Isolation Frequency And Susceptibility Pattern Of Non-O1 And Non-O139 Vibrio Cholerae In A Tertiary Health Care Laboratory, 1999-2012, S Irfan, N Fasih, N K. Ghanchi, Erum Khan

Department of Pathology and Laboratory Medicine

In the past decade the importance of non-O1 and non-O139 strains of Vibrio cholerae has been highlighted globally. This study aimed to evaluate the frequency and antimicrobial susceptibility profile of non-O1 and non-O139 V. cholerae in Pakistan. Data of stool specimens yielding growth of non-O1 and non-O139 V. cholerae isolated at a national referral laboratory from 1999 to 2012 were retrospectively analysed and evaluated for resistance to ampicillin, tetracycline, chloramphenicol, co-trimoxazole and ofloxacin. A total of 95 800 stool samples submitted over 1999-2012 yielded 3668 strains of V. cholerae, of which 6% were non-O1 and non-O139 V. cholerae. A high …

Composite Split Cord Malformation Associated With A Dermal Sinus Tract, Dermoid Cyst, And Epidural Abscess: A Case Report And Review Of Literature, Saad Akhtar, Abdul Azeem, Muhammad Shahzad Shamim, Muhammad Zubair Tahir

Section of Neurosurgery

Background: Split cord malformation (SCM) is typically present at a single level but rarely, may be present at multiple levels in the spinal cord and can be associated with a wide array of lesions such as myelomeningoceles, lipomas, teratomas, and dermal sinus tracts (DSTs).
Case description: We describe a case of a 15-month-old female child who presented with high-grade fever and progressive motor weakness in the lower limbs. Magnetic resonance imaging revealed the presence of SCM along with an epidural abscess, DST, and dermoid cyst. The child underwent surgery for excision of DST along with removal of the dermoid cyst …

Providing Care Beyond The Hospital: Perspective Of A Tertiary Care Hospital From A Developing Country, Saad Akhtar, Muhammad Waqas, Badar Uddin Ujjan, Adnan Salim, Gohar Javed, Syed Ijlal Ahmed, Malikah Surani, Marium Khan

Section of Neurosurgery

Background: Neurorehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing frequently is unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by a professional nurse.
Methods: This was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of 2 groups. Group 1 (consisting of patients cared for by a professional nurse) included 94 patients and …

Long-Tunneled Versus Short-Tunneled External Ventricular Drainage: Prospective Experience From A Developing Country, Muhammad Zubair Tahir, Zain A. Sobani, Muhammed Murtaza, Ather Enam

Section of Neurosurgery

Background: External ventricular drains (EVD) are commonly utilized for temporary diversion of cerebrospinal fluid (CSF). Many neurosurgeons prefer long-tunneled EVDs in their routine practice. However, it is still unclear whether this extended tunneling helps in reducing CSF infection. Keeping this in mind, we decided to compare infection rates in long-tunneled versus short-tunneled EVDs in the setting of a developing country.
Materials and methods: A prospective study of 60 patients was conducted. Consenting patients who underwent short-tunneled (Group A) or long-tunneled (Group B) EVDs between January 2008 and June 2009 were followed during the course of their inpatient care. All operational …

Segmental Excision Versus Intralesional Curettage With Adjuvant Therapy For Giant Cell Tumour Of Bone, Omar Yacob, Masood Umer, Marrium Gul, Irfan Qadir

Department of Radiology

Abstract

PURPOSE:

To review the functional outcome and local recurrence rate of 29 patients who underwent segmental excision or intralesionalcurettage with adjuvant therapy for giant cell tumour (GCT) of bone.

