Medical Specialties Commons^™

Acute Respiratory Distress Syndrome-A Concise Clinical Review, Erfan Hussain, Fahad Hamid

Department of Medicine

Acute Respiratory Distress Syndrome (ARDS) is a challenging and deadly disease faced by critical care specialists. The literature concerning ARDS has been increasing for the last 12 years and there are now many options available to treat this disease. However, not all of these options work and some may even be harmful to patients. The purpose of this paper is to provide the reader with a review of the new criteria for ARDS definition and to discuss the pros and cons of the various treatment options now available.

Characteristics, Sexual Behaviour And Risk Factors Of Female, Male And Transgender Sex Workers In South Africa, Marlise L. Richter, M. Chersich, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background. In South Africa, information on sex workers’ characteristics, sexual behaviour and health needs is limited. Current social, legal and institutional factors impede a safe working environment for sex workers and their clients.

Objectives. To describe characteristics and sexual behaviour of female, male and transgender sex workers, and assess their risk factors for unprotected sex.

Methods: Repeat cross-sectional surveys among sex workers were conducted in Hillbrow, Sandton, Rustenburg and Cape Town in 2010. Sex workers were interviewed once; any re-interviews were excluded from analysis. Unprotected sex was defined as any unprotected penetrative vaginal or anal sex with last two clients. …

Low Rate Of Recurrence Of Helicobacter Pylori Infection In Spite Of High Clarithromycin Resistance In Pakistan, Javed Yakoob, Shahab Abid, Wasim Jafri, Zaigham Abbas, Khalid Mumtaz, Saeed Hamid, Rashida Ahmed

Section of Gastroenterology

Background

The aim was to investigate the reinfection rate of H. pylori during a follow-up period of 12 months in adults who had undergone eradication therapy.

Methods

One hundred-twenty patients; 116 with gastritis, 3 with duodenal ulcer and 1 gastric ulcer, were studied. Their mean age was 41 ± 13 years (range 18–77) and male: female ratio of 2:1. H. pylori were cultured and antibiotic sensitivity was determined by Epsilometer test (E-test) for clarithromycin (CLR) and amoxicillin (AMX). Primers of urease C gene of H. pylori and Sau-3 and Hha I restriction enzymes were used for polymerase chain reaction-restriction fragment …

A Case Of Orbital Apex Syndrome In A Patient With Malignant Otitis Externa, Rashid Baig, Qazi Assad Khan, Mohammed Ali Sadiq, Mohammad Sohail Awan, Khabir Ahmad

Department of Surgery Docs

Abstract

A rare case of skull base infection with a rapid clinical course leading to visual loss and eventually death in a poorly-controlled diabetic patient is presented. A 37-year-old woman presented with a history of visual loss and painful protrusion of the right eye for the preceding 3 days.This was accompanied by vertigo and right-side facial weakness. The patient had perception of light in her right eye and 20/25 (presenting visual acuity) in the fellow eye, accompanied by right-side proptosis, total ophthalmoplegia, optic disc pallor and central retinal artery occlusion. Magnetic resonance imaging showed the presence of oedema with soft-tissue …

Morbidity Meetings: What Makes It To; What Stays Out Of The Forum, Khawaja Muhammad Inam Pal, Amyn Pardhan, Junaid Haroon

Section of General Surgery

Objectives: To review the utility of morbidity and mortality forum in General Surgery at a tertiary care hospital in Karachi, Pakistan.
Methods: The retrospective study was conducted at the Aga Khan University Hospital and reviewed morbidity data from March to May 2009. Case notes of all patients admitted to the General Surgical service during the study period were reviewed to identify in-hospital morbidities.
Results: There were a total of 340 inpatients during this period. Case notes identified 61 (17.94%) patients with morbidities; 35 (57.37%) males and 26 (42.62%) females. The morbidity record for the same period identified 32 (52.5%) patients, …

Etiology And Outcome Of Severe Community Acquired Pneumonia In Immunocompetent Adults., Ali Khawaja, Ali Bin Sarwar Zubairi, Fahad Khan Durrani, Afia Zafar

Department of Medicine

BACKGROUND: Community Acquired Pneumonia (CAP) is a commonly encountered disease, one third of which is Severe Community Acquired Pneumonia (SCAP) that can be potentially fatal. There is a paucity of data on etiology and outcome of patients with SCAP in South Asian Population.

