Medical Specialties Commons^™

Lefort 1 Access For Juvenile Nasopharyngeal Angiofibroma Treated Without Angiographic Embolization., Shaheen Ahmed, Muhammad Imran, Atiq Ahmed Khan, Anwar Ali, Syed Ijlal Ahmed, Asim Rehmani, Muhammad Faaiq Ali

Pakistan Journal of Neurological Sciences (PJNS)

To assess and analyze the clinical presentation of Juvenile nasopharyngeal angiofibroma and analyze the complications associated with JNA resection without pre surgical embolization using LeFort 1.

Cost And Quality Issues In Establishing Hematopoietic Cell Transplant Program In Developing Countries, Shahrukh K. Hashmi, Alok Srivastava, Walid Rasheed, Salman Adil, Tong Wu, Madan Jagasia, Amr Nassar, William Y. K. Hwang, Amir Ali Hamidieh, Hildegard T. Greinix

Section of Haematology/Oncology

The hematopoietic cell transplant (HCT) activity has grown significantly over the past two decades in both developing and developed countries. Many challenges arise in establishing new HCT programs in developing countries, due to scarcity of resources and manpower in expertise in HCT. While cost issues can potentially hinder establishment of new HCT programs in certain regions, the focus on quality and value should be included in the general vision of leadership before establishing an HCT program. The main challenge in most developing countries is the lack of trained/qualified personnel, enormous start-up costs for a tertiary care center, and quality maintenance. …

Graft And Mesh Use In Vaginal Surgery, Raheela Mohsin Rizvi, Novera G. Chughtai

Department of Obstetrics & Gynaecology

Pelvic organ prolapse and urinary incontinence are among the most common chronic disorders in women. These are common problems whose pathogenesis remains unclear. As life expectancy increases, significantly greater number of women now present with pelvic organ prolapse and urinary incontinence requiring surgical intervention. Currently, the lifetime risk of undergoing prolapse or continence surgery is one in 11, and up to 30% of patients will require repeat reconstructive surgery and repeat surgery for incontinence in 10%. In an attempt to improve surgical outcomes and to preserve vaginal capacity and coital function, a number of synthetic and biological prostheses have been …

Pharygeal Cervicobrachial Variant Of Guillian -Barre Syndrome, Hazim Brohi, Marium Mustaqeem, Sundus Khan

Pakistan Journal of Neurological Sciences (PJNS)

Guilain-Barre Syndrome (GBS) is a common cause of Neuro-muscular paralysis with a spectrum of clinical and electrophysiology variants. We present a case of thePharyneo-cervico-brachial type. A 25 yr old male came to the Medical OPD with the complains of one day history of upper limb weakness and decreased flexion of the neck , which was progressively worsening, along-with associated shortness of breath. His systemic inquiry and past medical/surgical histories were insignificant. Physical exam correlated withthe diagnostic criteria of PCB variant of GBS. Diagnosis was confirmed on EMG/NCS,which showed axonal neuropathy involving axillay and musculocutaneousnerve, along with absent F –waves latencies …

New Oral Anticoagulants (Noacs) For Cerebral Venous Thrombosis, Maria Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral venous thrombosis (CVT) is a relatively rare condition that results from thrombosis of the superficial or deep venous sinuses of the brain. The first ever reported case of the condition was back in 1825 and this was diagnosed at autopsy. It took more than 150 years before imaging modalities were developed that could diagnose cases earlier. With the advent of CT and MR venogram, the diagnosis has become much easier and is contributing to a larger number of cases being picked up. Despite that the incidence in Western literature stays low at 1.3-1.6 cases per 100,000 people. Middle Eastern …

Early Electrophysiological Findings In Guillain Barre Syndrome, Hazim Brohi, Rajesh Kumar, Sadia Mubarak, Muhammmad Anees Mumtaz

Pakistan Journal of Neurological Sciences (PJNS)

Early electrophysiological testing is more important as early abnormalities can be obtained even in the first week. However the electrical abnormalities may not be that prominently evident for definitive diagnosis in the first 2 weeks. However at times the decision of treatment has to be taken early. Research is required to look at different electrophysiological parameter which could give clue for an earlier diagnosis. The aim of our study is to determine early electrophysiological parameters with in first week to identify GBS at earliest.

