Medical Specialties Commons^™

Anticipated And Unanticipated Complications Of Severe Dengue In A Primigravida, Madiha Hashmi, Ghulam Zainab, Farah Khan

Department of Obstetrics & Gynaecology

As the incidence of dengue is rising among adults more cases of dengue fever are being reported during pregnancy. Physiological changes of pregnancy mask the pathognomonic features of severe dengue such as increased hematocrit, thrombocytopenia, and leukopenia and a high index of suspicion are required in endemic areas. Massive hemorrhage may complicate operative deliveries in unsuspected patients. World Health Organization recommends that all patients with severe dengue should be admitted to a hospital with access to intensive care facilities and blood transfusion. We present the successful management of hemorrhage and unanticipated complications of severe dengue in a young primigravida admitted …

Postnatal Growth Standards For Preterm Infants: The Preterm Postnatal Follow-Up Study Of The Intergrowth-21st Project, José Villar, Francesca Giuliani, Zulfiqar A. Bhutta, Enrico Bertino, Eric O. Ohuma, Leila Cheikh Ismail, Fernando C. Barros, Douglas G. Altman, Cesar Victora, Julia A. Noble, Michael G. Gravett, Manorama Purwar, Ruyan Pang, Ann Lambert, Aris T. Papageorghiou, Roseline Ochieng, Yasmin A. Jaffer, Stephen H. Kennedy

Paediatrics and Child Health, East Africa

Background: Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus.

Methods: The INTERGROWTH-21st Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks’ gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on …

Does Tranexamic Acid Reduce Blood Transfusion Following Surgery For Inter-Trochanteric Fracture? A Randomized Control Trial, Yasir Mohib, Rizwan Haroon Rashid, Moiz Ali, Akbar Jaleel Zubairi, Masood Umer

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the frequency of blood transfusion after surgery for fixation of inter-trochanteric fractures in patients given tranexamic acid versus placebo.

METHODS:

The randomised control trial was conducted at the Aga khan university hospital from May 1 to October 31, 2014, and comprised patients diagnosed with Inter-trochanteric fracture based on X-ray imaging. The patients were randomised into two equal groups based on a computer-generated random number table. The Intervention group received two doses of 10mg/kg body weight of tranexamic acid just before surgery and three hours later intravenously. The Control group received two doses of 10mg/kg body weight …

Prophylaxis Against Heterotopic Ossification After Elbow And Acetabular Fractures — Do We Really Need It, Rizwan Haroon Rashid, Irfan Qadir, Waseem Ahmed, Masood Umer

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the efficacy and safety of prophylactic modalities for heterotopic ossification prevention after elbow and acetabular surgeries.

METHODS:

The retrospective chart review was conducted at the Aga Khan University Hospital and comprised record of patients who underwent open reduction and internal fixation for elbow and acetabular fractures between 2010 and 2013. Data was classified into three groups: Group A patients had received single dose of radiotherapy; Group B patients had received indomethacin, and Group C patients had not received any prophylaxis. Outcome variables included time-to-fracture healing, heterotopic ossification, non-union and wound infection.

RESULTS:

Of the 104patients 70(67.3%) …

Osats For Total Knee Replacement: Assessment Of Surgical Competence In The Operating Room, Shahryar Noordin, Salim Allana

Department of Surgery Docs

No abstract provided.

K Wire Fixation Of Supra-Condylar Humerus Fractures In Children. Is Ulnar Nerve At Risk?, Waseem Ahmed, Haroon Rashid, Yasir Mohib, Rizwan Haroon Rashid

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare iatrogenic ulnar nerve injury in lateral entry pin fixation versus medial and lateral entry pin fixation in the treatment of supracondylar fractures of the humerus in children. Measurement of clinical parameters in terms of elbow range of motion and postop radiographic alignment was also targeted.

