Respiratory Tract Diseases Commons^™

Single Lung Ventilation In A Young Child For Repair Of Coarctation Of Aorta, Mohammad Hamid, Mansoor Ahmed Khan, Muneer Amanullah

Department of Anaesthesia

Single lung ventilation in small children is extremely challenging. In this case, a paediatric bronchial blocker was successfully inserted in a 19-month-old child to provide single lung ventilation using a modified insertion technique. It provided excellent working conditions during thoracotomy and our method of insertion may help in reducing the cost.

Lung Carcinoma: Its Profile And Changing Trends, Saad Siddiqui, Mohammed Usman Ali, Mahrukh Ayesha Ali, Noreen Shah, Shagufta Nasreen

Section of Pulmonary & Critical Care

BACKGROUND: Lung Carcinoma is the leading causes of morbidity and mortality worldwide with an incidence of 1.3 million cases per year. This study was undertaken to determine prevalence of various histological types of lung carcinoma and to analyse their changing trends with time.

METHODS: This is a retrospective analytical study. A total of 330 cases of lung carcinoma were analysed from 2003 to 2008. Cases from Khyber Pakhtunkhwa and Federally Administered Tribal Area (FATA) were included in this study. Furthermore, only cases of lung carcinoma were considered while other malignancies were excluded.

RESULTS: Squamous Cell carcinoma was found in 42.7% …

Drug Resistance Pattern In Multidrug Resistance Pulmonary Tuberculosis Patients, Nisar Ahmed Rao, Muhammad Irfan, Mir Mir Soomro, Zeeshan Mehfooz

Section of Pulmonary & Critical Care

Objective: To evaluate accuracy of modified Kenneth Jones scoring criteria (MKJSC) as a screening tool to diagnose tuberculous meningitis in children. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric Medicine, Unit-I, Bahawal Victoria Hospital, Bahawalpur, from May 2006 to March 2007. Methodology: A total of 100 children admitted through emergency in Paediatric Medicine, Unit-I, were included who were having fever and features suggestive of central nervous system (CNS) infection. Lumbar puncture was done in all patients after written consent. Findings of lumbar puncture were taken as gold standard for the diagnosis of TBM. MKJSC was applied on each …

Variables Predictive Of Outcome In Patients With Acute Hypercapneic Respiratory Failure Treated With Noninvasive Ventilatio, Nawal Salahuddin, Muhammad Irfan, Shereen Khan, Muhammad Naeem, Ahmad Suleman Haque, Shahid Javed Husain, Nisar Ahmed Rao, Ali Bin Sarwar Zubairi, Javaid Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors.

METHODS: This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of < 0.05 was considered statistically significant. Software used was SPSS 14.

RESULTS: Total numbers of patients included were 119; 52.9% were males. Mean age was 63.4 +/- 11.9 years. Overall Survival to …

Ccl2 Responses To Mycobacterium Tuberculosis Are Associated With Disease Severity In Tuberculosis, Zahra Hasan, Jacqueline M. Cliff, Hazel M. Dockrell, Bushra Jamil, Muhammad Irfan, Mussarat Ashraf, Rabia Hussain

Section of Pulmonary & Critical Care

Background

Leucocyte activating chemokines such as CCL2, CCL3, and CXCL8 together with proinflammatory IFNγ, TNFα and downmodulatory IL10 play a central role in the restriction of M. tuberculosis infections, but is unclear whether these markers are indicative of tuberculosis disease severity.

Methodology

We investigated live M. tuberculosis- and M. bovis BCG- induced peripheral blood mononuclear cell responses in patients with tuberculosis (TB) and healthy endemic controls (ECs, n = 36). TB patients comprised pulmonary (PTB, n = 34) and extrapulmonary groups, subdivided into those with less severe localized extrapulmonary TB (L-ETB, n = 16) or severe disseminated ETB (D-ETB, …

Wegener's Granulomatosis: A Diagnostic Challenge, Ali Bin Sarwar Zubairi, Hammad Bin Liaquat, Shahid Javed Husain, Kulsoom Fatima

Section of Pulmonary & Critical Care

Wegener's Granulomatosis (WG) is a necrotizing granulomatous vasculitis that primarily involves small vessels in the body. Patient usually presents in the fourth to fifth decade. The clinical presentation is variable; however, majority of patients (90%) seek medical attention for nasal and sinus symptoms with or without lower respiratory symptoms of cough, dyspnoea and haemoptysis. The typical form of WG tends to involve the triad of upper and lower respiratory tract and the kidneys; while involvement of other organs like ocular, cutaneous, rheumatological, neural, gastrointestinal and lower genito-urinary tract is occasionally seen. A "limited" form with clinical findings isolated to the …

Treatment Outcome Of Multi-Drug Resistant Tuberculosis In A Tertiary Care Hospital In Karachi, Nisar Ahmed Rao, Zeeshan Mahfooz, Muhammad Irfan