Burden And Pattern Of Neurological Diseases Seen In Neurology Department Of A Tertiary Care Hospital In Baluchistan, Wazir Akbar, Noor Ahmed Khosa, Abdul Bari Nasar

Pakistan Journal of Neurological Sciences (PJNS)

Neurologic disorders represent a major burden of disease globally. These are common and represent a major public health problem. The spectrum of diseases ranges from non communicable disorders like stroke and neurodegenerative disorders to central nervous system infections. The burden of neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of neurological diseases and the impediments to their management.The pattern of neurological admissions in hospital varies amongst different regions of the world and this depends on many factors including the regional burden of neurological disorders.

Dementia Survey Among Attendees Of A Dementia Awareness Event In Karachi, Pakistan, Qurat Ul Ain Khan, Yusra Hanif Khan, Mohammad Zaman Khan, Shireen Najam

Pakistan Journal of Neurological Sciences (PJNS)

There is little information available about peoples'knowledgeregarding symptoms of dementia, dementia diagnosis, and care arrangementsfor dementia patients in Pakistan. Aims: We aimed to find out if patients with dementia and their caregivers were aware of diagnosis, the most common and most distressing symptoms, and care arrangement for these patients.

The Role Of Mucin-Educated Platelet Activation In Tumor Invasiveness: An Unfolding Concern In The Realm Of Cancer Biology, Akbar Shoukat Ali, Arzoo Ajaz

Department of Obstetrics & Gynaecology

Metastasis is a complex and well-coordinated phenotypic transformation of cancer cells governed by aberrant genetic and molecular pathways. It has been approved as the most consistent cause of cancer death. With emerging insight into the genomics, transcriptomics and proteomics, progress has been made and reasonably large number of molecular pathways of metastasis has been forwarded, but our understanding of precise underlying molecular mechanisms remains largely scarce. It has been well-known for around a decade and more that platelets are intriguingly contributing to the cancer metastasis. However, it is only recently that cancer cells can activate platelets have started to become …

High-Volume Forced Diuresis With Matched Hydration Using The Renalguard System To Prevent Contrast-Induced Nephropathy: A Meta-Analysis Of Randomized Trials, Rahman Shah, Sarah J. Wood, Sajjad A. Khan, Amina Chaudhry, M. Rehan Khan, Mohamed S. Morsy

Section of Internal Medicine

Background: Contrast-induced nephropathy (CIN) is a well-recognized complication of coronary angiography that is associated with poor outcomes. Several small randomized controlled trials (RCTs) have recently shown that in patients with chronic kidney disease (CKD), furosemide-induced forced diuresis with matched hydration using the RenalGuard system can prevent its occurrence. However, individual studies have been underpowered and thus cannot show significant differences in major clinical endpoints.
Hypothesis: Forced diuresis with matched hydration using the RenalGuard system improves clinical outcomes in patients undergoing coronary angiography.
Methods: Scientific databases and websites were searched for relevant RCTs. The pooled risk ratios were calculated using random-effects …

Remaining Dentine Thickness Of Root Canals Prepared With K-3 And Protaper Rotary Systems, Sana Ehsen Nagi, Farhan Raza Khan, Munawar Rahman

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the remaining dentine thickness of root canals prepared with K-3 and ProTaper files..Methods: This in-vitro experimental study was conducted from 1st April-30th September 2015 at the dental clinics of Aga Khan University Hospital, Karachi, and comprised human teeth. Extracted human premolars and molars were included in the study using non-probability consecutive sampling. Canals were randomly allocated into two groups i.e. K-3 and ProTaper. Changes in inner and outer walls of canals were measured using Vixwin software at 1mm, 4mm, 7mm and 10mm from the apex. SPSS 20 was used for data analysis.Results: Of the 214 canals, 107(50%) …

Anaesthetic Management Of Supratentorial Tumor Craniotomy Using Awake-Throughout Approach, Faraz Shafiq, Fahad Salim, Ather Enam, Jai Parkash, Mohammad Faheem

Department of Anaesthesia

The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length …

A Suggested Plan For Specialist Doctor's Professional Growth And Development, Ahmed Nadeem Abbasi, Bilal Mazhar Qureshi

Department of Radiation Oncology

No abstract provided.

