Medicine and Health Sciences Commons^™

Should Carotid Endarterectomy Be Performed For Symptomatic Carotid Stenosis Pakistan?, N. A. Syed, A. Zakaria, B. A. Khealani, M. Wasay, S. M. Baig, Z. Sophie

Department of Medicine

Objective: The risk of stroke and death associated with carotid endarterctomy is operator dependant. Data regarding risks of this procedure are not available in Pakistan and therefore it is difficult to make accurate risk benefit analysis for individual patients. Our objective was to determine safety of carotid endarterectomy at an academic tertiary care center in Pakistan.

Methods: Patients who underwent carotid endarterectomy (CEA) at our hospital during a ten-year period were identified through ICD-9 coding system of the hospital medical records. Demographic features. associated medical problems and immediate postoperative complications were recorded and analyzed.

Results: Sixty-three carotid endarterectomies were performed …

Neurological Care In Pakistan: Actions Are Needed, M. Wasay

Department of Medicine

No abstract provided.

Status Epilepticus In Children: A Five-Year Experience At Aga Khan University Hospital, S H. Ibrahim, M A. Yezdan, S Q. Nizami

Department of Paediatrics and Child Health

Objective: Status epilepticus is an under diagnosed entity in Pakistan. It is a potentially reversible condition but has a high mortality, if it is not recognized and managed on time. The purpose of this study was to determine the clinical profile and the relationship of mortality of status epilepticus with its known risk factors.
Methods: This was a retrospective study. Medical records of all the patients admitted in the last five years (1998-2002) with a diagnosis of status epilepticus (ICDcode 345.30, 345.31) were reviewed. Data was recorded on a Performa and analyzed by using the statistical programme SPSS, chi square …

Socio-Economic And Diagnostic Aspects Of Tuberculosis In Pakistan, Saba Sohail

Department of Radiology

No abstract provided.

Spectrum Of Complications And Mortality Of Bacterial Meningitis: An Experience From A Developing Country, M. A. Rabbani, A. A. Khan, S. S. Ali, B. Ahmad, Mohammad Asim Beg, M. A. Khan, Mohammad Wasay

Department of Medicine

Objective:

The aim of this study was to obtain data on predisposing factors, causative organisms and their associated mortality and complications related to acute bacterial meningitis.

Methods:

The chart review of all patients in whom acute bacterial meningitis was diagnosed at The Aga Khan University Hospital from January 1995 through December 2001.

Results:

One hundred ninety-four patients were included in study. There were 146 males and 48 females. The mean age of our study population was 41±12.3 years. One hundred and ninety (97.9%) patients had community acquired meningitis; only 4 (2.0%) patients developed meningitis nosocomially. The two most common predisposing …

Ischemic Stroke Subtypes In Pakistan: The Aga Khan University Stroke Data Bank, N. A. Syed, B. A. Khealani, S. Ali, A. Hasan, H. Brohi, T. Mozaffar, N. Ahmed, A. Hameed, S. M. Baig, M. Wasay

Department of Medicine

Objective: Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital.

Methods: We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi.

Results: A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 …

Giant Choroid Plexus Papilloma Of The Third Ventricle, Ashfaq A. Razzaq, Khalid N. Chishti

Section of Neurosurgery

Abstract are not provided by the author/publisher

Situs Ambiguous, Saba Sohail, Mukhtiar Ahmed Memon, Allah Rakhiyo

Department of Radiology

The case of a female child is described who presented with recurrent respiratory infections and "recurrent right subphrenic abscess." Detailed radiological work-up identified situs ambiguous abdominis with bronchiectasis, duodenal malrotation, umbilical hernia and spina bifida.

Midazolam And Thiopentone Co-Induction: Looking For Improvement In Quality Of Anaesthesia, M A. Khan, F A. Khan

Department of Anaesthesia

Objective: To evaluate improvement in quality of anaesthesia induction using thiopentone and midazolam for co-induction of anaesthesia. An additional end point was taken as loss of response to a tetanic stimulation (50 Hz) delivered for 5 seconds after the loss of verbal contact and eyelash reflex.Methods: Ninety ASA I and II patients, within the age range of 20-60 years were studied. Patients were randomly divided into three equal groups; A, B and group C.Results: Onset of induction and loss of response to a tetanic stimulation was achieved earlier in group B as compared to the other study groups (p < 0.05).CONCLUSION: Co-induction with midazolam 0.02 mg x kg(-1) followed by thiopentone 3 mg x kg(-1) was superior to other two groups. Induction of anaesthesia in this group was found to be smoother and faster, provided better hemodynamic stability, better airway maintenance and with lesser incidence of untoward effects.

