Medicine and Health Sciences Commons^™

Acute Disseminated Encephalomyelitis In A Middle Age Female, Hina Mushtaq, Maria Qureshi, Irfan Ahsan

Pakistan Journal of Neurological Sciences (PJNS)

Acute disseminated encephalomyelitis (ADEM) is an autoimmune condition that predominately involve demyelination of the white matter of the brain and spinal cord. It resembles other acute demyelinating syndromes like multiple sclerosis and most often presents in childhood.This is a case of a 52-year woman, presented with lower limb weakness, confusion and spasticity throughout the body with no preceding illness. CSF showed increased proteins with no oligoclonal bands. MRI Brain showed abnormal high intensity areas in bilateral parietal, periventricular region, with no contrast enhancement. She was given 1gram iv methylprednisolone based on the diagnosis of ADEM and responded well.

Direct Current Stimulation And Epilepsy In Developing Countries: Opportunity And Challenges, Abdulrahman Al-Thaqib, Baradi, Raidah Saleem, Shahid Bashir

Pakistan Journal of Neurological Sciences (PJNS)

Transcranial direct current stimulation (tDCS) is one type of neuromodulation, which is an emerging technology that holds promise for the future studies on therapeutic and diagnosis applications in treatment of neurological and psychiatric diseases. Epilepsy is one of the commonest neurological disorders, caused by an enhanced cortical excitability favoring paroxysmal neuronal discharge. Cathodaldirect current stimulation (ctDCS) is a low-cost noninvasive portable neuro-stimulatory technique which can transiently decrease cortical excitability in humans. This was invasively demonstrated to reduce epileptiform discharges in animals.

Fatal Elizabethkingia Meningoseptica Cholangitis Following Biliary Stent Placement, Khalid Ahmed, Syeda Atia Qudsia, Abdul Rehman, Syed Hani Abidi

Department of Biological & Biomedical Sciences

Elizabethkingia (E.) meningosepticais a ubiquitous gram-negative bacillus belonging to the genus Chryseobacteriumand has been reported to cause nosocomial infections in both the immunocompromised and immunocompetent patients. E. meningoseptica can colonize the biliary tree after endoscopic procedures; and cholangitis, caused by this organism, is associated with a favorable prognosis. Here, we report a fatal case of cholangitis secondary to E. meningoseptica that developed following biliary stent placement. This case suggests that E. meningoseptica can be a cause of potentially fatal biliary tract infections in patients who undergo biliary tract endoscopic procedures. Clinicians must not disregard this organism as a contaminant (or …

Serum Tumour Necrosis Factor Alpha In Osteopenic And Osteoporotic Postmenopausal Females: A Cross-Sectional Study In Pakistan, Rafat Murad, Zahra Shezad, Saara Ahmed, Mussarat Ashraf, Murad Qadir, Rehana Rehman

Department of Biological & Biomedical Sciences

Objective: To compare biochemical parameters serum tumour necrosis factor alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D in postmenopausal women.
Methods: This cross-sectional study was carried out from June 2015 to July 2016 at Jinnah Medical and Dental College, Karachi, and comprised postmenopausal women. Bone mineral density done by dual energy X-ray absorptiometryscan categorised subjects by World Health Organisation classification into normal (T score > -1) osteopenic (T score between -1 and -2.5) and osteoporotic (T score < -2.5). Biochemical parameters like tumour necrosis alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D were measured by solid phase enzyme amplified sensitivity immunoassay method. SPSS 16 was used to analyse the data.
Results: Of the 146 women, 34(23%) were normal, 93(67%) were osteopenic and 19(13%) were osteoporotic. There was significant difference in mean body mass …

A Gender-Based Comparison In Health Behaviors And State Of Happiness Among University Students, Rehana Rehman, Amara Zafar, Aleena Mohib, Mukhtiar Baig

