Medicine and Health Sciences Commons^™

Parental [Correction Of Perinatal] Consanguinity: A Risk Factor For Developmental Delay In Pakistani Children, S Ibrahim, Z Habib, S Hyder, I S. Azam, R Ahmed

Department of Paediatrics and Child Health

Objective: To investigate the association of parental consanguinity and delayed development in terms of gross motor, fine motor, speech and social aspects in their children.
Methods: One hundred and seventy seven children (age 15 days--72 months) were evaluated for their developmental status utilizing the Denver Developmental Screening Test (DDST). An unmatched case-control study design was used. Case group consisted of 94 children and control group 83 children. Odds ratios were calculated for parental consanguinity and delay in gross and fine motor, speech and social development in their children, for cases and controls, utilizing Binary Multiple Logistic Regression Analysis. Acquired delay …

Prevalence Of Smokers Among Air-Conditioned Coaches, Pakistan, R Mal, N Rizvi, S Rathi

Section of Otolaryngology, Head & Neck Surgery

Objective: To estimate the proportion of smokers among passengers of air-conditioned (A/C) coaches running between Karachi and Hyderabad. Pakistan.METHOD: A cross-sectional survey was done on passengers and staff members of 20 air-conditioned coaches.Results: Of 847 passengers interviewed, 17.3% were smokers and 11.7% passengers smoked during travel while rest of them remained passive smokers. Out of 147 smokers 91.2% were literate persons. Among staff members 59.3% were smokers. Approximately 56% of smokers among passengers were in the age range of 14-40 years. In 95% of A/C coaches there were no anti-smoking warning signs or written words present.CONCLUSION: In this study majority …

Morphological Pattern Of Salivary Gland Tumours, M. S. Gill, S. Muzaffar, I. N. Soomro, Naila Kayani, A. S. Hussainy, Shahid Pervez, S. H. Hasan

Department of Pathology and Laboratory Medicine

Objective: To delineate the spectrum of salivary gland tumors in our setup.

Setting: The Aga Khan University Medical Centre, Karachi.

Method: Tumors were analysed considering histological type, age and sex of the patients and anatomic location. The diagnosis of individual tumours was based on the 1991 World Health Organisation Classification.

Results: During the span of eight years (1991-1998), 379 cases of salivary gland tumours were diagnosed. Of these, 205 (65.7%) were male and 174 (34.3%) were female. The median age at the time of diagnosis was 35 years. The median age for patients with malignant lesions (44 years) was 12 …

Bilateral Cervical Radiculopathy As A Presentation Of Spinal Tuberculosis: Report Of Two Cases, G R. Sharma, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Continuous Quality Assessment; Development Of A Simple Computer Based Model For Audit, N K. Waheed, F S. Awan, A Ahad, A Rahman, K M. Pal

Department of Surgery

Objective: Accurate assessment of quality of care is a fundamental first step in the process of quality improvement. The vast amount of data generated in a hospital mandates some form of computerization for management of information. We describe a locally developed simple computer based program to access relevant information from a hospital patient management network. The objective was to reduce the amount of manual work involved for busy clinicians attempting to audit quality of care.Methods: A single surgical procedure, Laparoscopic Cholecystectomy was chosen. Quality indicators were identified by literature review as conversion rate from laparoscopic to open cholecystectomy and length …

Percutaneous Transhepatic Biliary Stenting, T U. Haq, M Sanaullah, H Mohsin, M Y. Sheikh, B Ahmed

Department of Radiology

Objective: Bilary stenting with endoprosthesis is a palliative procedure to relieve malignant biliary obstruction. Percutaneous transhepatic technique has been employed whenever endoscopic technique was not possible or had failed.SETTING: Angiography/intervention suite, department of radiology, Aga Khan University hospital, Karachi.Methods: We present retrospective analysis of 17 patients with malignant jaundice who were treated with percutaneous techniques after the endoscopic route had failed.Results: The success rate was 94% with placement of single plastic stent in 14 patients, double stents in 3 patients and self-expandable stent in one patient. The overall complication rate was 41% including sepsis, liver abscess, biloma formation, biliary leakage …

Giant Hypothalamic Hamartoma And Associated Seizure Types, M K. Chishti, Ashfaq A. Razzaq

Section of Neurosurgery

No abstract provided.