Comparison Of Double Disc And Combined Disc Method For The Detection Of Extended Spectrum Beta Lactamases In Enterobacteriaceae, K Jabeen, A Zafar, R Hasan

Department of Pathology and Laboratory Medicine

Objective:
To compare double disc approximation and combined disc method for their ability to detect extended spectrum b lactamase (ESBL) production in enterobacteriaceae and determine the percentage of isolates which are falsely reported as sensitive in absence of ESBL detection, in a clinical microbiology laboratory of a tertiary care hospital between September-October 2002.
Methods:
Selected isolates were identified according to standard biochemical tests. Disc susceptibility tests were performed according to NCCLS. ESBL detection by combined disc [cefotaxime (30 ug) versus cefotaxime plus clavulanate (30+10 ug)] was compared with detection using double discs [amoxy-clavulanic acid (20+10 ug) and aztreonam (30 ug) …

Socio-Economic And Demographic Factors Associated With Injecting Drug Use Among Drug Users In Karachi, Pakistan, A. Agha, S. Parviz, M. Younus, Zafar Fatmi

Community Health Sciences

Objective: To identify the socio-economic and demographic factors associated with injecting drug users (IDUs) in Karachi.

Methods: We recruited 242 IDUs (taking drugs through sub-dermal routes) and 231 non-IDUs (taking drugs other than sub-dermal routes) from February through June 1996. IDUs were interviewed regarding sociodemographic factors, economic condition, and social network (marital status, living with spouse). In addition, information regarding location of drug users within the city (districts of Karachi) and current history of sexually transmitted diseases (STDs) were gathered. Moreover, blood samples were also obtained for HIV testing

.Results: Multivariate analysis showed that the income generation via illegal …

Septic Arthritis Of The Hip In Children: Aga Khan University Hospital Experience In Pakistan, Muhammad Umer, Pervaiz Hashmi, Tashfeen Ahmad, M Ahmed, Masood Umer

Section of Orthopaedic Surgery

Objective: To present clinical, radiological and bacteriological features and short term outcome of septic arthritis of the hip in children.
Methods: There were 23 male and 16 female children, including 6 neonates and 10 infants with a mean age of 3.9 years. Diagnosis of septic hip was made on clinical grounds, supplemented by X-rays, leukocyte count and the erythrocyte sedimentation rate (ESR). Thirty nine patients with 40 hips were followed for a mean time period of 76 weeks. All patients had a positive joint aspirate (pus) and underwent surgical decompression along with intravenous antibiotic therapy.
Results: Symptoms of pain, fever …

Helicobacter Pylori Infection And Micronutrient Deficiencies., Javed Yakoob, Wasim Jafri, Shahab Abid

Section of Gastroenterology

It is known that deficiencies of micronutrients due to infections increase morbidity and mortality. This phenomenon depicts itself conspicuously in developing countries. Deficiencies of iron, vitamins A, E, C, B12, etc are widely prevalent among populations living in the third world countries. Helicobacter pylori (H pylori) infection has a high prevalence throughout the world. Deficiencies of several micronutrients due to H pylori infection may be concomitantly present and vary from subtle sub-clinical states to severe clinical disorders. These essential trace elements/micronutrients are involved in host defense mechanisms, maintaining epithelial cell integrity, glycoprotein synthesis, transport mechanisms, myocardial contractility, brain development, cholesterol …

Candida Esophagitis: Risk Factors In Non-Hiv Population In Pakistan, Javed Yakoob, Wasim Jafri, Shahab Abid, Nadim Jafri, Muhammad Islam, Saeed Hamid, Hasnain Ali Shah, Akbar S. Hussainy

Section of Gastroenterology

AIM:

Candida esophagitis is a frequent infection in immunocompromised patients. This study was designed to determine its characteristics in non- human immune deficiency virus (HIV) infected patients attending a teaching hospital.

METHODS:

Clinical records of all patients coded by international classification of diseases 9th revision with clinical modifications' (ICD-9-CM), with candida esophagitis diagnosed by esophagogastroduodenoscopy (EGD) and histopathology over a period of 5 years were studied.