METHODS:

The retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, and comprised data of paediatric patients who underwent closed reduction and percutaneous pin fixation for the treatment of displaced extension type supracondylar fractures of the humerus between July 2007 and June 2012. Data regarding socio-demographic status, disease and …

Calcaneal Fractures: An Audit Of Radiological Outcome., Tashfeen Ahmad, Zehra Abdul Muhammad, Bilal Humayun Matin, Azeem Tariq Malik, S. A. Quadri

Department of Surgery Docs

Abstract

OBJECTIVE:

To assess radiological outcome of management of calcaneal fractures.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of calcanealfractures managed between February , 2008 and February, 2014 Cases were identified through medical records, and X-rays were reviewed through digital radiology archive. Bohler\'s angle, Gissane\'s angle, calcaneal height and width were assessed digitally on pre-operative and post-operative X-ray images.

RESULTS:

Of the27 patients, only 1(3.7%) was female. The cause of fracture was fall from height 15(56%), road traffic accidents 7(26%) and bomb blasts5(19%). Tongue type fractures were 16(59%) and 11(41%) were joint …

Clinic-Based Biopsy With A Small Curette: Is It A Reliable And Safe Option In Extremity Tumours?, Waseem Ahmed, Masood Umer, Yasir Mohib, Rizwan Haroon Rashid

Department of Surgery Docs

Objective: To establish the diagnostic accuracy and safety of clinic-based biopsy done with a small curette.
Methods: The retrospective study was conducted at Aga Khan University Hospital Karachi and comprised data of patients who underwent biopsy procedure of extremity tumours in clinic under local anaesthesia from July 2009 to June 2012. Patients who underwent the procedure in operating room under general anaesthesia were excluded and so were those with insufficient or missing information, or those who had the final procedure done elsewhere. Clinical parameters were evaluated and histo-pathology was compared with the final resected specimen.
Results: The mean age of …

Clinic Based Biopsy Vs. Theatre Biopsy Of Bone And Soft Tissue Extremity Tumours: Comparable Diagnostic Modalities, Waseem Ahmed, Masood Umer, Yasir Mohib, Rizwan Haroon Rashid

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the diagnostic accuracy of clinic-based biopsy versus theatre biopsy against final histopathology in patients presenting with extremity tumours.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of patients who underwent biopsy procedure of extremity tumours from January 2008 to December 2011. Data regarding socio-demographic status, disease-related and procedure-related variables were collected from the files. Histopathology report of biopsy was compared with the final histopathology after definite procedure of the tumour for concordance.

RESULTS:

Of the 87 patients whose records were reviewed, 42(48%) had undergone biopsy in theatre and 45(52%) …

Trends In Management Of Neck Of Femur Fracture, Tashfeen Ahmad, Umair Ashraf, Omar Irfan, Zehra Abdul Muhammad

Department of Surgery Docs

Abstract

OBJECTIVE:

To identify trends related to surgical procedure for the management of neck of femur fracture to see how the choice is changing over time in relation to different age groups.

METHODS:

The retrospective audit was conducted at Aga Khan University Hospital, Karachi, and comprised data of all patients who presented with neck of femur fracture from 1995 to 2014. Patients with open fractures and those having external fixators were excluded. Data was retrieved from the hospital database, and analysed using SPSS 17.

RESULTS:

Records of 1039 patients were reviewed. The proportion of patients in the 70+ years age …

Effect Of Continuous Passive Motion On Knee Flexion Range Of Motion After Total Knee Arthroplasty, Naveed Baloch, Akbar Jaleel Zubairi, Rizwan Haroon Rashid, Pervaiz Hashmi, Riaz Hussain Lakdawala

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare mean knee flexion in patients on continuous passive motion and those without it after total knee arthroplasty.

METHODS:

The randomised controlled study was conducted at Aga Khan University Hospital, from July 2013 to June 2014, and comprised patients who underwent total knee arthroplasty. Patients were randomly assigned to either group, with Group A receiving standardised physiotherapy from 1st postoperative day, and Group B receiving physiotherapy and one hour of continuous passive motion twice a day from 1st postoperative day until discharge. Outcome assessment was done on the day of discharge.

RESULTS:

Of the 76 patients, there …

Single Stage Bilateral Total Hip Replacement: Is It An Option Or A Risk?, S. A. Quadri, Rizwan Haroon Rashid, Akbar Jaleel Zubairi, Masood Umer, Pervaiz Hashmi

Department of Surgery Docs

Abstract

OBJECTIVE:

To evaluate safety and feasibility of two-stage total hip arthroplasty and to compare it with single-stage procedure.

