Medicine and Health Sciences Commons^™

Informed Consent And Some Of Its Problems In Pakistan, Robyna Irshad Khan

Department of Anaesthesia

Informed consent has become an essential element of human subject research. Certain components are essential for a well-understood informed consent. There are problems in procurement of a comprehensive and meaningful consent in the Pakistani research settings. The inefficient healthcare systems, low literacy rate with masses having no concept of individual rights, higher social status enjoyed by physicians inhibiting the patients from questioning them, and unwillingness to hear bad news are some of these factors. Establishing Bioethics education at all levels, encouraging the involvement of families in decision making, using improvisation in procurement of consent are suggested solutions. There needs to …

Sedation-Analgesia In Non Operative Locations: Practice Trends Of Anaesthetists, Fauzia Khan, Khalid Maudood Siddiqui, Rehan Qureshi

Department of Anaesthesia

Sedation/analgesia is a mode of anaesthesia which facilitates an uncomfortable or painful procedure, such as gastrointestinal endoscopy, in a rousable and cooperative patient. The objective of the study was to assess the practice trends for administering sedation analgesia in non operative locations in Aga Khan Hospital, Karachi by anaesthetists. It was a descriptive study which retrospective reviewed anaesthesia records. A total of 41 ASA I-IV cases were reviewed. Non invasive cardiorespiratory monitoring and clinical sedation monitoring were applied. Intravenous Propofol infusion and midazolam boluses were used, singly or in combination with fentanyl boluses. All our patients recovered uneventfully within 5 …

Precipitating Factors And The Outcome Of Hepatic Encephalopathy In Liver Cirrhosis., Dileep K. Rohra, Jaipal, Ameer A. Khowaja, Khalid Mahmood, Kanya Lal Ahuja

Department of Medicine

No abstract provided.

Why Pakistani Medical Graduates Must Remain Free To Emigrate, Zarmeneh Aly, Fawad Taj

Medical College Documents

No abstract provided.

Managing Severe Pneumonia In Children In Developing Countries - Increasing Resistance To First Line Antibiotics Means Recommendations Need Changing, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

First Successful Autologous Chondrocyte Implantation In Pakistan, Tashfeen Ahmad, Masood Umer, Loay Lubbad, Riaz Hussain Lakdawala, Anwar Ali Siddiqui

Section of Orthopaedic Surgery

Osteochondritis dissecans entails a hyaline cartilage defect of the articular surface causing pain and functional restriction in young adults, sometimes resulting in early degenerative arthritis. Conventional treatment methods such as abrasion chondroplasty and mosaicplasty have limitations in terms of quality of the resultant cartilage and donor site morbidity. A more recent technique, autologous chondrocyte implantation (ACI) results in hyaline cartilage formation and gives good long-term outcome, but requires a high-level cell culture facility and two surgical procedures. The patient was a young female with knee pain, intermittent locking and feeling of "joint mouse". MRI scan and arthroscopy showed a 2 …

Splenic Abscess: Outcome And Prognostic Factors, Abdul Rehman Alvi, Shazia Kulsoom, Ghina Shamsi

Section of General Surgery

Objective: To determine the spectrum of presentation, treatment outcome and prognostic factors of splenic abscess in a tertiary care hospital.
Study Design: Case-series.
Place and Duration of Study: Department of General Surgery, the Aga Khan University Hospital, Karachi, from July 1988 to July 2007.
Methodology: The records of 27 patients with splenic abscess, diagnosed from 1988 to 2007, were retrieved through ICD-10 coding system. The demographic data, physical and radiological findings, treatment modalities, bacteriology reports, morbidity and mortality were collected on a proforma.
Results: There were 12 males and 15 females with a mean age of 43.52+/-17.49 years. Common symptoms …

A Unique Variant Of Intestinal Tuberculosis, Abdul Rehman Alvi, Masooma Zaidi

Section of General Surgery

Duodenum is a rare site of involvement in intestinal tuberculosis. We report a 19 years old boy who presented with nonbilious vomiting and weight loss. His workup showed stricture in ascending colon, multiple liver abscesses with pneumobilia on CT scan. Upper GI endoscopy revealed stricture in 2nd part of duodenum distally. He was operated and duodenojejunostomy with limited right hemicolectomy (for stricture in this part of gut) were done. Biopsy report was suggestive of tuberculosis. Antituberculous treatment was started. He responded well and gained 20 kg weight at 3 months follow-up.

