Medicine and Health Sciences Commons^™

Accuracy Of Echocardiography In Diagnosing Total Anomalous Pulmonary Venous Return, Fatima Ali, Sonia Qureshi, Muneer Amanullah, Mehnaz Atiq

Department of Paediatrics and Child Health

Objective: Total anomalous pulmonary venous return is an uncommon cyanotic congenital heart defect. Echocardiography is the initial diagnostic tool. Complimentary non-invasive modalities like cardiac computerized tomographic angiography and cardiac magnetic resonance imaging have replaced the need for cardiac catheterization in difficult cases. This study aimed to determine the accuracy of echocardiography in diagnosing total anomalous pulmonary venous return, and to determine the factors that may decrease its sensitivity.
Methods: This was a cross-sectional study conducted at the Aga Khan University Hospital Karachi, Pakistan from January 2010 to August 2016. All patients who were diagnosed with Total anomalous pulmonary venous return …

The Effect Of Endometriosis On Live Birth Rate And Other Reproductive Outcomes In Art Cycles: A Cohort Study, Charles Muteshi, Eric O. Ohuma, Tim Child, Christian M. Becker

Obstetrics and Gynaecology, East Africa

Study question: What is the effect of endometriosis compared to unexplained subfertility on live birth rate in women undergoing IVF and embryo transfer (ET)?

Summary answer: Endometriosis decreases live birth rate in women undergoing IVF-ET treatment, particularly with increasing severity of the disease.

What is known already: Endometriosis affects up to 50% of women seeking fertility treatment and is known to reduce fecundity. There remains a debate as to effects of endometriosis on the outcomes of IVF treatment, with live birth being a secondary outcome or not reported in most studies.

Study design, size, duration: A retrospective cohort study analyzing …

Preliminary Radiological Result After Establishment Of Hospital-Based Trauma Registry In Level-1 Trauma Hospital In Developing Country Setting, Prospective Cohort Study, Obada Hussein Hasan, Adeel Samad, Zohaib Nawaz, Tashfeen Ahmad, Zehra Abdul Muhammad, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Injuries are the second most common cause of disability, the fifth most common cause of healthy years of life lost per 1000 people and unfortunately 90% of mortality takes place in low-to middle-income countries. Trauma registries guide policymakers and health care providers in decision making in terms of resource allocation as well as enhancing trauma care outcomes. Furthermore data from these registries inform policy makers to decrease the rate of death and disability occurring as a result of injuries. We present our experience in setting up an orthopedic trauma registry and the first short term follow-up of radiological outcomes. …

Tranexamic Acid For Significant Traumatic Brain Injury (The Crash-3 Trial): Statistical Analysis Plan For An International, Randomised, Double-Blind, Placebo-Controlled Trial, Ian Roberts, Antonio Belli, Amy Brenner, Rizwana Chaudhri, Bukola Fawole, Tim Harris, Rashid Jooma, Abda Mahmood, Temitayo Shokunbi, Haleema Shakur, Crash-3 Trial Collaborators

Section of Neurosurgery

Background: Worldwide, traumatic brain injury (TBI) kills or hospitalises over 10 million people each year. Early intracranial bleeding is common after TBI, increasing the risk of death and disability. Tranexamic acid reduces blood loss in surgery and death due to bleeding in trauma patients with extra-cranial injury. Early administration of tranexamic acid in TBI patients might limit intracranial bleeding, reducing death and disability. The CRASH-3 trial aims to provide evidence on the effect of tranexamic acid on death and disability in TBI patients. We will randomly allocate about 13,000 TBI patients (approximately 10,000 within 3 hours of injury) to an …

Clozapine Is Associated With Secondary Antibody Deficiency, Mark Ponsford, Daniel Castle, Tayyeb Tahir, Rebecca Robinson, Wendy Wade, Rachael Steven, Kathryn Bramhall, Mo Moody Mo Moody, Emily Carne, Catherine Ford

Brain and Mind Institute

Background: Schizophrenia affects 1% of the population. Clozapine is the only medication licensed for treatment-resistant schizophrenia and is intensively monitored to prevent harm from neutropenia. Clozapine is also associated with increased risk of pneumonia although the mechanism is poorly understood.AimsTo investigate the potential association between clozapine and antibody deficiency.

