Medical Specialties Commons^™

Thoracic And Lumbar Spinal Surgery Under Local Anesthesia For Patients With Multiple Comorbidities: A Consecutive Case Series, Muhammad Babar Khan, Rajesh Kumar, Ather Enam

Section of Neurosurgery

Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia.
Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) …

Promoter Hypermethylation Of Tumor Suppressor Genes Correlates With Tumor Grade And Invasiveness In Patients With Urothelial Bladder Cancer, Shumaila M. Bilgrami, Sohail A. Qureshi, Shahid Pervez, Farhat Abbas

Section of Urology

Purpose: To investigate the promoter methylation status at selected loci which encode for key proteins involved in apoptosis, DNA repair, cell cycle control and progression in urothelial cell carcinoma of bladder and compare the findings from tissue samples with that of plasma.
Methods: Total genomic DNA was isolated from 43 non-muscle invasive (low grade) and 33 muscle invasive (high grade) urothelial bladder cancer samples along with 10 control cases of normal bladder mucosa. Promoter methylation status was investigated for RASSF1A, APC, MGMT, CDKN2A and CDKN2B genes using real-time methylation-specific PCR with SYBR® green. Plasma samples from 16 patients with muscle …

Effects Of Hazardous And Harmful Alcohol Use On Hiv Incidence And Sexual Behaviour: A Cohort Study Of Kenyan Female Sex Workers, Matthew F. Chersich, Wilkister Bosire, Nzioki King’Ola, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Aims: To investigate putative links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa.

Methods: A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression.

Results: Participants had high levels of hazardous (17.3%, 69/399) and harmful drinking (9.5%, 38/399), while 36.1% abstained from alcohol. …

Response To Imatinib Mesylate In Patients With Early Chronic Phase Chronic Myeloid Leukemia And Derivative Chromosome 9 Deletion Or Clonal Evolution, Mohammad Usman Shaikh, Tariq Moatter, Naveen Naz Syed, Natasha Bahadur Ali, Salman Adil

Department of Pathology and Laboratory Medicine

Objectives: The significance of clonal evolution and derivative chromosome 9 in Philadelphia-positive CML is not fully characterized and studies have yielded conflicting results. After working on emergence of clonal evolution from our region, we continued to find out the response of Imatinib Mesylate on such cases of CML treated in our center.
Materials and methods: We conducted a cross sectional, prospective analysis on response of Imatinib Mesylate on patients with Philadelphia positive chronic myeloid leukemia with clonal evolution treated from period of September 2007 till 2010. Patients were grouped on basis of cytogenetic analysis performed by conventional cytogenetic and fluorescence …

A Rare Case Of Myasthenia Gravis With Coexisting Muscular Dystrophy, Sommayya Aftab, M Haroon Hamid, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Myasthenia gravis (MG) is an autoimmune disease in which antibodies are directed against postsynaptic membrane of neuromuscular junction, resulting in muscle weakness and fatigability. We report a rare case of an 11 years old boy who was a known case of myasthenia gravis presented with progressive weakness and wasting of facial and limb musculature and was found to have coexisting muscular dystrophy most like facioscapulohumeral muscular dystrophy (FSHD).

Association Of Airborne Aspergillus With Asthma Exacerbation In Southern Pakistan., Ali Bin Sarwar Zubairi, Iqbal Azam Syed, Safia Awan, Afia Zafar, Asifali Imam

Department of Medicine

Background: Exposure to airborne fungi has been related with exacerbation of asthma in adults and children leading to increased outpatient, emergency room visits, and hospitalizations. Hypersensitivity to these airborne fungi may be an important initial predisposing factor in the development and exacerbation of asthma.

Objective: This study was conducted to determine an association between fungal types and spore concentrations with the risk of asthma exacerbation in adults.

Methods: This cross-sectional study was conducted from May 2008 to August 2009 at the Aga Khan University Hospital Karachi, Pakistan. All adult (age≥16 years) patients presenting to the hospital with acute asthma exacerbation …

The Clinical Trial Design, Haider A. Naqvi

Department of Psychiatry

No abstract provided.