Section of Pulmonary & Critical Care

Objective: To assess the outcomes of pulmonary multidrug-resistant tuberculosis (MDR-TB) patients treated at Ojha Institute of Chest Diseases (OICD), a reference hospital for TB in Karachi, Pakistan. Methods: Clinical study for the period 1996-2006, with follow-up until June 2007 was performed. All the culture and sensitivity proven cases of MDR pulmonary TB were initially admitted for 3-6 months till the sputum converted negative. Treatment regimen was decided on individual basis, and included 4-6 drugs. Supervised treatment was given to all patients during the hospitalization. After discharge from the hospital, patients were followed at monthly interval at the outpatient department of …

Middle Aged Male With Pulmonary Tuberculosis And Refractory Hypercalcemia At A Tertiary Care Centre In South East Asia: A Case Report., Azra Rizwan, Najmul Islam

Department of Medicine

55-year male of Asian descent presented with weight loss, lethargy, drowsiness and low grade fever without cough. Examination revealed crackles in the chest but no focal neurological deficit. Chest X ray revealed an infiltrate consistent with tuberculosis. Biopsy of infiltrate was negative for malignancy. Corrected calcium level revealed parathyroid independent hypercalcemia. Further diagnostic work up for drowsiness and hypercalcemia was normal. Despite receiving hydration and pharmacotherapy for his hypercalcemia, his condition failed to improve. When steroids were started, the Patient's calcium levels and symptomatology resolved. Tuberculosis causing hypercalcemia is uncommon. Steroids are useful agents, particularly in refractory cases.

Community Acquired Pneumonia: Risk Factors Associated With Mortality In A Tertiary Care Hospitalized Patients, Muhammad Irfan, Syed Fayyaz Hussain, Khubaib Mapara, Shafia Memon, Mohammed Mogri, Muniza Bana, Amna Malik, Sara Khan, Nadia A Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To evaluate risk factors associated with mortality in patients hospitalized with CommunityAcquired Pneumonia (CAP) from a developing country.

METHODS: An observational study was conducted on adult patients admitted with a diagnosis of CAP from January 2002 to August 2003 at Aga Khan University hospital, Karachi, Pakistan. Clinical records were reviewed for demographic characteristics, clinical and laboratory features, hospital course, and risk factors associated with mortality.

RESULTS: A total of 329 patients (187 males) were admitted with CAP. Two-third of patients had underlying co-morbid medical illnesses. Complications developed in 15.7% cases and the overall mortality rate was 11%. Risk factors …

Assessment Of Asthma Control Using The Asthma Control Test At A Tertiary Care Centre In Karachi, Pakistan, Sana Shoukat, Saqib Ali Gowani, Ameer Ali Khowaja, Javaid Khan

Section of Pulmonary & Critical Care

The aim of our study was to assess asthma control among asthmatics at a tertiary care setting in Karachi using ACT questionnaire. The ACT questionnaire was filled by known asthmatics in January 2007. A total of 150 questionnaires were filled of which, 61 (40%) were males and 89 (60%) females. Mean ACT score was 17.71 +/- 4.41. Association between sex and asthma control was not statistically significant. Significant association was seen with asthma control and Ipratropium bromide inhaler. Asthma control among patients at a tertiary care centre is moderate. ACT can be used to follow patients in the hospital.

Primary Drug Resistance Against Mycobacterium Tuberculosis In Karachi, Nisar Ahmed Rao, Muhammad Irfan, Shahid Javed Hussain

Section of Pulmonary & Critical Care

OBJECTIVE: To evaluate the primary drug resistance of new culture positive cases of pulmonary tuberculosis in Karachi.

METHODS: All new suspected pulmonary tuberculosis patients were recruited initially. They were instructed to produce three-sputum samples for smear examination and on one of the specimen's culture was applied. Bronchoscopy and bronchial wash was done in patients who were not expectorating. Bronchial wash was then applied for both smear and culture for Mycobacterium tuberculosis.

RESULTS: Out of 79 cases recruited initially, 52 were able to produce sputum while bronchoscopy was performed in the remaining. AFB direct smear was positive in 32/52 sputum and …

Socio-Demographic Correlates Of Exhaled Breath Carbon Monoxide In Karachi's Adult Population, Majid Shafiq, Sumera Khan, M. Rizwanulhaq Khawaja, Suleman Haque, Javaid Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To examine the relationship between CO levels and putative factors including smoking status among residents of Karachi, an urban center with very high levels of air pollution.

METHODS: Two hundred and eighteen volunteering subjects were asked to maximally exhale into a Smokerlyzer breath CO analyzer. Each of the volunteers was also asked to reply to a questionnaire-based interview seeking demographic information as well as details of exposure to tobacco, traffic fumes and other air pollutants.

