Medical Specialties Commons^™

Gullain Barré Syndrome: Complications, Commonly Acquired Nosocomial Infections And Antibiotic Susceptibilities At Pakistan Institute Of Medical Sciences, Islamabad, Ali Zohair Nomani, Uzma Jamil, Mansoor Iqbal, Sumaira Nabi, Haris Majid Rajput, Misbah Ahmed, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Introduction: The cause of demise in GBS may be related to the sequelae of complications associated with the disease or its treatment. The primary objective of this study was to enumerate the prevalence of complications associated with treatment of patients with GBS at a tertiary care setup in Islamabad. The secondary objective was to determine the antibiotic susceptibility patterns of commonly encountered infections in GBS during hospital stay in our setup. Materials and methods: The study was carried out between Jan 2014 and June 2015 on one hundred patients of GBS aged ≥ 12 years. Baseline characteristics, complications and antibiotic …

Frequency Of Non-Motor Symptoms In Parkinson Disease: Experience From Pakistan, Saira Saad, Ali Zohair Nomani, Mazhar Badshah, Aamir Afzal

Pakistan Journal of Neurological Sciences (PJNS)

The objective of this study was to determine the frequency of non-motor symptoms (NMS) in patients with Parkinson's disease (PD) and to compare frequency in mild and severe disease. Materials and methods: This descriptive observational study was done from January 2015 to June 2015 at Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad. We used Non-Motor Symptom Questionnaire (NMS-Q); a validated scale using 30 questions related to 9 different domains of symptoms. Results: 62 patients were enrolled in the final data set of study (male 46, Female 16) with average age of 62.4 years (range=33-80). Non-motor symptoms were reported …

Assessing Decision Of Inpatient Or Outpatient Care In Community Acquired Pneumonia: Apt Care Study, Saleem Ullah, Javaid Khan, Amanullah Khan, Irfan Hashemy

Section of Pulmonary & Critical Care

Objective: To estimate the proportion of community-acquired pneumonia patients with disagreement between Confusion, Uraemia, Respiratory rate, Blood pressure, age > 65 years recommendation and physician\\\'s decision to hospitalise or not.
Methods: This cross-sectional nation-wide, non-interventional, cross-sectional study was carried out across 10 cities of Pakistan from December 2011 to May 2012, and recruited consenting adult patients with confirmatory diagnosis of community-acquired pneumonia on chest X-ray. Confusion, Uraemia, Respiratory rate, Blood pressure, age > 65 years recommendation for each patient was determined at the time of analysis. This recommendation was compared with treatment decision made by the physician. Disagreement was considered when the …

Establishment Of Site Specific Multi-Disciplinary Tumour Boards In Pakistan: Sharing Experience Of Neuro Oncology Team Based At A Tertiary Care University Hospital, Muhammad Waqas, Ahmed Nadeem Abbasi

Section of Neurosurgery

No abstract provided.

Uchunguzi (Journal Watch/ Montre De Journal) March 2017, Benjamin Wachira

Emergency Medicine, East Africa

Without the need for expensive videoconferencing equipment or computer networks, doctors in the developing world have found practical use for WhatsApp Messenger in clinical and administrative settings because the service is ubiquitous, free and easy to use. This study reviewed the literature on WhatsApp in clinical practice, to determine how it was used, and users’ satisfaction. It revealed that the service was widely used in intradepartmental communication across a range of aspects, including second opinion, changes in treatment plans, sharing of X-rays and photographs, scheduling of academic meetings, and sharing of educational materials such as papers. There was a report …

Diastolic Dysfunction In Coronary Artery Disease, Sarwat Hashmi, H R. Ahmad, Hasanat Sharif, Syedah Saira Bokhari

Department of Biological & Biomedical Sciences

No abstract provided.

