Medical Specialties Commons^™

Mammographic Density Assessed On Paired Raw And Processed Digital Images And On Paired Screen-Film And Digital Images Across Three Mammography Systems, Anya Burton, Graham Byrnes, Jennifer Stone, Rulla M. Tamimi, John Heine, Celine Vachon, Vahit Ozmen, Ana Pereira, Maria Luisa Garmendia, Christopher Scott, John H. Hipwell, Caroline Dickens, Joachim Schüz, Mustafa Erkin Aribal, Kimberly Bertrand, Ava Kwong, Graham G. Giles, John Hopper, Beatriz Pérez Gómez, Marina Pollán, Soo-Hwang Teo, Shivaani Mariapun, Nur Aishah Mohd Taib, Martín Lajous, Ruy Lopez-Riduara, Megan Rice, Isabelle Romieu, Anath Arzee Flugelman, Giske Ursin, Samera Qureshi, Huiyan Ma, Eunjung Lee, Reza Sirous, Mehri Sirous, Jong Won Lee, Jisun Kim, Dorria Salem, Rasha Kamal, Mikael Hartman, Hui Miao, Kee-Seng Chia, Chisato Nagata, Sudhir Vinayak, Rose Ndumia, Carla H. Van Gils, Johanna O. P. Wanders, Beata Peplonska, Agnieszka Bukowska, Steve Allen, Sarah Vinnicombe, Sue Moss, Anna M. Chiarelli, Linda Linton, Gertraud Maskarinec, Martin J. Yaffe, Norman F. Boyd, Isabel Dos-Santos-Silva, Valerie A. Mccormack

Imaging & Diagnostic Radiology, East Africa

Background: Inter-women and intra-women comparisons of mammographic density (MD) are needed in research, clinical and screening applications; however, MD measurements are influenced by mammography modality (screen film/ digital) and digital image format (raw/processed). We aimed to examine differences in MD assessed on these image types.

Methods: We obtained 1294 pairs of images saved in both raw and processed formats from Hologic and General Electric (GE) direct digital systems and a Fuji computed radiography (CR) system, and 128 screen-film and processed CR-digital pairs from consecutive screening rounds. Four readers performed Cumulus-based MD measurements (n = 3441), with each image pair read …

Referral Pattern Of Emergencies In Obstetrics: Implications For Defining Scope Of Services And Policy, Rahat Najam Qureshi, Rozina Sikandar Sultanali, Zahra Hoodbhoy, Raffat Bano, Nigar Jabeen

Department of Obstetrics & Gynaecology

Objective: To analyse referral pattern of high-risk obstetric cases from secondary to tertiary care hospitals and to assess their maternal and neonatal outcomes.

Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised all referred obstetric cases from secondary-level hospitals to tertiary-level care within and outside the Hospital between January 2011 and December 2014. Day and time of referral, reason for referral as well as maternal and neonatal outcomes were collected. SPSS 19 was used for data analysis.

Results: Of the 634 obstetric referrals, 279(44%) patients were referred to the study site, while 355(56%) …

Reference Ranges Of Handgrip Strength From 125,462 Healthy Adults In 21 Countries: A Prospective Urban Rural Epidemiologic (Pure) Study., Darryl P. Leong, Koon K. Teo, Sumathy Rangarajan, V. Raman Kutty, Fernando Lanas, Chen Hui, Xiang Quanyong, Qian Zhenzhen, Tang Jinhua, Romaina Iqbal

Community Health Sciences

BACKGROUND:

The measurement of handgrip strength (HGS) has prognostic value with respect to all-cause mortality, cardiovascular mortality and cardiovascular disease, and is an important part of the evaluation of frailty. Published reference ranges for HGS are mostly derived from Caucasian populations in high-income countries. There is a paucity of information on normative HGS values in non-Caucasian populations from low- or middle-income countries. The objective of this study was to develop reference HGS ranges for healthy adults from a broad range of ethnicities and socioeconomically diverse geographic regions.

METHODS:

HGS was measured using a Jamar dynamometer in 125,462 healthy adults aged …

Sleep Medicine: A Deserted Field In Pakistan, Bhojo A. Khealani

Pakistan Journal of Neurological Sciences (PJNS)

Sleep is an important and essential aspect of life and we spend about one third of our lives sleeping. Sleep disorders often manifest with insomnia and excessive daytime sleepiness. Large population based studies have shown that people who sleep longer and lesser have shorter life span1,2. Other symptoms of the slep disorders include snoring, abnormal motor behaviors etc.