Methods: Patients taking clozapine and patients who were clozapine-naive and receiving alternative antipsychotics were recruited and completed a lifestyle, medication and infection-burden questionnaire. Serum total immunoglobulins (immunoglobulin (Ig)G, IgA, IgM) and specific IgG antibodies to haemophilus influenzae type B, tetanus and IgG, IgA and IgM to pneumococcus were measured.

Results: Immunoglobulins …

Fatal Invasive Gastrointestinal Fungal Infection In Three Non-Immunocompromised Patients, Zubair Ahmad, Sidra Arshad, Romana Idress, Nasir Uddin, Jamshid Abdul-Ghafar

Department of Pathology and Laboratory Medicine

The importance and frequency of invasive fungal infections in different organs, including the gastrointestinal tract, has increased due to excessive use of aggressive immunosuppressive and immunomodulatory drugs in malignant diseases and organ transplantations as well as increased infections with the human immunodeficiency virus (HIV). Fungal infections in the small intestine or colon are usually part of a disseminated disease process and reach these organs through the bloodstream. Two of the patients were infants 10 and 15 days of age, while one was 23 years old. Patients presented with abdominal pain, intestinal obstruction, and rectal bleeding. Hirchsprung disease was suspected in …

Frequency Of Bloodstream Infection In Febrile Neutropenic Patients, Experience From A Developing Country, Basit Siddiqui, Rabeea Azmat, Shiyam Sunder Tikmani, Shumaila Rafi, Beenish Syed, Muhammad Tahir Khan, Hareem Rehman, Saleemullah Paracha

Section of Nephrology

Introduction: About 20% of febrile neutropenic patients are presented with bloodstream infection which is a leading cause of mortality among these patients. Awareness of the locally prevalent pathogens and their susceptibility pattern is important for proper treatment of infection which improves survival in these patients. The objective of this study was to determine the frequency of bloodstream infection in patients with febrile neutropenia admitted in Abbasi Shaheed Hospital.
Methods; This cross-sectional study was conducted in the Medical wards in Abbasi Shaheed Hospital, Karachi from 21-2-2016 to 20-8-2017. Patients of over 15 years of age of either gender with severe neutropenia …

Invasive Mediastinal Aspergillosis Presenting As Superior Vena Cava Syndrome In An Immunocompetent Patient, Yasmin Rahim, Aisha Memon, Javaid Khan

Section of Pulmonary & Critical Care

Invasive aspergillosis (IA) is a disease of the immunocompromised with a predilection for the lungs, although dissemination to all organs is possible. Its diagnosis remains a challenge due to the absence of specific clinical manifestations and laboratory findings. In most cases, diagnosis is eventually made via invasive methods. It carries with it a high mortality due to late diagnosis and delayed treatment. Here, we report a fascinating case of a young, otherwise healthy, immunocompetent patient that presented to us with superior vena cava syndrome and a mediastinal mass. It was anticipated that a malignancy would be found on further workup …

Integrating Standardized Whole Genome Sequence Analysis With A Global Mycobacterium Tuberculosis Antibiotic Resistance Knowledgebase, Rumina Hasan, Matthew Ezewudo, Amanda Borens, Álvaro Chiner-Oms, Paolo Miotto, Leonid Chindelevitch, Angela M. Starks, Debra Hanna, Richard Liwsk, Matteo Zignol