METHODS:

Records of 17 men and 12 women (mean age, 30.17 years) who underwent segmental excision (n=18) or intralesional curettage followed by adjuvant therapy (n=11) for GCT of the femur (n=13), tibia (n=8), radius (n=6), or ulna (n=2) were reviewed. Nine of the patients had recurrent GCT of bone and had undergone segmental excision (n=6) or intralesional curettage (n=3) elsewhere. Functional outcome was evaluated using the Musculoskeletal Tumour Society (MSTS) …

Fallopian Tube Cyst: A Rare Complication Of Tubal Sterilization, Sana Zahiruddin, Momna Khan, Maria Iftikhar

Department of Obstetrics & Gynaecology

Tubal sterilization is one of the most commonly employed permanent method of contraception, although it is considered very safe, rarely a cyst may develop in the fallopian tube after sterilization which may undergo torsion resulting in patient presenting with acute abdomen. We are presenting a case of a middle aged women presenting to emergency room with severe lower abdominal pain, she had past history of tubal ligation done 12 years back. Pelvic ultrasound showed right sided ovarian cyst, emergency laparotomy was performed for suspected torsion of ovarian cyst, which revealed normal ovary, however a right sided fallopian tube cyst was …

Bilateral Radicular Cyst With Severe Destruction Of The Buccal Cortical Plate Secondary To Endodontic Failure, Rabia Ghafoor, Kiran Rehman

Department of Surgery Docs

Abstract

Large apical radiolucencies after endodontic treatment are usually advised orthograde retreatment, apical surgery and that too with a guarded prognosis. Microsurgical techniques, the use of ultrasonic and magnification aides, have been in use in the developed countries for the past few decades and have shown significant improvement in long-term success of such cases. MTA is proposed as one of the best materials for sealing root end surfaces. In this report, the healing response of cases of 2 large apical radiolucencies, found separately in the anterior maxilla, which were treated by orthograde as well as retrograde endodontic treatments and guided …

Paucity Of Trauma Literature From A Highly Burdened Developing Country, Rizwan Sultan, Hasnain Zafar

Department of Surgery Docs

Abstract Introduction: Trauma is the leading cause of death among a younger population not only in USA but in Pakistan as well. The high prevalence of disease should result in a larger amount of data and a larger number of publications resulting in the ability to explore improvements in the field. This study aimed to review the trauma literature generated from Pakistan. Methods: Journals indexed with PubMed from January 2010 to December 2014 were searched using the search term ‘‘Trauma AND Pakistan’’ filtering for relevant dates and human reports only. The abstracts and articles were reviewed by the authors to …

Perceptions Of Medical Students Regarding Dimensions Of Environmental Wellness, Shahjahan Katpar, Rakhshaan Khan, Rabia Siddiqu, Mehwish Hussain, Rehana Rehman

Department of Surgery Docs

Abstract

OBJECTIVE:

To explore the status of awareness on environmental wellness in medical students of Karachi.

METHODS:

The cross-sectional questionnaire-based survey was carried out at Bahria University Medical & Dental College, Karachi, from January 2009 to July 2013, and comprised randomly selected medical students. The response options were; never, sometimes, mostly and always (numbered 0-4) and these were analyzed in terms of frequency, proportion and percentages by Predictive analysis software version18.

RESULTS:

Out of 800 questionnaires distributed, 736(92%) were received fully completed. There were 210(28.5%) male and 526(71.5%) female respondents, with a male-to-female ratio of 1:2.5. Female medical students were …

Labrad : Vol 42, Issue 1 - April 2016, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Biochemical Bone Profiles Available at Clinical Laboratoryof Aga Khan University Hospital
• Ionized Calcium Determination in Clinical Labortory
• Parathyroid Hormone Disorders and Issues of Testing
• Tubular Maximum Reabsorption Rate of Phosphate to Glomerular Filtration Rate (TmP/GFR)
• Renal Osteodystrophy: A Disturbed Metabolic Aspect of Renal Failure
• Update on Microbiological Diagnosis of Bone and Joint Disorders
• Classification of Tumours of Bone : An Update Based on the 2013 World Health Organization Classification of Tumours of Soft Tissue and Bone
• Recent Developments in Benign Bone Tumours
• Role of Clinical and Radiological Correlation in Orthopaedic Pathology
• CME Seminar on ‘World Osteoporosis Day’

Presenting Features, Treatment Patterns And Outcomes Of Patients With Breast Cancer In Pakistan: Experience At A University Hospital, Kumar S, Shaikh A. J, Rashid Ya, Masood N, Mohammed Atv, Malik Uz, Ghulam H

Department of Medicine

BACKGROUND:

Breast cancer is the most common cancer in Pakistani women. We report the presenting features, treatment patterns and survival of breast cancer from a University Hospital in Southern Pakistan and compare the data with international population based studies.

