Medical Specialties Commons^™

Frequency Of Worsening Liver Function In Severe Dengue Hepatitis Patients Receiving Paracetamol: A Retrospective Analysis Of Hospital Data., Ahsan Ali Syed, Faisal Aslam, Haris Hakeem, Faraz Siddiqui, Noreen Nasir

Department of Medicine

Objective: To determine the frequency of worsening liver function among hospital in-patients with severe dengue hepatitis receiving paracetamol.

Methods: This retrospective study was conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, and comprised records of dengue patients with severe hepatitis who received paracetamol for control of fever between June 2007 and December 2014. Alanine aminotransferase at baseline and following paracetamol administration was noted, as well as dosage and duration of paracetamol, along with participants' demographic details. Frequency of patients who developed worsening or improvement of alanine aminotransferase was also noted. SPSS 19 was used for data analysis. …

Validation Of Bioelectrical Impedance Analysis For Assessing Dry Weight Of Dialysis Patients In Pakistan, Huma Asmat, Romaina Iqbal, Fatima Sharif, Aamer Mahmood, Aamir Abbas, Waqar Kashif

Department of Medicine

Accurate dry weight estimation (DW) to achieve euvolemia is one of the key objectives of hemodialysis (HD). While conventionally DW is estimated by clinical examination, bioelectrical impedance analysis (BIA) has been proposed as an objective method to determine DW and has been tested extensively in the Western population. We aim to validate BIA for determining DW in a Pakistani population against the conventional clinician's method. This is a single-center validation study conducted at two outpatient HD units of Aga Khan Hospital, Karachi. One hundred and forty-eight DW readings of patients who were on maintenance HD were taken both by BIA …

Incidental Metastatic Mediastinal Atypical Carcinoid In A Patient With Parathyroid Adenoma: A Case Report., Zareen Kiran,, Asma Ahmed, Owais Rashid, Saira Fatima, Faizan Malik, Saulat H. Fatimi, Mubasher Ikram

Department of Medicine

Background: Atypical carcinoid arising from the mediastinal tissue is a rare neuroendocrine tumor and an association with parathyroid adenoma is very unusual. We report an unusual case of atypical carcinoid of mediastinum with metastasis in a patient presenting with parathyroid adenoma, which is the first case to be reported from Pakistan.

Case presentation: A 51-year-old Pakistani man was seen in postoperative intensive care after right parathyroidectomy and mediastinal mass resection for the management of postoperative hypocalcaemia. He had a background history of dyspnea. Examination was unremarkable. Preoperative laboratory evaluation revealed a calcium level of 12.7 mg/dl, phosphate of 1.9 mg/dl, …

Emerging Protagonists In Cancer Metastasis: An Oath Of Allegiance By Platelets, Akbar Shoukat Ali, Arzoo Ajaz, Heeba Hamid

Department of Anaesthesia

No abstract provided.

Anemia In Children With Palmar Pallor Aged 02 Months To 05 Years, Saroop Chand, Farzana Shaikh, Chetan Das, Yasmeen Memon, Mohammad Akbar Nizamani, Zulfiqar Ali Qutrio Baloch

Department of Paediatrics and Child Health

Objective:
To determine the frequency of anemia in children with palmar pallor aged 02 months to 05 years.
Patients and Methods:
This cross sectional descriptive study of six months (01-12-2012 to 31-05-2013) was conducted in the department of paediatrics at Liaquat University Hospital Hyderabad. All the children, from 02 months to 05 years, of either gender had palmar pallor on examination were recruited and evaluated for anemia by assessing the level of haemoglobin and categorized anemia as mild, moderate and severe. The data was analyzed in SPSS version 16.00, the frequency and percentage was calculated. The chi-square test was applied …

Preventive Gabapentin Versus Pregabalin To Decrease Postoperative Pain After Lumbar Microdiscectomy: A Randomized Controlled Trial, Mohsin Qadeer, Muhammad Waqas, Muhammad Jawad Rashid, Ather Enam, Salman Sharif, Ghulam Murtaza

Section of Neurosurgery

Study design: Randomized controlled trial.
Purpose: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital.
Overview of literature: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery.
Methods: This randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing …

Infection Control In Labor And Delivery Room, Learning From The Small Hospital Based Project, Savera Aziz Ali, Sumera Aziz Ali

School of Nursing & Midwifery

Background: It has been estimated that around 36% of the neonatal deaths occur due to infection in the lower and middle income countries. Infection control is a more substantial area of concern, particularly in Labor and delivery room. Multiple factors can cause infection in the labor room, therefore it is important to assess various factors of maternal and neonatal infection. Hence we explored multiple factors through this project and developed the action plan to address those factors effectively.
Methods: During our Leadership and Management course, we conducted a project in Labor room pertaining to a prevalent issue. The whole process …

18fdg Pet/Ct: A Sensitive Tool That Needs Better Users' Understanding, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Comparison Of The Effectiveness Of Zinc Supplementation In Tablets Form With That Of The Suspension Form In The Treatment Of Acute Diarrhoea, Sarwat Urooj, Hafeez Ullah Memon, Yasmeen Memon, Bibi Shazia Ali

Department of Paediatrics and Child Health

Objective: To compare the effectiveness of zinc supplementation in tablet form with that of the suspension form in the treatment of acute diarrhoea.Methods: A comparative study was carried out at the Liaquat University Hospital, Hyderabad, Pakistan from October 2008 to April 2009, and comprised children aged6-24 months suffering from acute diarrhoea. The patients were divided into two groups on the basis of even and odd numbers. Group A (even numbers) received dispersible zinc tablets, and group B (odd numbers) received zinc suspension. The patients were admitted for 3 days and improvement was checked at the end of 3rd day in …

Tailored Metabolic Workup For Urolithiasis – The Debate Continues, Hammad Ather, Imran Siddiqui, Tahmeena Siddiqui, M Nasir Sulaiman

Department of Surgery Docs

Abstract

Urolithiasis is one of the commonest afflictions of the urinary tract. Stones are of various chemical compositions, some share some common etiology; but most are specific to the structure and composition of stone. In view of highly recurrent nature of this condition, it is logical to have strategies for prevention. However, due to multiple factors most patients receive no or fragmented information on prevention. The current controversy is to the extent of metabolic workup in adult first time stone former. This requires longitudinal studies to show benefit in prevention strategies. Patients at high risk can have recurrence in weeks …

Hepatitis C Virus Seroprevalence In The General Female Population Of 9 Countries In Europe, Asia And Africa, Gary M. Clifford, Tim Waterboer, Bolormaa Dondog, You Lin Qiao, Dimitri Kordzaia, Doudja Hammouda, Namory Keita, , Nahid Khodakarami, Syed Ahsan Ali, Ang Tshering Sherpa, Witold Zatonski

Department of Surgery Docs

Abstract

BACKGROUND:

New oral treatments with very high cure rates have the potential to revolutionize global management of hepatitis C virus (HCV), but population-based data on HCV infection are missing in many low and middle-income countries (LMIC).

METHODS:

Between 2004 and 2009, dried blood spots were collected from age-stratified female population samples of 9 countries: China, Mongolia, Poland, Guinea, Nepal, Pakistan, Algeria, Georgia and Iran. HCV antibodies were detected by a multiplex serology assay using bead-based technology.

RESULTS:

Crude HCV prevalence ranged from 17.4% in Mongolia to 0.0% in Iran. In a pooled model adjusted by age and country, in …

Hookworm Infestation As A Cause Of Melena And Severe Anaemia In Farmer, Marvi Tariq, Syeda Maria Muzammil, Fareed Ahmed Sheikh, K. M. Inam Pal

Department of Surgery Docs

Abstract

Hookworm infections remain a major cause of morbidity in the developing world. Prevalence is highest in agricultural areas, where use of waste water for irrigation and poor hygiene increases infection rates among farmers. Infections present with gastrointestinal symptoms and chronic anaemia, and there are usually no signs of overt blood loss.
The following report describes a case of melena in a middle-aged farmer, where the diagnosis of hookworm infestation was delayed due to the unusual presentation. The patient underwent multiple blood transfusions before referral to the Aga Khan University Hospital (AKUH), Karachi and was managed conservatively with mebendazole at …

Superior Septal Approach Versus Left Atrial Approach For Mitral Valve Replacement: A Retrospective Cohort Study, Tooba Ansar, Taimur Asif Ali, Saneeha Shahid, Saulat H. Fatimi, Ghulam Murtaza

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the outcomes of superior septal approach and left atrial approach for mitral valve replacement.