METHODS:

The retrospective study was conducted at The Aga Khan University Hospital and comprised all cases of total hip replacements between January 2001 and December 2014 that were retrieved from the database using International Classification of Diseases (9th Revision) coding. A standardised questionnaire was completed, including patient demographics, primary diagnosis, peri and postoperative morbidity and mortality. Differences among patients\' data were analysed using chi square test for dichotomous variables and student t-test for continuous variables.

RESULTS:

Of the 48 cases, 34(71%) …

Bomb Blast Injuries: Tertiary Care Hospital In-Patient Experience Over The Last 20 Years, Naveed A. Pasha, Raja Samir Khan, Shahryar Noordin

Department of Surgery Docs

Abstract

OBJECTIVE:

To examine the distribution and nature of limb injuries in young bomb blast victimsand their management in a tertiary healthcare setting.

METHODS:

The retrospective study was conducted at the Aga Khan University Hospital, Karachi and data was searched using the University Medical Record Database with International Classification of Diseases-Ninth Revision-Clinical Modification codes for injuries and terrorism between 1990 and 2012. Data regarding injuries, including admission time, hospital stay duration, interventions and mortality, was collected and classified as per the New Injury Severity Score.

RESULTS:

There were 22 patients in the study; 19(86.3%) males and 3(13.7%) females. The mean …

Frequency And Severity Of Acute Toxicity Of Pelvic Radiotherapy For Gynecological Cancer, Asim Hafiz, Ahmed Nadeem Abbasi, Nasir Ali, Khurshid Ahmed Khan, Bilal Mazhar Qureshi

Department of Radiation Oncology

Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer.STUDY Design: A case series.PLACE AND DURATION OF STUDY: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012.METHODOLOGY: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapys side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at …

Residual Barriers For Utilization Of Maternal And Child Health Services: Community Perceptions From Rural Pakistan., Zahid Memon, Shehla Zaidi, Atif Riaz

Community Health Sciences

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the …

Can Contracted Out Health Facilities Improve Access, Equity, And Quality Of Maternal And Newborn Health Services? Evidence From Pakistan., Shehla Zaidi, Atif Riaz, F. Rabbani, Iqbal Azam Syed, Syeda Nida Imran, Nousheen Pradhan, Gul Nawaz Khan Nawaz Khan

Community Health Sciences

BACKGROUND:

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.

METHODS:

An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A …

Spectrum Of Histopathological Findings In Postmenopausal Bleeding, Muhammad Usman Tariq, Romana Idress, Ahmed Raheem, Naila Kayani

Department of Pathology and Laboratory Medicine

Objective:To determine the frequencies of histopathological findings in endometrial and endocervical biopsy samples with clinical history of Postmenopausal Bleeding (PMB). Study Design:Descriptive cross-sectional study. Place and Duration of Study:Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from February 2012 to January 2013. Methodology:Atotal of 157 consecutive endometrial and endocervical biopsy specimens with history of postmenopausal bleeding were included. After microscopic examination, frequencies of histological findings in different age groups were generated. Chi-square and independent sample t-tests were applied to see whether the difference was significant which was set at p < 0.05. Results:One hundred and twenty-one (77.1%) specimens showed benign pathologies while 36 (22.9%) were malignant. Endometrial polyp was seen in 67 (42.7%) cases followed by endometrial carcinomas in 25 (15.9%), endometrial hyperplasia in 21 (13.4%), cervical carcinoma in 12 (7.6%) and cervical polyps in 9 (5.7%) cases. Ahighly significant increase in the percentage of malignant and pre-malignant lesions was seen with increasing age group (p < 0.001). Mean age of patients with type-2 endometrial carcinoma was higher than type-1 endometrial carcinoma but statistical significance was not observed (70.2 ±6.5 vs. 61.8 ±9.1 years respectively, p=0.069). Conclusion:Although benign pathologies were more common in postmenopausal bleeding but the collective proportion of endometrial and cervical malignancies and pre-malignant conditions was quite high. Therefore, PMB should be urgently evaluated for cause and early commencement of treatment

