Medicine and Health Sciences Commons^™

Ewing's Sarcoma Arising From The Adrenal Gland In A Young Male: A Case Report, Muhammad Nauman Zahir, Tayyaba Zehra Ansari, Tariq Moatter, Wasim Memon, Shahid Pervez

Section of Haematology/Oncology

Background: Ewing's sarcoma uncommonly arises from extraosseous soft tissue or parenchymal organs. Primary adrenal Ewing's Sarcoma, although very rare, is extremely aggressive and commonly fatal.

CASE PRESENTATION: A 17 year old Pakistani male was referred to the outpatient oncology clinic at our center with a three month history of concomitant pain, swelling and dragging sensation in the right hypochondrium. Abdominal examination revealed a large, firm mass in the right hypochondrium extending into the right lumbar region and epigastrium. His genital exam was unremarkable and there were no stigmata of hepatic or adrenal disease.Computed tomography scans revealed a large peripherally …

Screening For Tuberculosis In Pregnancy: Do We Need More Than A Symptom Screen? Experience From Western Kenya, R J. Kosgei, D Szkwarko, S Callens, P Gichangi, Marleen Temmerman, A-B Kihara, J J. Sitienei, E J. Cheserem, P M. Ndavi, A J. Reid, E J. Carter

Obstetrics and Gynaecology, East Africa

Objectives: 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ⩾2 weeks’ duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya.

Design: Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya.

Results: Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26–35) and 26 years (IQR 24–31) in …

Outcome Of Radiologically Placed Tunneled Haemodialysis Catheters, Raza Sayani, Muhammad Anwar, Tanveer-Ul-Haq, Nauman Al-Qamari, Muhammad Asif Bilal

Department of Radiology

Objective: To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure.STUDY Design: Case series.PLACE AND DURATION OF STUDY: Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011.METHODOLOGY: All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, …

Glucocorticoids Induced Allergic Reaction, Emad Uddin Siddiqui, Shakeel Ahmed

Department of Emergency Medicine

Glucocorticoids can cause allergic reaction in rare cases. A ten year old boy, known asthmatic, was treated with intramuscular injection of glucocorticoids, followed by nausea, vomiting and abdominal pain. His lips turned pale along with palpitation and light headache. His right eye lid and lower lip were swollen. Heart rate was 177/min, and BP was 66/46 mmHg,. Patient spontaneously improved and symptoms resolved. IV fluids bolus, antihistamines or epinephrine were not required. The case was seen in September 2012.

Conscientious Objection To Provision Of Legal Abortion Care, Brooke R. Johnson Jr, Eszter Kismödi, Monica V. Dragoman, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion, a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to women’s health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing women’s access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when …

Primary Healthcare Providers’ Views On Improving Sexual And Reproductive Healthcare For Adolescents In Bolivia, Ecuador, And Nicaragua, Lina Jaruseviciene, Miguel Orozco, Marcia Ibarra, Freddy Cordova Ossio, Bernardo Vega, Nancy Auquilla, Joel Medina, Anna C. Gorter, Peter Decat, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved.

Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology.

Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and …

Mentoring Ethics In Postgraduate Surgical Training: A Developing Country Perspective From Pakistan, Mohsin Azam, Saleha Anwar, Muhammad Shahzad Shamim, Muhammad Waqas

Section of Neurosurgery

No abstract provided.

Grand Multiparity: Is It Still A Risk In Pregnancy?, Andrew H. Mgaya, Siriel N. Massawe, Hussein Kidanto, Hans N. Mgaya

Faculty of Health Sciences, East Africa

Background The association of grand multiparity and poor pregnancy outcome has not been consistent for decades. Classifying grand multiparous women as a high-risk group without clear evidence of a consistent association with adverse outcomes can lead to socioeconomic burdens to the mother, family and health systems. We compared the maternal and perinatal complications among grand multiparous and other multiparous women in Dar es Salaam in Tanzania.

