Medical Specialties Commons^™

Bilateral Maxillary Canine-First Premolar Transposition In Permanent Dentition, Sarwat Memon, Mubassar Fida

Department of Surgery Docs

ABSTRACT Transposition is a dental anomaly characterized by the exchange of position between two adjacent teeth, especially in relation to their roots, or development and eruption of a tooth in a position normally occupied by a nonadjacent tooth. Transposition of the maxillary canine and first premolar has a low prevalence in the population and it primarily affects maxillary canines and premolars. The aetiology of the transposition remains unclear, although it has been associated with genetic factors. It may also be related to a combination of localised factors such as malformation of adjacent teeth, tooth agenesis, retention of the deciduous canine …

Gestational Headaches: Characteristics And Influencing Factors In South-Western Nigeria, Philip Adebayo, Aramide Mikhail Tijani, Olukayode Abayom, Adeseye Abiodun Akintunde

Internal Medicine, East Africa

Background: factor s Headache is one of the common neurological diseases in pregnancy but its pattern and influencing are yet to be determined in our environment in Nigeria. The aim of this study was to determine the prevalence and characteristics, as well as the modifying factors for gestational headaches in Ogbomoşo, Nigeria.

Methods: This study was a biinsti pregnant women attending the antetutional crosssectional descriptive study. Three hundred and eight (308) eligible natal care of the Ladoke Akintola University of T local government hospitals in Ogbomoso were recruited consecu 2013. Using an interviewer administered questionnaire, sociodemographic, obstetrics and headache related …

Risk And Impact Of Inter-Ictal Depression On Quality Of Life Of Nigerian Women With Epilepsy Of Childbearing Age, Philip Adebayo, Olukayode Abayomi, Shamsideen Abayomi Ogun

Internal Medicine, East Africa

Background: Depression, the most common psychiatry comorbidity in patients with epilepsy is common among women, especially those of reproductive age. Although it could be said that the female gender is a risk factor for depression, the risk of inter-ictal depression and its impact on the quality of life (QoL) of women with epilepsy (WWE) has not been sufficiently studied among Nigerians.

Materials and Methods: In this cross-sectional case–control study, data were collected from 70 women (29 WWE and 41 women without epilepsy) within the age range ≥18 and ≤55 between July 2010 and March 2011. A questionnaire that includes items-related …

Hypertensive Crisis, Burden, Management, And Outcome At A Tertiary Care Center In Karachi, Aysha Almas, Ayaz Ghouse, Ahmed Raza Iftikhar, Munawar Khursheed

Department of Medicine

Objectives:. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi.
Methods: This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included.
Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) …

Clinical, Lifestyle, Socioeconomic Determinants And Rate Of Asymptomatic Intracranial Atherosclerosis In Stroke Free Pakistanis., Ayeesha Kamran Kamal, Farzin Majeed, Omrana Pasha, Hasan Rehman, Muhammad Islam, Iqbal Azam Syed, Muhammad Saleem Ilyas, Munawar Hussain, Kamran Masood, Bilal Ahmed, Sumaira Nazir, Zafar Sajjad, Scott E. Kasner

Department of Medicine

Background: Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region.

Methods: The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used …

Tackling The Existing Burden Of Infectious Diseases In The Developing World: Existing Gaps And The Way Forward, Zulfiqar Ahmed Bhutta, Rehana A. Salam, Jai K. Das, Zohra S. Lassi

Department of Paediatrics and Child Health

This series evaluates the effectiveness of community-based interventions (CBIs) to prevent and control infectious diseases of poverty (IDoP). Evidence from our reviews suggests that CBIs and school-based delivery platforms are effective in averting risk behaviors and reducing the disease burden. Co-implementation of interventions through existing community-based programs including immunization campaigns, antenatal care and maternal and child health programs have the potential to scale-up interventions for IDoP. Future research should focus on the process of developing and implementing efficient community-based programs through a comprehensive approach, and to gauge the effectiveness of various existing delivery models in order to improve morbidity and …

Frequency Of Cardiorenal Syndrome Type-I In Hospitalized Children With Acute Heart Failure In A Tertiary-Care Hospital, Mehjabeen Zaidi, Arshalooz Jamila Rehman, Anwarul Haque, Saleem Akhtar, Prem Kumar Maheshwar

Department of Paediatrics and Child Health

Objective: To determine the frequency of cardiorenal syndrome in hospitalized children with acute heart failure.