Clinical Profiles, Management And Outcome Of Myasthenic Crisis In A Tertiary Care Center In Karachi, Pakistan, Sara , Khan, Dureshahwar Kanwar, Sadia Nishat

Pakistan Journal of Neurological Sciences (PJNS)

To determine the clinical profiles, management and outcome of myasthenic crisis (MC) in patients presenting to a tertiary care hospital in Karachi, Pakistan. This was a retrospective study of forty patients with Myasthenic crisis(MC) admitted at the Aga Khan University Hospital, Karachi between 1999 and 2014.Demographics, clinical presentation, hospital course, management and outcomes were reviewed. Ventilatory support for respiratory muscle or bulbar weakness was taken as crisis identification at arrival. Out of the total 40 patients with MC; generalized onset was seen in 28 (70%) and isolated bulbar symptoms in 12 (30%) patients. Fifteen patients (37.5%) had MC as a …

Epidemiology And Prevalence Of Deep Venous Thrombosis In Patients With Spinal Cord Injury, Aatik Arsh, Haider Darain, Syed Muhammad Ilyas

Pakistan Journal of Neurological Sciences (PJNS)

Pressure ulcers in patients with spinal cord injury (SCI) are associated with incredible financial cost and human sufferings. The aim of this retrospective study was to determine prevalence of pressure ulcers amongst patients with different levels of SCI.

Attitude And Perception Of Physical Therapists Towards Multidisciplinary Team Aproach In Stroke Rehabilitation, Muhammad Naveed Babur, Shiasta Habibullah, Anam Aftab

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a long term disability in developing countries which is considered as major economic burden on part of Health care system. In developing countries multidisciplinary team approach for stroke rehabilitation is emerging in tertiary care hospitals and has considerably increased the chance of early independence, fast recovery and maximum outcome in daily activities of life. Objective: Objective of the study was to evaluate the attitude and perception of physical therapists towards multidisciplinary team approach working in stroke rehabilitation.

Concurrent Intracranial Chloromas And Leukemia Cutis In Chronic Myeloid Leukemia, Ateeque Ahmed Khan, Mahnoor Hafeez

Pakistan Journal of Neurological Sciences (PJNS)

Granulocytic sarcoma (chloroma) is an extramedullary solid tumor composed of immature white blood cells. Most common involvement sites are bone, periostium, soft tissue, lymph nodes and skin. Intracranial granulocytic sarcoma rarely occurs in meningeal or parenchymal form1. We report the of concurrent occurrence of intracranial chloromas and leukemia cutis in 26 years old male patient, known case of Chronic Myeloid Leukemia for 3 years [+ve Philadelphia (Ph) chromosome in bone marrow cells] who now presented to the Civil Hospital Karachi with continuous headache and multiple cutaneous nodules all over the body for last 2 months. The CT exam of the …

Nmda Encephalitis In An Elderly With Poor Prognosis, Farheen Niazi, Abdul Hameed, Tariq Hussain, Sarah Faiz, Hassan Atique

Pakistan Journal of Neurological Sciences (PJNS)

We present a case of a 65 years old man from Islamabad who presented with six months history of psychiatric and behavioural symptoms, significant weight loss. Later on he developed difficulty swallowing and altered sensorium. This was followed by an episode of shortness of breath leading to respiratory arrest, followed by ICU stay on ventilator support, then developed focal deficit in form of left sided weakness, dysautonomia, bradycardia leading to cardiac arrest and another cardiopulmonary resuscitation, myoclonic jerks, orofacial dyskinesias, status epilepticus, coma ultimately resulting in death of the patient. Patient was found to be NMDA receptor antibody positive. CT …

Rescue-Icp Trial, Muhammad Waqas, Muhammad Shahzad Shamim

Pakistan Journal of Neurological Sciences (PJNS)

Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension Peter J. Hutchinson, Angelos G. Kolias, Ivan S. Timofeev, Elizabeth A. Corteen, Marek Czosnyka, and other RESCUEicp Trial Collaborators N Engl J Med 2016; 375:1119-1130September 22, 2016DOI: 10.1056/NEJMoa1605215

Neurological Health Profile In Pakistan – A Health Systems Based Needs Assessment, Tauhid Awan, Arsalan Ahmad, Ather Javed, Mohammad Wasay, Muhammad Babar Khan, Haroon Awan

Pakistan Journal of Neurological Sciences (PJNS)

The aims of our study were to develop a neurological health profile in Pakistan from a health systems perspective, ascertain the readiness of neurology with regards to Sustainable Development Goals, and proffer recommendations for policy advocacy and planning in neurology.