Department of Biological & Biomedical Sciences

Objective: The presence of good healthy behaviors among university students is imperative for their future life. This study aimed to compare positive health behaviors and state of happiness between the two genders of Bahria University (BU), Karachi, Pakistan.
Subjects and methods: This cross-sectional study was conducted at BU, Karachi, Pakistan. A total 813 students participated in this study. The healthquestionnaire, adapted from Health and Behavior Survey and the Subjective Happiness Scale, was used to assess self-reported happiness. The data were analyzed using IBM SPSS version 22.
Results: Overall self-reported health behaviors were found to be more prevalent in females as …

Neonatal Purpura Fulminans, A Rare Genetic Disorder Due To Protein C Deficiency: A Case Report., Ghazala Irfan Kazi, Emaduddin Siddiqui, Saadia Tabassum, Badar Afzal, Irum Qamar Khan

Department of Emergency Medicine

Neonatal Purpura Fulminans is a rare and fatal disorder associated with perivascular haemorrhage and disseminated intravascular coagulation. Early clinical recognition, timely investigation and treatment is utmost important. A 6 days old baby boy was brought to emergency with blackish ulcers all over the body. Initially these were over the feet and scalp but later appeared on the abdomen. On examination, child was vitally stable, mildly icteric and had multiple erythematous large bullous blackish lesions on scalp, lower abdomen, perineum, back and soles. Neonatal reflexes and systemic examination was normal. Laboratory investigations showed normal CBC, PT/APTT and Protein S level while …

Treatment Of A Rare Vascular Complication Of Coronary Stenting In An Octagenarian, Hunaina Shahab, Bilal Hussain, Nasir Rahman, Fateh Ali Tipoo Sultan

Section of Cardiology

The ability of drug-eluting stent (DES) to inhibit intimal proliferation has resulted in a massive increase in their usage over the years. However, it is known that the application of DES can alter the normal cascade of vascular healing, resulting in delayed endothelialisation with risk of vascular complications. Coronary artery aneurysms (CAN) are defined as more than 50% dilatation of the coronary artery compared to the reference vessel diameter with the reported incidence after percutaneous intervention (PCI) being only around 0.35 to 6.0%. Previously, CAN had been reported with the use of bare metal stent secondary to stretch, stent fracture …

Myocarditis Mimicking Acute Coronary Syndrome - The Role Of Cardiac Magnetic Resonance Imaging In The Diagnosis, Fateh Ali Tipoo Sultan, Ghurfan Adnan

Section of Cardiology

Myocarditis is an inflammatory disease of myocardium with a wide range of clinical presentations. Myocarditis may mimic acute coronary syndrome (ACS) and adequate differential diagnosis is not possible by conventional tests. Cardiac magnetic resonance (CMR) has emerged as a leading imaging modality in the diagnosis of myocarditis in such patients. Here, we report three cases of myocarditis mimicking ACS with normal coronary arteries. CMR was used for confirming the diagnosis of myocarditis in all three patients presented here.

Electronic Cigarettes Use And Perception Amongst Medical Students: A Cross Sectional Survey From Sindh, Pakistan, Nousheen Iqbal, Zain A. Khan, Syed Muhammad Hamza Anwar, Omar Irfan, Babar Irfan, Ammar Mushtaq, Maria Bibi, Faraz Siddiqui, Javaid Khan

Section of Pulmonary & Critical Care

Objective: The manufacturers of electronic cigarettes (e-cigarettes) are actively marketing their product through electronic and social media. Undergraduate medical students are expected to have better knowledge and awareness as they directly interact with patients in their training, The purpose of this study is therefore, to determine knowledge, use and perception regarding e-cigarettes among medical students from Sindh, Pakistan.

Results: A cross-sectional study was conducted between 1st July and 30th September 2016 at five different medical colleges situated in the second largest province of Sindh, Pakistan. The data was collected through a structured, self-administered questionnaire. Of the 500 students, the mean …

Influence Of Supportive Care On Chemotherapy Patients' Self-Care Behaviour And Satisfaction: A Pilot Study Conducted In Karachi, Pakistan, Salima Shams, Adnan Jabbar, Kashmira Nanji, Rafat Jan, Ambreen Tharani

