Medicine and Health Sciences Commons^™

Narcotic Analgesics For Acute Migraine In The Emergency Room: Are We Meeting Headache Societies' Guidelines?, Mohammad Wasay, Khawaja Slaman Zaki, Saqib Uddin Khan, Rifat Rehmani

Department of Emergency Medicine

We analysed 161 patients with acute migraine in our emergency room (ER) to identify the use of narcotic analgesics as first-line treatment. Twenty-four percent of patients were treated with opioid analgesics and 76% patients were treated with non-opioid analgesics. Pain was completely relieved in 100 (62%) patients, partially relieved in 50 (31%) patients and was not relieved in 11 (7%) patients at the time of discharge. Pain relief was not related to the use of opioids vs. non-opioids. The treatment of acute migraine in our ER is in line with the guidelines of the Headache Societies and needs further improvement.

A Knowledge, Attitudes, And Practice Survey Among Obstetrician-Gynaecologists On Intimate Partner Violence In Flanders, Belgium, Kristien Roelens, Hans Verstraelen, Kathia Van Egmond, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) has consistently been found to afflict one in twenty pregnant women and is therefore considered a leading cause of physical injury, mental illness and adverse pregnancy outcome. A general antenatal screening policy has been advocated, though compliance with such guidelines tends to be low. We therefore attempted to identify potential barriers to IPV screening in a context where no guidelines have been instigated yet.

Methods: Questionnaire-based Knowledge, Attitude, and Practice survey among obstetrician-gynaecologists in Flanders, Belgium (n = 478).

Results: The response rate was 52.1% (249/478). Gynaecologists prove rather unfamiliar with IPV and therefore largely …

Antibiotic Susceptibility Of Atopobium Vaginae, Ellen De Backer, Rita Verhelst, Hans Verstraelen, Geert Claeys, Gerda Verschraegen, Marleen Temmerman, Mario Vaneechoutte

Obstetrics and Gynaecology, East Africa

Background: Previous studies have indicated that a recently described anaerobic bacterium, Atopobium vaginae is associated with bacterial vaginosis (BV). Thus far the four isolates of this fastidious micro-organism were found to be highly resistant to metronidazole and susceptible for clindamycin, two antibiotics preferred for the treatment of BV.

Methods: Nine strains of Atopobium vaginae, four strains of Gardnerella vaginalis, two strains of Lactobacillus iners and one strain each of Bifidobacterium breve, B. longum, L. crispatus, L. gasseri and L. jensenii were tested against 15 antimicrobial agents using the Etest.

Results: All nine strains of A. vaginae were highly resistant to …

Towards A Cure For Traumatic Paraplegia - Is There Cause For Hope?, Rashid Jooma

Section of Neurosurgery

In the past decade, great strides have been made in the field of CNS tissue repair and expectations have been raised that a cure of spinal paralysis is at hand. The two broad categories of investigational approaches to spinal regeneration are: (1) Enhancing the Regenerative Milieu of the Cord and (2) Cellular and Tissue Transplantation. Amongst the latter approaches, the early use of foetal cord tissue has given way to the more sophisticated studies on stem cell therapy and the implants of olfactory ensheating cells. These have engendered considerable public interest and are being offered as commercially available therapies in …

Estimation Of Blood Loss During Caesarean Section: An Audit, Fauzia A. Khan, Mueenullah Khan, Asif Ali, Ursula Chohan

Department of Anaesthesia

Objective: To evaluate the blood ordering practice and blood transfusion for Caesarean sections at our institution and to compare the estimated blood loss between anaesthetists and obstetricians.Methods: A review of 126 patients undergoing both elective and emergency Caesarean section was undertaken in 2002. Information collected included the number of blood units cross-matched preoperatively, type of surgery (emergency or elective), type of anaesthesia, parity of the patient, estimated blood loss by both anaesthetists and obstetricians, intraoperative and postoperative transfusion within 48 hours and pre and post operative haemoglobin (Hb) and haemocrit (Hct).Results: A total of 215 units were cross-matched for 126 …

Caesarian Section Rates And Perinatal Outcome At The Aga Khan University Hospital, Nairobi, Sikolia Wanyonyi, Evan Sequeira, Timona Obura

Obstetrics and Gynaecology, East Africa

Background: There has been a persistent rise in the rate of Caesarean sections over the years.Whether this rise is the cause of the decline in infant mortality and improved neonatal outcome still remains debatable.

Objective: To compare the Caesarian section rate and the perinatal outcome at the Aga Khan University Hospital for the years 2001and 2004.

Design: Retrospective study.

Setting: The Aga Khan University Hospital, Nairobi.

