Medicine and Health Sciences Commons^™

Can Telemedicine Improve Stroke Outcomes?, Quratulain Shaikh, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Prevalence Of Body-Focused Repetitive Behaviors In Three Large Medical Colleges Of Karachi: A Cross-Sectional Study., Efaza Umar Siddiqui, Syed Saad Naeem, Haider Naqv, Bilal Ahmed

Department of Medicine

Background: Body-focused repetitive behaviors (BFRBs) that include skin picking (dermatillomania), hair pulling (trichotillomania) and nail biting (onychophagia), lead to harmful physical and psychological sequelae. The objective was to determine the prevalence of BFRBs among students attending three large medical colleges of Karachi. It is imperative to come up with frequency to design strategies to decrease the burden and adverse effects associated with BFRBs among medical students.

Methods: A cross-sectional study was conducted among 210 students attending Aga Khan University, Dow Medical College and Sind Medical College, Karachi, in equal proportion. Data were collected using a pre tested tool, “Habit Questionnaire”. …

Recurrent Non-Aneurysmal, Metastatic Intraparenchymal Haemorrhages Following Resection Of Atrial Myxoma - Case Report And Literature Review., Emmon Raza, Ayeesha Kamran Kamal

Department of Medicine

Atrial myxomas are the commonest cardiac neoplasms. The most common extra-cardiac manifestations are embolic infarcts from tumour embolisation. Infrequently, aneurysm formation and intracranial haemorrhages also occur. Incredibly rare are space-occupying lesions and malignant transformation. The authors report a case of a previously healthy middle-aged lady who developed recurrent and expanding intraparenchymal haemorrhages following resection of a left atrial myxoma without any primary disease recurrence. The case described is completely different from the described literature in that her intracranial vasculature was free of aneurysms on angiography despite central nervous system haemorrhage and no myxomatous or malignant features were seen on histology …

Cabergoline Therapy For Macroprolactinoma During Pregnancy: A Case Report., Hira Shahzad, Aisha Sheikh, Lumaan Sheikh

Department of Medicine

Background: We assessed the safety of Cabergoline therapy during pregnancy in a lady with hyperprolactinemia intolerant to Bromocriptine.

Case presentation: We report the case of a 31 year old lady who presented to us with uncontrolled hyperprolactinemia. A pituitary Macroadenoma was demonstrated by MRI. Due to intolerance to Bromocriptine, Cabergoline was started. The patient improved and subsequently conceived. MRI in the second trimester demonstrated further reduction in the tumor size. It was decided to continue Cabergoline throughout pregnancy to ensure further reduction in tumor size until delivery and to hold Cabergoline during postpartum period to allow for an adequate interval …

Non-Compaction Of The Left Ventricle And Associated Ventricular Septal Defect., Abid Laghari, Javed Tai, Sumaira Saleem

Department of Medicine

A case report of a 28-year-old patient, who presented with symptoms and signs of congestive heart failure and had clinical signs of ventricular septal defect as well. On further work-up echocardiogram showed non-compaction of the left ventricle with severe left ventricular systolic dysfunction and a ventricular septal defect. He was treated with standard treatment of heart failure and is doing well.

Hepatocellular Carcinoma In Pakistan: Where Do We Stand?, Amna Subhan Butt, Z Abbas, Wasim Jafri

Department of Medicine

Evidence Acquisition: The age-standardized rate for HCC is 7.64/100 000 in males and 2.8/100 000 in females. Male to female ratio is 3.6:1. Usual age of presentation is in the fifth and sixth decade. Most patients present with advanced disease, as they are not in a regular surveillance program. This is more so for patients with NBNC chronic liver disease. As many sonologists in Pakistan are practicing without sufficient training to pick up early lesions, alpha-fetoprotein is still recommended to compliment ultrasound in the surveillance of HCC.