School of Nursing & Midwifery

Background and aim: Cancer is a daunting illness affecting a vast number of people globally. During the illness trajectory, cancer patients suffer from physical and/or psychosocial issues. These physical and psychosocial issues demand conscious actions by patients to maintain their well-being. Hence, the objective of the pilot study was to evaluate the level of self-care behaviors and satisfaction in women suffering from cancer after exposure to supportive care (education and mind diversion activities) delivered via a patient help group program.
Methods: The study was conducted at the chemotherapy day care unit of one of the tertiary care hospitals …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

Fibrolipomatous Hamartoma Of The Median Nerve With Macrodystrophia Lipomatosa, Muhammad Azeemuddin, Adeel A. Waheed, Noman Khan, Raza Sayani, Anwar Ahmad

Department of Radiology

Fibrolipomatous hamartoma (FLH) is a rare congenital condition that presents with a benign overgrowth of the bone and fibroadipose tissue termed as macrodystrophia lipomatosa (MDL). Although commonly seen in the median nerve, other peripheral nerves can be involved. Diagnosis can be made on magnetic resonance imaging (MRI) due to the characteristic coaxial cable appearance on axial images and the spaghetti appearance on sagittal images. Histology shows mature adipose and fibrous tissue infiltrating the epineural and perineural compartments. Multiple or debulking surgeries are often needed, with an emphasis on cosmetic aspects. We present one such case in which wide margin excision …

Myocardial Perfusion Imaging: The Gatekeeper And Advisor, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Inspire : Vol 1, Issue 2, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Hepatitis c test changed my life
• Dermatology faculty extending the footprint of Dept. of Medicine at various National and International Forums
• The regional impact of Auk's training program; a reflection from a former fellow, Dr Shereen khan fops', maps.
• Promotion; Dr. Faisal Ismail
• Dermatology faculty extending the footprint of Dept. of Medicine at various National and International Forums
• Dr. Yawer Saeed; The new Cardiologist/Poet on the Dom block

Cime Newsletter : March 2018, Cime

Centre for Innovation in Medical Education (CIME) Archives

- SONAM Skills Lab becomes Part of CIME

- Critial Care Nursing (CCN) Simulation Workshop for BScN Students

- 5th CEEA CME Course

- 3rd Annual Surgical Meeting

- Neurovascular Course @ CIME

- Postgraduate Medical Education Conference

- An Interview with the Crocodile

- CIME Video: Exploring The Human Patient Simulator

- Publication by Faculty

Role Of Interventional Radiology In The Management Of Peripheral Vascular Malformations: A Tertiary Care Center Experience., Misbah Tahir, Muhammad Anees Mumtaz, Anum Sultan, Raza Sayani

Department of Radiology

Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs. Purpose The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our …

The Loose End: Neurology Without Rehabilitation, Ahmad Zaheer Qureshi, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

In recent years, successive therapies for previously untreatable neurological conditions have been introduced in clinical practice and these advance interventions have remarkably changed the landscape of neurosciences1,2 .But, rehabilitation of the functional impairments caused by neurological diseases is often overlooked or sometimes even neglected. In other words, the role of a comprehensive and early multidisciplinary rehabilitation in neurological disease is unrecognized and poorly understood even among neurologists and neurosurgeons. Usually, lifesaving neurosurgical management or solving a diagnostic riddle in neurology is attributed to successful patient management; however in reality, this is the first step in establishing a care plan for …

The Rare And The Unexpected; Miller Fisher Syndrome, Saad Waheed, Jawad Hussian, Aqsa Shehzadi

Pakistan Journal of Neurological Sciences (PJNS)

Miller Fisher Syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS) which is an idiopathic neuromuscular paralysis. It is considered as autoimmune disease because there are antibodies which attack the nerve cell fibers resulting in paralysis of muscles. This disease exhibits a classic clinical triad of ataxia,areflexia, and ophthalmoplegiawhereas it could have more neurological symptoms.Basically it is diagnosed clinically but have a serological test for its confirmation i.e. anti-GQ1b antibody levels.Here, we report a stereotypical case of MFS with all of its cardinal symptoms with addition of some other symptoms like diplopia, ptosis of an eye and unilateral facial …

Biopsy Proven Case Of Creutzfeldt- Jacob Disease From Pakistan, Rizwana Shahid, Saad Shafqat