METHODS:

This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone isolated mitral valve replacement from May 2003 to April 2012. Cases were reviewed for the outcomes [primary: loss of normal sinus rhythm; secondary: complications, residual defect and mortality]. Patients with prior history of dysrhythmia, low ejection fraction (<30%), emergency/redo mitral valve replacement and concomitant coronary artery bypass grafting were excluded. SPSS 19 was used for data analysis.

RESULTS:

Of the 78 patients, 52(66.67%) were of superior septal approach and 26(33.33%) of left atrial approach. Both groups were comparable for …

Itopride For Gastric Volume, Gastric Emptying And Drinking Capacity In Functional Dyspepsia, Shahab Abid, Wasim Jafri, Maseeh Uz Zaman, Rakhshanda Bilal, Safia Awan, Aamir Abbas

Section of Gastroenterology

AIM: To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia (FD).

Methods: Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacityof tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. ¹³C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink …

Coping Styles And Depression Among Patients With Solid Organ Cancers Attending Two Tertiary Care Hospitals Of Karachi: A Cross Sectional Study., Khadija Vadsaria, Adnan Jabbar, Iqbal Azam Syed, Sameera Rizvi, Ghulam Haider, Haider Naqvi

Community Health Sciences

Cancer undoubtedly affects patients in all aspects. Cancer diagnosis is a stressful event and coping is the primary mechanism used to adjust and counteract the stress. This study aims to assess the coping styles and prevalence of depression among solid organ cancer patients during treatment phase, attending two tertiary care hospitals of Karachi. A cross-sectional survey was conducted among solid organ cancer patients at Aga Khan University Hospital and Jinnah Post Graduate Medical Center. Coping and depression were assessed by Brief COPE and Self Reporting Questionnaire (SRQ) 20 respectively. Purposive sampling technique was used to recruit 488 patients. Coping styles …

Re-Structuring University Hospital’S Internship Program Using Kern’S Six-Step Model Of Instructional Design, M. Tariq, Muhammad Shahzad Shamim, Amna Subhan Butt, Sana Saeed, Zia Ur Rehman, Barkat Virani, Asghar Ashraf, Irum Qamar, Farah Qamar, Raheela Mohsin Rizvi, Swaleha Tariq, Qurratulain Naeem

Department of Surgery Docs

Abstract Background: Internship is a phase of training wherein a graduate learns in the context of practice, acquiring skills under supervision so that he/she may become capable of functioning independently. We are reporting the process of curriculum restructuring for strengthening the Internship Program at this university hospital. Methodology: We used Kerns’ six-step model to evaluate and restructure the internship curriculum. Step 01: Problem Identification & General need assessment- Thorough literature review revealed Internship as the crucial year of training that needs to be fashioned around the competencies required to make good doctors

Multilevel Modeling Of Binary Outcomes With Three-Level Complex Health Survey Data., Shafquat Rozi, Sadia Mahmud, Gillian Lancaster, Wilbur Hadden, Gregory Pappas

Community Health Sciences

Complex survey designs often involve unequal selection probabilities of clus-ters or units within clusters. When estimating models for complex survey data, scaled weights are incorporated into the likelihood, producing a pseudo likeli-hood. In a 3-level weighted analysis for a binary outcome, we implemented two methods for scaling the sampling weights in the National Health Survey of Pa-kistan (NHSP). For NHSP with health care utilization as a binary outcome we found age, gender, household (HH) goods, urban/rural status, community de-velopment index, province and marital status as significant predictors of health care utilization (p-value < 0.05). The variance of the random intercepts using scaling method 1 is estimated as 0.0961 (standard error 0.0339) for PSU level, and 0.2726 (standard error 0.0995) for household level respectively. Both esti-mates are significantly different from zero (p-value < 0.05) and indicate consid-erable heterogeneity in health care utilization with respect to households and PSUs. The results of the NHSP data analysis showed that all three analyses, weighted (two scaling methods) and un-weighted, converged to almost identical results with few exceptions. This may have occurred because of the large num-ber of 3rd and 2nd level clusters and relatively small ICC. We performed a sim-ulation study to assess the effect of varying prevalence and intra-class correla-tion coefficients (ICCs) on bias of fixed effect parameters and variance components of a multilevel pseudo maximum likelihood (weighted) analysis. The simulation results showed that the performance of the scaled weighted estimators is satisfactory for both scaling methods. Incorporating simulation into the analysis of complex multilevel surveys allows the integrity of the results to be tested and is recommended as good practice.