Hallervorden Spatz Disease – A Rare Clinicoradiological Diagnosis, Anam Abrar, Arsalan Ahmad, Ejaz A Khan

Pakistan Journal of Neurological Sciences (PJNS)

Hallervorden Spatz disease, also known as pantothenate kinase associated neuro-degeneration, is a rare, progressive neurological disorder usually seen in first decade of life. It is associated with extrapyramidal effects, dysarthria and dementia. Hallervorden Spatz Disease is also associated with psychiatric symptoms, depression and behavioral changes. Affected patients are disabled predominantly by dystonia. MRI, in later stage of the disease, shows “eye of the tiger’ appearance which is fairly diagnostic of Hallervorden Spatz Disease. Response to drugs is often poor and of limited value to these patients. This report highlights a classical case of Hallervorden Spatz disease that presented as an …

Labrad : Vol 40, Issue 1 - April 2014, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Provocative Testing for Growth Hormone Disorders
• Serum Procalcitonin for Early Sepsis Diagnosis
• Monoclonal Gammopathy of Undetermined Significance (MGUS)
• Understanding Six Sigma Methodology
• Blood Collection for Culture
• Molecular Analysis of Alpha Thalassaemia by Multiple Ligation Probe Assay
• Prognostification of Acute Myeloid Leukemia with FLT 3 Mutation
• Interferon Gamma Release Assay (IGRA) for Detection of Mycobacterium Tuberculosis Infection in the Host
• Meeting Report: The 37th Annual Conference of the Pakistan Association of Pathologists

Correlations Of Skin Fold Thickness And Validation Of Prediction Equations Using Dexa As The Gold Standard For Estimation Of Body Fat Composition In Pakistani Children., Zainab Hussain, Tazeen H. Jafar, Maseeh Uz Zaman, Riffat Parveen Hussain

Department of Radiology

OBJECTIVE:

To determine the correlation between dual energy X-ray absorptiometry (DEXA) and skin fold thickness (SKF) equations for estimation of body fat (BF) composition in secondary school children and validation of prediction equations by Slaughter, Goran and Dezenberg.

DESIGN:

Cross sectional analytical study.

SETTING:

Joint Commission for International Accredited (JCIA) tertiary care hospital of Karachi, Pakistan from January 2010 to May 2010.

PARTICIPANTS:

The study was approved by the Hospital's ethical review committee. Written and verbal consents were obtained from principals of two schools and parents of 99 children (mean age of 14±1.89 years; min-max 9-19 years; 54 men and …

Stroke In Women: Burden, Challenges And Future For Pakistan, Maria Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

The burden of stroke is increasing around the world in both men and women. South Asia is home to 20% of the world’s population but harbors almost 80% of world strokes. Previously sex specific data on stroke incidence, prevalence, severity and mortality was not available. Now over recent years this aspect has received attention. A systematic review in 2009 concluded that although stroke in women is less common compared to men, it has a greater severity and case fatality. Although this kind of data is not available from Pakistan, some preliminary reports suggest that this might be the case in …

Clinical Predictors Of Mechanical Ventilation In Guillain-Barré Syndrome (Gbs), Sumaira Nabi, Sadaf Khattak, Muhammad Irshad Awan

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre’ Syndrome is the most common cause of acute flaccid paralysis worldwide. One of the most serious complications is respiratory failure warranting mechanical ventilation which is required in about 30% of the patients. Various studies have been carried out to identify clinical factors which could help identify patients with impending respiratory failure and facilitate elective mechanical ventilation in these patients to reduce the associated mortality. Material and methods: 92 patients diagnosed with GBS were enrolled from February 6, 2013 to August 5, 2013 in department of Neurology, PIMS, Islamabad. Each patient was then be managed accordingly and monitored for therequirement …

Impact Of Guillain Barre Syndrome On Psychosocial Functionings Of Patients In Islamabad, Muhammad Naveed Babur, Farrukh Shahzad, Waqar Ahmed Awan

Pakistan Journal of Neurological Sciences (PJNS)