Main outcome measures: The total Caesarian section rates, their indication and the perinatal outcome. Results: The overall Caesarian section rate was 20.4% in 1996,25.9% in 2001and 38.1% in 2004.The rate among patients managed by …

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

Foreign Body In The Esophagus: A Review, Omer Ashraf

Medical College Documents

Foreign body in the esophagus is a common emergency presentation. The approach towards a patient with a foreign body in the esophagus comprises a thorough history and systematic examination followed by relevant investigations. However, there is considerable debate over the most appropriate treatment option for such patients. This review aims to develop a comprehensive approach towards patients presenting with foreign body ingestion by developing clinical practice guidelines. These guidelines address not only the initial evaluation of the patient but also the various management alternatives and their advantages, limitations and applicability in various scenarios, based upon a review of the literature.

Incidence And Epidemiology Of Cerebral Venous Thrombosis., Fazeel Mukhtar Siddiqui, Ayeesha Kamran Kamal

Department of Medicine

Cerebral venous sinus thrombosis is a disorder whose epidemiology has changed over the past few decades. It is no longer regarded as a uniformly fatal disease. CVST is not a rare disorder. It may have a differential geographic distribution with a higher incidence in the Asian world. It is a disease of neonates, younger women and men, often a hypercoagulable state, either acquired (e.g., cancer) or a genetic prothrombotic condition may be present. Outcome is not uniformly dismal and prognostic criteria that detect patients with a poor outcome have become available from prospective studies. There is a paucity of well …

Cerebral Venous Thrombosis: Recent Advances And Need For An Asian Registry, Mohammad Wasay, Ayeesha K. Kamal

Department of Medicine

No abstract provided.

Knowledge And Attitudes About Health Research Amongst A Group Of Pakistani Medical Students, Hassan Khan, Muhammad Rizwanulhaq Khawaja, Abdul Waheed, Muhammad Ameen Rauf, Zafar Fatmi

Community Health Sciences

Background

Health research training is an important part of medical education. This study was conducted to assess the level of knowledge and attitudes regarding health research in a group of Pakistani medical students at Aga Khan University, Karachi.

Methods

It was a cross-sectional pilot study conducted among a group of Pakistani medical students. Through stratified random sampling, a pre-tested, structured and validated questionnaire was administered to 220 medical students. Knowledge and attitudes were recorded on a scale (graduated in percentages).

Results

Mean scores of students were 49.0% on knowledge scale and 53.7% on attitude scale. Both knowledge and attitudes improved …

Cerebral Venous Sinus Thrombosis In Neonates, Shahnaz Ibrahim

Department of Paediatrics and Child Health

Neonatal Cerebrovenous sinus thrombosis(CVST) is extremely rare, however it is a devastating condition and one needs to be aware of this condition to diagnose it. The risk factors for CVST are still not properly understood. The largest registry for stroke and for neonatal CVST is from the Canadian registry which quotes an incidence of 0.6per 100,000 population per year. No data is present for the neonatal CVST in this region.
One needs to be aware of this devastating condition to manage it timely and appropriately. To date there is no consensus on the role of anticoagulant therapy and therefore therapy …

Mri And Mrv In Cerebral Venous Thrombosis, Zafar Sajjad

Department of Radiology

Although Cerebral venous thrombosis is an uncommon cause of stroke among the young, it is being increasingly recognised. A prothrombotic risk factor is identified in the majority of the patients. In most instances it is seen in women in the post-partum period and those on oral contraceptives. Magnetic Resonance Imaging (MRI) has improved our ability to diagnose this condition however the variability of radiological and clinical presentation remains a challenge. MR in combination with MR venography (MRV) is the single most sensitive diagnostic technique. The MR appearance of the thrombus within the dual sinus or cortical vein is variable and …

Isolated Deep Venous Thrombosis--Case Series, Literature Review And Long Term Follow Up., Ayeesha Kamran Kamal, Ahmed Itrat, Sana Shoukat, Asumal Khealani, Kamran Kamal

Department of Medicine

Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported. We conducted a retrospective review of all patients admitted to a major tertiary care center, with the diagnosis of isolated deep venous thrombosis. Two patients were identified with isolated involvement of the deep venous system, they are reviewed in detail with long term follow up. Two young South Asian women in their thirties with rapid onset of neurologic signs and symptoms are …

Thrombolytic Therapy In Cerebral Venous Sinus Thrombosis., Ayeesha Kamran Kamal

Department of Medicine

The use of thrombolytic agents to rapidly lyse the clot has emerged as a therapeutic modality, in concert with interventional neuroradiologic approaches to deliver the agent locally at the site of thrombosis. There are no randomized, double blind, placebo, controlled trials to support thrombolysis as a first line therapy in patients with cerebral venous sinus thrombosis compared to standard therapy using anticoagulation with weight based dose adjusted unfractionated Heparin. Numerous case reports and a single non randomized trial have shown that it is comparatively safe and may rescue patients who are deteriorating despite anticoagulation with unfractionated Heparin. Consideration must be …