MATERIALS AND METHODS:

Medical records of patients diagnosed to have breast cancer between January 1999 and November 2008 were reviewed retrospectively.

RESULTS:

A total of 845 patients were identified. Median age of diagnosis was 48 years (range 18-92). Clinical stage was as follows: Stage I 9.9%; Stage II 48.5%; Stage III 26.2%; Stage IV 13.8%; data not available 1.5%. Approximately, half …

Quality Of Life Of Stroke Survivors And Their Primary Caregivers In Pakistan., Wardah Khalid, Shafquat Rozi, Tazeen S. Ali, Iqbal Azam Syed, Michael T. Mullen

Department of Medicine

No abstract provided.

Comparison Of Spinal Anesthesia Dosage Based On Height And Weight Versus Height Alone In Patients Undergoing Elective Cesarean Section, Khalid Maudood Siddiqui, Muhammad Asghar Ali, Hameed Ullah

Department of Anaesthesia

Background: Spinal anesthesia with bupivacaine, typically used for elective and emergency cesarean section, is associated with a significant incidence of hypotension resulting from sympathetic blockade. A variety of dosing regimens have been used to administer spinal anesthesia for cesarean section. The objective of this study was to compare the incidence of hypotension following two different fixed dosing regimens.Methods: This was a randomized double-blind clinical trial with a two-sided design, 5% significance level and 80% power. After approval of the hospital ethics review committee, 60 patients were divided randomly into two groups. In one group, the local anesthetic dose was adjusted …

Almond Supplementation Reduces Serum Uric Acid In Coronary Artery Disease Patients: A Randomized Controlled Trial., Humaira Jamshed, Anwar Gilani, Fateh Ali Tipoo Sultan, Faridah Amin, Jamshed Arslan Arslan, Sumaira Ghani, Madiha Masroor

Department of Biological & Biomedical Sciences

Objective

Elevated serum uric acid (UA), a biomarker of renal insufficiency, is also an independent prognostic marker for morbidity in coronary artery disease (CAD) and poses serious health risks. This study reports the effect of almond consumption on UA in CAD patients.

Study design

A randomized controlled clinical trial was conducted with three groups: no-intervention (NI), Pakistani almonds (PA) or American almonds (AA). Patients were recruited from the Cardiology Clinics, Aga Khan University Hospital. Two follow-ups were scheduled at week-6 and week-12. 150 patients were randomly divided in three groups (50 per group). NI was not given almonds, whereas the …

'Refractory Epilepsy': What Lies Beneath?, Syedah Saira Bokhari, Satwat Hashmi

Section of Internal Medicine

A 30-year-old woman presented to the emergency room with recurrent seizures for 5 days. She had been diagnosed with epilepsy 2 years previously but stopped treatment due to the side effects of her medications. She was now experiencing episodes every 15-30 min. While undergoing a brain MRI to investigate for structural central nervous system pathology, she experienced another episode, preceded by prodromal symptoms. Polymorphic ventricular tachycardia was noted during the event. Further investigation revealed a normal QT interval, normal electrolyte panel, normal coronaries and severe left ventricular systolic dysfunction. Cardiac MRI revealed non-ischaemic cardiomyopathy. The patient was managed with heart …

Systematic Review On Human Resources For Health Interventions To Improve Maternal Health Outcomes: Evidence From Low- And Middle-Income Countries, Zohra S. Lassi, Nabiha B. Musavi, Blerta Maliqi, Nadia Mansoor, Andres De Francisco, Kadidiatou Toure, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and …

A Dataset To Assess Providers׳ Knowledge And Attitudes Towards The 2013 American College Of Cardiology/American Heart Association Cholesterol Management Guideline, Yashashwi Pokharel, Lynne Steinberg, Winston Chan, Julia M. Akeroyd, Peter H. Jones, Vijay Nambi, Khurram Nasir, Laura Petersen, Christie M. Ballantyne, Salim S. Virani

Office of the Provost

We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used to examine our objectives.

Imparting Research Ethics In Emergency Medicine-A Perspective From The Developing World, Shahan Waheed, Muhammad Akbar Baig, Asad Mian

Department of Emergency Medicine

No abstract provided.