Department of Pathology and Laboratory Medicine

Drug-resistant tuberculosis poses a persistent public health threat. The ReSeqTB platform is a collaborative, curated knowledgebase, designed to standardize and aggregate global Mycobacterium tuberculosis complex (MTBC) variant data from whole genome sequencing (WGS) with phenotypic drug susceptibility testing (DST) and clinical data. We developed a unified analysis variant pipeline (UVP) ( https://github.com/CPTR-ReSeqTB/UVP ) to identify variants and assign lineage from MTBC sequence data. Stringent thresholds and quality control measures were incorporated in this open source tool. The pipeline was validated using a well-characterized dataset of 90 diverse MTBC isolates with conventional DST and DNA Sanger sequencing data. The UVP exhibited …

Role Of Palliative Csf Diversion In Patients With Intracranial Metastatic Disease And Symptomatic Hydrocephalus, Farhan A. Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Hydrocephalus, unless treated, is one of the terminal manifestations of intracranial metastatic disease. Single lesions causing obstructive hydrocephalus are amenable to surgical resection, but in the setting of multiple lesions and communicating hydrocephalus from leptomeningeal disease, the approach to treatment is much less defined. The use of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) has been described, but data is limited. In this review, we summarize the sparse data available in literature describing the use of CSF diversion for patients with metastatic disease presenting with hydrocephalus and neurological decline.

Compound Heterozygosity For A Whole Gene Deletion And P.R124c Mutation In Cyp21a2 Causing Nonclassic Congenital Adrenal Hyperplasia, Hamza Nasir, Syed Ibaad Ali, N Haque, Stefan K. Grebe, Salman Kirmani

Section of Diabetes, Endocrinology and Metabolism

We present a family with 2 members who received long-term steroid treatment for presumed classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, until molecular testing revealed nonclassic CAH, not necessarily requiring treatment. A 17-year-old male presented to our clinic on glucocorticoid and mineralocorticoid treatment for classic CAH. He was diagnosed at 4 years of age based on mild-moderate elevations of 17-hydroxyprogesterone (17-OHP) and adrenocorticotropic hormone (ACTH), but without evidence of precocious adrenarche/puberty. Due to his diagnosis, his clinically asymptomatic 3-year-old sister was tested and also found to have elevated ACTH and 17-OHP levels and was started on glucocorticoids for …

Men’S Health In Industries: Plastic Plant Pollution And Prevalence Of Pre-Diabetes And Type 2 Diabetes Mellitus, Sultan Ayoub Meo, Faris Jamal Almutairi, Majed Mohammed Alasbali, Turki Badr Alqahtani, Saad Saeed Almutairi, Rakan Abdulaziz Albuhayjan, Fawziah Al Rouq, Naseer Ahmed

Department of Biological & Biomedical Sciences

Plastic production is prominently increasing and its pollution is an emerging environmental global health concern. This study aimed to investigate the occurrence of pre-diabetes and type 2 diabetes mellitus (T2DM) among nonsmoking plastic industry workers. Three hundred and forty volunteers male plastic industry workers were interviewed after medical history and examination; finally, 278 nonsmoking plastic industry workers were selected. The mean age for the participants was 38.03 ± 10.86 years and body mass index was 25.52 ± 3.15 (kg/m)². The plastic industry workers had been exposed to plastic plant pollution for 8 hr daily, 6 days in a …

Neurology Advocacy In Pakistan, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Advocacy is an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions. Advocacy can include many activities that a person or organization undertakes including media campaigns, public speaking, commissioning and publishing research or conducting exit poll or the filing of an amicus brief. Lobbying (often by lobby groups) is a form of advocacy where a direct approach is made to legislators on an issue which plays a significant role in modern politics

Bilateral Psoas Abscess After Extracorporeal Shock Wave Lithotripsy: Reminder Of A Rare Complication, Sidra Zafar, Syed Usman Bin Mahmood, Arsal Tharwani, Noreen Nasir