Study Design: Descriptive study.

Place and Duration of Study: Paediatric Intensive Care Unit, The Aga Khan University Hospital, Karachi, from December 2010 to December 2011.

Methodology: Sixty eight (68) children with acute heart failure fulfilling the selection criteria were evaluated for worsening of renal function (WRF). Serum creatinine was done at baseline and repeated at 72 hours to see the worsening of renal function. Estimated serum creatinine clearance was calculated by Schwartz formula.

Results: Mean age of patients was 43.6 ± 55.2 months. There were …

Empyema Thoracis In Children: Clinical Presentation, Management And Complications, Ali Faisal Saleem, Abdul Sattar Shaikh, Reema Sajjad Khan, Fazal Khan, Ahmad Vaqas Faruque, Muhammad Arif Mateen Khan

Department of Paediatrics and Child Health

Objective: To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan.

Study Design: Descriptive, analytical study.

Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010.

Methodology: Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test …

Subacute Sclerosing Panencephalitis: Clinical And Demographic Characteristics, Arshad Rafique, Nida Amjad, Prem Chand, Syed Sohail Zahoor Zaidi, Muhammad Suleman Rana, Khalid Ahmed, Shahnaz Ibrahim

Department of Paediatrics and Child Health

Objective: To determine the clinical and demographic characteristics of children diagnosed with Subacute sclerosing panencephalitis (SSPE).

Study Design: Case series.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2000 to June 2012.

Methodology: A retrospective analysis was done, regarding medical charts of 43 children under the age of 16 years with a discharge diagnosis of SSPE. Demographic and clinical characteristics were recorded. Results were expressed as percentages.

Results: Most of the 43 patients were male (72%). The average age at presentation was 8.7 years with average duration of symptoms being 100.6 days. History of …

Frequency Of Retinopathy Of Prematurity In Premature Neonates With A Birth Weight Below 1500 Grams And A Gestational Age Less Than 32 Weeks: A Study From A Tertiary Care Hospital In A Lower-Middle Income Country, Arjumand Sohaila, Shiyam Sunder Tikmani, Iqtidar Ahmed Khan, Huba Atiq, Ali Syed Muhammad Akhtar, Prem Kumar, Kishwer Kumar

Department of Emergency Medicine

Introduction: Retinopathy of prematurity (ROP) is a treatable cause of blindness in neonates. In Pakistan, ROP is often not recognized early because screening and treatment programs are not yet in place in most neonatal units, even in tertiary care hospitals. It is hoped that this report will help inform medical professionals of the magnitude of the problem and help to design appropriate management strategies.

Objectives: The aim was to determine the frequency of ROP in premature and very low birth weight (BW) neonates (BW(GA)weeks).

Study Design: Cross-sectional study.

Study Setting : Neonatal intensive care unit (NICU) of a tertiary care …

Polio Travel Restrictions: A Sledgehammer To Crack A Nut?, Rashid Jooma

Section of Neurosurgery

Imposition by WHO of mandatory vaccination for international travelers from Pakistan has caused confusion and panic amongst travelers besides the adverse effect on the country's image from the widely reported statement. It is felt that the announced measure is not primarily supported by science but is rather a response to disillusionment in the donors about the repeatedly missed eradication targets set by WHO. In the past few years, exportation of poliovirus from Pakistan has caused outbreaks in China, Iraq and Syria besides the ongoing two way transmission with Afghanistan, but the carriers in these spreads are mainly land route travelers. …

Maternal Near-Miss And Death And Their Association With Caesarean Section Complications: A Cross-Sectional Study At A University Hospital And A Regional Hospital In Tanzania, Helena Litorp, Hussein Kidanto, Mattias Rööst, Muzdalifat Abeid, Lennarth Nyström, Birgitta Essén

Faculty of Health Sciences, East Africa

Background The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications.