Role Of Acute Pain Service In Optimizing Postoperative Pain Relief In A Tertiary Care Teaching Hospital, Aliya Ahmed, Muhammad Yasir

Department of Anaesthesia

Objective: To assess the frequency and types of adjustments that acute pain service makes to postoperative analgesic regimes to improve pain relief or treat side effects.Methods: The prospective observational study was conducted at the Aga Khan University Hospital, Karachi, from December 1, 2012, to March 31, 2013. Data was collected from Acute Pain Service register four hours after the pain rounds by a Service member not involved in rounds. Data was collected on a standardised form and analysed using SPSS 19.Results: Of the 323 patients, 209(65%) were receiving epidural infusions and 114(35%) were receiving intravenous patient-controlled analgesia. Overall, 114(35%) required …

Determinants Of Method Switching Among Social Franchise Clients Who Discontinued The Use Of Intrauterine Contraceptive Device, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Wajahat Hussain, Ghulam Mustafa, Muhammad Ishaque, Safdar Ali, Aftab Ahmed, Marleen Temmerman

Community Health Sciences

Introduction: Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether.
Methods: The data used for this study comes from a larger cross-sectional survey conducted in nine (9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, …

The Role Of Quality Health Services And Discussion About Birth Spacing In Postpartum Contraceptive Use In Sindh, Pakistan: A Multilevel Analysis, Hannah Tappis, Anis Kazi, Waqas Hameed, Zaib Dahar, Anayat Ali, Sohail Agha

Community Health Sciences

Introduction: Rapid population growth, stagnant contraceptive prevalence, and high unmet need for family planning present significant challenges for meeting Pakistan's national and international development goals. Although health behaviors are shaped by multiple social and environmental factors, research on contraceptive uptake in Pakistan has focused on individual and household determinants, and little attention has been given to community characteristics that may affect access to services and reproductive behavior.
Methods: Individual and community determinants of contraceptive use were identified using multivariable multilevel logistic regression to analyze data from a 2014 cross-sectional survey of 6,200 mothers in 503 communities in Sindh, Pakistan.
Results: …

Bicompartmental Decompressive Craniectomy: Report Of Two Cases, Saad Akhtar, Badar Uddin Ujjan, Muhammad Waqas, Muhammad Waqas Khan Waqas Khan, Gohar Javed

Section of Neurosurgery

A recent study of randomized controlled trials showed favorable outcomes with use of decompressive craniectomy in managing and treating uncontrolled intracranial pressures accompanied with cerebral edema due to trauma. We present the details of bicompartmental decompressive craniectomy on two patients who presented with severe head trauma of supra- and infratentorial pathologies. The surgical management techniques and long-term follow-up are discussed in detail.

Neurofibromatosis Type 2 Patient Presenting With Medulloblastoma, Jan Kalimullah, Abdul Malik Amir Humza Sohail, Rai Shahjehan, Sabeehuddin Siddique, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome with a frequency of 1 in 25,000 live births and a penetrance of almost 100% by the sixth decade of life. The main tumors occurring in NF2 patients are bilateral vestibular schwannomas, other peripheral, cranial and spinal nerve schwannomas, intracranial and intraspinal meningiomas, ependymomas, and gliomas.
Case description: We report the case of a 6-year-old boy who presented with a 1-month history of nausea and recurrent vomiting. Physical examination was positive for ataxic gait and left-sided facial nerve palsy. Family history was positive for NF2 in the patient's father and …

Dietary Almonds Increase Serum Hdl Cholesterol In Coronary Artery Disease Patients In A Randomized Controlled Trial., Humaira Jamshed, Fateh Ali Tipoo Sultan, Romaina Iqbal, Anwar Gilani

Section of Cardiology

Background: More than one-half of coronary artery disease (CAD) patients have low HDL cholesterol despite having well-managed LDL cholesterol. Almond supplementation has not been shown to elevate circulating HDL cholesterol concentrations in clinical trials, perhaps because the baseline HDL cholesterol of trial subjects was not low.