RESULTS:

Fifty-one patients (27 males, 24 females, range 21-77 years old and mean age 52.9 years) fulfilled the criteria (0.34% of the EGD). The common predisposing factors were carcinoma (OR 3.87, CI 1.00-14.99) and …

Renal Carcinoid Tumour, Z Ahmad, N Yaqoob, S Muzaffar, A S. Hussainy, S H. Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Renal Teratoma: A Rare Entity, N Yaqoob, Z Ahmed, N Jafri, S Muzaffar, S H. Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Topographical Expression Of Class Ia And Class Ii Phosphoinositide 3-Kinase Enzymes In Normal Human Tissues Is Consistent With A Role In Differentiation, Soha Salama El Sheikh, Jan Domin, Prakitpunthu Tomtitchong, Paul Abel, Gordon Stamp, El-Nasir Lalani

Department of Pathology and Laboratory Medicine

Background: Growth factor, cytokine and chemokine-induced activation of PI3K enzymes constitutes the start of a complex signalling cascade, which ultimately mediates cellular activities such as proliferation, differentiation, chemotaxis, survival, trafficking, and glucose homeostasis. The PI3K enzyme family is divided into 3 classes; class I (subdivided into IA and IB), class II (PI3K-C2α, PI3K-C2β and PI3K-C2γ) and class III PI3K. Expression of these enzymes in human tissue has not been clearly defined.

Methods: In this study, we analysed the immunohistochemical topographical expression profile of class IA (anti-p85 adaptor) and class II PI3K (PI3K-C2α and PI3K-C2β) enzymes in 104 formalin-fixed, paraffin embedded …

Pharmacy Newsletter : September 2003, Pharmacy Department

Pharmacy Newsletter

Content:

• Heparin Induced Thrombocytopenia (HIT)
• Antibiotics and Dialysis
• Management of Helicobacter pylori Infection
• Story of A Pharmacist In a Busy Pharmacy
• ACE inhibitor, diuretic and NSAID: a dangerous combination

Laparoscopic Appendicectomy At The Aga Khan Hospital, Nairobi, S. C. Patel, G. F. Jumba, S. Akmal

General Surgery, East Africa

Objective: To evaluate our experience of laparoscopic appendicectomy at the Aga Khan Hospital, Nairobi over a six year period from the inception of the technique and to assess its advantages and disadvantages.

Design: Case series study.

Setting: The Aga Khan Hospital, Nairobi.

Patients: One hundred and six cases operated on from May 1996 to June 2002. Main outcome measures: Clinical presentation, age and sex demographics, average hospital stay, operating time, intra-operative and post-operative complications and outcome.

Results: There was a female preponderance with a female to male ratio of 2:3:I. Mean age was 30.6 years. There was a slightly more …

The Transformative Effect Of Training In Counselling And Its Application, On The Community Counsellors Themselves, S Naeem, Badar S. Ali, S Mubeen, Iqbal Azam

Department of Psychiatry

Objective: To identify the changes in community counsellors' own level of anxiety and depression as a result of learning counselling skills and to explore their subjective experiences after learning and providing counselling.Design: Quantitative: Repeated Measures. / Qualitative: Focus Group Discussions.SETTING: A lower middle class semi urban community of Karachi, Pakistan.PARTICIPANTS: Twenty-one self selected women from the community.Results: Reduction was seen in the post training scores of anxiety and/or depression in the trainees. As a result of learning and then providing counselling the community counsellors' self esteem, self confidence and sense of competence were enhanced and they developed a more positive …

Rare Complication Of Sinus Venosus-Type Atrial Septal Defect Repair, M Murad, S A. Sami, R Hashmi, V Bari

Department of Radiology

No abstract provided.

A Comparison Of Morphine And Nalbuphine For Intraoperative And Postoperative Analgesia, F N. Minai, F A. Khan

Department of Anaesthesia

Introduction: Short acting narcotics are not available in Pakistan and the supply of drugs like morphine and pethidine is short and erratic; therefore there is a need for investigating acceptable alternatives for analgesia, to be used for balanced anaesthesia.Objective: We studied the agonist-antagonist narcotic nalbuphine compared to morphine, for intra and postoperative pain relief in total abdominal hysterectomies.Methods: In a randomised double blind trial, fifty ASA I and II patients in two groups of twenty five each were given equianalgesic doses of morphine and nalbuphine. Hemodynamic stability, intraoperative analgesia, recovery profiles, incidence of side effects and need for postoperative supplements …

Risk Factors For Cardiovascular Disease In School Children--A Pilot Study., A. K. Khuwaja, Zafar Fatmi, W. B. Soomro, N. K. Khuwaja

Community Health Sciences

OBJECTIVE:

To assess the frequencies of risk factors for cardiovascular disease in school children. The information may help in designing interventions aimed at modifying unhealthy lifestyle in children, which may reduce the later incidence of cardiovascular disease in adults.