GuillainBarre Syndrome (GBS) is a rare autoimmune disease of unknown causes that affects peripheral nervous system. Objectives: To review the impacts of the GuillainBarre Syndrome on the psychosocial functioning of the patients and to assess the relationship between GuillainBarre Syndrome and the psychosocial functioning Methodology: Comparative cross sectional survey was conducted on 100 participants (50 GBS patients from Shifa International Hospitals and 50 normal participants from Islamabad in 6 months time from February to July 2013. Data collected through Structured Questionnaire in hospital settings for GBS patients and normal persons from Islamabad through Psychosocial functioning scale and social functioning scale …

Variants And Variations Among Gullian Barre Syndrome Presenting As Acute Flaccid Paralysis, Alam Ibrahim Siddiqui, Ghulam Rasool Bouk, Lal Chand, Sarfraz Ahmed Mahesar, Ghulam Mustafa Tunio

Pakistan Journal of Neurological Sciences (PJNS)

Acute flaccid paralysis (AFP) is a clinical syndrome characterized by rapid onset of weakness that frequently includes respiratory and bulbar weakness. An accurate and early diagnosis of the cause has important bearing on the management and prognosis. Guillian Barre Syndrome (GBS) is a post infectious polyradiculoneuropathy involving mainly motor but sometimes sensory and autonomic nerves.

Neuroradiological Manifestations Of Tuberculous Meningitis, Sumaira Nabi, Sadaf Khattak, Mazhar Badshah, Haris Majid Rajput

Pakistan Journal of Neurological Sciences (PJNS)

Tuberculous meningitis (TBM) represents the most severe form of extra pulmonarytuberculosis (1).The early and exact diagnosis of TBM is important but difficult due to time consuming definitive microbiological procedures (2).Neuroimaging is an important initial investigation in tuberculous meningitis(3).This study was conducted to evaluate the neuroradiological findings in patients with tuberculous meningitis, as a useful modality for itsearly diagnoses and prompt treatment.

Spontaneous Intracranial Hypotension, Mehwish Sayed, Ahmed Asif, Bushra Reha, Amanullah Khan

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous intracranial hypotension (SIH) is uncommon and usually undiagnosed entity which present most commonly with postural headache. The diagnosis is difficult because of the nonspecific symptoms and lack of awareness about the disease .It is important to recognize SIH as if the disease goes undiagnosed it can cause a significant delay in initiation of the treatment and exposing patient to the risks associated with the treatment for the disorders mimicking intracranial hypotension . We describe a patient with SIH and outline the important clinical and radiological features of this syndrome. The aim of presenting this case report is to emphasize …

Radiosurgery: Current Recommendations For Intracranial Lesions And Practices In Pakistan, Hussain Shallwani, Sohaib Tariq, Muhammad E Bari

Pakistan Journal of Neurological Sciences (PJNS)

Radiosurgery is defined as the use of high-dose ionizing radiation for precise and total destruction of a chosen target, avoiding concomitant or delayed harm to adjacent tissues. The three types of radiations include gamma rays (GammaKnife) by Cobalt-60, X8 rays using linear accelerator (LINAC) system, and charged-particles generated from synchocyclotron. Recommendations: Based on current evidence, radiosurgery has proven benefits as the treatment of certain brain metastases, vestibular schwannomas, meningiomas, and some skull base tumors. Conclusion: This review describes the current recommendations for use of radiosurgery for intracranial pathologies. Radiosurgery is a relatively newer modality in the developing country of Pakistan. …

Isoflavones And Alzheimer’S Disease: The Effects Of Soy In Diet, Sara Habib, Asad Ali Khan Afridi, Mohammad Wasay, Romaina Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Pathologically, Alzheimer’s disease is a result of aggregation of amyloid peptides and protein tau in the brain forming neurofibrillary tangles which are highly toxic to neuronal circuits in the brain. Recent evidences report that apart from aging, estrogen deficiency is one of the risk factors predisposing to the development of Alzheimer’s disease. Isoflavones, also known as phytoestrogens, are metabolized by the body forming compounds that are known to interfere with neurotoxic pathways and through their anti-fibrillization effects they play a role in reducing apoptosis of neurons and glial cells and promote axonal regeneration. Experimental studies on transgenic models with Alzheimer’s …