Management Of Myelomeningocele, A Sattar M. Hashim, Shahid Ahmed, Rashid Jooma

Section of Neurosurgery

Objective: T To find out best possible protocol to provide productive life to children born with myelomeningocele.
Study design: Descriptive study.
Place & Duration of study: Department of Neurosurgery, Jinnah Postgraduate Medical Centre Karachi from December 2001 to December 2006.
Patients and Methods: The medical record of 415 children with myelomeningocele operated at our center was reviewed retrospectively. The surgical & medical management protocol used for different sites of myelomeningocele was studied.
Results: The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; however, children with ruptured myelomeningocele were consistently repaired early. All …

Displaced And Dispossessed: Caring For The World’S Refugees, Shela Akbar Ali Hirani

School of Nursing & Midwifery

No abstract provided.

Prosthetic Valve Thrombosis Despite Seemingly-Adequate Anticoagulation: The Dangers Of Transient Lapses In Anticoagulation, Fahim H. Jafary, K. Hassan

Section of Cardiology

We report a 19-year-old woman with thrombosis of a prosthetic mitral valve that was most likely due to a short dip in anticoagulation in the days preceding the event. Interestingly, at presentation the Patient was super-therapeutic, most likely a result of hepatic congestion as the heart began to fail, creating an illusion of thrombosis despite adequate anti coagulation.

Interferon Associated Retinopathy, Hassan Khan, Kamran Hamid, Aga Hassan Feroze

Section of Ophthalmology

We describe a case of retinopathy with swollen optic nerve head (ONH) in a hepatitis C patient treated with combination of interferon and ribavirin. A 33-years old man presented with sudden bilateral visual loss and headache. On examination, the Visual Acuity of right eye and left eye was hand movement and counting fingers respectively. Right fundus showed ONH swelling, healthy macula, with tortuous dilated vessels and small scattered, intra retinal haemorrhages. Retinopathy was only present in the right eye, however, poor vision in both eyes suggested neurovisual involvement.

Investigating Factors Associate To Nurses’ Attitudes Towards Perinatal Bereavement Care, Moon Fai Chan, Feng-Lan Lou, David Arthur, Feng-Lin Cao, Lai Har Wu, Ping Li, Miharu Sagara- Rosemeyer, Loretta Yuet Foon Chung, Li Lui

School of Nursing & Midwifery

Aim: The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background: Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period.
Method: Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in …

Infiltrating Syringomatous Adenoma Of Nipple, Nazia Riaz, Shaista Masood Khan, Romana Idress, Naila Kayani

Section of General Surgery

Infiltrating syringomatous adenoma of the nipple is a rare, benign lesion with distinct clinical and histological features. Origin from ducts of dermal sweat glands has been postulated. Important differential diagnosis include nipple adenoma, tubular carcinoma and adenosquamous carcinoma. Appropriate local management includes accurate diagnosis and complete excision to avoid local recurrences. This report describes the condition in a 39-year-old parous lady.

Frequency Of Abnormal Pap Smears And Assessment Of Risk Factors For Cervical Cancer In An Out-Patient Clinic, Firdous Jahan, Naheed Nabi, Waris Qidwai, Iqbal Azam

Department of Family Medicine

No abstract provided.

Endovascular Stenting For Carotid Artery Stenosis: Results Of Local Experience At Aga Khan University Hospital, Karachi, Muhammad Azeem Uddin, Tanveer Ul Haq, Ishtiaque Ahmed Chishty, Zafar Sajjad, Basit Salam

Department of Radiology

Objective: To evaluate the results, complications and initial follow-up of patients after percutaneous stent placement for carotid artery disease.Methods: A retrospective study was carried out on patients treated with carotid artery stenting at the Radiology Department of Aga Khan University Hospital, Karachi, from September 2002 to December 2005. The patients were selected according to the institutional guidelines for Carotid Angioplasty and stenting. Preliminary angiogram was performed in all patients followed by stent deployment. Distal protection device was used in 12 patients. All patients underwent pre and post procedure independent neurological examinations. Follow-up consisted of serial duplex ultrasonography and clinical assessment.Results: …