High Burden Of Subclinical Lead Toxicity After Phase Out Of Lead From Petroleum In Pakistan, Hafsa Majid, Aysha Habib Khan, Nadeem Ullah Khan, Imran Siddiqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

Objective: To evaluate the frequency of subclinical lead toxicity.
Study design: Cross-sectional study.
Place and duration of study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014.
Methodology: Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity.
Results: Amongst …

High Burden Of Subclinical Lead Toxicity After Phase Out Of Lead From Petroleum In Pakistan, Hafsa Majid, Aysha Habib Khan, Nadeem Ullah Khan, Imran Siddiqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

Objective: To evaluate the frequency of subclinical lead toxicity.
Study design: Cross-sectional study.
Place and duration of study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014.
Methodology: Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity.
Result: Amongst …

Cxc Chemokines Exhibit Bactericidal Activity Against Multidrug-Resistant Gram-Negative Pathogens, Erum Khan, Matthew A. Crawford, Debra J. Fisher, Lisa M. Leung, Sara Lomonaco, Christine Lascols, Antonio Cannatelli,, Gian Maria Rossolini, Yohei Doi, David R. Goodlett

Department of Pathology and Laboratory Medicine

The continued rise and spread of antimicrobial resistance among bacterial pathogens pose a serious challenge to global health. Countering antimicrobial-resistant pathogens requires a multifaceted effort that includes the discovery of novel therapeutic approaches. Here, we establish the capacity of the human CXC chemokines CXCL9 and CXCL10 to kill multidrug-resistant Gram-negative bacteria, including New Delhi metallo-beta-lactamase-1-producing Klebsiella pneumoniae and colistin-resistant members of the family Enterobacteriaceae that harbor the mobile colistin resistance protein MCR-1 and thus possess phosphoethanolamine-modified lipid A. Colistin-resistant K. pneumoniae isolates affected by genetic mutation of the PmrA/PmrB two-component system, a chromosomally encoded regulator of lipopolysaccharide modification, and containing …

Negative Predictive Value Of Ultrasound In Predicting Tumor-Free Margins In Specimen Sonography, Saira Naz, Saima Hafeez,, Zainab Hussain, Kiran Hilal

Department of Radiology

OBJECTIVE: To evaluate the success of ultrasound in post-excision specimen visualization, and negative predictive value of ultrasound for estimation of tumor-free margins using histopathology as the gold standard.

STUDY DESIGN: Cross-sectional analytical study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, Pakistan, from May 2010 till January 2013.

METHODOLOGY:

Sonography of all breast nodules was done before and after exicision by two female radiologists with at least five years clinical experience. All surgeries were performed by the same referring breast surgeons. All nodules were non-palpable and had histopathology as well as specimen sonography performed at AKUH. …

Primary Headache Disorders In The Adult General Population Of Pakistan – A Cross Sectional Nationwide Prevalence Survey, Herekar Aa, Ahmad A, Uqaili Ul, Ahmed B, Effendi J, Alvi Sz, Shahab Ma, Javed U, Herekar Ad, Khanani R, Steiner Tj

Section of Neurology

Back Ground: The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include almost all of Eastern Mediterranean Region (EMR). We report a nationwide population-based study in Pakistan, an EMR country with the sixth largest population in the world, conducted as a project within the Global Campaign against Headache.

Methods: We surveyed six locations from the four provinces of Pakistan: Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and visited rural and urban households in each. One adult member (18-65 years) of each household, also randomly selected, was interviewed by a trained non-medical interviewer …

Dealing A Neonate With Charge Syndrome: Anaesthesia Perspective Of Perioperative Care, Khalid M Siddiqui, Muhammad Ali Asghar, Amjad Nadeem

Department of Anaesthesia

CHARGE syndrome is a condition that can disturb numerous areas of human body. As an abbreviation CHARGE stands for: coloboma, heart defects, atresia choanae, and retardation of growth, genital, and ear abnormalities. The configuration of malformations differs among individuals with this disorder, and the various health issues can be life-threatening during infancy and childhood. Affected individuals typically have several main features or a combination of major and minor appearances. Here we are presenting a case report of a neonate with CHARGE syndrome who underwent successful repair of choanal atresia under general anaesthesia with invasive monitoring.

