Medicine and Health Sciences Commons^™

Paternalistic Model Of Medical Practice, Waris Qidwai

Department of Family Medicine

No abstract provided.

Use Of Services Of Spiritual Healers Among Patients Presenting To Family Physicians At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai

Department of Family Medicine

Objective: To study the use of the services of spiritual healers, among patients visiting the family physicians, at a teaching hospital in, Karachi. Design: Cross-sectional survey
Place and Duration of Study: Family practice center, the Aga Khan University, Karachi, from February to June, 2001
Subjects and Methods: A total of 387 patients were surveyed. A questionnaire was developed and administered to collect information on the use of the services of spiritual healers among the respondents.
Results: Most of the respondents were young, well educated and better placed socio-economically. The use of the services of spiritual healers …

Implications For The Practice Of A Patient Expectation And Satisfaction Survey, At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, R. H. Dhanani, F. M. Khan

Department of Family Medicine

Objective: To study the expectations and satisfaction of patients visiting Family Practice Clinics, at the Aga Khan University Hospital, in Karachi, Pakistan. Methodology: A cross sectional survey of 316 patients was carried out. A questionnaire, based on the study objectives was developed and administered. The participating patient signed a consent form, after assurance of confidentiality was provided. Data on the demographic profile of the patients was collected.
Results: The mean age was 33.81 years, with 105 (33.2%) women, and 211 (66.8%) men. The majority were married, with education above intermediate level and were in private or government service or were …

Prevalence And Perceptions About Consanguineous Marriages Among Patients Presenting To Family Physicians, In 2001 At A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, Iqbal Azam, Faisal M Khan

Department of Family Medicine

Aim: Consanguineous marriages are common in Pakistan despite their declining popularity in the developed world. In the present study, a questionnaire based survey was used to record the attitudes and perceptions of consanguineous marriages among the sample population.
Methods: A questionnaire was developed to collect information on the acceptability of, and perceptions about, consanguineous marriages among patients presenting to family physicians, at the Family Practice Center of the Aga Khan University Hospital in Karachi, Pakistan. Demographic data was collected as part of the questionnaire. Each participating patient signed a consent form after assurance of confidentiality was provided.
Results …

Lifelong Learning In Medical Education: From Cme To Cpd, Zarrin Seema Siddiqui

Department for Educational Development

Lifelong learning is a concept taken up by governments and educational institutions worldwide to acknowledge the need for continuous learning irrespective of the profession. In the context of medicine, lifelong learning has always been formally considered an ethical obligation of doctors although the term Continuing Medical Education (CME) is more commonly used than Continuous Professional Development (CPD). This article traces the history of continuous professional development from early years through current programs introduced worldwide.

Accessibility And Effectiveness Of Healthcare Providers, Waris Qidwai

Department of Family Medicine

No abstract provided.

Use Of Intravenous Anti-D In Patients With Refractory And Relapsed Immune Thrombocytopenic Purpura, R. Sajid, Salman Adil, Z. Fadoo, S. Sabir, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To determine the response to IV anti-D and its comparison with splenectomy as second line therapy in refractory and relapsed cases of ITP, in the Aga Khan University Hospital, Karachi.
Methods: A total of 23 patients with chronic ITP were treated with either anti-D or splenectomy as second line treatment. The patients were assessed for time to achieve a response to second line treatment, duration ofresponse and adverse events.
Results: There were 12 patients in the anti-D group and 11 in the splenectomy group. The mean platelet count at presentation was 9,000/cumm. The mean age was 8.9 …

Fludarabine Induced Immune Thrombocytopenia In A Patient With Cd5 Positive B Cell Chronic Lymphocytic Leukemia, M. Usman, Salman Adil, R. Sajid, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Fludarabine is a purine nucleoside analogue, which inhibits DNA synthesis by inhibiting DNA polymerase and ribonucleoside reductase.1 It affects both dividing and non- dividing cells.2 Fludarabine possesses proven efficacy in the treatment of a variety of indolent B cell lymphoproliferative disorders including chronic lymphocytic leukemia3, low-grade non-Hodgkin's lymphoma4 and Waldenstrom macroglobulinemia.5 It is also a part of conditioning regimes in non-myeloablative bone marrow transplantation.6 The common side effects include myelosuppression, immunosuppression, and neurologic toxicity.7 The rare side effects are immune mediated hemolytic anemia8 and thrombocytopenia.9 Here we describe a case of a middle-aged lady who was diagnosed as B cell …