Results: Majority of HCC patients present with nonresectable disease. Interventions such as transarterial …

Are Robots Any Better In Stroke Rehabilitation?, Muhammad Faisal Wadiwala, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

What Is Better Antiplatelet Agent To Prevent Recurrent Stroke?, Muhammad Faisal Wadiwala, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Temozolomide For Relapsed Primary Cns Lymphoma., Asif Husain Osmani, Nehal L Masood

Department of Medicine

Primary CNS lymphoma (PCNSL) is an aggressive form of non-Hodgkin's lymphoma that accounts for 3% of all primary brain tumours. No clear risk factors for PCNSL in immunocompetent patients are known. The disease is more common in men and in elderly persons. Patients with AIDS who have low CD4+ counts are at the greatest risk for PCNSL. Virtually all PCNSLs in patients with AIDS express an Epstein-Barr virus (EBV)-related genome. PCNSL is less frequently associated with EBV in patients without AIDS. A 42 years old gentleman diagnosed with primary CNS lymphoma with negative serological test for human immunodeficiency virus was …

Diabetes Related Knowledge Among Residents And Nurses: A Multicenter Study In Karachi, Pakistan., Asma Ahmed, Abdul Jabbar, Lubna Zuberi, Muhammad Islam, Khusro Shamim

Department of Medicine

Background: Assessment of knowledge among resident trainees and nurses is very important since majority of patients admitted in hospital have underlying diabetes which could lead to adverse clinical outcomes if not managed efficiently. Therefore, the purpose of this study was to evaluate and compare the knowledge related to the management of diabetes among registered nurses (RN) and trainee residents of internal medicine (IMR), family medicine (FMR) and surgery (SR) at tertiary care hospitals of Karachi, Pakistan.

Methods: A validated questionnaire consisting of 21 open ended questions related to diabetes awareness was acquired through a study done at Thomas Jefferson University …

Triple Valve Endocarditis By Mycobacterium Tuberculosis: A Case Report., Quratulain Shaikh, Syed Faisal Mahmood

Department of Medicine

BACKGROUND:

Granulomas caused by Mycobacterium Tuberculosis have been observed at autopsy in the heart, pre-dominantly in the myocardium and endocardium, but rarely involving the coronary vessels and valvular structures. Mycobacterium tuberculosis valvular endocarditis is extremely rare, with most reports coming from autopsy series.

CASE PRESENTATION:

We report the case of a 17 year old immunocompetent girl who presented with history of fever, malaise, foot gangrene and a left sided hemiparesis. On investigation she was found to have infective endocarditis involving the aortic, mitral and tricuspid valves. She had developed a right middle cerebral artery stroke. She underwent dual valve replacement …

Fulminant Invasive Aspergillosis Of The Mediastinum In An Immunocompetent Host: A Case Report., Muhammad Tariq Shakoor, Samia Ayub, Zunaira Ayub, Syed Faisal Mahmood

Department of Medicine

Introduction: Invasive aspergillosis is a serious complication in immunocompromised patients. It is an opportunistic disease, which predominantly occurs in the lungs, although dissemination to virtually any organ is possible. Invasive aspergillosis in an immunocompetent patient with extension to the mediastinum has rarely been reported. Here, we present the case of a patient with no apparent immunodeficiency state, who presented with Aspergillus endocarditis and fulminant invasive aspergillosis with extensive involvement of the mediastinal structures, which ultimately was responsible for her death. To the best of our knowledge, this is the first reported case in the literature on fulminant invasive mediastinal aspergillosis …

Extending The Window For Thrombolysis In Acute Stroke., Muhammad Faisal Wadiwala,, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Hcv Behavioral Health Preparation Of The Racial/Ethnic Minority: Measurement Development Of A Hcv Treatment Readiness Tool In Spanish And English, Michele Vella, Joseph L. Yozviak Do, Facp, Judith Lash Rn

Department of Medicine

No abstract provided.