Iron Deficiency Anemia Among Women Of Reproductive Age, An Important Public Health Problem: Situation Analysis, Minaz Mawani, Savera Aziz Ali, Gulshan Bano, Sumera Aziz Ali

Section of Internal Medicine

Background: Iron deficiency is a major cause of anemia and is more prevalent in developing countries, posing additional burden on health care systems, in the presence of scarcity of resources. The high-risk group consists of females and children but comparatively it is higher in females due to physiological reasons. Multiple factors can predict anemia, which in turn leads to various adverse outcomes.

Objective: The purpose of this literature review was to review and synthesize the findings from literature about the burden, causes, outcomes and important interventions of iron deficiency anemia for developing countries.

Methods: An extensive literature review was carried …

Aneurysm In The Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery Variant: Case Report And Review Of Literature, Saad Akhtar, Abdul Azeem, , Amyna Jiwani, Gohar Javed

Department of Surgery Docs

Abstract

INTRODUCTION:

There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20-24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature.

PRESENTATION OF CASE:

We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). …

Is Laparoscopic Pyeloplasty A Comparable Option To Treat Ureteropelvic Junction Obstruction (Upjo)? A Comparative Study, Mazhar Ali, Syed Raziuddin Biyabani, Rajab Ghirano, Wajahat Aziz, Khurram Mutahir Siddiqui

Department of Surgery Docs

Objective: To compare laparoscopic with open pyeloplasty.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients who underwent surgical correction of ureteropelvic junction obstruction between during January 2008 and December 2012. Patients with laparoscopic pyeloplasty were placed in group 1 and those with open pyeloplasty in group 2.The groups were compared for operative time, hospital stay, perioperative complications, blood loss, duration of surgery, outcome and follow-up. Data was analysed using SPSS 19.
Results: Of the 73 patients, 29(40%) were in group 1, and 44(60%) in group 2. A crossing vessel could be …

Functional Outcome Of Anorectal Malformations And Associated Anomalies In Era Of Krickenbeck Classification, Saqib Hamid Qazi, Ahmad Vaqas Faruque, Muhammad Arif Mateen Khan, Umama Saleem

Department of Surgery Docs

Abstract

OBJECTIVE:

To describe the management and functional outcome of anorectal malformations and associated anomalies according to Krickenbeck classification.

STUDY DESIGN:

Case series.

PLACE AND DURATION OF STUDY:

The Aga Khan University Hospital, Karachi, from January 2002 to December 2012.

METHODOLOGY:

Anorectal anomalies were classified according to Krickenbeck classification. Data was collected and proforma used regarding the primary disease associated anomalies, its management and functional outcome, according to Krickenbeck classification. Cases included were: all those children with imperforate anus managed during the study period. Qualitative variables like gender and functional outcome were reported as frequencies and percentages. Quantitative variables like …

Surgical Management Of Inflammatory Bowel Disease: A Low Prevalence, Developing Country Perspective, Sana Nasim, Tabish Chawla, Ghulam Murtaza Sheikh

Department of Surgery Docs

OBJECTIVE:

To determine the outcomes of surgical management of inflammatory bowel disease.

METHODS:

The retrospective case series was conducted at Aga Khan University Hospital, Karachi, and comprised medical record of adult patients operated between January 1986 and December 2010 for inflammatory bowel disease. Outcomes consisted of complications till last follow-up and 30-day mortality (disease or procedure related). Functional status of patients with ileal pouch was determined via telephone. SPSS 16 was used to analyse data.

RESULTS:

Of the 36 patients whose records were reviewed, 21(58%) were males, and body mass index was less than 23 in 34(91%). A total of …

Clinical Presentation Of Ovarian Tumors, Qamarunissa Muhabat, Fakharunissa Waheed, Waqar Unissa, Nigar Jabeen

Department of Obstetrics & Gynaecology

Ovarian malignancy is a serious disease affecting women of all ages, more so above 50 years, and they are still difficult to treat, partly because no truly effective therapy has yet been developed although presentation is often vague and non-specific, the symptoms are definitely present. It is important to recognize the symptoms so far, there is no test yet available, which is truly specific and suitable for screening and early detection of epithelial ovarian carcinoma. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory.