Cyclosporin Induced Fatal Rhabdomyolysis In A Young Patient With Acquired Aplastic Anemia: A Case Report, M. Usman, S. N. Adil, G. N. Kakepoto, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Cyclosporin is used as an immunosuppressive agent in the management of a variety of autoimmune disorders1 and in patients of organ transplant to suppress host immunity and prevent rejection.2 It is now well established that acquired aplastic anemia is secondary to immune mediated destruction of stem cells in the bone marrow3 and hence Cyclosporin is used as a first line immunosuppressive drug alone or in combination with anti lymphocyte globulin in the management of aplastic anemia.1 Rhabdomyolysis is a rare side effect of Cyclosporin.4 Here we describe a case of fatal rhabdomyolysis in a young patient who received cyclosporin for …

Chromosomal Abnormalities As A Cause Of Recurrent Abortions: A Hospital Experience, M. Azim, A.H. Khan, Z.L. Khilji, J.A. Pal, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To analyze the chromosomal abnormalities in couples with history of recurrent abortions.
Design: Retrospective study.
Setting: Cytogenetic section, Department of Pathology at the Aga Khan University Hospital. Karachi, Pakistan. Patients: Three hundred couples with history of recurrent abortions. Main outcome measure: Structural chromosomal abnormalities in carrier couples.
Results: G-banded chromosomes were analyzed from both partners of 300 couples who had had two or more spontaneous abortions. Sixteen (5.3%) couples showed a chromosomal aberration in one of the partners. Seven translocations, 5 inversions, 2 deletions and 2 sex chromosomal abnormalities were identified. There was an increase in …

Comparison Of Keorolac With Morphine For Intraoperative Analgesia In Patients Undergoing Total Abdominal Hysterectomy, S. S. Hasan, Fazal Hameed Khan, M. Ahmed

Department of Anaesthesia

Direct laryngoscopy and endotracheal intubation during anaesthesia and cutting, stretching and tissue manipulation during surgery is the most painful time for a patient undergoing surgery. The elicited pain during a surgical procedure is associated with significant hemodynamic changes including rise in blood pressure, heart rate, sweating, pupillary dilatation etc. These hemodynamic changes are not desirable and may produce deleterious effects in patients with hypertension, ischemic heart disease and cerebro-vascular disease and impose a great challenge for anaesthesiologist to maintain physiologic homeostasis during these periods of stress. Opioids are considered to be the corner stone in the management of intraoperative and …

Prostate Cancer: Some Clinical And Scientific Dilemmas., Paul D. Abel, El-Nasir Lalani

Department of Pathology and Laboratory Medicine

No abstract provided.

Antipyretic, Parasitologic, And Immunologic Effects Of Combining Sulfadoxine/Pyrimethamine With Chloroquine Or Paracetamol For Treating Uncomplicated Plasmodium Falciparum Malaria, E. Hugosson, D. Tarimo, M. Troye-Blomberg, S.M. Montgomery, Zul Premji, A. Bjorkman

Pathology, East Africa

Sulfadoxine/pyrimethamine (SP) is increasingly used against malaria in sub-Saharan Africa because of chloroquine resistance. However, chloroquine may have a beneficial antipyretic effect. We therefore compared the combination of SP plus chloroquine, chloroquine alone, SP alone, and SP plus paracetamol in the treatment of uncomplicated Plasmodium falciparum malaria in 175 Tanzanian children (1-4 years old) in a randomized trial. Outcome variables were axillary temperatures every six hours, daily parasitemias, and serum levels of IgG antibodies to P. falciparum. Lower mean temperatures (6-48 hours) were achieved with SP plus chloroquine or paracetamol than with SP alone (P < 0.001) or chloroquine alone (P < 0.05). All three SP-treated groups showed high and similar parasite reduction (0-48 hours), whereas treatment with chloroquine alone was much less effective. Levels of IgG antibodies to P. falciparum increased significantly (P < 0.001) and similarly in the four treatment groups between days 0, 2. and 3. Thus, the addition of chloroquine or paracetamol to SP improved the clinical outcome, but did not affect the parasitologic response or antibody production.

Brainstem Encephalitis With Kikuchi-Fujimoto Disease, Saad Shafqat, Saima Bano Memon, Shiraz Hyder, Sheema H Hasan, Raymond A Smego

Section of Neurology

A case of young woman is described who developed clinical and MRI features of brainstem encephalitis in the setting of fever and cervical lymphadenopathy. Lymph node biopsy revealed histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease), which may reflect host response to an unspecified immune insult.