Anaesthetic Management Of Nesidioblastosis In Two Infants, Muhammad Saad Yousuf, Mohsin Nazir, Fauzia Khan

Department of Anaesthesia

Nesidioblastosis is the most common cause of non-transient, recurrent and persistent hypoglycaemia in neonates and infants. It is a disorder of diffuse proliferation of beta cells of the pancreas leading to hyperinsulinemia and hypoglycaemia. The main aim is to prevent the severe episodes of hypoglycaemia which can cause damage to the brain and/or mental retardation. In this case report we present two cases of nesidioblastosis and their perioperative anaesthetic course for near-total pancreatectomy. First case was a 7 months old female who had repeated episodes of convulsions since birth. Second case was a 4-month-old female child who again presented with …

Understanding Biological Mechanisms Underlying Adverse Birth Outcomes In Developing Countries: Protocol For A Prospective Cohort (Amanhi Bio-Banking) Study, Abdullah H. Baqui, Rasheda Khanam, Fyezah Jehan, Muhammad Imran Nisar, Atiya Hussain, Muhammad Ilyas, Aneeta Hotwani, Muhammad Sajid, Shahida Qureshi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Objectives: The AMANHI study aims to seek for biomarkers as predictors of important pregnancy-related outcomes, and establish a biobank in developing countries for future research as new methods and technologies become available.
Methods: AMANHI is using harmonised protocols to enrol 3000 women in early pregnancies (8-19 weeks of gestation) for population-based follow-up in pregnancy up to 42 days postpartum in Bangladesh, Pakistan and Tanzania, with collection taking place between August 2014 and June 2016. Urine pregnancy tests will be used to confirm reported or suspected pregnancies for screening ultrasound by trained sonographers to accurately date the pregnancy. Trained study field …

Societal Costs Of Micronutrient Deficiencies In 6- To 59-Month-Old Children In Pakistan, Simon Wieser, Beatrice Brunner, Christina Tzogiou, Rafael Plessow, Michael B. Zimmermann, Jessica Farebrother, Sajid Bashir Soofi, Zaid Ahmad Bhatti, Imran Ahmed, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: In Pakistan, nearly half of children younger than 5 years are stunted, and 1 in 3 is underweight. Micronutrient deficiencies, a less visible form of undernutrition, are also endemic. They may lead to increased morbidity and mortality as well as to impaired cognitive and physical development.
Objective: To estimate the lifetime costs of micronutrient deficiencies in Pakistani children aged between 6 and 59 months.
Methods: We develop a health economic model of the lifetime health and cost consequences of iodine, iron, vitamin A, and zinc deficiencies. We assess medical costs, production losses in terms of future incomes lost, and …

Spectrum Of Celiac Disease In Paediatric Population: Experience Of Tertiary Care Center From Pakistan, Danish Abdul Aziz, Misha Kahlid, Fozia Memon, Kamran Sadiq

Department of Paediatrics and Child Health

Objective: To determine clinical features and relevant laboratory investigations of patient with celiac disease (CD) and comparing classical celiac disease (CCD) with Non-diarrheal celiac disease (NDCD).
Methods: This is a five years retrospective study conducted at The Aga Khan University Hospital Karachi, Pakistan from January 2010 to December 2015, enrolling children from one year to 15 years of either gender diagnosed as celiac disease in accordance with revised ESPGHAN criteria. Biopsy samples with grade 2 or more on Modified Marsh Classification were considered as consistent with celiac disease. Celiac patients were categorized into Classical celiac disease (with Chronic Diarrhea) and …

Psoas Abscess Masquerading As A Prosthetic Hip Infection: A Case Report, Muhammad Atif, Azeem Tariq Malik, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Psoas abscess is an unusual condition and is defined as a collection of pus in the iliopsoas compartment. Due to the unique anatomy of psoas muscle it forms a conduit for spread of infection from upper part of body to hip joint in neglected cases.
Case Presentation: A 67year old lady presented with left groin pain for three weeks. She underwent an uncemented unipolar hemiarthoplasty eight years back. Currently, she developed fever and was unable to do any active left hip range of motion. Passive motion of the left hip was restricted to 30° flexion, no internal rotation, 5° …

Recurrent Renal Cancer In Birt-Hogg-Dube Syndrome: A Case Report, Hammad Ather, Nida Zahid

Department of Surgery Docs

Introduction: Birt-Hogg-Dube syndrome (BHDS) is a rare autosomal dominant disease. It is caused by constitutional mutations in the FLCN gene. Since BHDS is a rare syndrome therefore it is unknown to many physicians. However, it is important to identify this rare syndrome at early stages because incidence of renal cancer in BHD patients is very high and its detection at early stages can prevent its metastasis. Hence, we want to present a case of BHDS and draw the attention of the treating physician to this rare inherited disorder and discuss its appropriate diagnosis and management.CASE PRESENTATION: We present a case …