Primary Hepatic Carcinoid Tumor With Poor Outcome, Om Parkash, Adil Ayub, Buria Naeem, Sehrish Najam, Zubair Ahmed, Wasim Jafri, Saeed Hamid

Section of Gastroenterology

Primary Hepatic Carcinoid Tumor (PHCT) represents an extremely rare clinical entity with only a few cases reported to date. These tumors are rarely associated with metastasis and surgical resection is usually curative. Herein, we report two cases of PHCT associated with poor outcomes due to late diagnosis. Both cases presented late with non-specific symptoms. One patient presented after a 2-week history of symptoms and the second case had a longstanding two years symptomatic interval during which he remained undiagnosed and not properly worked up. Both these cases were diagnosed with hepatic carcinoid tumor, which originates from neuroendocrine cells. Case 1 …

A Randomised Controlled Trial Comparing The Effect Of Adjuvant Intrathecal 2 Mg Midazolam To 20 Micrograms Fentanyl On Postoperative Pain For Patients Undergoing Lower Limb Orthopaedic Surgery Under Spinal Anaesthesia, Francis Codero, Vitalis Mung’Ayi, Sharif Thikra

Anaesthesiology, East Africa

Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. Used intrathecally, fentanyl improves the quality of spinal blockade as compared to plain bupivacaine and confers a short duration of post-operative analgesia. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of post-operative analgesia. No studies have been done comparing intrathecal fentanyl with bupivacaine and intrathecal 2 mg midazolam with bupivacaine.

Objective: To compare the effect of intrathecal 2mg midazolam to intrathecal 20 micrograms …

Relationship Between Visual Prostate Score (Vpss) And Maximum Flow Rate (Qmax) In Men With Urinary Tract Symptoms, Mazhar A. Memon, Hammad Ather

Department of Surgery Docs

Abstract

OBJECTIVE:

To evaluate correlation between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with lower urinary tract symptoms.

MATERIAL AND METHODS:

This is a cross sectional study conducted at a university Hospital. Sixty-seven adult male patients>50 years of age were enrolled in the study after signing an informed consent. Qmax and voided volume recorded at uroflowmetry graph and at the same time VPSS were assessed. The education level was assessed in various defined groups. Pearson correlation coefficient was computed for VPSS and Qmax.

RESULTS:

Mean age was 66.1±10.1 years (median 68). The mean voided volume …

Enteric Cyst In The Left Posterior Mediastinum Mimicking A Hydatid Cyst On Chest Computed Tomography Scan, Shazib Sagheer, Abdul Malik Amir Humza Sohail,, Yousaf Bashir Hadi,, Saulat H. Fatimi

Department of Surgery Docs

Abstract

Mediastinal enteric cysts are a rare occurrence among adults and are usually asymptomatic. In most cases they are an incidental finding in the right hemi-mediastinum and are associated with vertebral anomalies. We report the unusual case of a 23 year old male who had a mediastinal mass on chest X-ray as an incidental finding. Chest Computed Tomography (CT) scan revealed no vertebral anomalies and a cystic mass in the left posterior mediastinum with features similar to those of a hydatid cyst.Posterolateral thoracotomy was done and the cyst was excised. Histopathology report revealed it to be an enteric cyst.

Occupational Health Of Self-Employed Skilled Labourers And Daily-Wage Workers In Pakistan., Noor Ul-Ain Baloch, Abdul Rehman Alvi, Muhammad Awais

Department of Surgery Docs

No abstract provided.

Trail Without Catheter After Transurethral Resection Of Prostate: Clamp It Or Not?, Vikash Talreja, Aun Ali, Summaya Saeed, Kiran Rani, Sunil Sadruddin Samnani, Farah Naz Farid, Mumtazuddin Haider

Department of Surgery Docs

Abstract

Background. There has been argument between clinical practitioners about clamping catheter or not prior to its removal after transurethral resection of prostate (TURP). We conducted a clinical trial to assess whether clamping has any role in early bladder tone recovery particularly in patients who undergo TURP. Methods. Randomized clinical trial was conducted at a tertiary care hospital, Karachi from January 2014 to July 2015. Eighty-six study participants who underwent TURP were randomly allocated into two groups of 43 participants each. In Group I, patient's Foley catheter was not clamped prior to its removal and in Group II Foley catheter …