Ct Scan In Children With Acute Bacterial Meningitis: Experience From Emergency Department Of A Tertiary-Care Hospital In Karachi, Pakistan, Jabeen Fayyaz, Arshalooz Rehman, Akhter Hamid, Munawar Khursheed, Nukhba Zia, Asher Feroze, Uzma R. Khan

Department of Emergency Medicine

Objective: To determine the role of computed tomography scan in children presenting to emergency department with symptoms and signs of suspected acute bacterial meningitis.

Methods: The retrospective analysis was done on children who were admitted through the Emergency Department at Aga Khan University Hospital, Karachi, from September 2009 to September 2011 with the diagnosis of acute bacterial meningitis. Information related to age, gender, presenting complaints, clinical signs and symptoms, computed tomography scan findings and final outcome of patients was gathered from the medical records. SPSS 19 was used for statistical analysis.

Results: A total of 192 patients were admitted with …

Promoter Hypermethylation Of Tumor Suppressor Genes Correlates With Tumor Grade And Invasiveness In Patients With Urothelial Bladder Cancer, Shumaila M. Bilgrami, Sohail A. Qureshi, Shahid Pervez, Farhat Abbas

Department of Pathology and Laboratory Medicine

Purpose: To investigate the promoter methylation status at selected loci which encode for key proteins involved in apoptosis, DNA repair, cell cycle control and progression in urothelial cell carcinoma of bladder and compare the findings from tissue samples with that of plasma.
Methods: Total genomic DNA was isolated from 43 non-muscle invasive (low grade) and 33 muscle invasive (high grade) urothelial bladder cancer samples along with 10 control cases of normal bladder mucosa. Promoter methylation status was investigated for RASSF1A, APC, MGMT, CDKN2A and CDKN2B genes using real-time methylation-specific PCR with SYBR® green. Plasma samples from 16 patients with muscle …

Validation Of A Food Frequency Questionnaire For Assessing Macronutrient And Calcium Intake In Adult Pakistani Population, Romaina Iqbal, Mohammad Ali Haroon, Farhan Javed Dar, Mujtaba Bilgirami, Gulshan Bano, Aysha Habib Khan

Community Health Sciences

Objective: To develop and validate a food frequency table (FFQ) for use in urban Pakistani population.
Study design: A validation study.
Place and duration of study: The Aga Khan University, Karachi, from June to November 2008.
Methodology: Healthy adult females, aged ³ 18 years who consented to be included in the study were inducted, while males, unhealthy females, aged below 18 years or who did not consent were excluded. The FFQ was administered once while 4, 24 hours recalls spread over a period of one year were administered as the reference method. Daily intakes for energy, protein, fat, and calcium …

Attendance At Cervical Cancer Screening And Use Of Diagnostic And Therapeutic Procedures On The Uterine Cervix Assessed From Individual Health Insurance Data (Belgium, 2002-2006), Marc Arbyn, Valérie Fabri, Marleen Temmerman, Cindy Simoens

Obstetrics and Gynaecology, East Africa

Objective: To assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data.

Methods: The Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25-64 that had a Pap smear within the last 3 years.

Results: Cervical cancer screening coverage was 61% at national level, for the target population of …

Current Trends In Undergraduate Medical And Dental Research: A Picture From Pakistan, Waqar Jeelani, Sanaa Masood Aslam, Asrar Elahi

Department of Surgery Docs

Abstract

BACKGROUND:

Initiatives taken over the last few years have led us to the day when most of the medical and dental institutions in the developed countries have established a strong research culture at undergraduate level but the situation is quite the contrary in Pakistan. This study was carried out to investigate the current trends in undergraduate medical and dental research and to highlight the research barriers.