Difficulties In Laparoscopic Cholecystectomy: Conversion Versus Surgeon's Failure, Aun Ali, Summaya Saeed, Rabel Khawaja, Sunil Sadruddin Samnani, Farah Naz Farid

Department of Surgery Docs

Background: Laparoscopic cholecystectomy is considered to be gold standard treatment for symptomatic gall stones. Despite several benefits there are still disadvantages of laparoscopic cholecystectomy in difficult cases where anatomy is disturbed even in experienced hand. Aim of this study is to identify advantages of early conversion to open cholecystectomy in difficult cases and how it should not be associated with surgeon's failure.
Methods: Observational study was conducted at tertiary care hospital of Karachi, Pakistan from January 2012 till June 2015. All patients who presented to general surgery department with symptomatic gall stones and planned for laparoscopic cholecystectomy was included in …

Use Of M-Health Technology For Preventive Medicine In Pakistan, Minaz Mawani, Muhammad Masood Kadir

Section of Internal Medicine

No abstract provided.

Stars In Cytoplasm: Pediatric Neuroblastoma, Monazza Chaudhary, Shahzad Sarwar, Natasha Bahadur Ali

Section of Haematology/Oncology

We report a case of a 2-year-old female child who presented with abdominal distention and fever. On examination, there was a palpable mass in the right hypochondrium. Computed tomography of the abdomen revealed a large mass in the right suprarenal area. Biopsy of the mass revealed malignant round blue cell neoplasm. Bone marrow examination showed diffuse infiltration with atypical mononuclear cells and cytogenetic studies showed positivity for NMyc translocation.

Massive Pulmonary Embolism Presenting As Seizures, Shahrukh Hashmani, Fateh Ali Tipoo Sultan, Murtaza Kazmi, Amammarah Yasmeen

Department of Pathology and Laboratory Medicine

Pulmonary embolism can present in various ways, though seizure activity has been rarely reported. We report a 38 years old male who had met a road traffic accident, underwent surgery, presented a month later with seizures, chest pain, shortness of breath and low blood pressure. Massive pulmonary embolism was diagnosed on CTPA, with classical features on ECG and echocardiogram and the patient was successfully managed with thrombolysis. Massive pulmonary embolism (MPE) should be kept in mind in patients who present with seizures, chest pain and haemodynamic instability.

Alternate Efflux Pump Mechanism May Contribute To Drug Resistance In Extensively Drug-Resistant Isolates Of Mycobacterium Tuberculosis, Akbar Kanji, Rumina Hasan, Ambreen Zaver, Asho Ali, Kehkashan Imtiaz, Mussarat Ashraf, Taane G. Clark, Ruth Mc Nerney, Samreen Shafiq, Zahra Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Mycobacterial Contamination Of Bronchoscopes: Challenges And Possible Solutions In Low Resource Settings, Dania Khalid Saeed, Sadia Shakoor, Seema Irfan, Rumina Hasan

Department of Pathology and Laboratory Medicine

The use of bronchoscopes has increased in tuberculosis (TB) diagnostics to circumvent the diagnostic challenges that are associated with low sputum volume and smear-negative TB. In healthcare facilities situated in low income countries that have a high burden of TB, adequate decontamination of bronchoscopes is a challenge and often overlooked to save on time and costs. This amplifies the risk of outbreaks and pseudo-outbreaks due to Mycobacterium tuberculosis and nontuberculosis mycobacteria. In this minireview, we review published literature of contaminated bronchoscopes causing pseudo-outbreaks of M. tuberculosis and nontuberculosis mycobacteria in an effort to determine common sources, and possible mitigation strategies …

Pulmonary Infections After Tuberculosis, Kauser Jabeen

Department of Pathology and Laboratory Medicine

Aims and Objective: Despite effective treatment of pulmonary tuberculosis (TB) patients, destruction of lung parenchyma may lead to complications including repeated infections. These infections are often misdiagnosed or wrongly identified as TB recurrence, and hence are not treated effectively. The frequency and severity of these infections vary with the extent of damage, and are much more prominent in patients with post-TB bronchiectasis and fibrocavitary diseases. This presentation will focus on the epidemiology, treatment, and management of post-TB infections and challenges, and the impact of these infections on public health in high-TB-burden countries.
Methods: Published literature and review articles were evaluated …