Methods A cross-sectional study was undertaken at Muhimbili National Hospital (MNH). A standard questionnaire enquired the following variables: demographic characteristics, antenatal profile and detected obstetric risk factors as well as maternal and neonatal risk …

City Tumour Board Karachi: An Innovative Step In Multidisciplinary Consensus Meeting And Its Two Years Audit., Asghar Hussain Asghar, Ahmed Nadeem Abbasi, Abid Jamal, Ghulam H, Sadia Rizvi

Department of Medicine

Management of cancer patients is a team work which usually comprises of surgeons, oncologists, radiologists, pathologists, psychiatrist, nutritionist and a nurse. Any patient who is suffering from any tumour needs a multimodality meeting as cancer treatment is not a single persons job. Most of the time, it is difficult to get the whole team together for a plan discussion due to their busy schedule. This problem was overcome by starting a tumour board meeting early morning of Sunday in Karachi which was named "City Tumour Board (CTB) Karachi". Its first meeting was held on Sunday March 28, 2010 and since …

Clinically Significant Contrast Induced Acute Kidney Injury After Non-Emergent Cardiac Catheterization--Risk Factors And Impact On Length Of Hospital Stay., Waqar Kashif, Ali Khawaja, Syed Ather Hussain

Department of Medicine

Objective: To evaluate the frequency and risk factors associated with clinically significant contrast-induced nephropathy(CIN) in patients undergoing non-emergent coronary angiography.

Study Design: Descriptive study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007.

Methodology: Case records of patients who underwent coronary angiography with a serum creatinine of ≥ 1.5 mg/dl atthe time of procedure were evaluated. Clinically significant contrast induced nephropathy (CSCIN) was defined as either doubling of serum creatinine from baseline value within a week following the procedure or need for emergency hemodialysis after the procedure.Results: One hundred …

Tumor Necrosis Factor -Α, Interleukin-10, Intercellular And Vascular Adhesion Molecules Are Possible Biomarkers Of Disease Severity In Complicated Plasmodium Vivax Isolates From Pakistan., Afsheen Raza, Najia K. Ghanchi, Ali Bin Sarwar Zubairi, Ahmed Raheem, Sobia Nizami, Mohammad Asim Beg

Department of Medicine

Background: Cytokine-mediated endothelial activation pathway is a known mechanism of pathogenesis employed by Plasmodium falciparum to induce severe disease symptoms in human host. Though considered benign, complicated cases of Plasmodium vivax are being reported worldwide and from Pakistan. It has been hypothesized that P.vivax utilizes similar mechanism of pathogenesis, as that of P.falciparum for manifestations of severe malaria. Therefore, the main objective of this study was to characterize the role of cytokines and endothelial activation markers in complicated Plasmodium vivax isolates from Pakistan.

Methods and Principle Findings: A case control study using plasma samples from well-characterized groups suffering from P.vivax …

Granulocyte-Colony Stimulating Factor For Mobilizing Bone Marrow Stem Cells In The Sub Acute Stroke. How Safe Is The Use Of Granulocyte-Colony Stimulating Factor In Sub-Acute Stroke? Is This Stem Cell Trial Of Recovery Enhancement Beneficial?, Fauzia Nomani, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Peripartum Cardiomyopathy: Ten Year Experience At A Tertiary Care Hospital In Pakistan., Abid Laghari, Aamir Hameed, K. Kazmi

Department of Medicine

Background: There is very little literature regarding peripartum cardiomyopathy from the Asian countries. We conducted this study to determine demographic details, clinical presentations, complications and recovery of left ventricular (LV) systolic function in peripartum cardiomyopathy (PPCMP) patients of Pakistani origin.

Method: A ten year retrospective case series of PPCMP was conducted at the Aga Khan University Hospital. Patients were also followed up for six months after presentation, with special regard to improvement in the LV function.

Results: Total 45 patients were included, 25 (55.5%) primigravida and 8 (17.7%) gravida 2 and the remaining 12 (26.6%) were multigravida. Fourteen patients (31.1%) …

Locking Compression Plate In Musculoskeletal Oncology'a Nriend In Need', Masood Umer, Kashif Abbas, Shahid Khan, Haroon Ur Rashid

Department of Surgery

Abstract

BACKGROUND:

We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture.

METHODS:

A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends.