Recent Advances In Epilepsy, Mughis Sheerani

Pakistan Journal of Neurological Sciences (PJNS)

Listening to Dr Sarosh Irani in a recent Epilepsy conference about Fascio Brachial dystonic seizures associated with voltage gated potassium channel (VGKC complex/LG1 antibodies)(1) and then reading reports published in Neurology about continued recent use of trephination ‘expelling the demons’ in India(2), I was wondering how far we are in Southeast Asia in the understanding and treatment of this fascinating illness.

Labrad : Vol 43, Issue 1 - March 2017, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Chikungunya
• Rapid Molecular Diagnosis of Chlamydia Trachomatis (CT) and Neisseria Gonorrhoeae (NG) Urethritis
• Overview of Rubella Testing
• Most Common Bone and Soft Tissue Infections Seen in our Practice
• Diagnosis of Helicobacter Pylori Infection in Developing Countries- Pros & Cons
• Screening for Neonatal Infections with TORCH Profile
• Blood and Bone Marrow Changes in Viral Infections
• Malaria
• World Rare Disease Day
• Radiology Pathology Correlation

Endothelin Signaling In Bone, Jasmin Kristianto, Michael Johnson, Rafia Afzal, Robert D. Blank

Department of Anaesthesia

The endothelin (ET) system includes 3 small peptide hormones and a pair of G-protein-coupled receptors. This review first outlines the ET signaling pathway and ET metabolism. Next, it summarizes the role of ET1 signaling in craniofacial development. Then, it discusses observations relating ET signaling to osteoblastic and other osteosclerotic processes in cancer. Finally, it describes recent work in our laboratory that points to endothelin signaling as an upstream mediator of WNT signaling, promoting bone matrix synthesis and mineralization. It concludes with a statement of some remaining gaps in knowledge and proposals for future research.

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety At A Tertiary Hospital In Kenya: A Cohort Study, Anthony Kamau, Vitalis Mung’Ayi, Gerald Yonga

Anaesthesiology, East Africa

Background: Preoperative anxiety is a common perioperative complication seen in approximately 11-80% of adults undergoing surgery. One of the goals of the preanaesthesia clinic is to allay anxiety. A preanaesthesia clinic evaluation has been shown to reduce anxiety however current studies on anxiety and the preanaesthesia clinic have not quantified this reduction.

Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward.

Methods: Fifty one adult patients with 28 patients in anaesthesia clinic (AC) group and 23 in the ward (W) group were sequentially recruited from both the surgical, gynaecology and …

X-Linked Agammaglobulinemia - First Case With Bruton Tyrosine Kinase Mutation From Pakistan, Samreen Kulsom Zaidi, Sonia Qureshi, Farah Naz Qamar

Department of Paediatrics and Child Health

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency with more than 600 mutations in Bruton tyrosine kinase (Bkt) gene which are responsible for early-onset agammaglobulinemia and repeated infections. Herein we present a case of a 3-year-old boy with history of repeated diarrhoea and an episode of meningoencephalitis with hemiplegia. The workup showed extremely low levels of immunoglobulin with low CD+19 cells. Genetic analysis showed Btk mutation 18 c.1883delCp.T628fs. To the best of our knowledge this is the first report of a case of XLA confirmed by molecular technique from Pakistan.

Frequency Of Color Blindness In Pre-Employment Screening In A Tertiary Health Care Center In Pakistan, Shaukat Ali Chhipa, Farzeen K. Hash, Shehreen Ali, Mustafa Kama, Khabir Ahmed

Department of Surgery Docs

Abstract

OBJECTIVE:

To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital.

METHODS:

The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis.

RESULTS:

Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 (53.44%) were males and 1600 (46.65%) females. The mean age was 29.01 (±6.53) years. A total of 0.9% …

Twin Chorionicity And Prospective Stillbirth Risk: Experience At A Tertiary Care Hospital, Shazia Masheer, Zaheena Islam, Dhanwanti Dileep, Shama Munim

Department of Obstetrics & Gynaecology

Objective: To determine the prospective risk of stillbirth, perinatal death and neonatal morbidities in twins.

Methods: This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised cases of twin pregnancies from January 2001 to December 2012. . Cases of both monochorionic diamniotic and dichorionic diamniotic twin pregnancies were included. SPSS 19 was used for data analysis.