A Qualitative Exploration Of Perceptions And Experiences Of Contraceptive Use, Abortion And Post-Abortion Family Planning Services (Pafp) In Three Provinces In China, Yan Che, Esther Dusabe-Richards, Shangchun Wu, Yi Jiang, Xiaojing Dong, Jian Li, Wei-Hong Zhang, Marleen Temmerman, Rachel Tolhurst, Inpac Group

Obstetrics and Gynaecology, East Africa

Background: The INPAC project aims to evaluate the effectiveness of integrated post-abortion family planning (PAFP) services into existing hospital based abortion services in China. A qualitative study was conducted in three provinces to contribute to developing effective PAFP services through understanding influences on contraceptive use, experiences of abortion and existing PAFP, and their effect on future contraceptive practices from the perspective of users, in the context of social and institutional change.

Methods: Twenty-nine in-depth interviews (IDIs) were undertaken with women who had experienced abortion between 1 and 6 months prior to interview, recruited from three urban and two rural facilities …

Intrahepatic Biliary Cystadenoma Mimicking Hydatid Cyst Of Liver: A Clinicopathologic Study Of Six Cases, Zubair Ahmad, Nasir Uddin, Wasim Memon, Jamshid Abdul Ghafar, Arsalan Ahmed

Department of Pathology and Laboratory Medicine

Background: Intrahepatic biliary cystadenomas are rare hepatic neoplasms, which are usually cystic. These tumors are often misdiagnosed as simple liver cysts and hydatid cysts clinically and radiologically owing to nonspecific clinical and radiologic features. These tumors require complete resection, as recurrence and malignant transformation can occur following incomplete excision. It is essential that these tumors be diagnosed accurately so that they can be adequately excised.
Methods: Clinical and radiological features of six cases of biliary cystadenoma are described.
Results: All of these cases were resected with the clinical and/or radiological impression of simple liver cysts and/ or hydatid cysts. Out …

Ventricular Depolarisation Vectors In Exercise Induced Myocardial Ischaemia, Cameruddin W. Vellani, Mohammad Yusuf, Sadia Mahmud, Satwat Hashmi

Section of Cardiology

Ischaemia reduces membrane excitability and conduction of myocardial depolarisation. This would alter the synergy of electromotive forces that contribute to a resultant force at any instant. Changes in magnitude and direction of resultant forces are reflected in electrocardiographic signals. Here we show a method for obtaining the coordinates of resultant electrical forces during exercise derived from a bipolar orthogonal lead system for calculation of electrical vectors in three planes. In a trial, analysis of changes in vectors indicated that the extent of reduction in magnitude with exercise was significantly greater in groups of patients categorized by impaired effort tolerance and …

Water, Sanitation And Hygiene Interventions For Acute Childhood Diarrhea: A Systematic Review To Provide Estimates For The Lives Saved Tool, Nazia Darvesh, Jai K. Das, Tyler Vaivada, Michelle F. Gaffey, Kumanan Rasanathan, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: In the Sustainable Development Goals (SDGs) era, there is growing recognition of the responsibilities of non-health sectors in improving the health of children. Interventions to improve access to clean water, sanitation facilities, and hygiene behaviours (WASH) represent key opportunities to improve child health and well-being by preventing the spread of infectious diseases and improving nutritional status.
Methods: We conducted a systematic review of studies evaluating the effects of WASH interventions on childhood diarrhea in children 0–5 years old. Searches were run up to September 2016. We screened the titles and abstracts of retrieved articles, followed by screening of the …

Modelling Stunting In List: The Effect Of Applying Smoothing To Linear Growth Data, Simon Cousens, Jamie Perin, Parul Christian, Lee Shu-Fune Wu, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta, Claudio Lanata, Richard L. Guerrant, Aldo A. M. Lima, Kåre Mølbak

Department of Paediatrics and Child Health

Background: The Lives Saved Tool (LiST) is a widely used resource for evidence-based decision-making regarding health program scale-up in low- and middle-income countries. LiST estimates the impact of specified changes in intervention coverage on mortality and stunting among children under 5 years of age. We aimed to improve the estimates of the parameters in LiST that determine the rate at which the effects of interventions to prevent stunting attenuate as children get older.
Methods: We identified datasets with serial measurements of children's lengths or heights and used random effects models and restricted cubic splines to model the growth trajectories of …