RESULTS: Out of the 218 participating subjects, 75% were males and 27% were current or ex-smokers. The mean CO level was 2.92 parts per …

Bleomycin Induced Pneumonitis: A Case Successfully Managed With High-Dose Steroids, Shahid Javed Husain, Ali Bin Sarwar Zubairi, Muhammad Irfan

Section of Pulmonary & Critical Care

No abstract provided.

Chest Radiographs In Acute Pulmonary Embolism, Ali Bin Sarwar Zubairi, Shahid Javed Husain, Muhammad Irfan, Kulsoom Fatima, Muhammad Atif Zubairi, Muhammad Islam

Section of Pulmonary & Critical Care

Background: Pulmonary embolism (PE) is a serious clinical entity carrying significant morbidity and mortality. Clinically, it is a difficult condition to diagnose and remains under treated condition in Pakistan due to non-availability of objective tests and lack of awareness among physicians.This study was conducted to determine the chest radiographic presentation in known cases of acute PE presenting to a tertiary care hospital.
Methods: Hospital records of patients with a diagnosis of acute PE were reviewed from June 2000 until June 2004. Fifty diagnosed cases of acute PE on Spiral Computed tomography (CT) of the chest demonstrating an intraluminal-filling defect were …

Knowledge, Attitude And Misconceptions Regarding Tuberculosis In Pakistani Patients, Javaid Ahmed Khan, Muhammad Irfan, Amna Zaki, Madiha Beg, Syed Fayyaz Hussain, Nadeem Rizvi

Section of Pulmonary & Critical Care

Objective:

To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB.

Methods:

A cross sectional study was conducted at Out-patient clinics of two teaching hospitals (private and public) in Karachi, Pakistan. A questionnaire was filled for the purpose.

Results:

A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease. Contaminated food was considered the …

Uterine Perivascular Epithelioid Cell Tumour Presenting As A Cervical Mass, Najamul Sahar Azad, Shahid Pervez, Naila Kayani, Aliya Begum Aziz

Department of Pathology and Laboratory Medicine

Perivascular Epithelioid Cell Tumour (PEComa) also known as myelomelanocytic tumours are uncommon, recently described mesenchymal tumours that include angiomyolipoma, clear cell "sugar" tumour of the lung, lymphangioleiomyoma and tumours composed predominantly of epithelioid cell morphology. A predilection for uterus has been described. However up till now only 14 cases of uterine PEComas have been described. All of these were seen in adult females in the peri and post menopausal age group (from 40-75years), and almost all were located in the region of body of uterus. A single case in the upper cervical region has been reported with uterine PEComatoses. We …

Rapidly Developing Optic Neuritis Secondary To Ethambutol: Possible Mechanism Of Injury, Sajjad Ali, Uzma Usman, Mohammad Wasay

Department of Medicine

Optic neuritis has been described among the toxic effects of Ethambutol. This side effect is dose related. The mean duration of Ethambutol induced optic neuritis (EON) is three months. We report a case of EON after few days of exposure to Ethambutol and the symptoms resolved after discontinuation of Ethambutol. This most likely represents an idiosyncratic reaction which is different as compared to dose related optic neuritis.

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

Department of Radiology

No abstract provided.

Outbreak Of Sars, Ambreen Shakil, Muhammad Imran Omar, Saba Sohail

Department of Radiology

No abstract provided.

Pulmonary Langerhans Cell Histiocytosis, Muhammad Irfan, Javed Hussain, Riaz Lakdawala, Fayyaz Hussain, Javaid Khan

Section of Pulmonary & Critical Care

No abstract provided.

Association Of Iron Deficiency Anaemia In Children Of 1-2 Years Of Age With Low Birth Weight, Recurrent Diarrhoea Or Recurrent Respiratory Tract Infection - A Myth Or Fact?, Niloufer Sultan Ali, Rukhsana Wamiq Zuberi

Department for Educational Development

No abstract provided.

Respiratory Arrest In A Child After Flushing Of Pancuronium From The Dead Space Of Intravenous Cannula, Robyna Irshad Khan, Fazal Hameed Khan, Hamid Iqil Naqvi

Department of Anaesthesia

It is common practice for patients admitted to Intensive Care Units to have indwelling intravenous cannulae. Sometimes these cannulae are used only for the administration of drugs and are closed otherwise. Residual drugs in the deadspace of these intravenous cannulae as well as connected stoppers or 3-way stopcocks can later be flushed unknowingly. We would like to report a case in which inadvertent flushing of residual pancuronium caused complete muscle paralysis and respiratory arrest in a young child.

Churg-Strauss Syndrome With Intestinal Perforation, Javaid A. Khan, Imran Hassan, Shahid Pervez, Wasim Jafri, Shaista Khan

Department of Pathology and Laboratory Medicine

No abstract provided.