Medicine and Health Sciences Commons^™

Associations Of The Plasticity Region Ofh. Pyloriin Patients With Gastroduodenal Diseases, Javed Yakoob, Z Abbas, Shagufta Naz, Shahab Abid, Wasim Jafri

Section of Gastroenterology

No abstract provided.

Clinical Radiology Research In Pakistan: From Evidence To Practice, Waseem Akhtar, Arif Ali, Mubashir Aslam, Gul-E-Khanda

Department of Radiology

OBJECTIVE: To assess the clinical radiology research productivity in Pakistan by type of publication, sources of funding and name of journals.

METHODS: A systematic search strategy using key words related to techniques and type of clinical radiology was carried out to identify various studies published in Indexed (Medline) and non-indexed (Pakmedinet) medical journals.

RESULTS: Total of 397 studies were identified out of which 173(43%) from Medline (indexed database) and 220 (57%) from pakmedinet (Indexed and non- indexed database of Pakistan Medical journals). Original articles were 294 (74%) but most of them (68%) were published in non-indexed journals and significantly different …

Is Chaalia/Pan Masala Harmful For Health? Practices And Knowledge Of Children Of Schools In Mahmoodabad And Chanesar Goth, Karachi, Sameena Shah, Riaz Qureshi, Iqbal Azam Syed

Department of Family Medicine

OBJECTIVE: To determine the practices and knowledge of harmful effects regarding use of Chaalia and Pan Masala in three schools of Mahmoodabad and Chanesar Goth, Jamshed Town, Karachi, Pakistan.

METHODS: To achieve the objective a cross-sectional design was used in three government schools of Mahmoodabad and Chanesar Goth, Jamshed Town, Karachi. Students of either gender drawn from these schools fulfilling the inclusion and exclusion criteria were interviewed using a pre-coded structured questionnaire. Along with demographic data, questions regarding frequency of Chaalia and Pan Masala use, practices of this habit in friends and family and place of procurement of these substances, …

Predictors Of Lymph Node Involvement In Bladder Cancer Treated With Radical Cystectomy, Zaheer Alam, Muhammad Hammad Ather, Anila Jamshaid, Khurram Muhammad Siddiqui, Muhammad Nasir Sulaiman

Section of General Surgery

Objective: To identify the clinical variables associated with prevalence of lymph node metastasis in patients with bladder cancer treated by radical cystectomy and lymphadenectomy for primary bladder cancer.
Methods: Review of records of Ninety-five patients who underwent radical cystectomy and pelvic lymph node (LN) dissection during the period of 1995-2008 from a prospectively maintained database. Eighteen patients were excluded due to lack of data on the nodal status, leaving 77 evaluable patients. Associations between LN metastasis and age, gender, duration of disease, number of transurethral resection (TUR) prior to cystectomy, pathological grade and tumour stage was analyzed. Data was analyzed …

Old Disease, New Targets. Part-Ii, Haematological Malignancies, Shiyam Kumar, Nehal Masood, Salman Naseem Adil

Department of Pathology and Laboratory Medicine

In last two decades newer therapies in cancer treatment have emerged and have opened new horizons. New term of targeted therapy has emerged and for certain malignancies the paradigm has really changed after the introduction of these agents. We have learnt and have seen the outcome of some diseases after the addition of these monoclonal antibodies (MoABs) and tyrosine kinase inhibitors (TKIs). Rituximab a MoAB against CD-20 has really paved its role in the treatment of B-cell lymphomas and become the sort of standard therapy. The TKIs are newer agents available in a pill form and have inhibited many pathways …

Vaginal Clear Cell Adenocarcinoma With Associated Mullerian Duct Anomalies, Renal Agenesis And Situs Inversus: Report Of A Case With No Known In-Utero Exposure With Diethyl Stilboestrol, Zeeshan-Ud-Din, Aamir Ahsan