Pakistan Journal of Neurological Sciences (PJNS)

Creutzfeldt-Jakob disease (CJD) is a rare type of prion disease leading to a rapidly progressive dementia (RPD) and other associated neurological features specially startle myoclonus. The annual incidence of CJD has been reported to be 1 per million or 271 people in USA2, but from Asia especially from Pakistan, only few case reports have been published. The probable cause behind the rarity of this disease in our society is still unclear.The diagnosis of CJD requires a high level of suspicion and lack of the availability of specific markers like CSF 14-3-3 in our setup makes it more difficult. Similarly brain …

Bilateral Wrist Drop In A Middle Age Man, Ghulam Shabbir, Zakir Jan, Haris Majid Rajput

Pakistan Journal of Neurological Sciences (PJNS)

Peripheral neuropathy is a common disorder which often causes disability.Among metals lead intoxication leads to bilateral radial neuropathy. Patients with lead neuropathy present with weakness that primarily involves the wrist and finger extensors. Lead intoxication in humans causes axonal degeneration. We report a case of middle age male who presented with bilateral wristsdrop, workup revealed that he had bilateral radial nerve neuropathy which was secondary to his occupational exposure to lead causing lead intoxication. Chronic lead exposure as a risk factor for neuropathy should be identified and treated promptly as its avoidance and treatment can save major disabilities.

Treatment And Outcome In Patients With Infantile Spasms And Lennox Gastaut Syndrome, Arif Herekar, Nasir Yaqoob

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: AIM: To measure and assess the efficacy of ACTH and Vigabatrin in Infantile Spasm and their Unresponsiveness in Lennox-Gastaut Syndrome in Pakistani Population MATERIALS AND METHODS A study was conducted between year 2006 to 2016 evaluating 120 patients presenting to Neurodiagnostic Centre, Hamdard University Hospital and National Medical Centre, Karachi. Infantile spasms and Salaam Attacks were the basic diagnosis both clinically and electroence phalographically. Age ranges between 1 month to 1.5 years. All patients were administered appropriate doses of Anti Epileptics, ACTH and vitamin supplements RESULTS Amongst 120 patients of Infantile Spasm that we have encountered in last decade …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

Capacity Building In Sub-Saharan Africa: Models Of Care, Patrick J. Loehrer, Barry Rosen, Elkanah Omenge, Julie R. Gralow

Obstetrics and Gynaecology, East Africa

No abstract provided.

Evaluation Of Root Morphology And Canal Configuration Of Maxillary Premolars In A Sample Of Pakistani Population By Using Cone Beam Computed Tomography, Muhammad Rizwan Nazeer, Farhan Raza Khan, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objectives: To evaluate the root canal morphology of maxillary premolars.

Method: This retrospective study was conducted from November 2016 to January 2017 at Aga Khan University Hospital, Karachi, and reviewed Cone Beam Computed Tomography images of maxillary first and second premolars done from November 2014 to October 2016. Frequency distribution of Vertucci's classification was determined. Chi square test was applied to determine any association between Vertucci's type and gender. SPSS 19 was used for data analysis.

Results: Of the 114 first premolars, 74(68.6%) were bi-rooted and 36(31.5%) were single-rooted. The mean lengths of buccal and palatal roots were …

Cough, Hemoptysis And Hair Expectoration: An Intrapulmonary Teratoma, Shanila Ahmed, Habib Kibzai, Talha Shahzad, Saulat Fatimi, Madiha Bilal L Qureshi

Section of Haematology/Oncology

Teratomas can be found in different organs of the body and may involve gonads, saccrococcygeal region, mediastinum and other sites. Intrathoracic teratomas always occur in mediastinum and less often arise within the lung. As teratomas mostly involve sex organs (gonads), they rarely occur as extra-gonadal tumors accounting for only 3% of all the cases and very small percentage of such tumors occur in mediastinum.We reported an interesting case of middle aged male who presented to us with symptoms of cough, hemoptysis and trichoptysis (hair expectoration).We found that patient had intrapulmonary teratoma that was initially being treated as case of pulmonary …