Childhood And Adolescent Obesity: Primary Health Care Physicians’ Perspectives From Riyadh, Saudi Arabia, Faiza Nasser Alotaibi, Majeedah Alotaibi, Shiakhah Alanazi, Hanan Al-Gethami, Deemah Alateeq, Rowaydah Mishiddi, Amna Rehana Siddiqui

Community Health Sciences

BACKGROUND & OBJECTIVES:

Primary health care (PHC) physicians are foremost to confront childhood and adolescent obesity. Our objective was to evaluate PHC Physicians perspectives for managing overweight/obesity in children and adolescents.

METHODS:

PHC services from eight public hospitals in Riyadh participated. A self-administered tool maintaining anonymity evaluated facilitators and barriers for managing overweight/obese children and adolescent patients. Physicians who 'always' recommended weight management for an overweight / obese patient during past year, by involving patient, parents, and others were classified as having positive and appropriate practice.

RESULTS:

Of the 58 respondents, 51.7% had appropriate practices. Lack of patient motivation (82.2%), …

Validation Of Respiratory Questionnaire For Lung Function Assessment Among An Occupational Group Of Textile Workers In Pakistan, Tanzil Jamali, Asaad Ahmed Nafees

Community Health Sciences

Objective: To determine the association of spirometric lung pattern with respiratory symptoms and to validate the American Thoracic Society respiratory questionnaire for lung function assessment among textile workers.
Methods: This cross-sectional survey was conducted from August to December 2009 among adult textile workers of Karachi. Data was collected through the American Thoracic Society Division of Lung Disease respiratory questionnaire and the lung function was assessed by using a spirometer. Results of three acceptable readings of spirogram were recorded and the best of the three readings was used for analysis. SPSS 19 was used for data analysis.
Results: There were 372 …

Coinfection With Lichtheimia Corymbifera And Aspergillus Flavus In An Immune-Competent Patient Mimicking As Pulmonary-Renal Syndrome, Ali Bin Sarwar Zubairi, Farah Idress, Kauser Jabeen, Saima Kamal, Afia Zafar

Department of Medicine

Lichtheimia corymbifera and Aspergillus flavus pulmonary coinfection has been rarely reported in immune-competent patients. We report case of a young male who presented with clinical features of pulmonary-renal syndrome and was later diagnosed to have bilateral polymicrobial fungal lung infection.

Barriers And Perceptions Regarding Code Status Discussion With Families Of Critically Ill Patients In A Tertiary Care Hospital Of A Developing Country: A Cross-Sectional Study, Ahsan A. Syed, Aysha Almas, Quratulain Naeem, Umer F. Malik, M. Tariq

Department of Medicine

Background: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown.
Aim: To determine the barriers and perceptions in discussion of code status by physicians.
Design: Questionnaire-based cross-sectional study.
Setting and participants: This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included. …

Parental Perception And Childhood Obesity: Contributors To Incorrect Perception, Hiba Ashraf, Nida Ilyas Shamsi, Ruhma Ashraf

Medical College Documents

Objectives: To determine parental recognition of their child's weight, and to identify the contributing reasons for incorrect perception.

Method: This cross-sectional study was conducted from April to October 2010 at Aga Khan University Hospital, Karachi, and comprised parents of healthy children aged 5-14 years. An interviewer-based pre-tested questionnaire consisting of socio-demographic details, anthropometric measurements, and parental perception about their child's weight was administered. Data was analysed using SPSS 21. Both univariate and multivariate logistic regression were applied to assess for the risk factors associated with incorrect parental perception.