Department of Pathology and Laboratory Medicine

A 27 year old female presented with two months history of continuous vaginal bleeding. On evaluation, she was diagnosed as a case of vaginal clear cell adenocarcinoma (VCCA) along with associated Mullerian duct anomalies including didelphys uterus with double vagina; left sided renal agenesis and situs inversus. Although VCCA is strongly linked to in-utero exposure with Diethyl stillboestrol (DES), this patient had no known history regarding such exposure. Also, only a few cases have been described in the literature in which this tumour was seen in association with Mullerian duct anomalies and renal agenesis; in the absence of known DES …

High-Dose Imatinib In Newly Diagnosed Chronic-Phase Chronic Myeloid Leukemia: High Rates Of Rapid Cytogenetic And Molecular Responses, Jorge E. Cortes, Hagop M. Kantarjian, Hagop M. Kantarjian, Stuart L. Goldberg, Bayard L. Powell, Francis J. Giles, Meir Wetzler, Luke Akard, John M. Burke, Mansoor Saleh

Haematology and Oncology, East Africa

Purpose: Long-term clinical outcome data have established imatinib 400 mg/d as standard front-line treatment for newly diagnosed patients with chronic myeloid leukemia (CML).

Patients and Methods: The Rationale and Insight for Gleevec High-Dose Therapy (RIGHT) trial is a multicenter study of imatinib 400 mg twice a day as initial therapy in 115 patients (70% Sokal low risk) with newly diagnosed CML in chronic phase who were observed for both molecular and cytogenetic responses for up to 18 months. Eighty-three patients (72%) completed the study, 10 patients (9%) discontinued the study because of adverse events, and six patients (5%) discontinued because …

Cancellation Of Surgery In Patients Attending The Preoperative Anaesthesia Assessment Clinic: A Prospective Audit, Tauseef Ahmed, Mueenullah Khan, Fauzia Khan

Department of Anaesthesia

OBJECTIVE: To find the causes of operating room cancellation in patients attending preoperative anaesthesia clinic and scheduled for surgery at our institution.

METHODS: This audit included all those patients who presented to the pre anaesthesia clinic with their surgeries planned in the main operating rooms of our hospital. The duration of this audit was two months. Cancelled cases were identified from the operating room lists and the reasons for cancellations were categorized into above mentioned four factors.

RESULTS: Fifty five (55) cancellations were identified; patient related factors (58%) were the most frequent cause followed by anaesthetic (22%), surgical (18.2%) and …

Arterio-Venous Fistula Of Upper Arm Observed With Injection Abscess, Saba Sohail, Misbah Talpur

Department of Radiology

No abstract provided.

H. Pylori Infection In Children: Population-Based Age-Specific Prevalence And Risk Factors In A Developing Country, Wasim Jafri, Javed Yakoob, Shahab Abid, S Siddiqui, Nasim Jafri, Safia Awan, Shaikh Qamaruddin Nizami

Section of Gastroenterology

No abstract provided.

Outcome Of Chronic Anal Fissures Treated With Glyceryl Trinitrate At Aga Khan University Hospital Nairobi, Ilkul H. Johnbosco

Master of Medicine in General Surgery

Background: The medical treatment for chronic anal fissure is modeled to eliminate sphincter spasm and hypertonia so that blood flow to the anal sphincter improves and the fissure heals. Efficacious pharmacological therapy avoids complications related to surgical treatment including incontinence and the risks of surgery and anesthesia. Conservative treatment of chronic anal fissure has been reported with wide variation in the healing rates. However there are few reports of conservatively treated chronic anal fissures fromAfrica, with only one paper identified in this study. Furthermore, the influence of clinical characteristics of fissures on the healing rates and recurrences have not been …

Population Study Of 1311 C/T Polymorphism Of Glucose 6 Phosphate Dehydrogenase Gene In Pakistan - An Analysis Of 715 X-Chromosomes., Bushra Moiz, Amna Nasir, Tariq Moatter, Zulfiqar Ali Naqvi, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Background:Nucleotide 1311 polymorphism at exon 11 of G6PD gene is widely prevalent in various populations of the world. The aim of the study was to evaluate 1311 polymorphism in subjects carrying G6PD Mediterranean gene and in general population living in Pakistan.