Uterine Arteriovenous Malformations After Suction Evacuation Of Missed Miscarriage, Arshia Javed, Reeta Chander, Zahra Hoodbhoy

Department of Obstetrics & Gynaecology

Uterine arteriovenous malformation (AVM) is an uncommon but life-threating source of bleeding. AVM is an abnormal connection between uterine arteries and veins. Patients typically present with vaginal bleeding following miscarriage (medical/surgical) or cesarean section. The treatment of choice depends on the symptoms, age, desire of fertility, localization and size of the lesion. Uterine artery embolization is the first choice in symptomatic patients of reproductive age group. We report a case of AVM presenting after dilation and evacuation with extensive lesion, which was successfully treated with bilateral uterine artery embolization.

Uterine Arteriovenous Malformations After Suction Evacuation Of Missed Miscarriage, Arshia Javed, Reeta Chander, Zahra Hoodbhoy

Department of Obstetrics & Gynaecology

Uterine arteriovenous malformation (AVM) is an uncommon but life-threating source of bleeding. AVM is an abnormal connection between uterine arteries and veins. Patients typically present with vaginal bleeding following miscarriage (medical/surgical) or cesarean section. The treatment of choice depends on the symptoms, age, desire of fertility, localization and size of the lesion. Uterine artery embolization is the first choice in symptomatic patients of reproductive age group. We report a case of AVM presenting after dilation and evacuation with extensive lesion, which was successfully treated with bilateral uterine artery embolization.

Risk Factors For Stroke And Tia's In Pakistan: A Community-Based Study, Abdul Malik, Farrukh Malik, Ismail Khatri, Sadaf Nasir

Pakistan Journal of Neurological Sciences (PJNS)

OBJECTIVES: To estimate the frequency of risk factors for stroke and transient ischemic attacks in Pakistan; a multi-city community-based study. METHOD: This cross-sectional community-based study was conducted in various health care facilities including government funded District Head Quarters hospitals, private hospitals and medical centers, and community-based clinics across 27 cities all over Pakistan over a period of three years between 2013 and 2015. Nearly 900 patients were screened during stroke (Falij) screening camps at these facilities and the data regarding past stroke and transient ischemic attack (TIA) symptoms were recorded along with relevant neurological examinations. A 25 item self-administered questionnaire …

Effect Of Minor Surgery Under Propofol Anaesthesia On Brain Bdnf And Cognition, Muhammad Rafiq, Zahid Mahmood, Sajed Ali, Laure Pain

Pakistan Journal of Neurological Sciences (PJNS)

Brain Derived Neurotrophic Factor (BDNF) is a brain protein implicated in learning, memory and other cognitive functions. Changes in cellular brain functions as well as cognitive defects have been observed the days following anaesthesia, even for short-duration anaesthesia with/without surgery. Despites the role of neurotrophic factors in cognition, no data are still available on brain effects after anaesthesia. Purpose: To study the effect of minor surgery under short duration anaesthesia on cognition by investigating BDNF levels in plasma, hippocampus and cortex. METHODS: Male rats received an intra-peritoneal injection of either 120 mg/kg of propofol or intralipids solution or minor surgery …

Factors Associated With Month 2 Smear Non-Conversion Among Category 1 Tuberculosis Patients In Karachi, Pakistan, Kimberly A. D'Souza, Syed M A. Zaidi, Maria Jaswal, Shahid Butt, Saira Khowaja, Shifa Salman Habib, Amyn A. Malik

Community Health Sciences

Predictors of smear non-conversion at baseline can help identify cases at risk for failure of tuberculosis treatment. Retrospective data for smear-positive Category 1 patients in Karachi, Pakistan, was analyzed. Predictors of sputum conversion were determined using multiple logistic regression with sputum conversion as outcome variable and patient demographics, baseline weight, baseline sputum smear grade, case-finding approach as explanatory variables. Age ≥35 years, baseline sputum grade of 3+ were significantly associated with predicting sputum smear positivity at month 2 of treatment. Monitoring compliance to TB treatment should be considered amongst older patients and those with a high sputum grade at baseline.