METHODS:

A cross-sectional study was conducted on 206 students (ages 14-18 years), enrolled in higher secondary school. Students were interviewed about their lifestyles, family history of cardiovascular disease and its risk factors. Moreover, they were assessed for height, weight and blood pressure.

RESULTS:

Twenty nine percent of the children were physically inactive, 31% were taking unhealthy diet daily, 21% were overweight …

Spectrum Of Cutaneous Appendage Tumors At Aga Khan University Hospital, N Yaqoob, Z Ahmad, S Muzaffar, M S. Gill, I N. Soomro, S H. Hasan

Department of Pathology and Laboratory Medicine

Objective: To determine the frequency of various types of cutaneous appendage tumors in our practice.
Method: This is a partly retrospective and partly prospective study conducted at the Department of Pathology, Histopathology Section, The Aga Khan University Hospital, Karachi between 1st January 1997 and 31st December 2001.
Results: One hundred sixty six skin appendage tumors were diagnosed during the study period. 87.3% were benign, while 12.6% were malignant. Male female ratio was almost equal. Mean age was 41.72 years. 37.34% showed eccrine differentiation, 14.45% showed apocrine differentiation and 41.56% showed pilosebaceous differentiation, 6.62% exhibited mixed differentiation. The 5 commonest tumors …

Irritable Bowel Syndrome In Health Care Professionals In Pakistan, Wasim Jafri, Javed Yakoob, Nadim Jafri, Mahesh Maloni, Saeed Hamid, Hasnain Ali Shah, Shahab Abid

Section of Gastroenterology

Objective: To evaluate the symptomatology of irritable bowel syndrome (IBS) among health care professionals attending an IBS symposium in a tertiary care university hospital. Method: A questionnaire designed to incorporate Manning and Rome II criteria was distributed among participants of an IBS symposium, most of them were health care professionals. A total of 100 questionnaires were distributed, 41 had symptoms fulfilling criteria of IBS. In these patients male: female ratio was 28:13 with age range 18-68. Results: The predominant symptom was abdominal pain 87.8 % (36/41) which was aggravated post-prandially 72.2% (29/41), relieved following defecation in 87 % (35/41) with …

Extrarenal Wilms' Tumor, M Yunus, R Hashmi, S H. Hasan, H M. Brohi

Department of Radiology

No abstract provided.

N-Acetyl-Beta-D-Glucosaminidase In Acute Myocardial Infarction, M Perwaiz Iqbal, Khawar A. Kazmi, Hasan R. Jafri, Naseema Mehboobali

Department of Biological & Biomedical Sciences

The objective of the study was to investigate whether the lysosomal enzyme, N-Acetyl-beta-D-glucosaminidase (NAG) activity is increased in plasma of patients with acute myocardial infarction (AMI) and to determine if there is any association between plasma levels of NAG and severity of myocardial infarction (MI). NAG activity in plasma was monitored in 69 patients with AMI and 135 normal healthy subjects using a spectrofluorimetric method. A modified Aldrich ST elevation score was used to gauge the severity of MI in terms of size of the infarct. Plasma NAG levels in AMI patients and normal healthy subjects were found to be …

Isolated Congenital Bilateral Absence Of Vas Deferens (Cbavd): A Rare Anomaly And Diagnostic Dilemma, M Moazzam, Syed Raziuddin Biyabani, C K. Jadoon

Section of Urology

No abstract provided.

Peritumoral Cystic Meningioma, Arshad A. Siddiqui, Junaid Asharaf, Ahmed Ali Shah

Section of Neurosurgery

A case of 39 years old male is described who presented with headache, right-sided focal fits and decreased power in the right hand. CT scan brain showed a left fronto-parietal cystic lesion with centrolateral intramural nodule with homogenous enhancement. At surgery, the extra-axial lesion with cyst containing xanthochromic fluid had a well-defined capsule that could easily be separated from the peri-lesional cortical surface. The dural-based nodule with its cyst wall was resected in toto. The histopathology of mural nodule was reported as meningioma while the cyst wall histology revealed meningothelial cells.

What Is Wrong With Medical Audit?, J H. Rizvi

Department of Obstetrics & Gynaecology

No abstract provided.