Labrad : Vol 33, Issue 1 - January 2008, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Diagnosis of Malaria
• Imaging Feature of Synovial Sarcoma in Pediatrics Patients
• Fine Needle Aspiration Biopsy: The best test to differentiate benign from malignant thyroid nodules
• HLA-B27 and Disease Association
• Bacterial Contamination of Blood Components
• Pathology Quiz
• Biochemical Investigations
• Leishmaniasis
• Answers to Quiz
• CD55 and CD59 for the Diagnosis of PNH
• Meeting Report

Waiting For Child Developmental And Rehabilitation Services: An Overview Of Issues And Needs, Anton R. Miller, Robert Armstrong, Louise C. Mâsse, Anne F. Klassen, Jane Shen, Maureen E. O’Donnell

Paediatrics and Child Health, East Africa

Concern about the length of time that children, young people, and families may have to wait to access assessment, diagnostic, interventional, therapeutic, and supportive child developmental and rehabilitation (CDR) services is widespread, but adequate data collection and research on this issue remain limited. We review key concepts and issues relevant to waiting for CDR services from the published literature, a national workshop devoted to this topic, and international experience. We conclude that gaps in data, evidence, and consensus challenge our ability to address the issue of waiting for CDR services in a systematic way. A program of research coupled with …

Correlation Of Three Immunohistochemically Detected Markers Of Neuroendocrine Differentiation With Clinical Predictors Of Disease Progression In Prostate Cancer, Hammad Ather, Farhat Abbas, Nuzhat Faruqui, Mohammad Israr, Shahid Pervez

Section of Urology

Background: The importance of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade is gaining acceptance. There is limited literature on the relative significance of three commonly used markers of NE differentiation i.e. Chromogranin A (CgA), Neuron specific enolase (NSE) and Synaptophysin (Syn). In the current work we have assessed the correlation of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade and to determine the relative value of various markers.
Materials and Methods: Consecutive samples of malignant prostatic specimens (Transurethral resection of prostate …

Focus On The Profession: Academic And Clinical Departments, Robert Armstrong

Paediatrics and Child Health, East Africa

The departments within the Faculty of Medicine at UBC play a central role in achieving the goals of the expanded medical school, and the goals of the broader health care system. Four strategies are needed for success: make professionalism the tie that binds the Faculty of Medicine and the health authorities; engage clinical and academic de­partments as key drivers of professionalism; ensure knowledge development and continuous learning are recognized as central to professionalism; challenge government to focus on supporting professionalism.

Reducing Hiv/Aids In Young People In Sub-Sahara Africa: Gaps In Research And The Role Of Theory, Kristien Michielsen, Marleen Bosmans, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

This paper discusses the role of education in preventing HIV in children and young people in sub-Sahara Africa and presents the results of policy advisory research conducted on behalf of the Belgian Development Cooperation. The research consisted of a literature review and a field study in Rwanda. Relative to the high number of HIV prevention activities in sub-Sahara Africa, there is a limited number of scientific data on HIV risk reduction interventions for young people in this region. Longitudinal studies are especially scarce. Preliminary results show that many interventions have only a marginal impact on reducing sexual risk behaviour. Factors …

Successful Pregnancy Outcome Following Laparoscopic Myomectomy: Case Report, R. B. Parkar, Sikolia Wanyonyi, W. J. Kamau, D. Otieno

Obstetrics and Gynaecology, East Africa

Laparoscopic myomectomy is now widely used as an alternative to laparotomy in the management of symptomatic uterine fibroids. The advantages of this minimal access approach outweigh those of the open techniques. The pregnancy outcomes between the two methods have been studied and are comparable, but there still exists a lot of scepticism locally concerning this. It is against this background that we present a 31 year old nulliparous lady who had a two year history of primary infertility secondary to multiple uterine fibroids, the largest being fundal and measuring 6.6cm. She underwent a successful laparoscopic myomectomy in November, 2006 and …

Prevalence, Risk Factors And Outcome Of Acute Kidney Injury At The Aga Khan University Hospital Nairobi, Peter W. Munyu

Master of Medicine in Internal Medicine

Introduction: Acute kidney failure (acute kidney injury, AKI) is a group of syndromes that result in a decline in the glomerular filtration rate. In 2002, the Acute Dialysis Quality Initiative (ADQI) group proposed the RIFLE criteria to standardize the definitions of AKI severity and outcome. This criterion has been validated in several studies. AKI is frequently encountered in hospitalized patients; it has a negative impact on mortality and morbidity. A lot of work has been done to describe the epidemiology of AKI in developed countries. The same does not apply for developing countries. This study was designed to evaluate AKI …