Results: Parents of a total of 330 eligible children …

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At A Tertiary Hospital In Kenya, Stephen Omondi, John Weru, Asim Jamal, Gerald Yonga

Internal Medicine, East Africa

Background: An advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on lifesustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of …

Effect Of Puerperal Infections On Early Neonatal Mortality: A Secondary Analysis Of Six Demographic And Health Surveys, Saverio Bellizzi, Quique Bassat, Howard L. Sobel, Mohamed M. Ali, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour.

Methods: The association between signs suggestive of puerperal infection and early neonatal mortality (life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990-2013 systematic analysis for the Global Burden of Disease Study.

Results: Signs of …

Incidence Of Venous Thromboembolism In Cancer Patients Treated With Cisplatin Based Chemotherapy - A Cohort Study, Muhammad Nauman Zahir, Quratulain Shaikh, Munira Shabbir-Moosajee, Adnan Abdul Jabbar

Department of Radiation Oncology

Background: Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents.Methods: Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed …

Vaccine Coverage And Adherence To Epi Schedules In Eight Resource Poor Settings In The Mal-Ed Cohort Study, Christel Hoest, Jessica C. Seidman, Gwenyth Lee, James A. Platts-Mills, Syed Asad Ali, Maribel Paredes Olortegui, Pascal Bessong, Ram Chandyo, Sudhir Babji, Venkata Raghava Mohan

Department of Paediatrics and Child Health

Background: Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings.
Methods: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained …

Systemic Sclerosis: Clinical Manifestations, Anesthetic And Orthopedic Considerations In A Patient, Obada Hasan, Muneeba Jessar, Muhammad Ashar, Shahryar Noordin, Tashfeen Ahmad

Section of Orthopaedic Surgery

Introduction: Systemic sclerosis is a rare and progressive multisystem autoimmune disorder that is characterized pathologically by vascular abnormalities, connective tissue sclerosis and atrophy of skin and various internal organs (e.g., alimentary tract, lungs, heart, kidney, CNS), and autoantibodies. With an unknown etiology, Scleroderma is a complex polygenetic disease. A recent Genome Wide Association Study (GWAS) confirmed a strong association with the Major Histocompatibility Complex (MHC) and autoimmunity. We provide a case scenario along with a review of the systems involved and challenges physicians can face in dealing with this rare disease.
Case Presentation: Our patient, a known case of systemic …

Neurorobotics In Pakistan, Ather Enam, Muhammad Waqas

Section of Neurosurgery

No abstract provided.

Prevalence Of Non-Alcoholic Fatty Liver Disease In Overweight And Obese Children Seeking Ambulatory Health Services In Nairobi, Anne Njeri Mburu

Master of Medicine in Paediatrics and Child Health

Introduction: Non-alcoholic fatty liver disease is often an asymptomatic condition one of the leading causes of chronic liver disease and is associated with an increase in cardiovascular morbidity. Being overweight or obese has been positively linked to non-alcoholic fatty liver disease in children. There is evidence to show that when detected early, non-alcoholic fatty liver disease is reversible primarily upon institution of lifestyle changes targeted at weight reduction. Establishing the prevalence of non-alcoholic fatty liver disease in overweight and obese Kenyan children would serve as a benchmark for long term monitoring of associated morbidity and guide in public health policies …

Complication Rate And Diagnostic Yield Of Percutaneous Native Kidney Biopsies: A 10-Year Experience At A Tertiary Care Hospital In Pakistan, Sonia Yaqub, Nayla Ahmed, Urooj Fatima, Ayesha Maqbool, Waqar Ashif, Syed A. Hussain

Section of Nephrology

The use of an automated biopsy device, and real-time ultrasound for percutaneous kidney biopsies (PKBs) has improved the likelihood of obtaining adequate tissue for diagnosis and also has reduced the complications associated with the procedure. We aimed to determine the frequency and type of complications associated with PKB and to determine the diagnostic yield. It was a retrospective file-based review of cases who underwent PKB of native kidney between January 2003 and December 2013 at the Aga Khan University Hospital in Karachi, Pakistan. PKBs were performed by trained nephrologists or radiologists using an automated device with a 16/18-gauge needle under …