Meld Score: Utility And Comparison With King's College Criteria In Non-Acetaminophen Acute Liver Failure., Om Parkash, Khalid Mumtaz, Saeed Hamid, Syed Hasnian Ali Shah, Wasim Jafri

Department of Medicine

Objective: To compare Model for End-stage Liver Disease Score (MELD Score, MS) and King’s College Hospital (KCH) criteria for finding correlation of mortality in non-acetaminophen induced acute liver failure (NAI-ALF).

Study Design: An analytical cross-sectional study.

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

Methodology: The study included patients with NAI-ALF. KCH criteria were labelled as good and bad prognosis groups. MELD score were calculated by using the MELD calculator. ROC was plotted and sensitivity analysis was done. ETA was used to see correlation between MELD and KCH.

Results: Ninety-one patients with mean …

Atypical Pathogens Causing Community-Acquired Pneumonia In Adults., Ali Bin Sarwar Zubairi, Afia Zafar, Nawal Salahuddin, Ahmed Suleman Haque, Shahan Waheed, Javaid Khan

Department of Medicine

Objective: To determine the frequency of community-acquired respiratory pathogens with special focus on atypical organisms in patients presenting to a tertiary care facility with community-acquired pneumonia (CAP).

Methods: The descriptive study on adult patients was conducted from February 2007 to March 2008 at the Aga Khan University Hospital, Karachi. It comprised 124 consenting patients of age 16 and above who presentd with a diagnosis of community-acquired pneumonia. The diagnostic modalities used were based on significant changes in antibody titer or persisting high antibody titers in the case of Mycoplasma pneumoniae and Chalmydia pneumoniae infections, or bacterial antigen in urine, in …

Long-Term Effect Of Carotid Surgery In Asymptomatic Stenosis., Muhammad Faisal Wadiwala, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Gender Differences In Risk Factors, Mortality, And Length Of Stay Of Patients Discharged From A Pakistani Stroke Unit: A Comparative Cross-Sectional Study, Farzin Majeed, Bilal Ahmed, Maria Khan, Shaista Anwar Siddiqi, Ayeesha Kamran Kamal

Department of Medicine

BACKGROUND: Differences between women and men in relation to stroke are increasingly being recognized. There is a scarcity of data on gender-based differences in stroke risk factors and outcomes from Pakistan.

METHODS: We enrolled 231 consecutive patients diagnosed with acute stroke. All patients received care along a standardized stroke pathway in a single stroke unit. We analyzed demographic and medical factors, NIHSS scores, and outcomes.

RESULTS: Of 213 consecutive hospitalized patients, 135 patients were men and 76 were women. The male to female ratio was 1.84. The mean age of males was 62.3913.56, as compared to females 61.15911.60 years. Hypertension, …

Thrombocytosis And Coronary Occlusion, Amit N. Nanavati Md, Nainesh C. Patel Md, James A. Burke Md, Phd

Department of Medicine

No abstract provided.

Hdl Cholesterol--How Do I Raise My Patients Good Cholesterol?, Quratulain Shaikh, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Virulence Markers Of Helicobacter Pylori In Patients With Diarrhoea-Dominant Irritable Bowel Syndrome., Javed Yakoob, Zaigham Abbas, S. Naz, M. Islam, Waseem Jafri

Department of Medicine

Recent studies suggest that irritable bowel syndrome (IBS) is associated with low-grade inflammation. This study aims to determine the distribution of Helicobacter pylori cytotoxin-associated gene A (cagA) and vacuolating cytotoxin A (vacA) alleles (e.g., s1 and s2) in Patients with diarrhoea-dominant IBS (IBS-D) as the latter causes vacuolation in colonic epithelial cells in vitro. One hundred and seventy Patients meeting Rome III criteria for IBS-D (mean age: 40 +/- 15 years) were enrolled. Gastric biopsy was assessed histologically and DNA extraction was performed by polymerase chain reaction (PCR) for H. pylori genus 16S ribosomal DNA (16S rDNA), cagA and vacA …