Problem Based Learning, Jamsheer J Talati

Section of Urology

No abstract provided.

A Critical Step In The Operative Management Of Non-Functioning Asymptomatic Incidentaloma, M H. Ather, S Altaf, A Memon

Section of Urology

No abstract provided.

Thymic Hyperplasia: A Cause Of Respiratory Distress, F K. Tareen, S Hussain, F Moazam

Department of Surgery

No abstract provided.

Problem Based Learning In The 3rd World Context, V Zaman

Department of Pathology and Laboratory Medicine

No abstract provided.

Neoplastic Growth Of Cerebral Cavernous Malformation Presenting With Impending Cerebral Herniation: A Case Report And Review Of The Literature On De Novo Growth Of Cavernomas, Arshad A. Siddiqui, Rashid Jooma

Section of Neurosurgery

Background: Cerebral cavernomas are rare vascular anomalies and their expansile growth has been considered to be mainly due to recurrent hemorrhages. They are not generally reported to show aggressive behavior.
Case description: A 27-year-old male presented with headache, visual disturbances, and a 17-year history of seizures. He was known to have a temporal lobe lesion on CT scan, consistent with a diagnosis of cavernous malformation but with no relevant family history. Serial clinical and radiological follow-up revealed a progressive increase in the size of the lesion with formation of a growing cyst of 7 cm in diameter, which produced mass …

An Audit Of Blood Cross-Match Ordering Practices At The Aga Khan University Hospital: First Step Towards A Maximum Surgical Blood Ordering Schedule, T Chawla, G N. Kakepoto, M A. Khan

Department of Surgery

Objective: In the absence of an explicit maximum blood order policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence based estimates of average requirement in a particular procedure. This study was done to assess current practice and the feasibility of a prospective randomized work to develop practice guidelines.METHOD: We audited transfusion data for elective surgical procedures in our hospital during the last 2 years. Cross-matched to transfused ratio (C/T ratio) and Transfusion Index (Ti) for each of the elective surgical procedures was performed during the study period. C/T ratio is used as …

Infected Endometrioma With Ascites And Bilateral Pleural Effusion, T Naru, N Chaudhury

Department of Obstetrics & Gynaecology

No abstract provided.

Post-Infarction Left Venticular Free Wall Rupture, S M. Nadeem, S A. Sami, G Khan, N Basir, K A. Kazmi

Section of Cardiology

No abstract provided.

Anaesthetic Management For A Patient With Severe Multiple Sclerosis, E I. Khan, N Amjad, A A. Khan

Department of Anaesthesia

No abstract provided.

Treatment Of Tibial Diaphyseal Fractures With Closed Flexible Intramedullary Ender Nails: 39 Fractures Followed For A Period Of Two To Seven Years, Hussain R. Usman, Muhammad A. Umer, Masood Umer

Department of Surgery

Abstract

OBJECTIVE:

To assess the efficacy of flexible intramedullary Ender nails for the treatment of tibial diaphyseal.

MATERIALS AND METHODS:

This is a retrospective review of patients treated with the Ender Nail for both open and closed tibial shaft fractures. Between January 1989 and December 1994, 43 fractures were treated with these nails. The configuration of each fracture was determined using the Orthopedic Trauma Association classification and the extent of soft tissue damage was assessed using the Gustilo and Anderson's classification. Four patients were excluded from the study due to inadequate follow-up. There were 27 closed and 12 open fractures. …

Conversion Disorder: Difficulties In Diagnosis Using Dsm-Iv/Icd-10, E U. Syed, R Atiq, S Effendi, S Mehmud

Department of Psychiatry

Objective: Conversion disorder presents differently in various cultures. The commonest symptoms in the Asian subcontinent may be very different from those seen in Western Hemisphere. This causes some difficulty in making a diagnosis while using DSM-IV and ICD-10.METHOD: This study searched inpatient records for the last 10 years at the Aga Khan University and collected some demographic data as well as assessed the phenomenology of conversion disorder in the patient population.Results: We found unresponsiveness to be the most common symptom in this sample thus not exactly fitting the DSM-IV/ICD-10 picture.CONCLUSION: We observed that current criteria of conversion disorder as stated …

Behind The Counter: Pharmacies And Dispensing Patterns Of Pharmacy Attendants In Karachi., Fauziah Rabbani, F. H. Cheema, N. Talati, S. Siddiqui, S. Syed, S. Bashir, L. Z. Zuberi, A. Shamim, Q. Mumtaz

Community Health Sciences

BACKGROUND:

There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries.