Results: Of the 394 cases, 84(21.3%) were monochorionic diamniotic twins and 310(78.7%) were dichorionic diamniotic twins. There were no cases of stillbirth beyond 30 and 34 weeks in monochorionic and dichorionic twins, respectively. Neonatal mortality stood reduced beyond 36 …

Motivating And Demotivating Factors For Community Health Workers Engaged In Maternal, Newborn And Child Health Programs In Low And Middle-Income Countries: A Systematic Review., Leah Shipton, Aysha Zahidie, F. Rabbani

Community Health Sciences

This systematic review aimed to synthesize primary research on motivating factors of community health workers (CHWs) for maternal, neonatal, and child health (MNCH) in low and middle-income countries (LMICs). Peer-reviewed literatures were systematically searched in five databases. Identified studies were then screened and selected for inclusion. The eligibility criteria were reported primary qualitative, quantitative, or mixed methods research, with participants being CHWs in LMICs who address MNCH, which investigated motivation or related concepts of retention, attrition, and performance. A thematic synthesis process was used to analyze findings of motivating factors, reported by included studies. Seventeen qualitative, quantitative, or mixed methods …

A Case Of Hashimoto’S Encephalopathy In A Patient With Lithium Toxicity, Saba Zaidi, Bashir A. Soomro, Dr Imran Chaudary, Fasiha Sohail

Pakistan Journal of Neurological Sciences (PJNS)

Hashimoto’s encephalopathy is a rare neurological disorder of unknown etiology. We presented, a case of middle aged male with bipolar disorder on Lithium carbonate for 30 years, admitted with altered behavior for 2 weeks and high Lithium levels. He was admitted with the suspicion of Lithium toxicity. EEG showed generalized epileptiform discharges. MRI brain revealed frontal cortical atrophy. CSF detailed report was normal. Further workup showed a high TSH level and positive anti-TPO (anti thyroid peroxidase) antibodies. Based on clinical picture, raised antibodies and no discernible cause, diagnosis of probable Hashimoto’s encephalopathy was made. He received pulse of methylprednisolone for …

Role Of Neuroradiology In Predicting Outome In Spontaneous Intracerebral Hemorrhage, Sumaira Nabi, Mazhar Badshah, Shahzad Ahmed, Ali Zohair Nomani

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous intracerebral hemorrhage (ICH) accounts for 8-13% of all strokes and is associated with a high mortality and morbidity. Western studies have identified various clinical and radiological factors which help in predicting outcome in patients with spontaneous ICH. Materials and methods: A consecutive series of 100 patients diagnosed with spontaneous ICH admitted to the neurology department were enrolled from 1stJanuary to 30th June, 2014.Radiological parameters on CT brain (plain) were recorded. In-hospital outcome was measured at the end of 7 days of hospital stay in terms of survival or mortality. Different radiological parameters and their effect on outcome were compared …

Frequency Of Miller Fisher Variant Of Guillain Barré Syndrome At A Tertiary Care Hospital, Karachi, Kiran Waqar, Sadaf Nasir, Khalid Sher, Meraj Fatima, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Miller fisher syndrome is generally considered a rare but important variant of Guillain Barré Syndrome (GBS) having geographically variable incidence. Patients with this clinical syndrome are often misdiagnosed and mismanaged due to lack of awareness on the part of physician. Objective: To determine frequency of Miller fisher syndrome (MFS), variant of GBS in patients presenting to a tertiary care hospital in Karachi. Methods: This descriptive cross sectional study was conducted in the Department of Neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. The duration was from April, 2014 to April, 2016 (two years). A total of 100 patients were included in …

Transcranial Direct Current Stimulation And Stroke Recovery: Opportunities And Challenges, Murtaza G, Hussain F, Iqbal M, Shahid Bashir

Pakistan Journal of Neurological Sciences (PJNS)