Section of Nephrology

Extracorporeal shock wave lithotripsy (ESWL) is among the most widely used modalities for treatment of urolithiasis since its introduction in the 1980s. The non-invasive technique reduces the risk of post-procedure complications and produces excellent stone free rates. However, complications may still follow and albeit rare, there are reports in literature of abscess formation post ESWL. Herein, we report the case of a young, immunocompetent gentleman who developed bilateral psoas abscess after undergoing this procedure. He was successfully managed at our institute with intravenous antibiotics, percutaneous abscess drainage and was discharged on day 5 post-intervention in a stable condition. There have …

Palatable Food Dampens The Long-Term Behavioral And Endocrine Effects Of Juvenile Stressor Exposure But May Also Provoke Metabolic Syndrome In Rats, Eliza Fatima Ali, Jennifer Christine Mackay, Samantha Graitson, Jonathan Stewart James, Christian Cayer, Marie-Claude Audet, Pamela Kent, Alfonso Abizaid, Zul Premji

Brain and Mind Institute

The juvenile period is marked by a reorganization and growth of important brain regions including structures associating with reward seeking behaviors such as the nucleus accumbens (NA) and prefrontal cortex (PFC). These changes are impacted by stressors during the juvenile period and may lead to a predisposition to stress induced psychopathology and abnormal development of brain reward systems. Like in humans, adult rodents engage certain coping mechanisms such as increases in the consumption of calorie-rich palatable foods to reduce stress, but this behavior can lead to obesity and metabolic disorders. In this study, we examined whether stressors during the juvenile …

Incidence, Patterns And Associated Factors For Occupational Injuries Among Agricultural Workers In A Developing Country, Unaib Rabbani, Zafar Fatmi

Community Health Sciences

Background: Injuries are common among agricultural workers, and a large section of the population is employed in agriculture worldwide. We aimed to determine the incidence, patterns and associated risk factors of occupational injuries among the agricultural workers in a developing country.
Methods: A cross-sectional study in Hyderabad, Pakistan was conducted from December 2012 to February 2013. Information was collected about incidence, pattern and associated risk factors of occupational injuries from 472 agricultural workers. Injury incidence and patterns for place, severity, type, agent, parts of body affected and work activity were calculated. Analysis was performed using SPSS version 19.0. Multivariate logistic …

Behavioral Challenges In Childhood Epilepsy, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Behavioral problems among children with epilepsy is one of the most common problem. Severity of the problem ranges from 16% to 77% as compared to 9% in the general pediatric population. Such a huge variation in the results reflects probable difference in the methodology. Structured interviews that include parents, children and clinician’s reports have identified a higher rate of behavioral problems when compared to self-report instruments. Higher rates are reported in clinical samples recruited from tertiary care medical centers, where they have a lot of referrals from the peripheral small units. Most researchers agree that children with epilepsy have three …

Role Of Adc Values And Ratios Of Mri Scan In Differentiating Typical From Atypical/Anaplastic Meningiomas, Muhammad Azeemuddin, Waseem Mehmood Nizamani, Muhammad Usman Tariq, Mohammad Wasay

Department of Radiology

Atypical/anaplastic meningiomas are prone to aggressive behaviour which affects treatment planning and prognostication. Our aim was to assess the role of Apparent Diffusion Coefficient (ADC) values of MRI brain in differentiating typical from atypical/anaplastic meningioma. We reviewed 84 typical and 37 atypical/anaplastic meningiomas and compared mean ADC values and ADC ratios of their preoperative MRI brain. At 3 Tesla, mean ADC value for typical meningioma was1.03±0.10x10-3 and 0.63±0.05x10-3 for atypical/anaplastic meningioma. At 1.5 Tesla, mean ADC value for typical meningioma was 1.05±0.11x10-3 and atypical/ anaplastic meningioma was 0.70 ± 0.04x10-3. The mean ADC ratios were 1.08 ± 0.17 and 0.85 …