Results:

Patients already known to be G6PD deficient were tested for 563C-T (G6PD Mediterranean) and 1311 C-T mutation through RFLP based PCR and gene sequencing. A control group not known to be G6PD deficient was tested for 1311C/T only.C-T transition at nt 1311 was detected in 60/234 X-chromosomes with 563 C-T mutation (gene frequency of 0.26) while in …

The Influence Of Antiretroviral Therapy On Qtc Interval Amongst Hiv Patients At Aga Khan University Hospital, Nairobi, Jay Shavadia

Master of Medicine in Clinical Pathology

Aim: To determine the influence of antiretroviral (ARV) therapy on the QTC interval amongst HIV-infected patients. Design: Prospective Comparative survey of two population samples Patients and Setting: One hundred and thirty ARV naïve and one hundred and thirty treated HIV-positive patients selected from in and out patient departments of Aga Khan University Hospital underwent clinical evaluation and 12 lead resting ECG between August 2008 and March 2009. Methodology: Eligible HIV-positive patients were conveniently sampled and had a 12-lead electrocardiogram (ECG) performed to determine the QTinterval, corrected for the heart rate by the Bazzet formula. Analysis was then performed to determine …

Does “Asymptomatic” Mean Without Symptoms For Those Living With Hiv Infection?, Suzanne Willard, William L. Holzemer, Dean J. Wantland, Yvette P. Cuca, Kenn M. Kirksey, Carmen J. Portillo, Inge B. Corless, Marta Rivero-Méndez, María E. Rosa, Patrice K. Nicholas, Mary Jane Hamilton, Elizabeth Sefcik, Jeanne Kemppainen, Gladys Canaval, Linda Robinson, Shahnaz Moezzi, Sarie Human, John Arudo, Lucille Sanzero Eller, Eli Bunch, Pamela J. Dole, Christopher Coleman, Kathleen Nokes, Nancy R. Reynolds, Yun-Fang Tsai, Mary Maryland, Joachim Voss, Teri Lindgren

School of Nursing & Midwifery, East Africa

Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as ‘‘asymptomatic’’ by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003 - 2005 and 2005 - 2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and …

Knowledge, Attitudes And Practices Around Health Research: The Perspective Of Physicians-In-Training In Pakistan, Hassan Khan, Sadaf Khan, Arshad Iqbal

Department of Surgery Docs

Background:Health research training is an essential component of medical education and a vital exercise to help develop physician research skills. This study was carried out to assess the level of knowledge, attitudes and practices towards research amongst a group of Post Graduate Medical Trainees (PGMTs') at Aga Khan University (AKU), Pakistan.

Methods:

A cross sectional health research survey was carried out on all PGMTs' at AKU Pakistan. AKU is a tertiary care health facility which offers residency in 28 specialties and fellowship in 16 programs. Knowledge, attitudes and practices related to health research were assessed using a pretested, structured …

Cumulative Incidence Of Post Dural Puncture Headache Following Caesarean Section Under Spinal Anaesthesia At The Aga Khan University Hospital Nairobi, Ednah K. Gisore

Master of Medicine in Anaesthesiology

Introduction: Post dural puncture headache can be a debilitating complication of subarachnoid anaesthesia for a new mother. Successful management of post dural puncture headache requires adherence to clear policies and protocols with close follow up of patients by an experienced obstetric anaesthetist. Objective: This study examined the cumulative incidence and severity of post dural puncture headache in obstetric patients who consented for spinal anaesthesia for caesarean section at the Aga Khan University Hospital, Nairobi. Study site: The Aga Khan University Hospital, Nairobi. Study Design: Prospective Cohort study. Study Population: All women who underwent caesarean sections under spinal anaesthesia and fulfilled …

The Prevalence Of Postoperative Pain Following Day Surgery In The First 48 Hours At Aga Khan University Hospital, Nairobi, Gilbert Mwaka