Transcranial direct current stimulation (tDCS) is one type of neuromodulation, which is an emerging technology that holds promise for the future studies on therapeutic and diagnosis applications in treatment of neurological and psychiatric diseases. However, there is a serious question among developing countries with limited financial and human resources, about the potential returns of an investment in this field and regarding the best time to transfer this technology from controlled experimental settings to health systems in the public and private sectors. This article reviews the tDCS as tools of neuromodulation for stroke and discusses the opportunities and challenges available for …

Spectrum Of Gullian Barre Syndrome In Children, Dr. Shaila Ali, Dr. M. Zia Ur Rehman, Dr. Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

GBS is a post-infectious poly-neuropathy involving mainly motor but sometimes also sensory and autonomic nerves. This is an epidemiological report on seasonal & monthly distribution of GBS & differences in GBS incidence between male & female in Punjab, Pakistan. Objective: To determine the seasonal variation, age and gender differentiation in children with GBS along with EMG/NCS findings. Study Design: Retrospective, observational,cross sectional study. Place and duration of study: Department of Neurology, Childrens Hospital & The Institute of Child Health, Lahore from January 2014 to December 2014. METHODS: We extracted data from multi centers retrospectively in a 1 year period (January …

A Giant Right Subclavian- Axillary Artery Aneurysm Presenting As Brachial Plexopathy, Mahnoor Hafeez,, Ateeque Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension, who was referred to the Surgical Department of Civil Hospital Karachi in September 2016 with rapidly progressive mass at right shoulder region and acute onset of ipsilateral limb sensory and motor deficit for last 3 weeks. The nerve conduction studies (NCS) revealed right brachial plexopathy. Computed Tomography demonstrated an 8.2x8.7cm (width x length) fusiform giant aneurysm of right subclavian-axillary artery with reactive axillary lymphadenitis. Early Aneurysmectomy and arterial reconstruction with saphenous vein graft interposition was planned. Unfortunately, she succumbed to death due to spontaneous …

Intracranial Hypertension And Optic Nerve Sheath Fenestration, Irfan Jeeva

Pakistan Journal of Neurological Sciences (PJNS)

Intracranial Hypertension is a neurological condition secondary to raised intracranial pressure in the absence of identifiable intracranial pathology and with normal cerebrospinal fluid composition. It can be a challenging condition to manage. One of the treatment modalities, optic nerve sheath fenestration is an important, yet under utilized mode of treatment, particularly in patients with visual symptoms.

Central Nervous System Tuberculosis In Children, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Brain and spinal cord tuberculosis are one of the commonest neurological infection in developing countries. Its associated with high morbidity and mortality. Diagnosis is based on clinical features, cerebrospinal fluid and brain imaging. Combination of antituberculous drugs should be started as early as possible to prevent the complications. The patient's clinical stage at presentation is the most important prognostic factor. Surgical procedures are directed at management of the hydrocephalus. Focal lesions, intracranial tuberculomas, and tuberculous abscesses, are usually located in cerebral or cerebellar hemispheres, uncommonly in brainstem and very rarely in spinal cord. They do not usually require surgical intervention …

Giant Ganglioneuroma In A 5-Year Child, Hamza Abdur Rahim Khan, Fazal Wahab Khan, Saulat H. Fatimi

Department of Surgery Docs

ABSTRACT We report a 5-year boy presenting with pain in the lower chest and upper abdomen. On evaluation with computed tomography scan of the chest, he was found to have a large 16 x 14 cm posterior mediastinal mass compressing the inferior vena cava and liver, and shifting the heart to the opposite side. Tumor was approached via right postero-lateral thoracotomy and dissected off from esophagus, heart, inferior vena cava and lungs. The entire tumor was resected without any complications. Postoperative course was unremarkable. Resection of the tumor was successful. The histopathology showed it to be giant ganglioneuroma with no …