Labrad : Vol 44, Issue 2 - September 2018, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Inappropriate Requesting Of Glycated Haemoglobin (HBA1c) By Clinicians
• Fecal Calprotectin (S100a8/S100a9)
• Fecal Pancreatic Elastase: A Test for Pancreatic Insufficiency
• Radiology Pathology Correlation
• Myelodysplastic Syndromes (MDS)
• WHO Classification of Head and Neck Tumours: An Update
• Plasma Metanephrines in Diagnosis of Pheochromocytoma
• Megaloblastic Anemia
• Aplastic AnemiaTransfusion Associated Circulatory Overload (Taco): A Severe But Preventable Transfusion Reaction

Cime Newsletter : September 2018, Cime

Centre for Innovation in Medical Education (CIME) Archives

-Live Orbital and Oculoplastic Surgery Telecast and Fundoscopy Simulator Training
-CIME at SimGHOSTS
-Endoscopy Workshop in Partnership
-A Masterclass on the Mini-Gastric Bypass Procedure
-Vascular Surgery Workshop
-Complicated Intra-Abdominal Infections Workshop
-Shoulder Dystocia - Team Training Workshop
-Simulation Saves Lives by Dolliewood Production

Pharmacy Newsletter : September 2018, Pharmacy Department

Department of Pharmacy Archives

Content:

• Stress Ulcer Prophylaxis
• New Update: Direct Oral Anti-Coagulants (DOACs)
• Case Study: Use of Cholestyramine for Management Of Digoxin Toxicity
• Updates : Use of Doxycycline in Children
• Serotonin Syndrome – Myths & Misconceptions

Reducing Typhoid Burden Within A Generation, Zulfiqar Ahmed Bhutta, Anita K. M. Zaidi, Tikki Pangestu

Department of Paediatrics and Child Health

No abstract provided.

Fungal Osteomyelitis In A Patient With Chronic Granulomatous Disease: Case Report And Review Of The Literature, Muhammad Khalid, Syed Asad Ali

Department of Paediatrics and Child Health

Chronic granulomatous disease (CGD) is the most common of the primary immunodeficiency in children. It is caused by single gene defect resulting in dysfunctional nicotinamide adenine dineucleotide phosphate (NADPH) oxidase complex causing recurrent bacterial and fungal infections. Here we present the case of a 9 year old boy who was a known case of CGD since three years of age. He presented with recent history of fever, left sided pain in the scapular region and difficulty in breathing. Chest imaging revealed developing left upper lobe consolidation and erosion of the 3rd posterior rib. The child underwent video assisted thoracoscopic surgery …

Invasive Community Acquired Methicillin-Resistant Staphylococcal Aureus (Ca-Mrsa) Infections In Children, Muhammad Khalid, Samina Junejo, Fatima Mir

Department of Paediatrics and Child Health

Staphylococci are gram-positive bacteria divided into coagulase positive and coagulase negative classes, Staphylococcus aureus is the most important bacterium of this class. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has changed a lot. It is no more the problem of only hospitalised patients. Children coming from community has also been increasingly affected by MRSA-called community acquired methicillin-resistant (CA-MRSA) infection. The higher severity of CA-MRSA is due to its ability to produce the toxin Panton-Valentine Leukocidin (PVL) associated with staphylococcal cassette chromosome mec (SCCmec) type IV gene. Here, we are presenting five cases of CA-MRSA infection in children having age range 0.5 …

Correlation Between The Atlas Morphology And The Maxillo-Mandibular Divergence Pattern, Hafiz Taha Mahmood, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Objective: To evaluate the correlation between atlas morphology and maxillo-mandibular divergence.
Study design: Cross-sectional, analytic study.
Place and duration of study: Dental Clinics, The Aga Khan University Hospital, Karachi, Pakistan from February to August 2017.
Methodology: Pretreatment lateral cephalograms of 208 subjects, aged 18 to 25 years, were evaluated. The atlas parameters were categorized into atlas dorsum, anteroposterior and ventrum, and measured on View Pro-X software. Various maxillary (FPPP, SNPP and FHPP angles) and mandibular (SNGoGn, saddle, articulare, gonial, sum of posterior and Y-axis angles) parameters were used to evaluate the divergence pattern of the individuals. Mann-Whitney U-test was used …

