muhammad Rizwanulhaq Khawaja, Shehzad Ghaffar

Community Health Sciences

Background

Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of …

Significance Of Immunohistochemistry In Accurate Characterization Of Malignant Tumors, Zubair Ahmed, Najamul Sahar Azad, Yasmeen Bhurgari, Rashida Ahmed, Naila Kayani, Shahid Pervez, Sheema Hasan

Department of Pathology and Laboratory Medicine

Background: To determine in a large series of surgical biopsies the role and significance of immunohistochemistry in the adequate and accurate characterization of malignant tumors.

Methods: A retrospective study of 20,000 consecutive surgical biopsies reported in the Section of Histopathology, AKU in 2003. Data was obtained by retrieving the filed surgical biopsy reports in the section.

Results And Conclusions: Out of the 20,000 biopsies, 6534 (32.67%) were neoplastic. 4726 neoplasms (72.33%) were malignant, and 1808 (27.67%) were benign. Immunohistochemistry was performed on 29.49% of malignant tumors, and 4.97% of benign tumors. Immunos were performed on only 2.82% of routine squamous …

Metaplastic Carcinoma Of The Breast, An Intriguing Rarity., Naila Kayani, Fozia Rauf, Yasmin Bhurgri

Department of Pathology and Laboratory Medicine

Abstract Metaplastic carcinoma breast is categorized as a rare heterogenous neoplasm generally characterized by a mixtureof adenocarcinoma with dominant areas of spindle cell, squamous and/or other mesenchymal differentiation. Todetermine the epidemio-demographic and histopathologic characteristics of this rare entity a retrospective studywas conducted to review all cases at the Aga Khan University Hospital (AKUH) Karachi, received during 1st January2000 to 31st August 2005. Twenty-four patients were identified with a mean age at diagnosis of 46.4 (±SD 3.8) years,and an age range of 28-68 years. The mean tumor size was 7.9 cm, range 2.0–17.0 cms (±SD 4.77). The specimenswere mostly obtained by …

The Growing Burden Of Chronic Kidney Disease In Pakistan, Tazeen H. Jafar

Section of Nephrology

No abstract provided.

Trans-Mastoid Approach To Otogenic Brain Abscess, Ashfaq A. Razzaq, Rashid Jooma, Shahid Ahmed

Section of Neurosurgery

The treatment of otogenic brain abscess initially involves excision or aspiration of the abscess through a temporal or sub-occipital route depending on its location. This is followed by a mastoidectomy by the ENT surgeon to eradicate the primary source of infection. During the last three years, we have approached such lesions through a mastoidectomy followed by excision of the abscess through the same approach. This trans-mastoid approach is technically feasible in following the tract of suppuration, and clearing the cause and effect of pathology, at the same sitting. This paper describes our initial experience with the trans-mastoid approach to otogenic …

Life Threatening Mediastinal Haematoma: A Complication Of Central Venous Catheterization, Omer Ashraf, Hasanat Sharif

Section of Cardiothoracic Surgery

Central venous catheterization (CVC) has established risks and benefits in its application as a vascular access source, particularly in situations involving temporary cannulation. We present a rare case of life-threatening mediastinal haematoma resulting from CVC usage. Even though aggressive intervention yielded survival, the patient was left with permanent vocal compromise owing to traumatic palsy of the right recurrent laryngeal nerve. One should be careful in selection of venous access and be aware of alternatives routes.