Methods We performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital …

Prevalence Of Anxiety And Depression Among Medical Students Of Shifa College Of Medicine, Anam Abrar, Mehrunissa Kazim, Madiha Hanif, Shafaq Mansoor, Sadaf Tahir, Neil Makken, Wahab Yousufzai

Pakistan Journal of Neurological Sciences (PJNS)

To yield information regarding the prevalence of anxiety and depression among medical students in Islamabad and to emphasize on the need of psychological and mental well being of medical students.Methods: This is a cross-sectional study done at Shifa College of Medicine. A questionnaire was administered to 361 students who were present at the time of distribution and were consented. The instrument used to assess anxiety and depression level was the Aga khan University Anxiety and Depression Scale (AKUADS). The data collected was tabulated and analyzed using SPS v. 16.Results: Out of a total of 500 students in a five year …

Epidemiology Of Cerebral Venous Thrombosis In Asian Countries, Aleena Zia, Mohammad Wasay, Subash Kaul

Pakistan Journal of Neurological Sciences (PJNS)

ECerebral venous thrombosis (CVT) is a rare form of venous thromboembolism (VTE). CVT represents almost 0.5% -3% of all the types of stroke, affecting predominantly younger people, with an estimated incidence for adults of 3-4 per million, and for children 7 per million. In the pre-antibiotics era, the leading cause of CVT were septic processes, currently, the aseptic form of CVT predominates. (1) About 75% of all adult patients are women, over the past decade, advances in neuroimaging and treatments have significantly improved the disease’s prognosis with 80% of sufferers having a good neurological outcome. (2) The largest source of …

Predictors Of Hospital Stay And Mortality In Dengue Virus Infection-Experience From Aga Khan University Hospital Pakistan, Muhammad Abdul Mabood Khalil, Jackson Tan, Muhammd Ashhad Ullah Khalil, Safia Awan, Manickam Rangasami

Section of Nephrology

Background: Dengue virus infection (DVI) is very common infection. There is scarcity of data on factor associated with increased hospitalstay and mortality in dengue virus infection (DVI). This study was done to know about factors associated with increased hospital stay and mortality in patients admitted with DVI.

Results: Out of 532 patients, two third (72.6%) had stay ≤3 days while one third (27.4%) had stay greater than 3 days. The mean length of hospital stay was 3.46 ± 3.45 days. Factors associated with increased hospital stay (>3 days) included AKI (acute kidney injury) (Odd ratio 2.98; 95% CI 1.66-5.34), …

Unmet Need For Contraception And Unintended Pregnancies Among Women Of Reproductive Age Group: A Situation Analysis, Sumera Aziz Ali, Savera Aziz Ali

School of Nursing & Midwifery

Each year approximately 210 million pregnancies occur worldwide and more than one-third (75 to 80 million) of these are unintended, more than half of these (46 million) unintended pregnancies undergo unsafe abortions. In Pakistan 16% of the births are reported to be unwanted and if the unwanted fertility is eliminated, total fertility in Pakistan would be 3.1 births per woman. Total demand for family planning in Pakistan is 55%, while the contraceptive prevalence rate is 35% and unmet need for family planning is 20%. Reasons for unmet need and unintended pregnancy include lack of permission, fear of side effects, poor …

Impact Of Peak/Mid Luteal Estradiol On Pregnancy Outcome After Intracytoplasmic Sperm Injection, Rehana Rehman, Zahir Hussain, Huma Zahir, Rakhshaan Khan

Department of Biological & Biomedical Sciences

Abstract

Objective: To compare peak to mid estradiol ratio with the probability of successful conception after intracytoplasmic

sperm injection.

Method: The quasi-experimental study was conducted in an infertility clinic at Islamabad from June 2010 till August

2011, and comprised couples subjected to intra-cytoplasmic sperm injection. Down-regulation of ovaries was

followed by calculated stimulation, ovulation induction, oocytes retrieval, intra cytoplasmic sperm injection, in vitro

maturation of embryos and finally blastocysts transfer. Serum estradiol was measured by enzyme-linked

immunosorbent assay on ovulation induction day and the day of embryo transfer. Failure of procedure was detected

by beta human chorionic gonadotropin5-25mIU/ml (Group I; …

Analytic Study Of Clinical Presentation Of Intracranial Space-Occupying Lesions In Adult Patients, Bashir A. Soomro, Sameen Khalid, Shafaq Alvi

Pakistan Journal of Neurological Sciences (PJNS)