RESULTS:

There were 8 males and 17 females in the study. The …

Rectal Carcinoma Under 40 Years Of Age: Seven-Year Post-Treatment Follow-Up At A Tertiary Care Hospital In Pakistan, Naveed Haroon, Salma Khan, Rehman Alvi

Department of Surgery

Objectives: To determine epidemiological characteristics, clinical presentation, histopathological features, and long-term follow-up of patients below 40 years of age with carcinoma rectum.Methods: The retrospective case series comprised all patients presenting with histopathological diagnosis of carcinoma rectum with age 15-40 years at the Aga Khan University Hospital between January 1994 and December 2004. Details regarding patient demographics, pre-operative assessment, management and tumour grade and stage were obtained from a prospectively maintained database. Continuous and categorical variables in the data were analysed.Results: Of the 23 patients in the study, 14 (60.89%) were male and 9 (39.13%) were female. Mean age of the …

Correlation Between Central Corneal Thickness Measurements Using Two Uifferent Ultrasonic Pachymeters, Sharmeen Akram, Zarksis H, Anklesaria A, Khabir Ahmad

Department of Surgery

Purpose: To assess correlation between central corneal thickness measurements using two different ultrasonic pachymeters. Material and Methods: This prospective study involved normal subjects aged 16 to 45 years. Central corneal thickness was measured in 47 eyes by two ultrasonic pachymeters – Tomey SP – 100 and Sonomed 300 AP. Correlations between CCT measurements assessed by the two pachymeters were tested by Pearson correlation. Results: Forty seven eyes were included in the study. The mean (± SD) age of the subjects was 27.79 years (± 6.88).The mean (± SD) Tomey Pachymeter CCT was 536.45 m (34.37) and the mean (SD) Sonomed …

First Report Of Ndm-1-Producing Acinetobacter Baumannii In East Africa, Gunturu Revathi, Kristopher L. Siu, Po-Liang Lu, Li-Yueh Huang

Pathology, East Africa

Background: The emergence of carbapenem-resistant Acinetobacter baumannii (CRAB) was observed in a Kenyan hospital from 2009 to 2010. Further investigation of the dissemination of CRAB isolates and the molecular characterization of associated resistance determinants were therefore performed.

Methods: Antibiotic susceptibilities were determined by broth microdilution and Etest. Metallo-blactamases were detected by Etest method. Clonal relationships were studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). b-Lactam and aminoglycoside resistance determinants and the clonal relatedness to widespread European clones were studied by PCR and sequencing.

Results: Sixteen CRAB isolates from 10 patients possessed six pulsotypes; half of the isolates …

Anthracycline-Induced Cardiotoxicity: Prospective Cohort Study From Pakistan, Abdul Sattar Shaikh, Ali Faisal Saleem, Shazia Samad Mohsin, Muhammad Matloob Alam, Mehnaz Atiq Ahmed

Department of Paediatrics and Child Health

Objectives: To identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan.

Design: Prospective cohort study.

Setting: Aga Khan University, Karachi, Pakistan.

Participants: 110 children (aged 1 month–16 years).

Intervention: Anthracycline (doxorubicin and/or daunorubicin).

Outcome measurements: All children who received anthracycline as chemotherapy and three echocardiographic evaluations (baseline, 1 month and 1 year) between July 2010 and June 2012 were prospectively analysed for cardiac dysfunction. Statistical analysis including systolic and diastolic functions at baseline, 1 month and 1 …

Importance Of Clinical Toxicology Teaching And Its Impact In Improving Knowledge: Sharing Experience From A Workshop, Nadeem Ullah Khan, Jabeen Fayyaz, Uzma Rahim Khan, Asher Feroze

Department of Emergency Medicine

Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge.Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was ued for statistical analysis of the data.RESULT: There were 22 participants in the course. The pre-test mean …

Maternal Anaemia And Duration Of Zidovudine In Antiretroviral Regimens For Preventing Mother-To-Child Transmission: A Randomized Trial In Three African Countries, Benn K.D. Sartorius, Matthew F. Chersich, Mary Mwaura, Nicolas Meda, Marleen Temmerman, Marie Louise Newell, Timothy M. M. Farley, Stanley Luchters, The Kesho Bora Study Group

Obstetrics and Gynaecology, East Africa

Background: Although substantiated by little evidence, concerns about zidovudine-related anaemia in pregnancy have influenced antiretroviral (ARV) regimen choice for preventing mother-to-child transmission of HIV-1, especially in settings where anaemia is common.

