Medicine and Health Sciences Commons^™

Treatment Of Spinal Tuberculosis: Role Of Surgical Intervention, Ather Enam, Ahmed Ali Shah

Section of Neurosurgery

The treatment of tuberculosis of the spine (Pott's disease) is essentially conservative and a vast majority of patients can be successfully managed on antituberculo us therapy (ATT) alone.1 Surgery is indicated in a few specific cases where deformity of spine, pain, or neurological compromise is becoming a serious issue. In cases where surgery is indicated the benefits are almost immediate and excellent. Tuberculosis (TB) is one of the leading causes of infectious disease-related deaths in under-developed countries and it has had a resurgence in developed countries as well. The most common site of bony dissemination of this disease is in …

Neck Recurrence In Early Carcinoma Tongue, Mubasher Ikram, Sadaf Fatima Jafferbhoy, Maisam Abbas Shiraz Onali

Section of Otolaryngology, Head & Neck Surgery

Objective: To study the efficacy of different locoregional treatment options for tongue cancer in determining the prognosis, with reference to recurrence of disease in neck.

Methods: This is a retrospective analysis of 80 patients with early (T1/T2) carcinoma tongue who had hemiglossectomy with or without neck surgery and radiotherapy for 14 years.

Results: Eighty patients were included in this study, 49 (61.3%) men and 31 (38.8%) women; 36 (45%) patients with T1 lesion and 44 (55%) with T2 lesion. Sixty two patients (77.5%) were staged cN0 and 18 patients had a clinically palpable neck nodes (cN+). Thirty seven patients were …

Health And Needs Assessment Of Geriatric Patients: Results Of A Survey At A Teaching Hospital In Karachi, Syed Nabeel Zafar, Hammad Ashraf Ganatra, Sarah Tehseen, Waris Qidwai

Department of Family Medicine

Objective: To study the health and needs of geriatric patients

Methods: A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management.

Results: Four hundred and two (402) subjects above the age of 65 were surveyed. Most of the subjects were retired (40.5%) married (76.4%) men (69.7%). Ages ranged from 65 to 90 years, the mean being 70.57 years and …

Botulinum Toxin Type-A In The Management Of Cerebral Palsy: Low Or High Dose?, Alper I. Dai, Mohammad Wasay

Department of Medicine

Cerebral palsy is the most common cause of severe physical disability in childhood. Spasticity is a common and disabling symptom for many patients with cerebral palsy. Therapy for spasticity is symptomatic with the aim of increasing functional capacity and relieving discomfort. Spasticity treatment by orally administered drugs and intramuscular chemodenervation agents has become more frequent. Most oral medications to treat spasticity have been inadequately studied in children, especially those with cerebral palsy. Since its first use in pediatric patients, reported in 1993, botulinum toxin (BTX-A), a relatively recent addition to the available medical interventions for children with cerebral palsy, has …

Preparing For The Next Natural Disaster – Need For A Who Coordinating Centre, Mohammad Wasay, Saad Shafqat

Department of Medicine

No abstract provided.

Comparison Between Tramadol And Pethidine In Patient Controlled Intravenous Analgesia, Faisal Shamim, Muhammad Qamarul Hoda, Khalid Samad, Salman Sabir

Department of Anaesthesia

Objective: To compare the efficacy and side effects related to Tramadol with Pethidine in patient controlled intravenous analgesia (PCIA) after total abdominal hysterectomies. Methods: A total of 60 patients were randomized to receive either Tramadol or Pethidine by PCIA (30 in each group) after total abdominal hysterectomy. Pain assessments were recorded one hour after starting the PCIA and then at 6, 12, and 24 hours by using visual analogue scale (VAS). Nausea vomiting score and sedation score were also recorded. Good attempts, total attempts and total drug consumption was noted from PCIA pump at the end of the study period. …

Subependymal Giant Cell Astrocytoma, Zubair Ahmad, Fouzia Rauf, Najamul Sahar Azad, Aamir Ahsan

Department of Pathology and Laboratory Medicine

Subependymal giant cell astrocytomas (SEGAs) are slowly growing tumours corresponding to WHO grade I. They are intraventricular and usually occur in the setting of tuberous sclerosis complex. They often result in obstructive hydrocephalus. Treatment is usually restricted to surgical resection, recurrences are rare and long term prognosis is excellent. We present a series of three cases.