Comparison Of Doppler Studies In Obstetrics With Fetal Outcome, Sheila Waa

Master of Medicine in Imaging and Diagnostic Radiology

Purpose: to compare umbilical artery and middle cerebral Doppler ultrasound values in normal and high risk pregnancies with fetal outcome. Method: 121 consecutive pregnancies (at or over 28 weeks gestation), stratified into low and high risk pregnancies based on clinician information were prospectively examined with doppler ultrasound of UA and MCA. Results: outcome was available for 100 of the 121 patients. 26% of pregnancies had poor outcome. Of these 73% (19) and 27% (7) were classified as high risk and low risk respectively. UA alone or in combination with MCA was shown to have 100% specificity for predicting fetal outcome. …

Knowledge, Attitude And Use Of Labour Pain Relief Methods Among Women Attending Antenatal Clinic In Nairobi, Vitalis Mung’Ayi, David Nekyon, Robinson Karuga

Anaesthesiology, East Africa

Background: Labour analgesia has rapidly gained popularity in obstetric practice. Low usage in the developing world has raised concern.

Objectives: To assess the knowledge, attitude and use of labour pain relief methods in women attending antenatal clinic in Nairobi.

Design: A prospective study.

Setting: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya.

Subjects: Two hundred and two consecutive expectant mothers attending antenatal clinic at the Aga Khan University Hospital, Nairobi.

Results: Fifty-six per cent of the participants had knowledge about labour pain relief methods. Friends, the antenatal clinic and books/leaflets were the major source on information. …

Evaluation Of Suspected Renal Colic Patients With Unenhanced Low-Dose Multidetector Computed Tomography (Mdct), Nebayosi Twahirwa

Master of Medicine in Imaging and Diagnostic Radiology

Acute renal colic is probably one of the most excruciatingly painful event a person can endure. [1]. Though this is typical of urinary tract calculi, it’s important to note that non-calculus and non-genitourinary conditions can present in a similar manner. Unenhanced helical CT (CT KUB), originally described by Smith et al [2] in 1995, is one single radiological test that has proven successful in the valuation of patients presenting with renal colic. This technique has been shown to be more accurate compared to abdominal radiography [3,4], ultrasound and has replaced excretory urography in the detection of urinary tract calculi in …

Primary Drug Resistance To Antituberculous Drugs In Nwfp Pakistan, Arshad Javaid, Abdul Ghafoor, Abdul Rab, Anila Basit, Zia Ullah, Shaukat Ali, Afia Zafar, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: To assess the prevalence of Primary drug resistance to Antituberculous drugs in NWFP
Method: A cross-sectional prevalence study was undertaken to evaluate the prevalence of drug resistance among new TB patients, using a non-probability convenience sampling methodology. Sample size was calculated according to the population and WHO's estimated incidence of smear positive tuberculosis in the province/country. Sputum samples were obtained from 122 newly diagnosed patients of pulmonary tuberculosis from centres in Peshawar and Abbotabad in NWFP.
Results: Sensitivities were performed by proportion method which showed the following resistance values in 118 eligible patients: 15 (12.7 %) …

Hepatic Angiosarcoma With Metastasis To Small Intestine, Zubair Ahmad, Azizun Nisa, Romana Idrees, Khurram Minhas, Shahid Pervez, Khalid Mumtaz

Department of Pathology and Laboratory Medicine

Hepatic angiosarcomas are rare tumours with poor prognosis, with patients usually dying within 6 months. Metastases mainly occur in lymph nodes, spleen, lungs, bones and adrenals. Metastasis to small intestine is even rarer. Similarly, primary or metastatic angiosarcomas in small intestine are extremely rare, often present with recurrent gastrointestinal bleeding and anemia, and have an extremely poor prognosis. Both primary or metastatic intestinal angiosarcomas may exhibit epithelioid morphology. It may be very difficult to differentiate between primary and secondary cases in intestine and especially when the tumour exhibits epithelioid morphology.

Pediatric Emergency Medicine--An Evolving Sub-Speciality In Pakistan, Emaduddin Siddiqui, Junaid Razzak

Department of Emergency Medicine

No abstract provided.

Sehat-1: Pehli Class: Asatza Aur Sehat Ke Karkuno Ke Liye Aik Gaed, Tashmin Kassam-Khamis, Farah Shivji, Sadia Muzaffar Bhutta

Books

No abstract provided.