Tuberculosis In Vulnerable Populations In Eastern Mediterranean Region-Implications For Control, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objectives: Socially and economically disadvantaged or "vulnerable" people are at high risk of tuberculosis (TB) and also contribute to active chains of TB transmission. Included in such vulnerable populations are children, women, prisoners, people living with human immunodeficiency virus, the homeless, and displaced people. The ongoing active transmission of TB among such populations is made more difficult to assess and control by difficult access, health inequities, poverty, and other chronic and debilitating health conditions at individual, domestic, and community levels.
Methods: The 22 Eastern Mediterranean Region member states encompass diverse sociopolitical and socioeconomic situations with far-reaching effects on vulnerable populations …

Bilateral Moyamoya Disease In A 2-Year-Old Pakistani Male Treated With Bilateral Encephaloduroarteriosynangiosis: A Positive Outcome., Shahvaiz Magsi, Adeel Khoja, Mansoor Ali Merchant Rameez, Ariba Khan, Noman Ishaque

Department of Medicine

Background. We present a rare case of bilateral moyamoya disease presenting as multiple strokes and neurological deficits, treated with the neurosurgical procedure, encephaloduroarteriosynangiosis (EDAS), in a 2-year-old male Pakistani minor. A positive outcome was achieved and the patient recovered fully. Case Summary. Our patient presented with a history of seizures and multiple episodes of hemiparesis (on and off weakness) at the age of 2 years. He had a delayed speech development and could not speak more than a few words. He had a slight slurring of speech too. He was diagnosed with bilateral moyamoya disease on Computed Tomography Angiography (CTA). …

Clinical Manifestations And Outcomes Of Pulmonary Aspergillosis: Experience From Pakistan., Nousheen Iqbal, Muhammad Irfan, Ali Bin Sarwar Zubairi, Kauser Jabeen, Safia Awan, Javaid Khan

Department of Medicine

Introduction: Pulmonary aspergillosis has variable course of illness, severity and outcomes depending on underlying conditions. There is limited data available on the clinical manifestations and outcome of pulmonary aspergillosis from Pakistan.

Methods: To determine the clinical manifestations and outcome of pulmonary aspergillosis in a tertiary care hospital a retrospective study was conducted from 2004 to 2014 in patients admitted with pulmonary aspergillosis at the Aga Khan University Hospital Karachi, Pakistan.

Results: Of the 280 cases with provisional diagnosis of aspergillosis 69 met the inclusion criteria. The mean age was 45±15.7 years, 48 (69.6%) were men and 21 (30.4%) had diabetes …

Secretory Paraspinal Paraganglioma Of Thoracolumar Spine: Case Report And Review Of Literature, Saad Akhtar, Sidra Sattar, Muhammad Ehsan Bari, Naila Kayani, Sarosh Moeen

Section of Neurosurgery

Background: Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla chromaffin cells, however, when present extra-adrenally they are called paragangliomas. Paragangliomas rarely produce catecholamine in excess, which is evident by clinical symptoms, urine, and blood biochemistry. Total resection of these tumors can lead to complete clinical and biochemical resolution. This case report presents the clinical features, radiological findings, and neurological outcome in a middle-aged female with a secretory paraganglioma.
Case description: We present the case of a 34-year-old female who presented with a 2-year history of dizziness, flushing, headache, palpitations, and hypertension. Her blood workup showed raised urinary catecholamine levels. …

Epidemiology And Impact Of Campylobacter Infection In Children In 8 Low-Resource Settings: Results From The Mal-Ed Study, Shahida Qureshi, Aneeta Hotwani, Sadia Shakoor, (Mal-Ed) Network Investigators, Imran Ahmed, Didar Alam, Syed Asad Ali, Zulfiqar Ahmed Bhutta, Muneera Rasheed, Sajid Bashir Soofi, Ali Turab, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: Enteropathogen infections have been associated with enteric dysfunction and impaired growth in children in low-resource settings. In a multisite birth cohort study (MAL-ED), we describe the epidemiology and impact of Campylobacter infection in the first 2 years of life.
Methods: Children were actively followed up until 24 months of age. Diarrheal and nondiarrheal stool samples were collected and tested by enzyme immunoassay for Campylobacter Stool and blood samples were assayed for markers of intestinal permeability and inflammation.
Results: A total of 1892 children had 7601 diarrheal and 26 267 nondiarrheal stool samples tested for Campylobacter We describe a high …

Criteria-Based Audit To Improve Quality Of Care Of Foetal Distress: Standardising Obstetric Care At A National Referral Hospital In A Low Resource Setting, Tanzania, Andrew H. Mgaya, Helena Litorp, Hussein L. Kidanto, Lennarth Nyström, Birgitta Essén

Obstetrics and Gynaecology, East Africa

Background, In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting.