Frequency And Characteristics Of Breast Lymphomas Presenting To A Tertiary Care Hospital, Pakistan, Nausheen Yaqoob, Shahid Pervez, Naila Kayani, Rashida Ahmed, Zubair Ahmed, Sheema Hasan

Department of Pathology and Laboratory Medicine

Objective: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms.

Methods: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information.

Results: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total …

Incorporating Endoscope In Middle Ear Surgery, Shehzad Ghaffar, Mubasher Ikram, Ahsan Raza

Section of Otolaryngology, Head & Neck Surgery

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30° endoscope allowed for complete visualization of the …

Clinical Characteristics Of Pulmonary Tuberculosis In Adult Pakistani Patients With Co-Existing Diabetes Mellitus, A Jabbar, S F. Hussain, A A. Khan

Section of Pulmonary & Critical Care

A review was made of the records of all patients with pulmonary tuberculosis and diabetes mellitus admitted over a 5-year period to a teaching hospital in Karachi, Pakistan. Among 42358 patients, the total number with both tuberculosis and diabetes was 173. The prevalence of tuberculosis in diabetic patients was 10-times higher than in non-diabetic patients and prevalence increased with duration of diabetes. The lower lung field was most frequently involved, followed by the upper and middle. Bilateral involvement was seen in half and an associated pleural effusion in one-third of the patients. Cavitating lesions were seen in 32% of men …

Social Environment And Depression Among Pregnant Women In Urban Areas Of Pakistan: Importance Of Social Relations., Ambreen Kazi, Zafar Fatmi, Juanita Hatcher, Muhammad Masood Kadir, Unaiza Niaz, Gail A. Wasserman

Community Health Sciences

Aspects of the social environment, including social conditions (socio-economic status, household situations, chronic illnesses) and social relations (attitude and behaviors of relations) are major determinants of depression among women. This study evaluates the relative power of social relations and social conditions in predicting depression among pregnant women in Pakistan. In the qualitative phase of the study, social environmental determinants were identified through literature search, and experts' opinions from psychologists, psychiatrists, gynecologists, sociologists and researchers. Along with this, 79 in-depth interviews were conducted with pregnant women drawn from six hospitals (public and private) and two communities in Karachi, Pakistan. Identified determinants …

Geographic Data On Health Inequities: Understanding Policy Implications, Gregory Pappas

Community Health Sciences

No abstract provided.

Triple Therapy For Helicobacter Pylori Infection In Patients Presenting To A Tertiary Care Center In Pakistan, Shahab Abid, Javed Yakoob, Wasim Jafri, Z Abbas, Khalid Mumtaz

Section of Gastroenterology

No abstract provided.

Distribution Of Virulence Marker Of Helicobacter Pylori Patients With Functional Dyspepsia In Pakistan, Javed Yakoob, Shahab Abid, Wasim Jafri, Z Abbas

Section of Gastroenterology

No abstract provided.

Surgical Ligation Of Scrotal Varicocele For Male Factor Infertility Is A Valid Option Of Treatment, Muhammad Moazzam, Khurram M. Siddiqui, Mohammed H. Ather, S Raziuddin Biyabani

Section of Urology

Objective: To evaluate the role of surgical ligation of scrotal varicocele for treatment of male factor infertility.
Methods: We studied 60 patients who presented with infertility and were also found to have scrotal varicocele. Patients with other probable causes contributing to infertility were excluded. Diagnosis was made by clinical examination and scrotal ultrasonography. All the patients underwent either laparoscopic varicocelectomy or open retroperitoneal high ligation of the testicular veins. Operative time and hospital stay was recorded. All patients were evaluated for postoperative improvement of semen parameters and development of any postoperative complication. The results were analyzed by commercially available software. …

P27kip1 And P130 Cooperate To Regulate Hematopoietic Cell Proliferation In Vivo, Inês Soeiro, Azim Mohamedali, Hanna M. Romanska, Nicholas C. Lea, Emma S. Child, Janet Glassford, Stephen J. Orr, Claudia Roberts, Kikkeri N. Naresh, El-Nasir Lalani, David J. Mann, Roger J. Watson, N. Shaun B. Thomas, Eric W. -F. Lam