OBJECTIVE:

This study obtained background information on pharmacies assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi.

METHODOLOGY:

This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants.

RESULTS:

Of the 219 pharmacies surveyed, 62% reported more than 50 customers daily and 20% also sold items of general provision. Mean operating hours were 13. Only 24 (11%) had a visible license. On an average 3 attendants were …

Diagnostic Issues In Abdominal Tuberculosis, M R. Khan, I R. Khan, K M. Pal

Department of Surgery

Objective: To analyze the modes of presentation and diagnostic issues in the management of abdominal tuberculosis at a tertiary care hospital in a developing country, where most of the established diagnostic modalities are available.SETTING: The Aga Khan University Hospital, Karachi.Methods: This study is a retrospective review of medical records of all inpatients, diagnosed to have abdominal tuberculosis, from January 1991 to December 1997. The data was collected and particularly analyzed for spectrum of presentation and role of various diagnostic modalities. Of special interest was the sub-group of patients, who after all investigations did not have a firm diagnosis. Following a …

Histological Pattern Of Central Nervous System Neoplasms, Z. Ahmed, S. Muzaffar, Naila Kayani, Shahid Pervez, A. S. Husainy, S. H. Hasan

Department of Pathology and Laboratory Medicine

Objective:

To see in a large series of patients the histological pattern of CNS neoplasms and to provide a comprehensive data about the frequency of CNS neoplasms in Pakistani patients and to give a clearer idea about their prevalence.

Method:

Retrospective study of all consecutive cases of CNS neoplasms diagnosed at The Aga Khan University Hospital (AKUH) between 1st January 1994 and 31st December, 1999.

Setting:

The section of Histopathology, AKUH, Karachi.

Observation:

Our series included a large number of cases i.e., 1110 . There are very few local studies on CNS tumours and none so large . Our data …

Comparison Of Spontaneous With Controlled Mode Of Ventilation In Tonsillectomy, F A. Khan, G A. Memon

Department of Anaesthesia

Methods: This randomized study compares spontaneous versus controlled ventilation in 60 ASA I and II patients undergoing tonsillectomy as regards haemodynamic stability, recovery characteristics, intra- and immediate postoperative complications and surgical impressions.Results: The patients in the balanced anaesthesia (B) group showed less haemodynamic variability compared to baseline after tracheal intubation, mouth gag application and removal and incision. Two patients had dysrhythmias in the B group compared to six in the spontaneous breathing (S) group. Six patients in the S group had a rise in endtidal carbon dioxide concentration above 7.8 kPa (60 mmHg). Recovery scores were higher in the B …

Maternal Deaths In A Developing Country: A Study From The Aga Khan University Hospital, Karachi, Pakistan 1988-1999, R N. Qureshi, S Jaleel, R Hamid, S F. Lakha

Department of Obstetrics & Gynaecology

Objective: The maternal deaths occurring over a twelve-year period (1988-1999) in a tertiary referral center were reviewed. The purpose of the study was to assess the causes of these maternal deaths.
Setting: The Aga Khan University Hospital (AKUH) Karachi, Pakistan.
Methods: The medical records of maternal deaths were reviewed. These were women who had either registered for delivery at the hospital; or were referred from another hospital or from home, when an emergency developed. They were either admitted to the Medicine, Surgery and the Obstetrics and Gynaecology Departments at the hospital.Results: A total of 81 maternal deaths were identified, of …

Flow Cytometric Analysis Of Childhood Leukemias, R. Z. Yusuf, Shahid Pervez, S. A. Aziz, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To collect demographic data for childhood (less than 15 years) leukemias in Karachi, describe the accuracy of the cell surface markers routinely used in the flow cytometric analysis of leukemic cells and arrive at an ideal panel of antibodies for analyzing leukemic samiples.