Methods: Eligible HIV-infected pregnant women in Burkina Faso, Kenya and South Africa were followed from 28 weeks of pregnancy until 12–24 months after delivery (n = 1070). Women with a CD4 count of 200-500cells/mm3 and gestational age 28–36 weeks were randomly assigned to zidovudine-containing triple-ARV prophylaxis continued during breastfeeding up to 6-months, or to zidovudine during pregnancy plus single-dose nevirapine (sd-NVP) at labour. Additionally, two cohorts were …

Salmonella Cholecystitis: Atypical Presentation Of A Typical Condition, Rehan Ali, Shakeel Ahmed, Maqbool Qadir, Huba Atiq, Muhammad Hamid

Department of Emergency Medicine

Salmonella cholecystitis is a rare but important complication of Salmonella typhi infection. We are reporting an 11 years old female child who presented with complaints of high-grade fever, jaundice and right sided abdominal pain (Charcot's triad). Her examination showed tender hepatomegaly. Initial blood results revealed high white cell counts with left shift, deranged liver function tests. Abdominal ultrasonography revealed distended gallbladder with minimal layer of sludge seen within its lumen along with streak of pericholecystic fluid. Blood culture grew Salmonella typhi. She was successfully treated with intravenous ceftriaxone.

Diagnosis, Treatment And Follow-Up In Four Children With Biotinidase Deficiency From Pakistan, Bushra Afroze, Mohammad Wasay

Department of Medicine

Biotinidase deficiency is an inherited disorder in which the vitamin biotin is not recycled. If untreated, affected individuals develop neurological and cutaneous symptoms. Untreated individuals with biotinidase deficiency either succumb to disease or are left with significant morbidity. We describe clinical course and follow-up of 4 children from Pakistan. All 4 presented with classical symptoms of biotinidase deficiency and responded dramatically to oral biotin within days to weeks. Biotinidase deficiency is reported in Pakistani children from different part of world, however; there is no such report from Pakistan. This highlights lack of awareness of biotinidase deficiency among physicians in Pakistan

A Rare Aetiology Of Respiratory Failure In A 10-Year-Old Boy: Inflammatory Myofibroblastic Tumour., Ali Khawaja, Prem Kumar Maheshwar, Anwarul Haque, Ali Bin Sarwar Zubairi

Department of Medicine

Primary neoplasms of the respiratory tract are rarely encountered in the paediatric population. Inflammatory myofibroblastic tumour (IMT) is a rare soft tissue mesenchymal tumour but a distinct disease entity accounting for less than 1% of all primary lung tumours. We report a case of a 10-year-old boy who presented with respiratory failure and left lung collapse. On flexible fiberoptic bronchoscopy, a pedunculated mass in the lower part of the trachea originating from the left main stem bronchus was identified. The patient subsequently underwent a left-sided pneumonectomy with complete resection of the mass. The histopathological analysis was consistent with IMT. Two …

Citicoline In The Treatment Of Acute Ischaemic Stroke: An International, Randomized, Multicentre, Placebo-Controlled Study (Ictus Trial) Is The Use Of Citicoline Is Beneficial For Acute Ischaemic Stroke?, Fauzia Nomani,, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Hirayama Disease, A Rare Cause Of Posture Related Cord Compression: A Case Report From Radiological Perspective, Shumaila Arooj, Fatima Mubarak, Muhammad Azeemuddin, Zafar Sajjad, Wasey Jilani