Master of Medicine in Anaesthesiology

Introduction: Day case surgery services are increasing all over the world. The prevalence of postoperative pain after day surgery is found to be high ranging from 17% to 60%. Little is known about the prevalence of postoperative pain, in Kenya and East Africa, after day case surgeries. Objective: The objectives of this study were to investigate the prevalence of postoperative pain after day surgery at Aga Khan University (AKUH), Nairobi, to determine the severity/intensity of postoperative pain following day case surgery, and to determine the influence of anxiety and worry on the patients report on postoperative pain. Study site: The …

Esophageal Squamous Cell Carcinoma Risk Factors In A Kenyan Population: A Case Control Study, Stanley M. Machoki

Master of Medicine in General Surgery

Background: Esophageal squamous cell carcinoma (ESCC) is a common malignancy inKenya with a dismal outcome with a majority of patients presenting late. The factors that are operative in the etiology of this disease and its geographic distribution withinKenya have not been characterized thus far. Objectives: The objective of this study was to determine the association of ESCC with Khat chewing, which is prevalent in parts ofKenya, and other commonly implicated risk factors (i.e. smoking, alcohol, diet, socioeconomic status, caustic ingestion and first degree family history of ESCC). We also determined the geographic (provincial) origin, age/sex and ethnicity of cases visiting …

Middle Aged Male With Pulmonary Tuberculosis And Refractory Hypercalcemia At A Tertiary Care Centre In South East Asia: A Case Report., Azra Rizwan, Najmul Islam

Department of Medicine

55-year male of Asian descent presented with weight loss, lethargy, drowsiness and low grade fever without cough. Examination revealed crackles in the chest but no focal neurological deficit. Chest X ray revealed an infiltrate consistent with tuberculosis. Biopsy of infiltrate was negative for malignancy. Corrected calcium level revealed parathyroid independent hypercalcemia. Further diagnostic work up for drowsiness and hypercalcemia was normal. Despite receiving hydration and pharmacotherapy for his hypercalcemia, his condition failed to improve. When steroids were started, the Patient's calcium levels and symptomatology resolved. Tuberculosis causing hypercalcemia is uncommon. Steroids are useful agents, particularly in refractory cases.

Neuroradiology, Zafar Sajjad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Central Role Of Tau Protein In Alzheimer»S Disease And Related Tauopathies, Khalid Iqbal, Omar Chohan, Inge Grundke-Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Psychiatry, Syed Ahmer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Ace-I Induced Angioedema: A Case Report And Review Of Literature, Philip Adebayo, Olutayo Christopher Alebiosu

Faculty of Health Sciences, East Africa

Although rare, angioedema has been documented to occur following the administration of angiotensin-Converting Enzyme Inhibitors. Angiotensin-converting enzyme inhibitors are the leading cause of drug induced angioedema. Angiotensin-converting enzyme inhibitors induced angioedema is a class effect that can affect between 0.1% and 0.5% of patients taking the drug. It is rarely documented in Nigeria. Lisinopril is a commonly prescribed angiotensin-converting enzyme inhibitors-I which is considered to be generally safe and well tolerated. We report a case of angioedema following the use of lisinopril.

Impact Of Change In Maternal Age Composition On The Incidence Of Caesarean Section And Low Birth Weight: Analysis Of Delivery Records At A Tertiary Hospital In Tanzania, 1999–2005, Projestine S. Muganyizi, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS) and low birth weight deliveries (LBWT) at Muhimbili National Hospital in Tanzania.

Methods We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain …

Community Acquired Pneumonia: Risk Factors Associated With Mortality In A Tertiary Care Hospitalized Patients, Muhammad Irfan, Syed Fayyaz Hussain, Khubaib Mapara, Shafia Memon, Mohammed Mogri, Muniza Bana, Amna Malik, Sara Khan, Nadia A Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To evaluate risk factors associated with mortality in patients hospitalized with CommunityAcquired Pneumonia (CAP) from a developing country.