Materials and Methods: Data from 62 consecutive cases of childhood leukemias referred to the Department of Pathology, Aga Khan University Hospital. (AKUH) between January 1995 and December 1998 was analyzed using Epi Info Version 6. Flow cytometry on all samples was performed using standard protocols.

Results: The mean age of patients was 8.2 years and 49 …

Vestibular Schwannomas: Clinical Presentation, Management And Outcome, M S. Awan, H U. Qureshi, A A. Sheikh, M M. Ali

Section of Neurosurgery

Objective: To review the demographic trends clinical spectrum, diagnosis, management and outcome of patients with vestibular Schwannoma and to identify areas where improvements are needed.
Methods: All patients with vestibular schwannoma admitted to the Aga Khan University Hospital over the past 11 years were reviewed retrospectively.
Results: The age range of majority of 22 patients analyzed, was 41-50 years (23%). Hearing loss was the most common presenting symptom (96%). Other clinical features included cranial nerve palsies (59%) and headache (55%). Fifty percent had signs of raised intracranial pressure. Neuroimaging revealed "Stage IV b" (tumor distorting the brainstem and compressing the …

Sustained Remission In A Case Of Lupus Nephritis With Cyclosporin Therapy, M A. Rabbani, S M. Shah, A Ahmad

Section of Nephrology

Systemic lupus erythematosus (SLE) in severe form still presents a major therapeutic challenge. Aggressive treatment of severe renal lesions has improved the prognosis of renal disease over the last decade. However, this benefit is quite frequently offset by the side effects and toxicity of the treatment. Moreover, the disease may appear to be poorly responsive to treatment with steroids and cytotoxic drugs. We report a case of lupus nephritis that relapsed despite having adequate steroid and cytotoxic therapy, but later was successfully treated with cyclosporin. Fifteen months after discontinuing the treatment with cyclosporin, the patient continued to remain in remission.

Female Genital Tuberculosis Revisted, R N. Qureshi, S Samad, R Hamid, S F. Lakha

Department of Obstetrics & Gynaecology

Objective: To assess the clinical presentation of genital tuberculosis and to study various modes of diagnosis and treatment.SETTING: The Aga Khan University Hospital (AKUH), Karachi.
Method: A retrospective case review of all index female cases of genital tuberculosis, admitted to AKUH over twelve years of period.
Result: A total of 40 cases of genital tuberculosis were reported during this time period. Majority of cases were between 25-45 years. The commonest presenting symptoms were infertility (42.5%) and abdominal pain (42%). Others included fever, ascites, irregular vaginal bleeding, oligomenorrhea, chest pain and pain in the flanks. Main mode of treatment was antituberculous …

Physician Assisted Suicide Perceptions Among Patients Presenting To Family Physicians At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, H. Qureshi, S. S. Ali, M. Alam, S. I. Azani

Department of Family Medicine

Objective: To study the perceptions on physician assisted suicide, among patients presenting to family physicians, at a teaching hospital in Karachi, Pakistan.
Method: The study was carried out at the Community Health Center of The Aga Khan University Hospital, Karachi, between December 1999 and May 2000. The principal and co-investigators filled a pre-coded and pre­tested questionnaire consisting of important demographic characteristics and bio-medical ethics issues. A system of convenience sampling was used and a written consent was taken from respondents over the age of 16 years, who agreed to participate. The data were managed by using the Epi …

An Analysis Of Anemia And Child Mortality, B.J. Brabin, Zul Premji, F. Verhoeff

Pathology, East Africa

The relationship of anemia as a risk factor for child mortality was analyzed by using cross-sectional, longitudinal and case-control studies, and randomized trials. Five methods of estimation were adopted: 1) the proportion of child deaths attributable to anemia; 2) the proportion of anemic children who die in hospital studies; 3) the population-attributable risk of child mortality due to anemia; 4) survival analyses of mortality in anemic children; and 5) cause-specific anemia-related child mortality. Most of the data available were hospital based. For children aged 0-5 y the percentage of deaths due to anemia was comparable for reports from highly malarious …

Pneumoperitoneum Following Mechanical Ventilation In A Child, Fazal Hameed Khan, Nadeem Ahmad

Department of Anaesthesia

No abstract provided.