Evaluation Of The Parasight Platform For Malaria Diagnosis, Yochay Eshel, Arnon Houri-Yafin, Hagai Benkuzari, Natalie Lezmy, Mamta Soni, Malini Charles, Jayanthi Swaminathan, Hilda Solomon, Pavithra Sampathkumar, Zul Premji, Caroline Mbithi, Zaitun Nneka, Simon Onsongo, Daniel Maina, Sarah Levy-Schreier, Caitlin Lee Cohen, Dan Gluck, Joseph Joel Pollak, Seth J. Salpeter

Pathology, East Africa

The World Health Organization estimates that nearly 500 million malaria tests are performed annually. While microscopy and rapid diagnostic tests (RDTs) are the main diagnostic approaches, no single method is inexpensive, rapid, and highly accurate. Two recent studies from our group have demonstrated a prototype computer vision platform that meets those needs. Here we present the results from two clinical studies on the commercially available version of this technology, the Sight Diagnostics Parasight platform, which provides malaria diagnosis, species identification, and parasite quantification. We conducted a multisite trial in Chennai, India (Apollo Hospital [n = 205]), and Nairobi, Kenya …

Anaesthetic Management In A Child With Goldenhar Syndrome, Waqas Ahmed Khan, Bushra Salim, Ausaf Ahmed Khan, Shakaib Chughtai

Department of Anaesthesia

Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head and …

Another Approach For Prone Positioning Under General Anaesthesia, Dileep Kumar, Mohammad Hamid, Kelash Kumar

Department of Anaesthesia

No abstract provided.

Physical Manipulation Of Larynx As A Technique For Insertion Of Nasogastric Tube, Sheema Siraj, Mehmood Mian, Fauzia Anis Khan

Department of Anaesthesia

No abstract provided.

Distribution Of Gastric Carcinoma In An Area With A High Prevalence Of Helicobacter Pylori., Javed Yakoob, Syeda Sadia Fatima, Z Abbas, Syed Farrukh Mustafa, Hamza Abdur Rahim Khan, Muhammad Faraz Raghib, Safia Awan, Zubair Ahmad

Section of Gastroenterology

BACKGROUND/AIMS:

South Asia is an enigma for gastric cancer (GC) because it is a low risk region with a high prevalence of Helicobacter pylori (H. pylori) infections. We evaluated the trend of GC clinical presentation and risk factors in patients with dyspeptic symptoms.

MATERIALS AND METHODS:

The medical records of patients, coded by the international classification of diseases (ICD-10-CM, 2015, Diagnosis Code C16.9) for malignancies of stomach diagnosed by esophagogastroduodenoscopy (EGD) and histopathology, were studied.

RESULTS:

394 GC cases with a mean age of 54±15 years, range of 18 to 88, were analyzed. 256 (65%) were male. Distal non-cardiac and …

Tobacco Control Environment: Cross-Sectional Survey Of Policy Implementation, Social Unacceptability, Knowledge Of Tobacco Health Harms And Relationship To Quit Ratio In 17 Low-Income, Middle-Income And High-Income Countries., Clara K. Chow, Daniel J. Corsi, Anna B. Gilmore, Annamarie Kruger, Ehimario Igumbor, Jephat Chifamba, Wang Yang, Li Wei, Romaina Iqbal, Prem Mony, Rajeev Gupta, Krishnapillai Vijayakumar, V Mohan, Rajesh Kumar, Omar Rahman, Khalid Yusoff, Noorhassim Ismail, Katarzyna Zatonska, Yuksel Altuntas, Annika Rosengren, Ahmad Bahonar, Afzal Hussein Yusufali, Gilles Dagenais, Scott Lear, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Sumathy Rangarajan, Koon Teo, Martin Mckee, Salim Yusuf

Community Health Sciences

OBJECTIVES:

This study examines in a cross-sectional study 'the tobacco control environment' including tobacco policy implementation and its association with quit ratio.

SETTING:

545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014.

PARTICIPANTS:

Community audits and surveys of adults (35-70 years, n=12 953).

PRIMARY AND SECONDARY OUTCOME MEASURES:

Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression …

Homocysteine As A Biomarker For Thrombosis: What Is The Learning Curve?, Bushra Moiz

Department of Pathology and Laboratory Medicine

No abstract provided.