Objective: This clinical trial was designed to test the effect of almond supplementation on low HDL cholesterol in CAD patients.

Methods: A total of 150 CAD patients (50 per group), with serum LDL cholesterol ≤100 mg/dL and HDL cholesterol ≤40 mg/dL in men and ≤50 mg/dL in women, were recruited from the Aga Khan …

Isoniazid Induced Motor-Dominant Neuropathy, Rabeeya Arsalan, Saniya Sabzwari

Department of Family Medicine

Isoniazid though a very effective treatment for tuberculosis can cause severe motor-dominant neuropathy which can be reversible with pyridoxine supplementation. A 45-year-old female diagnosed with psoas abscess, culture positive for mycobacterium tuberculosis, was started on anti- tuberculous treatment with four drugs, including isoniazid at a dose of 5 mg/kg/day. Three months later she developed severe motor weakness of lower limbs with loss of ankle and knee reflexes. She was treated with vitamin B6 injections and isoniazid treatment was continued. Her motor weakness gradually improved in a few months, but mild sensory impairment persisted even after two years. There is need …

Deadly Heat Wave In Karachi, July 2015: Negligence Or Mismanagement?, Adnan Salim, A. Ahmed, N. Ashraf, M. Asher

Section of Neurosurgery

No abstract provided.

Accreditation Of Healthcare Facilities: A Friend Or Foe?, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Sexual And Reproductive Health Risks Amongst Female Adolescents Who Use Amphetamine-Type Stimulants And Sell Sex: A Qualitative Inquiry In Yunnan, China, Xu-Dong Zhang, Angela Kelly-Hanku, Jia-Jia Chai, Jian Luo, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: China, as other Southeast Asian countries, has witnessed an increased use in amphetamine-type stimulants (ATS) amongst urban youth. Amongst female adolescents who both sell sex and use ATS, risk behaviours are compounded resulting in even poorer health outcomes. However, limited knowledge exists on ATS use patterns and ATS-related risk behaviours, particularly in this context. This research aimed to improve the understanding of these issues amongst female adolescents who use ATS and sell sex, and to inform future programming.

Method: This study utilised monthly focus group discussions (four in total) with the same study participants in Yunnan, China. From within …

Establishing Quality Control Values For Hematology Parameters: An Insight, Muhammad Shariq Shaikh

Department of Pathology and Laboratory Medicine

No abstract provided.

Hereditary Sensory Autonomic Neuropathy Ii, A Rare Disease In A Large Pakistani Family, Fazal M. Arain, Prem Chand

Department of Paediatrics and Child Health

Hereditary Sensory Autonomic Neuropathy II (HSAN II) is a rare genetic disorder, characterized by severe loss of pain, temperature and touch sensation. Injuries in these patients can progress to necrosis and shedding of digits and limbs. Here we report two cases of HSAN II belonging to a Pakistani family. Individual 1, a forty five year old man, had complete loss of pain sensation since birth. Self-mutilation and complication of injuries resulted in the shedding of all the digits and right foot and surgical amputation of left leg. Individual 2, a five year old girl,had delay in healing of wounds and …

Congenital Factor Vii Deficiency In Children At Tertiary Health Care Facility In Pakistan, Muhammad Matloob Alam, Bushra Moiz, Karim Abdur Rehman, Priyanka Jethwani, Zehra Fadoo

Department of Paediatrics and Child Health

This study presents the demographics, clinical spectrum, and outcome of patients with congenital factor VII (FVII) deficiency at a tertiary care center over a period of 12 years. Of the 49 patients, 27 (55%) patients were males. Consanguinity was found in 92% of the patients. The median age of symptom onset was 2.4 (interquartile range [IQR]: 1.1-6.5) years with a median age of 5.8 (IQR: 3.1-10) years at diagnosis. Life-threatening complications like intracranial bleeding (ICB) and intra-abdominal bleeding (IAB) were observed in 8 (16.4%) patients. We found that 11 (55%) of the 20 patients with FVII coagulant activity (FVIIc) 5% …