Clinical Practice Guidelines For The Management Of Ischemic Stroke In Pakistan, Saad Shafqat

Section of Neurology

Ischemic stroke represents a huge global burden, being the leading cause of physical disability and the third leading cause of death worldwide¹. Although rigorous epidemiological data from Pakistan are lacking, stroke is certainly the commonest reason for admission to a neurology ward in our part of the world, as elsewhere. Recent years have seen a number of new developments in the clinical approach to stroke, including in the areas of diagnostic work-up, acute treatment and secondary prevention. These developments enable the formulation of clinical practice guidelines for achieving standardized management of ischemic stroke, with the overall aini of …

Cost Of Acute Stroke Care At A Tertiary Care Hospital In Karachi, Pakistan, B. A. Khealani, Z. F. Javed, N. A. Syed, Saad Shafqat, Mohammad Wasay

Section of Neurology

Objective:To evaluate cost of acute stroke care and its determinants at a tertiary care hospital in Karachi and to find out predictors of high cost care. Acute stroke is a leading cause of morbidity and mortality. Cost of care is the single most important determinant in availability of acute stroke care at a tertiary care hospital in Pakistan.It is also an important factor in development of public health policies and medical insurance plans. Average nnual income in Pakistan is 4881 rupees (U$ 85).
Methods: Medical and billing records of 443 patients with acute stroke were retrospectively reviewed from …

Moyamoya Disease: An Elusive Diagnosis, K. B. Asumal, N. Akhtar, N. A. Syed, Saad Shafqat, S. M. Baig

Section of Neurology

Moyamoya disease is an idiopathic vasculopathy, affecting vessels of Circle of Willis.1 It usually manifests as stroke, but can also cause seizures and cognitive impairment.2 Ischemic strokes are common in children and hemorrhagic strokes in adults.1 We describe our experience with moyamoya disease in four patients who presented with ischemic strokes, at an academic tertiary care center and emphasize that this diagnosis should be considered in young patients, especially children, who present with stroke.

Current Treatments Of Vitiligo, Azam J. Samdani

Department of Medicine

No abstract provided.

Prenatal Chromosomal Diversification Of Leukemia In Monozygotic Twins, Helena Kempski, Karen A. Mensa- Bonsu, Lyndal Kearney, G. Reza Jalali, Ian Hann, Mohammad Khurshid, Mel Greaves

Section of Haematology/Oncology

Previous studies on concordant acute lymphoblastic leukemia (ALL) in identical twins have identified the leukemia as monoclonal with MLL or ETV6-RUNX1 gene fusion as early or initiating events in utero. In the latter case, postnatal latency is associated with secondary genetic events such as ETV6 deletion. We describe here a pair of infant twins with concordant acute monoblastic leukemia (AML). They are a unique pair in that their leukemia blasts display extensive intraclonal chromosomal diversity. Comparison of the leukemic cells between the two twins by karyotype and fluorescence in situ hybridization identifies a common or shared stem line …

Febrile Seizures: Factors Affecting Risk Of Recurrence In Pakistani Children Presenting At The Aga Khan University Hospital, Z Habib, S Akram, S Ibrahim, B Hasan

Department of Paediatrics and Child Health

Objectives: To (a) describe the effect of temperature rise on seizure recurrence in the ER (b) investigate the effect of age, gender, family and developmental history, type, duration and multiple seizures, past history and number of seizures and treatment given (either late or early) on seizure recurrence in the ER and (c) explore prognostic indicators for seizure recurrence.
Methods: Data from 352 children [ages 3-84 months; 220 males (62.5%) 132 females (37.5%)] was taken using chart reviews for the years January 1998-August 2000 inclusive, from the Pediatric department of the Aga Khan University Hospital. Descriptive statistics, Chi-square, and Discriminant …

District Hospital Based Injury Data-Are They An Option In A Developing Country?, Junaid Abdul Razzak, David Marsh, S. Stansfield

Department of Emergency Medicine

No abstract provided.