Department of Pathology and Laboratory Medicine

To investigate the potential functional cooperation between p27^Kip1 and p130 in vivo, we generated mice deficient for both p27^Kip1 and p130. In p27^Kip1−/−;p130^−/− mice, the cellularity of the spleens but not the thymi is significantly increased compared with that of their p27^Kip1−/− counterparts, affecting the lymphoid, erythroid, and myeloid compartments. In vivo cell proliferation is significantly augmented in the B and T cells, monocytes, macrophages, and erythroid progenitors in the spleens of p27^Kip1−/−; p130^−/− animals. Immunoprecipitation and immunodepletion studies indicate that p130 can compensate for the absence …

Role Of A Probiotic (Saccharomyces Boulardii) In Management And Prevention Of Diarrhoea, A G. Billoo, M A. Memon, S A. Khaskheli, G Murtaza, Khalid Iqbal, M Saeed Shekhani, Ahson Q. Siddiqi

Department of Paediatrics and Child Health

AIM: To assess the efficacy and safety of Saccharomyces boulardii (S. boulardii) in acute watery diarrhoea and its role in reducing the frequency of episodes of diarrhoea in subsequent two months.
Methods: Children from 2 mo to 12 years of age, with acute diarrhoea were selected according to inclusion criteria and randomised in S. boulardii group (treated with ORS, nutritional support and S. boulardii, 250 mg bid) and in control group (treated with ORS and nutritional support only). Active treatment phase was 5 d and each child was followed for two months afterwards. Frequency and consistency of stools as well …

Current Concepts In The Diagnosis And Treatment Of Typhoid Fever, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Brain Tumor Stem Cells: Role In Neuro-Oncogenesis And Therapeutic Implications, Muhammad Zeeshan Ozair, Adil Hameed Khan, Ather Enam

Department of Biological & Biomedical Sciences

Malignant brain tumors are notorious for high morbidity and mortality. Our deficient understanding of brain tumor pathogenesis is reflected in our inability to cure this disease. Treatment remains palliative at best. The cancer stem cell hypothesis of brain tumors promises to consolidate many observations which have previously eluded neuroscientists and may reveal why aberrations in developmental programs are among the commonest findings in brain tumors. It is ironic that brain ontogeny and cancer - two processes with very different outcomes - exploit similar mechanisms to multiply, migrate,and survive. Implications of this hypothesis extend beyond mere academic interest. It may explain …

Central Nervous System Involvement In Dengue Viral Infection, Romasa Channa, Mohammad Wasay

Department of Medicine

Neurological manifestations of dengue infection are rare. This review includes data regarding the epidemiology of the disease, neurological manifestations,pathogenesis, diagnosis and prognosis. It is based on 9 original articles and 10 case reports, adding up to 200 cases of dengue fever with neurological manifestations. Relevant cases have been reported from Asia, the Pacific rim, the Americas, the Mediterranean region, and Africa. A wide range of neurological manifestations has been reported. Altered consciousness and seizure are among the more common manifestations. The exact pathogenesis of this disease has not yet been established. However, recent studies hypothesize that the virus is neurotropic. …

One Year Experience Of Mri Under General Anaesthesia, Shahla Siddiqui

Department of Anaesthesia

A case series over one year of our experience of using Propofol and Laryngeal mask airway (LMA) in children under 10 years of age undergoing MRI under general anaesthesia is presented. All paediatric patients under the age of ten attending out-patient department were included in the case series starting from January 1st, 2004 till December 31st, 2004. All patients underwent general anaesthesia using Propofol / LMA technique as described in detail in communication below. A total of 78 children were included; the only patient requiring intubation was the youngest: a neonate of 1 day who had a large orbital mass. …

Tuberculosis Of The Scapula, Yousuf A. Husen, Naila Nadeem, Fawad Aslam, Muhammad Ali Shah

Department of Radiology

Tuberculosis (TB) of the scapula is an extremely rare presentation of osteoarticular tuberculosis. In a tuberculosis endemic setting with a rising burden of acquired immunodeficiency syndrome, this rare presentation may become more frequent. The common presentation is with longstanding Complaints of pain and swelling in the shoulder region, typically in young adults. Classic radiographic features include a well defined radiolucent lesion with minimal sequesteration. The erythrocyte sedimentation rate is usually elevated and initially these patients are frequently mis-diagnosed and thus a high index of clinical suspicion is required. Medical therapy with antituberculous drugs is the standard modality of treatment. This …

Mixed Epithelial And Stromal Tumour Of Kidney, Fozia Rauf, Nausheen Yaqoob, Akhtar Husain