Intracranial space-occupying lesions can be caused by a variety of disease processes, ranging from neoplasms to non-neoplastic lesions including hematomas, abscesses and vascular malformations. This article provides an overview of varied clinical presentations of patients with intracranial space-occupying lesions.Methods:A total of 200 cases of intracranial space-occupying lesions presenting at Neuro Clinic and Care were retrospectively analyzed. Adult patients from all age groups and both genders were included in this study. Results: 165 patients (82.5%) had neoplastic lesions while 35 (17.5%) had non-neoplastic lesions. Metastatic lesions from primary tumor elsewhere in the body comprised the most common group with81 cases (40.5%), …

Knowledge, Attitude And Perceptions About Tetanus And Rabies Among Family Physicians; Results Of A Survey At A Teaching Hospital In Karachi, Pakistan, Siddiqui Sj, Jehan F, Awan S S, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

To assess the knowledge, attitude and perception among family physicians about tetanus and rabies. Setting: This study was conducted at the International Family Physicians Conference held at the Aga Khan University. Method: It was a cross sectional study of convenient sampling. The participants were asked to fill a pre-tested questionnaire comprising of 26 questions. Both open and close ended questions were included. A total of 111 doctors fulfilling the inclusion criteria filled in the questionnaire.Result: Out of 111 doctors who participated in this study, vast majority were working in the urban area (86.5%). 59.5% had not seen a case of …

Management Of Multiple, Late Onset Complications In A 33-Year-Old Female, With A Ventriculoperitoneal Shunt And Crohn's Disease, C Gkolemis, P Zogopoulos, P Kokkalis, G Stamatopoulos, N Syrmos, T.S. Paleologos

Pakistan Journal of Neurological Sciences (PJNS)

Numerous complications can occur after the placement of a venticuloperitoneal shunt. The late onset of an autoimmune disease such as Crohn's disease can be the disruptive factor for a previously well functioning shunt. A 33-year-old female with a ventriculo-peritoneal shunt since the age of 7, as well as Crohn's disease since the age of 25, presented in the ER with dysuria, long-lasting fever and intermittent severe headache. The patient underwent a CT scan of the chest, abdomen and brain. An enlargement of the ventricular system was revealed, suggesting malfunction of the shunt. Simultaneously, the abdominal scan revealed an abnormal course …

Cramp Fasciculation Syndrome: A Peripheral Nerve Hyperexcitability Disorder, Bhojo A. Khealani

Pakistan Journal of Neurological Sciences (PJNS)

Cramp fasciculation syndrome is mildest among all the peripheral nerve hyperexcitability disorders, which typically presents with cramps, body ache and fasciculations. The diagnosis is based on clinical grounds supported by electrodiagnostic study. We report a case of young male with two months’ history of body ache, rippling, movements over calves and other body parts, and occasional cramps. His metabolic workup was suggestive of impaired fasting glucose, radiologic work up (chest X-ray and ultrasound abdomen) was normal, and electrodiagnostic study was significant for fasciculation and myokymic discharges. He was started on pregablin and analgesics. To the best of our knowledge this …

Cost-Effective Practice Of Neurology: An Idea Whose Time Has Come, Rashid Jooma

Pakistan Journal of Neurological Sciences (PJNS)

Pakistanis spent $ 7.2 billion on healthcare in 2013 (3.1% of our Gross Domestic Product), representing a per capita expenditure of $ 39.4. The government contribution to this was no more than 31.4% ($ 12.4 per capita). The public allocations to health thus represent a paltry 4.7% of total government expenditure and are just shy of 1% of our GDP.

To Determine The Frequency Of Depression In Patients With Primary Epilepsy, Wazir Akber, Noor Ahmed Khosa, Amanullah Sarangzai

Pakistan Journal of Neurological Sciences (PJNS)

Depression is well known common co-morbid psychiatric condition associated with primary epilepsy. This study showed that frequency of depression was 62% in primary epilepsy patient presenting to the Neurology outpatient clinic of a tertiary care hospital. Female gender, high seizures frequency, polytherapy with AEDs and long duration of primary epilepsy were found to be the factors leading to frequent occurrence of depression in primary epilepsy patients Objective: To determine the frequency of depression in patients with primary epilepsy presenting to the Neurology outpatient clinic of Aga Khan University Hospital Karachi.Study Design: Cross-sectional study. Study Setting: Neurology outpatient department at Aga …

Coil Embolization Of Wide Neck Cerebral Aneurysms Using Balloon Remodeling Technique-Initial Experience In Pakistan, Qasim Bashir, Hina Nabi Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

The balloon remodeling technique [BRT] was developed for neuroendovascular treatment of wide-necked cerebral aneurysms. Herein, we describe our initial experience of aneurysm embolization using BRT in Pakistan with the new double-lumen balloon catheters (Sceptor C and Ascent) and Hyperform balloon micro catheter and discuss its benefits.