Primary Billiary Cirrhosis (Antimitochondrial Antibody Negative) Leading To Secondary Amyloidosis., Om Parkash, Aysha Almas

Department of Medicine

A 49 years old lady presented with low-grade fever (99-100°F) for 2 years. During this time she was extensively worked-up for pyrexia of unknown origin but no diagnosis could be established. Her Initial blood work-up was all negative except high alkaline phosphatase and gamma GT (374 IU and 195 IU respectively). She later presented to our tertiary care centre with facial swelling, flushing and bilateral pedal swelling for 3 months. Along with generalized body swelling she had frothy urine. She was diagnosed as nephrotic syndrome on the basis of nephrotic range proteinuria. Her Renal biopsy done for workup of nephrotic …

What Is The Role Of Free Radical Scavengers In Acute Stroke?, Muhammad Faisal Wadiwala, Ambreen Sonawalla, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

My Patient Has A Lot Of Variability In His Blood Pressure Measurements? Should I Be Worried? What Can I Do Which May Be Better?, Quratulain Shaikh, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Biotinidase Deficiency In Pakistani Children; What Needs To Be Known And Done, Bushra Afroze, Mohammad Wasay

Department of Medicine

No abstract provided.

Relation Of Torsion And Myocardial Strains To Lv Ejection Fraction In Hypertension, Mustafa I. Ahmed Md, Ravi V. Desai Md, Krishna K. Gaddam Md, Bharath A. Venkatesh Phd, Shilpi Agarwal Ms, Md, Seidu Inusah Ms, Steven G. Lloyd Md, Thomas S. Denney Jr Phd, David Calhoun Md, Louis J. Dell'italia Md, Himanshu Gupta Md

Department of Medicine

No abstract provided.

Can Community Based Interventions Control Hypertension In Developing Countries? What Is The Evidence From Pakistan?, Farzin Majeed, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Functional, Cognitive And Psychological Outcomes, And Recurrent Vascular Events In Pakistani Stroke Survivors: A Cross Sectional Study., Maria Khan, Bilal Ahmed, Maryam Ahmed, Myda Najeeb, Emmon Raza, Farid Khan, Anoosh Moin, Dania Shujaat, Ahmed Arshad, Ayeesha Kamran Kamal

Department of Medicine

Background: There is little direct data describing the outcomes and recurrent vascular morbidity and mortality of stroke survivors from low and middle income countries like Pakistan. This study describes functional, cognitive and vascular morbidity and mortality of Pakistani stroke survivors discharged from a dedicated stroke center within a nonprofit tertiary care hospital based in a multiethnic city with a population of more than 20 million.

Methods: Patients with stroke, aged > 18 years, discharged alive from a tertiary care centre were contacted via telephone and a cross sectional study was conducted. All the discharges were contacted. Patients or their legal surrogate …

Cross-Sectional Study Identifying Forms Of Tobacco Used By Shisha Smokers In Pakistan., Sameer Ur Rehman, Mohammed Ali Sadiq, Maria Adnan Parekh, Ali Bin Sarwar Zubairi, Javaid Khan, Philippe M. Frossard

Department of Medicine

Objectives: To estimate the frequency of different forms of tobacco intake such as smoker's tobacco, chewable tobacco and snuff tobacco among shisha smoker's and to study the patterns and predictors of shisha smoking affecting youth from different cities of Pakistan.

Methods: A cross-sectional study was conducted including youth from four cities. Participants were asked to fill out a data collection tool at shisha cafes, shopping malls and restaurants. Data was analyzed using SPSSv.18.

Results: A total of 406 participants, 296 (73%) males and 110 (27%) females were included in the study. There were 163 (40%) cigarette smokers; 65(16%) chewed tobacco …

My Patient Has An Elevated Hs-Crp. What Does This Mean? What Should I Do Now?, Maria Khan, Emmon Raza, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.