Department of Pathology and Laboratory Medicine

Mixed epithelial and stromal tumour of kidney is a recently described, rare entity and includes cases previously termed as cystic hamartoma of renal pelvis and adult mesoblastic nephroma. We report a case of 36 years old female who presented with a history of recurrent loose stools for 5 years. During ultrasound abdomen, a solid right renal mass was incidentally found in upper pole of right kidney. On gross examination it was a 3.5 cm diameter mass which was microscopically composed of both epithelial and stromal components in the form of cystically dilated tubules and fascicles of spindle shaped cells. These …

Systemic Mastocytosis: A Rare Entity, Naveen Naz Syed, Bushra Moiz

Department of Pathology and Laboratory Medicine

An 18 year old female presented with generalized maculopapular rash and headaches. The skin and bone marrow biopsy revealed numerous mast cells which stained metachromatically with giemsa and toludine blue stains and showed positivity with CD68 and CD117 on immunohistochemistry. Her clinical presentation and laboratory findings were consistent with the diagnosis of indolent systemic mastocytosis. Because of the benign course of the disease, patient was offered only anti-histamine drugs that were quite successful in alleviating her symptoms.

Viral Hemorrhagic Fever - An Icu Perspective, Asghar Ali, Shahla Siddiqui

Department of Anaesthesia

No abstract provided.

Knowledge And Skills In Community Oriented Medical Education (Come)Self-Ratings Of Medical Undergraduates In Karachi, Ayesha Aziz, Ambreen Kazi, Ashraf Jahangeer, Zafar Fatmi

Community Health Sciences

Objective:

To assess the satisfaction of medical students regarding community oriented knowledge and skills that are proposed to be part of the current undergraduate medical curriculum.

Methods: Competencies listed in the regulations for medical education designed by the Pakistan Medical and Dental Council (PMDC) were used to develop a self-administered questionnaire. Using the questionnaire 220 final year students of 3 public sector medical schools self-rated the knowledge and skills that should be part of the curriculum. For analysis the questions were grouped into courses of Basic, Clinical and Community Health Sciences. Students ranked their perceptions on a Likert scale of …

Right Ectopic Gestation Following In Vitro Fertilisation: Case Report, R. B. Parkar, Yamal Patel

Obstetrics and Gynaecology, East Africa

The management of ectopic gestation has in recent years transformed from the normally accepted laparotomy to the laparoscopic approach. The objective of this case report is to describe a rare occurrence of an ectopic gestation following in vitro fertilisation procedure.A 35-year-old para 0 + 0, presented with lower abdominal pain and per vaginal bleeding six weeks after an in vitro fertilisation was done in South Africa. The patient was admitted with severe lower abdominal pain and per vaginal bleeding at six weeks gestation following an in vitro fertilisation procedure. She had undergone an "evacuation" one-week prior to this episode due …

Hepatitis B And C: Prevalence And Risk Factors Associated With Seropositivity Among Children In Karachi, Pakistan, Wasim Jafri, Nadim Jafri, Javed Yakoob, Muhammad Islam, Syed Farhan Ali Tirmizi, Tazeen Jafar, Saeed Akhtar, Saeed Hamid, Hasnain Ali Shah, Sheikh Qamaruddin Nizami

Section of Gastroenterology

Background

Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to chronic liver disease and hepato-cellular carcinoma (HCC). This cross-sectional study estimated the prevalence and identified risk factors associated with Hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) sero-positivity among children 1 to 15 years of age.

Methods

The study targeted the low to middle socioeconomic population that comprises 80% to 85% of the population. Consent was obtained from parents of the eligible children before administering questionnaire and collected a blood sample for anti-HCV and HBsAg serology.

Results

3533 children were screened for HBsAg and …

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 …

Wernekink Comissure Syndrome: A Rare Midbrain Syndrome Secondary To Stroke, Alper I. Dai, Mohammad Wasay

Department of Medicine

Wernekink commissure involves the decussation of superior cerebellar peduncle (SCP) in midbrain. We report an elderly hypertensive, diabetic man who developed slurred speech, ataxia, and internuclear ophthalmoplegia. MRI examination revealed an unusual ischemic stroke involving Wernekink commissure. This rare stroke pattern involving decussation of SCP occurs in the setting of small arterial disease. The association between the anatomic location of the stroke and clinical findings is noteworthy.