Department of Radiology

Hirayama Disease is a disease of young adults lying in the age group between twenty to thirty years. It is an extremely uncommon disorder. Its other synonyms are juvenile muscular atrophy of the distal upper extremity (JMADUE) or monomelic amyotrophy (MMA). A previously healthy 25-year-old man presented with gradually increasing weakness in both hands for the past few years. There was neither history of trauma nor family history of neuromuscular disease. MRI was advised. Routine cervical sagittal MR images (Non-flexion or extension) revealed cord flattening and atrophy at C5 to C7 levels.There was evidence of syrinx. Flexion MRI was performed …

Psychosocial Experiences Of Women With Vesicovaginal Fistula: A Qualitative Approach., Farah Naz Farid, Maimoona Azhar, Sunil Sadruddin Samnani, Saleema Allana, Angeela Naz, Farzana Bohar, Shershah Syed

Department of Surgery

Abstract

Vesicovaginal fistula (VVF) is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women's Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships …

Incidence And Outcome Of Small For Gestational Age Fetuses: An Experience From A Secondary Care Hospital, Riffat Bano, Nousheen Asim, Ammara Mushtaq, Mehreen Adhi, Noureen Afzal

Department of Obstetrics & Gynaecology

The objective of the study was to determine the frequency and outcome of Small for Gestational Age (SGA) foetuses, and its association with the mode of delivery, foetal birthweight, maternal age and gestational age. It was a hospital-based descriptive study, conducted at Aga Khan Hospital for Women, Karachi, from January 2009 to December 2010. Mode of deliveries, foetal birthweight, maternal age and gestational age of SGA foetuses were recorded and analszed. Of a total of 6024 deliveries during the study period, 722(11.98%) had SGA foetuses. Maternal age in such cased ranged between 20-40 years in 588(81.44%), while 406(56.23%) of these …

Childhood Acute Iymphoblastic Leukaemia: Experience From A Single Tertiary Care Facility Of Pakistan, Naureen Mushtaq, Zehra Fadoo, Ahmed Naqvi

Department of Paediatrics and Child Health

Objective: To evaluate the demographic features, outcome and prognostic factors seen in children with acute lymphoplastic leukaemia at a tertiary care hospital.
Methods: The retrospective descriptive study was conducted at Aga Khan University Hospital, Karachi, comprising data related to children below 15 years of age and treated between January 1997 and December 2006. Kaplan Meir survival curves were used to describe overall and event-free survival rates. Cox Proportional Hazards model was used to describe factors associated with death and relapse. SPSS 16 was the main statistical tool.
Results: Of the total 121 children diagnosed with the condition, 79 (65.3%) were …

Community-Based Management And Outcome Of Omphalitis In Newborns In Karachi, Pakistan, Farah Naz Qamar, Shiyam Sundar Tikmani, Fatima Mir, Anita Kazmi Mehdi Zaidi

Department of Paediatrics and Child Health

Objectives: To describe the clinical profile and outcome in newborns with omphalitis managed with home or clinic-based therapy.
Methods: The descriptive study was conducted from September 2004 to August 2007 in three low-income communities in Karachi, Pakistan. Newborns with omphalitis detected by community health workers through active surveillance were referred to local clinics. Those with physician-confirmed omphalitis were treated for 7 days with topical gentian violet or oral cephalexin (as monotherapy) or topical gentian violet and oral cephalexin (combination therapy) at physician discretion, or injectable therapy (procaine penicillin and gentamicin) if clinical signs of sepsis were also present and family …

Job's Syndrome With An Atypical Presentation, Abbas Ali Tasneem, Sabahat Sarfaraz, Syed Mujahid Hassan, Nasir Hassan Luck, Sabiha Anis, Zaigham Abbas

Section of Gastroenterology

Hyper Immunoglobulin E syndrome also called Job's or Buckley Syndrome is a rare primary immunodeficiency disease characterized by elevated serum IgE levels (> 2000 IU/ml), recurrent infections and eosinophilia. Other features include coarse facies and non-immunologic abnormalities of the dentition, bones, vasculature and connective tissues. We are reporting a case of a twenty four years old male with coarse facies who presented with severe pallor and upper gastrointestinal bleeding. Investigations revealed markedly elevated serum IgE levels (11,800 IU/ml), severe anaemia, esophageoduodenal erosions, Helicobacter pylori (H. pylori) gastritis and oro-esophageal candidiasis.