Clippers (Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive To Steroids)–Case Report With Neuroimaging, Abdul Salam, Farah Sana, Rashed Nazir, M. Azhar Saeed, Yasir Iqbal, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Background: CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory disease process primarily involving the pons and adjacent structures. Clinically, the patient may present with cerebellar signs such as dysarthria, gait ataxia and with cranial nerve palsies. It shows good response to steroids / immunosuppressive therapy. Pathologically, there is infiltration of T lymphocytes into the perivascular spaces of brainstem. The disease follows a relapsing and a remitting course and the earlier the treatment is started with high dose steroids and the more prolonged it is, the better the clinical outcome will be.

Sporadic Cjd And Retinitis Punctata Albescansa Case Report And Literature Review, Quratulain Khan, Yusra Hanif Khan

Pakistan Journal of Neurological Sciences (PJNS)

Introduction Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common form of CJD causing 85% of all cases. Various phenotypes of sCJD have been identified including Heidenhain variant which has early and predominant visual symptoms with most pronounced neuropathological changes in occipital lobe. Methodology. We are reporting a case of sCJD with Retinitis Punctata Albescens (RPA), a variant of Retinitis Pigmentosa (RP), which to our knowledge has not been reported before. A 51 year old, married, right handed, Pakistani woman presented with dementia and gait problems for 3 months and visual hallucinations for 2 months. Ophthalmological examination 3 years prior to …

Endovascular Treatment Of Intracranial Aneurysms Using Balloon Remodeling Technique, Wasey Jilani, Tanveer Ul Haq

Pakistan Journal of Neurological Sciences (PJNS)

Endovascular treatment with coils is widely used in the management of intracranial aneurysms. However, this type of treatment can be technically challenging for anatomic reasons, particularly when the neck of the aneurysm is wide or when the dome-to-neck ratio is not favorable. Previous studies described the remodeling technique for extending the indications and feasibility of the endovascular treatment to wide-neck intracranial aneurysms. In remodeling technique, a non-detachable balloon is temporarily inflated in front of the neck of the aneurysm during each coil placement. At the end of the procedure, the remodeling balloon is removed and no device is left in …

Autism- Towards Comprehensive Assessment And Management, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

Autism is a pervasive, neurodevelopmental disorder characterized by stereotyped movements and impairment in social skills and communication patterns. Prevalence patterns show an increasing burden of about 1 in 150 children affected by the disorder. Most affected individuals have symptoms that interfere greatly with quality of life. Although a burgeoning concern, research on the prevalence, etiological factors and presentation patterns is limited in LAMI countries, leading to a minimal understanding of the disorder at individual, professional and societal level. There is an urgent need to enhance awareness and education to decrease stigma that maybe associated with autism.

Psychiatric Disorders In Neurology, Rizwan Taj, Mamoona Manzoor

Pakistan Journal of Neurological Sciences (PJNS)

Psychiatric disorders (PDs) are very frequent in neurological illnesses. Depression, anxiety and cognitive impairment are frequently seen in many neurological disorders such as stroke, Parkinson disease (PD), epilepsy and multiple sclerosis (MS). In addition, hallucinations, delusions, obsessive-compulsive disorder, sleep disorders, Impulse control disorders (ICDs), somatization, bipolar disorder, behavior problems and psychological problem are also seen. Depression in stroke and epilepsy has bidirectional relationship. Lesion location affects both frequency and severity of depression in stroke patients.

Shifting Of Vitamin D Deficiency To Hypervitaminosis And Toxicity, Aysha Habib, Hafsa Majid, Romaina Iqbal

Department of Pathology and Laboratory Medicine

No abstract provided.