Methods, During 2013–2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for …

Improving Standards Of Care In Obstructed Labour: A Criteria-Based Audit At A Referral Hospital In A Low-Resource Setting In Tanzania, Andrew H. Mgaya, Hussein Kidanto, Lennarth Nystrom, Birgitta Essén

Faculty of Health Sciences, East Africa

Objective In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting.

Methods A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases …

Breech Delivery At A University Hospital In Tanzania, Ulf Högberg, Catrin Claeson, Lone Krebs, Agneta Skoog Svanberg, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background There is a global increase in rates of Cesarean delivery (CD). A minor factor in this increase is a shift towards CD for breech presentation. The aim of this study was to analyze breech births by mode of delivery and investigate short-term fetal and maternal outcomes in a low-income setting.

Methods The study design was cross-sectional and the setting was Muhimbili National Hospital (MNH), Dar-es-Salaam, Tanzania. Subjects were drawn from a clinical database (1999–2010) using the following inclusion criteria: breech presentation, birth weight ≥ 2,500 g, single pregnancy, fetal heart sound at admission, and absence of pregnancy-related complication as …

Criteria-Based Audit To Improve Quality Of Care Of Foetal Distress: Standardising Obstetric Care At A National Referral Hospital In A Low Resource Setting, Tanzania, Andrew H. Mgaya, Helena Litorp, Hussein Kidanto, Lennarth Nyström, Birgitta Essén

Faculty of Health Sciences, East Africa

Background In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting.

Methods During 2013–2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for …

Mahaim Tachycardia Induced Cardiomyopathy, Ibrahim Gul, Qamaruddin Roziman, Aamir Hameed Khan

Section of Cardiology

We present the case report of a 22-year man, with incessant palpitations, chest pain, shortness of breath, and pulsations in his neck for the past 7 months. He was referred to the cardiology unit for workup of wide complex tachycardia (WCT). His echocardiography, 6 months earlier, had demonstrated severe left ventricular (LV) systolic dysfunction, severe global hypokinesia, mild tricuspid regurgitation (TR), and mild mitral regurgitation (MR) which resolved with medical therapy including beta-blockers. He underwent electrophysiological study, which revealed a decremental right sided atriofascicular pathway causing a WCT with left bundle branch block (LBBB) morphology and left axis deviation (LAD, …

Obstetric Patients In Intensive Care Unit: Perspective From A Teaching Hospital In Pakistan, Rahat Qureshi, Sheikh Irfan Ahmed, Amir Raza, Ayesha Khurshid, Uzma Chishti

Department of Obstetrics & Gynaecology

Objective: Review of obstetric cases admitted to the intensive care unit.
Design: Ten year retrospective review of individual patients' medical records.
Participants: Records of obstetric patients admitted from 2005-2014.
Setting: Aga Khan University Hospital Karachi.
Main outcome Measures: Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.
Findings: A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay …

Methemoglobin And Nitric Oxide Therapy In Ugandan Children Hospitalized For Febrile Illness: Results From A Prospective Cohort Study And Randomized Double-Blind Placebo-Controlled Trial, Andrea Conroy, Michael Hawkes, Kyla Hayford, Laura Hermann, Chloe Mcdonald, Suparna Sharma, Sophie Namasopo, Robert Opoka, Chandy John, Conrad Liles

Paediatrics and Child Health, East Africa

Background: Exposure of red blood cells to oxidants increases production of methemoglobin (MHb) resulting in impaired oxygen delivery to tissues. There are no reliable estimates of methemoglobinemia in low resource clinical settings. Our objectives were to: i) evaluate risk factors for methemoglobinemia in Ugandan children hospitalized with fever (study 1); and ii) investigate MHb responses in critically ill Ugandan children with severe malaria treated with inhaled nitric oxide (iNO), an oxidant that induces MHb in a dose-dependent manner (study 2).

Methods: Two prospective studies were conducted at Jinja Regional Referral Hospital in Uganda between 2011 and 2013. Study 1, a …