Post-Chemotherapy Residual Mass In Stage Iic Seminomatous Testicular Tumor, N A. Ahmad, S R. Biyabani, Farhat Abbas

Section of Urology

Introduction

The management of patients with residual masses following chemotherapy for advanced seminoma remains a difficult problem with no clear guidelines. While most patients with advanced seminoma achieve a complete or partial response with cisplatin based chemotherapy¹, a significant number will reveal a residual mass on follow up CT scan or MR imaging^2,3. Management options for post chemotherapy residual mass in a case of seminoma include close observation, radiation therapy and excisional surgery. While 80 to 85% of residual masses represent either fibrosis or necrotic tissue needing no further therapy, 10 to 15% may contain viable …

Symptomatic Granulomatous Prostatitis Following Bacillus Calmette-Guerin Immunotherapy For Bladder Cancer, M A. Noor, S R. Biyabani, I A. Burney, J Talatia

Section of Urology

No abstract provided.

Cancer Patterns In Quetta (1998-1999), Yasmin Bhurgri, Hadi Bhurgri, A. Ajam, Shahid Pervez, S. H. Hasan, A. Usman, J. A. Khan, Q. Kasi, I. Kasi, A. G. Rasool, A. Bhurgri, N. Faridi, J. Malik

Department of Pathology and Laboratory Medicine

Introduction: Quetta, the capital of Baluchistan, is located at latitude 30,25; longitude 67.00. It has a population of 759,245; 425,474 males (56%) and 333,771 females (44%); Census 1998. The majority of residents are Persian or Baluchi speaking Baluchs.

Methodology: The cancer cases from Quetta reported to the Karachi Cancer Registry were reviewed. The data included cases from the Aga Khan University Hospital (AKUH), Pathology Department (Quetta collection point) and health care facilities in Karachi. The residents of Baluchistan were ascertained and cancer cases residents of Quetta identified with the help of recorded addresses and retraceable telephone numbers.

Results: During a …

View Box Case--12 Osteomyelitis, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Leiomyosarcoma Presenting As A Spontaneously Ruptured Renal Tumor-Case Report, Mohammad Moazzam, M Hammad Ather, Akber S. Hussainy

Department of Pathology and Laboratory Medicine

Background:
Ruptured renal neoplasms can be a catastrophic clinical presentation. Angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50-60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall.
Case presentation:
A 70 years old male, with hypertension and ischemic disease, developed acute left flank pain. The general physician evaluated this using ultrasound, which showed a solid left renal …

View Box Case-11 Synovial Osteochondromatosis With Osteoarthrosis, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Radiologic Features Of Hallervorden Spatz Disease, K B. Asumal, M Wasay, S N. Ali

Section of Neurology

Hallervorden Spatz Disease is a rare familial neurodegenerative disorder, which primarily affects children but also can occur in adults1 . Major clinical features are abnormal involuntary movements and cognitive impairment2 . Diagnosis is based on clinical and radiological features. The radiological features are hypointense signals in globus pallidus and substantia niagra on MR! of brain3 . Occasionally the pallidal hypointense signals surround hyperintense signals, this is known as “tigereye-sign”4 and is postulated to be specific for Hallervorden Spatz Disease. We report two brothers with such MRI findings.

Morbidity And Outcome Of Low Birthweight Babies Of Adolescent Mothers At Kenyatta National Hospital, Nairobi, A. Wasunna, K. Mohammed

Paediatrics and Child Health, East Africa

Objective: To compare the morbidity and outcome of low birthweight babies (birthweight < 2000gm) of adolescent (age < 20 years) and older mothers.

Design: Cross sectional descriptive study.

Setting: The newborn Unit of the Kenyatta National Hospital. Main outcome measures: All babies weighing less than 2000gm at birth whose mothers consented to the study had their gestational age verified using the Dubowitz scoring system. They were then followed up by daily clinical assessment untill discharge, death or up to one month in the ward. The babies were divided into two groups according to their mother's age and then compared with respect to episodes of illness, duration of hospital stay, and overall …

Thalidomide Prevents Donor Corneal Graft Neovascularization In An Alkali Burn Model Of Corneal Angiogenesis, A. Abbas, Aga Hassan Feroze, G. F. Hyman, B. Khan

Section of Ophthalmology

Objective: Thalidomide is a potent inhibitor of angiogenesis. We evaluated the effects of Thalidomide on corneal angiogenesis and on tissue survival of grafts in rabbit eyes with pre-existing neovascularization secondary to alkali burn.
Methods: Sixteen rabbits received alkali burns to one cornea. One month post-injury, assessments of corneal neovascularization were performed followed by corneal transplantation. Four rabbits received oral Thalidomide and ten got placebo (powdered sugar) for thirty days. Total corneal neovascularization (NV), clock hours (CH) involved in (NV), longest (NV) pedicle length (NVP) and the duration of time required for NV to develop were assessed.
Results: Thalidomide significantly decreased …