METHODS: An observational study was conducted on adult patients admitted with a diagnosis of CAP from January 2002 to August 2003 at Aga Khan University hospital, Karachi, Pakistan. Clinical records were reviewed for demographic characteristics, clinical and laboratory features, hospital course, and risk factors associated with mortality.

RESULTS: A total of 329 patients (187 males) were admitted with CAP. Two-third of patients had underlying co-morbid medical illnesses. Complications developed in 15.7% cases and the overall mortality rate was 11%. Risk factors …

Differential Live Mycobacterium Tuberculosis- , M. Bovis Bcg-, Recombinant Esat6-, And Culture Filtrate Protein 10-Induced Immunity In Tuberculosis, Zahra Hasan, Bushra Jamil, Mussarat Ashraf, Muniba Islam, Maqboola Dojki, Muhammad Irfan, Rabia Hussain

Section of Pulmonary & Critical Care

The high prevalence of Mycobacterium tuberculosis makes it imperative that immune responses to evaluate could be predictive of infection. We investigated live Mycobacterium- and recombinant antigen-induced cytokine and chemokine responses in patients with active tuberculosis (TB) compared with those of healthy controls from an area where TB is endemic (ECs). M. tuberculosis-, M. bovis BCG-, ESAT6-, and culture filtrate protein 10 (CFP10)-induced responses were determined in peripheral blood mononuclear cells from patients with pulmonary TB (n = 38) and ECs (n = 39). The levels of the cytokines gamma interferon (IFN-γ) and interleukin-10 (IL-10) and the …

Multiple Major Artery Compression By An Idiopathic Aortic Aneurysm: An Unusual Cause Of Hypertensive Encephalopathy, Shakeel Ahmed, Syed Rehan Ali, Husen Yousuf

Department of Paediatrics and Child Health

Multiple major artery compression by an aortic aneurysm is extremely rare in the paediatric population. Most arterial aneurysms in children are secondary to infections mainly mycotic, connective tissue disorder, vasculitis, collagen vascular diseases, and other causes. True idiopathic aneurysms are the least common and a few reports in children have been published. We describe an 8 year old boy who presented with hypertensive encephalopathy and later was found to have an idiopathic, symptomatic suprarenal aortic aneurysm compressing multiple major arteries of the abdomen. The child was subsequently managed on multiple antihypertensive medication and later required engraftment of the renal and …

Anaesthesia At Remote Location: Use Of Modified Bain Circuit (Mapleson D) At Kunri Christian Hospital (Kch), Ehtesham Izhar Khan, Hameed Ullah, Rehana Kamal

Department of Anaesthesia

OBJECTIVE: To develop a safe general anaesthesia technique for remote areas with lack of facilities.

METHODS: Four types of anaesthesia techniques using TIVA and modified Bain circuit were planned. Monitoring facility was limited to manual sphygmomanometer, palpation of radial pulse and monitoring of colour of skin and blood. Depth of anaesthesia was assessed using EVANs, RPST scoring system. Patients were asked in recovery room for awareness.

RESULTS: Surgeries done were cesarean sections, laparotomies, gynaecological, urological, hernia and burn contractures. Six patients had RPST score of 5 or more and three patients in recovery room complained of awareness. Cost per Anaesthesia …

Perioperative Complications Affecting Anesthetic Outcome In Intraventricular Neuroendoscopy, P. Ganjoo, Swati Sethi, M.S Tandon, Diljit Singh, Rajiv Chawla, B.C Pandey

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Atypical Eclampsia, Aamer Imdad, Lumaan Sheikh, Ayesha Malik

Department of Obstetrics & Gynaecology

Eclampsia occurring without prior signs and symptoms of preeclampsia is called atypical eclampsia. We present a case of 28 year old primigravida who developed intrapartum seizures. There was no prior clinical or biochemical evidence of preeclampsia. We have discussed the differentials of intrapartum seizures and a review of literature on atypical eclampsia.