Mechanism Of Neuronal Injury In Cerebral Venous Thrombosis, Uzma Usman, Mohammad Wasay

Department of Medicine

The impact of CVT on the brain is wide spectrum, ranging from completely normal parenchyma to brain oedema and/or haemorrhage. Multiple factors relate to neuronal injury in CVT including; dural sinus pressure, increased venous flow velocities, collateralization of venous channels, rate of occlusion, development of cytotoxic and vasogenic oedema, recanalization and accelerated myelination. It is suggested that recanalization of occluded vein, as well as, the presence or absence and the efficiency of intracranial venous collaterals, may have an impact on the extent of brain tissue damage and hence the prognosis of acute CVT.

Role Of Surgery In Cerebral Venous Sinus Thrombosis, S. Ather Enam

Department of Surgery

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity.

Obstetric Cerebral Venous Thrombosis, Bhojo Khealani, Uzma U Mapari, Rozina Sikandar Sultanali

Department of Obstetrics & Gynaecology

Pregnancy and puerperium are most prevalent prothrombotic states leading to cerebral venous thrombosis. Likelihood of stroke to be of venous origin is greater in stroke associated with pregnancy compared to stroke unrelated to pregnancy. Pregnancy induces several changes in coagulation system, which persists at least during early puerperium, rendering it a prothrombotic state. Hypercoaguability worsens further after delivery as a result of volume depletion and trauma. During puerperium additional risk factors include infection and instrumental delivery or Caesarean section. The management follows general rules as for the venous thrombosis unrelated to pregnancy, however the prognosis is different.

Oral Contraceptives And Cerebral Venous Thrombosis: Case Report And A Brief Review Of Literature, Mughis Sheerani, Mian Zainul Sajadeen Urfy

Section of Neurology

Cerebral venous thrombosis remains an important and sometimes an elusive cause of strokes. Oral contraceptives seem to have a strong causative association with this entity. We describe a case that highlights the importance of asking specific questions about oral contraceptive use in patients with strokes due to cerebral venous sinus thrombosis, especially, where the cause remains cryptic.

Prognostic Indicators In Cerebral Venous Sinus Thrombosis, Bilal Hameed, Nadir Ali Syed

Section of Neurology

Cerebral venous sinus thrombosis (CVT) can affect all age groups, particularly women of childbearing age. Overall prognosis for survival and functional independence is better than it was believed. Mortality usually ranges from 6-15% and transtentorial herniation is the major cause of death. Approximately 80% of patients are functionally independent in the long term. Altered mental status and cerebral haemorrhage at presentation are the strongest predictors of death and disability. Patients with CVT related to pregnancy and puerperium generally do better than patients with other causes. Septic CVT carries a worse prognosis than aseptic CVT and of the latter, patients with …

Complications Associated With Cerebral Venous Thrombosis., Fazeel Mukhtar Siddiqui,, Ayeesha Kamran Kamal

Department of Medicine

Although CVT is associated with a good outcome in the majority of cases, it may be complicated by numerous unique and sometimes rare complications. The purpose of this review is to discuss the acute and chronic complications of CVT in greater detail. Awareness may lead to a more aggressive approach in those in which these complications are anticipated and perhaps avoided.
The complications of CVT may be temporally divided into those unique to the acute stage and those that are associated with the chronic stage of CVT. They are venous infarction and haemorrhage, subarachnoid haemorrhage, a rapid progression and pulmonary …

Heparin In The Treatment Of Cerebral Venous Thrombosis., Saad Shafqat, Ayeesha Kamran Kamal, Mohammad Wasay

Department of Medicine

Cerebral venous thrombosis (CVT) is a potentially life-threatening condition requiring rapid diagnosis and urgent treatment. Heparin anticoagulation is the time-honoured treatment, and is advocated in all cases of CVT, irrespective of etiology or presence of haemorrhage. The supportive evidence is largely observational; data from randomized placebo-controlled trials shows a nonsignificant trend favouring heparin. Current practice is to begin heparin (unfractionated or low-molecular weight) immediately on confirmation of the diagnosis. Newer antithrombotic agents such as ximelagatran may offer advantages over heparin and need to be investigated in the treatment of CVT.