Rapid Development Of Hepatocellular Carcinoma After Eradication Of Hepatitis C Virus With Directly Acting Antiviral Treatment, Fakhar Ali Qazi Arisar, Saeed Hamid

Section of Gastroenterology

Hepatitis C is a major risk factor for the development of hepatocellular carcinoma (HCC), arising typically on a background of liver cirrhosis. Treatment of hepatitis C has been revolutionized by the addition of oral direct-acting antivirals (DAAs) with sustained virological response (SVR) rates above 90%. There is a recent concern under debate about the increased risk of early HCC recurrence in patients with chronic hepatitis C who were treated with direct-acting antivirals. Nonetheless, these reports mostly focused on patients who were cirrhotic and were already treated for HCC. We report 4 cases of treatment naive, chronic hepatitis C patients who …

Prevention Of Neural Tube Defects By Folic Acid In Pregnancy., Atiq Ahmed Khan, Ruth K.M.

Pakistan Journal of Neurological Sciences (PJNS)

Pakistan is a developing country facing variety of challenges including maternal malnutrition and neonatal mortality. Globally Pakistan has the third highest neonatal mortality rate(1). Maternal malnutrition contributes to low birth weight neonates and birth anomalies. A study conducted in tertiary care hospital of Karachi catering to lower socioeconomic background showed 10.9% of birth defects to be of central nervous system. Maternal factor related to neural tube defects in same study showed 81.3 % mothers had not taken folic acid during pregnancy(

Hyperglycemia In Acute Subarachnoid Hemorrhage, Maher Bano Malik, Jehangeer Shoro, Haris Majid Rajput

Pakistan Journal of Neurological Sciences (PJNS)

Subarachnoid hemorrhage (SAH) is associated with high inhospital mortality and morbidity. Hyperglycemia occurs frequently in acute medical conditions including SAH and is associated with poor outcome. The aim of the study was to determine the frequency of Hyperglycemia in patients of subarachnoid hemorrhage.

Chikungunya Virus Associated Guillain-Barre Syndrome With Variable Presentation: A Case Series., Salman Farooq, Muhammad Imran, Ejaz Karim, Dureshahwar Kanwar, Muhammad Bilal Tariq

Pakistan Journal of Neurological Sciences (PJNS)

Chikungunya Virus Is A Mosquito-borne Alpha Virus Which Occasionally Causes Neurologic Complications Including Guillain-barre Syndrome, Myelitis, Myopathies And Encephalitis. Pakistan Experienced Its First Chikungunya Outbreak In The Metropolis Of Karachi Officially Confirmed By World Health Organization In December 2016. During This Outbreak, Over 30,000 People Have Been Reported To Be Infected In Different Parts Of Karachi. We Report Four Cases Of Chikungunya Virus Infection Associated Guillain-barre Syndrome Having An Atypical Clinical Presentation And Variable Outcome. Each Case Presented As A Different Variant Of Gbs Including Acute Inflammatory Demyelinating Polyneuropathy, Acute Motor And Sensory Axonal Neuropathy And Pharyngeal-cervical-brachial.

Personality Traits And Mental Health Of University Male Students Viewing Internet Pornography, Komal Razzaq, Muhammad Rafiq, Fatima Sana, Zahid Mahmood

Pakistan Journal of Neurological Sciences (PJNS)

Studies have indicated that viewing internet pornography is like addiction and has been implicated in the development of psychosocial issues leading to mental health. However, in view of Pakistani culture, psychosocial issues and mental health problems associated with viewing internet pornography especially in perspective to personality traits are not studied yet. Objective: Objective of the current study was to investigate any effect of personality traits on mental health of university male students viewing internet pornography.