METHODS:

A cross-sectional study was conducted at six medical and dental colleges of Rawalpindi and Islamabad. A structured questionnaire was used to collect data from 300 students. Results were recorded as percentages. Findings …

Novel Anticancer Agents In Clinical And Preclinical Trials, Adnan Salim

Section of Neurosurgery

No abstract provided.

Bifocal Metachronous Giant-Cell Tumour Of Ulna And Distal Radius, Hasnain Raza, Pervaiz Hashmi

Section of Orthopaedic Surgery

A 36 years old gentleman had giant cell tumour (GCT) in distal ulna for which he underwent resection of distal half of ulna but developed recurrence of the tumour. Following proper evaluation (grading and staging), he underwent wide margin excision of tumour including removal of distal three-fourth of ulna and reconstruction by free vascularised osteocutaneous fibular transfer. The distal reconstructed fibula was stabilized with extensor carpi ulnaris (ECU). Two years after the surgery, he developed a metachronous GCT lesion in ipsilateral distal radius for which he had curettage and bone grafting with preservation of articular surface.

Early Psychosis Symptoms, Haider A. Naqvi, Sajjad Hussain, Muhammad Islam, Shafqat Huma

Department of Psychiatry

Objective: To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking.STUDY Design: A cross-sectional study.PLACE AND DURATION OF STUDY: The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009.METHODOLOGY: A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis (IROAS).Results: Fifty five (59%) participants were male while 41% (n=38%) were female. Using IROAS, 108 …

Distribution, Severity And Radiologic Features Of Intracranial Stenosis In Asymptomatic Pakistanis., Ayeesha Kamran Kamal, Farzin Majeed, Muhammad S. Ilyas, Munawar Hussain, Kamran Masood, Bilal Ahmed, Hasan Rehman,, Zafar Sajjad, Scott E. Kasner8

Department of Medicine

Background: Intracranial atherosclerotic disease (ICAD) is the most common ischemic stroke subtype globally. It accounts for 30–50% of all ischemic strokes in Asians. Aims—The aim of the study is to report the frequency of asymptomatic ICAD and its associated Magnetic Resonance Imaging (MRI) findings.

Methods: 200 adult participants were recruited from the Radiology Departments of two major diagnostic centers in Karachi. Eligible participants were confirmed for the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS). QVSFS negative subjects underwent MRI on a 1.5 Tesla scanner. Images were centrally reviewed on Di com Viewer 3.0 with …

Uchunguzi (Journal Watch/Montre De Journal) March 2014, Benjamin Wachira

Family Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent.

5-Fu Induced Acute Toxic Leukoencephalopathy: Early Recognition And Reversibility On Dwi-Mri, Shayan Sirat Maheen Anwar,, Fatima Mubarak, Zafar Sajjad, Muhammad Azeemuddin

Department of Radiology

Acute toxic leukoencephalopathy (ATL) is a rare adverse effect of 5-Fluorouracil (5-FU) chemotherapeutic agent. It is imperative for the radiologist to confidently identify the white matter changes caused by this agent in case of toxicity. This will help in early detection and appropriate management of patient, as the condition is reversible both clinically and on imaging. We report a case of a 29 years old gentleman, known case of carcinoma of esophagus who suffered from acute toxic leukoencephalopathy secondary to leukotoxic therapeutic agent 5-FU, and illustrate the reversible imaging findings of this condition on withdrawal of the inciting agent.

Training The Resident In Percutaneous Nephrolithotomy, Muhammad Hammad Ather, Chi-Fai Ng, Gholamraza Pourmand, Palle J. Osther

Section of Urology

Objective: From the trainers' perspective percutaneous nephrolithotomy (PCNL) is one of the most challenging endourological procedures. In this review we examine the problems arising when training residents in PCNL, and how to facilitate this process.
Methods: The recommendations are derived from discussions and consensus during the First European Urolithiasis Society (EULIS) meeting held in London in September 2011. In addition, we searched Medline for articles identified using the keywords 'training', 'percutaneous surgery', 'renal calculi', 'PCNL', 'virtual reality' and 'simulators'. We also assessed the effect of modern technology, including the availability of virtual reality models vs. operating room training, and how …