Cerebral Venous System Anatomy, Muhammad Azeem Uddin, Tanveer Ul Haq, Muhammad Zafar Rafique

Department of Radiology

Cerebral venous system can be divided into a superficial and a deep system. The. superficial system comprises of sagittal sinuses and cortical veins and these drain superficial surfaces of both cerebral hemispheres. The deep system comprises of lateral sinus, straight sinus and sigmoid sinus along with draining deeper cortical veins. Both these systems mostly drain themselves into internal jugular veins. The veins draining the brain do not follow the same course as the arteries that supply it. Generally, venous blood drains to the nearest venous sinus, except in the case of that draining from the deepest structures, which drain to …

Computed Tomographic Imaging Of Cerebral Venous Thrombosis, Mohammad Kamran Kamal

Department of Radiology

Cerebral venous thrombosis (CVT) is an entity which is not rare and can have devastating consequences if not diagnosed and treated in a timely manner. Although, the gold standard for diagnosing this entity is a catheter angiogram, magnetic resonance venography, by virtue of its non-invasiveness and detailed demonstration of the cerebral venous structures, has become the diagnostic modality of choice for this entity. However, in a resource-strapped country like Pakistan, CT scan remains the primary first (and sometimes the only) diagnostic modality used in patients with neurological problems. Therefore, it is important to recognize the signs of cerebral venous thrombosis …

Pathophysiology Of Cerebral Venous Thrombosis--An Overview., Ahmed Itrat, Sana Shoukat, Ayeesha Kamran Kamal

Department of Medicine

Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described. A Medline search of all articles detailing pathophysiology of CVST was done, using keywords: cerebral venous thrombosis and pathophysiology. In addition, major texts were reviewed for additional references. The pathophysiology of CVST depends on two interconnected events, local signs due to venous infarct, e.g., hemiparesis and global signs due to raised ICP from an obstructed venous system--papilloedema and isolated intracranial hypertension being one of them. Pathophysiology of CVST is diverse and makes it easier to understand the diversity of clinical presentations.

Local Thrombolytic Treatment Of Cerebral Venous Thrombosis In Three Paediatric Patients, Mohammad Wasay, Rohit Bakshi, Alper Dai, Steve Roach

Section of Neurology

There is increasing evidence that local thrombolysis can be used with relative safety and efficacy in adults with superior sagittal sinus thrombosis (SSST). However, little data is available on the use of local thrombolysis in children with SSST. We report three patients who received local thrombolysis for dural sinus thrombosis. Two patients received urokinase and one patient received urokinase followed by local TPA infusion. Recanalization was achieved in two patients.

Diagnostic Dilemma Of Abdominal Tuberculosis In Non-Hiv Patients: An Ongoing Challenge For Physicians, Rustam Khan, Shahab Abid, Wasim Jafri, Zaigham Abbas, Khalid Hameed, Zubair Ahmad

Section of Gastroenterology

AIM: To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.Methods: Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs) during the period 1999 to 2004 were analyzed. Patient's characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved (intestinal, peritoneal, visceral, and nodal) and response to treatment was also noted.Results: There were 209 patients enrolled. One hundred and twenty-three (59%) were females. Symptoms were abdominal pain 194 (93%), fever 134 (64%), night sweats 99 (48%), …

Keeping Alive The "Jazba", Murad M. Khan

Department of Psychiatry

No abstract provided.

Child Health And Survival In The Eastern Mediterranean Region, Zulfiqar A. Bhutta, Asim Belgaumi, Rab Mohammad Abdur, Zein Karrar, Mohamed Khashaba, Nezha Mouane

Department of Paediatrics and Child Health

No abstract provided.

Polymorphism Of Hla-Dr And Hla-Dq In Rheumatoid Arthritis Patients And Clinical Response To Methotrexate--A Hospital-Based Study, Azra Arif I Ali, Tariq Moatter, Jawed Altaf Baig, Ahmed Iqbal, Azmat Hussain, Mohammad Perwaiz Iqbal

Department of Biological & Biomedical Sciences

Objective: To investigate the frequency and distribution of DRB1 and DQB1 alleles in Patients with rheumatoid arthritis (RA) and analyze the relationship between clinical response to methotrexate (MTX) and the HLA-DR and HLA-DQ genotypes in these patients.
Methods: In this case-control study, the HLA-DRB1 and HLA-DQB1 polymorphism in 91 RA patients and 91 healthy controls was done using polymerase chain reaction and sequence specific primers.
Results: There was no statistical difference in frequencies of HLA-DRB1*03, DRB1*04, DRB1*07, DRB1*10, DRB1*11, DRB1*12, DRB1*13, DRB1*14, DRB1*15 and DRB1*16 genotypes between patients and controls. However, DRB1*01 was found to be significantly more common (p=0.015) …