METHODS: A retrospective cross-sectional study was conducted from March 2002 till December 2008 on patients of 16 years and above who were admitted with the diagnosis of SCAP in accordance to the criteria of American Thoracic Society Guidelines (2001). The patients underwent clinical and diagnostic evaluations to detect the severity of illness as well as the etiology …

Is Has-Bled Score Better Than Chads2 And Hemor2rhages Schemes In Assessing 1 Year Risk Of Major Bleed In Atrial Fibrillation Patients?, Syed Habibullah Kamran, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Comparison Of Clinical And Csf Profiles In Children With Tuberculous And Pyogenic Meningitis; Role Of Csf Protein: Glucose Ratio As Diagnostic Marker Of Tuberculous Meningitis, Farah Naz Qamar, Arshalooz Jamila Rahman, Sania Iqbal, Khadija Humayun

Department of Paediatrics and Child Health

Objectives: To compare the clinical and laboratory features of tuberculous meningitis with bacterial meningitis and to determine if protein glucose ratio in the cerebrospinal fluid can be predictive of the condition.
Methods: It was a retrospective descriptive study at the Paediatric Ward of Aga Khan University Hospital, Karachi, for which records of 46 patients with tuberculous meningitis and 33 with bacterial meningitis were reviewed. All records related to the study period that was from January 2005 to October 2010. The records were retrieved in December 2010. Tuberculous meningitis was defined as illness > or = 14 days, basal enhancement or tuberculoma …

Evaluating Audio Computer Assisted Self-Interviews In Urban South African Communities: Evidence For Good Suitability And Reduced Social Desirability Bias Of A Cross-Sectional Survey On Sexual Behaviour, Roxanne Beauclair, Fei Meng, Nele Deprez, Marleen Temmerman, Alex Welte, Wim Delva, Niel Hens

Obstetrics and Gynaecology, East Africa

Background: Efficient HIV prevention requires accurate identification of individuals with risky sexual behaviour. However, self-reported data from sexual behaviour surveys are prone to social desirability bias (SDB). Audio Computer-Assisted Self-Interviewing (ACASI) has been suggested as an alternative to face-to-face interviewing (FTFI), because it may promote interview privacy and reduce SDB. However, little is known about the suitability and accuracy of ACASI in urban communities with high HIV prevalence in South Africa. To test this, we conducted a sexual behaviour survey in Cape Town, South Africa, using ACASI methods.

Methods: Participants (n = 878) answered questions about their sexual relationships on …

Loss Of Dystrophin Staining In Cardiomyocytes: A Novel Method For Detection Early Myocardial Infarction, Satwat Hashmi, Suhail Al-Salam

Department of Biological & Biomedical Sciences

Myocardial infarction (MI) is the most frequent diagnosis made in majority of sudden death cases subjected to clinical and medicolegal autopsies. When sudden death occurs at a very early stage of MI, traditional macroscopic examination, or histological stains cannot easily detect the myocardial changes. For this reason we propose a new method for detecting MI at an early stage. Murine model of MI was used to induce MI through permanent ligation of left anterior descending branch of left coronary artery. Five groups of C57B6/J mice were used for inducing MI, which includes 20 minutes, 30 minutes, one hour, four hours …

Iud Discontinuation Rates, Switching Behavior, And User Satisfaction: Findings From A Retrospective Analysis Of A Mobile Outreach Service Program In Pakistan, Syed Khurram Azmat, Waqas Hameed, Ghulam Mustafa, Wajahat Hussain, Aftab Ahmed, Mohsina Bilgrami

Community Health Sciences

Background: In Pakistan, the uptake rate for the intrauterine device (IUD) is very low at 2.5%. The most popular modern contraceptive methods in Pakistan are female sterilization and use of condoms. The Marie Stopes Society established its mobile outreach service delivery program with the aim of increasing use of modern quality contraceptive services, including the long-term reversible IUD, by women living in hard-to-reach areas. The present study attempts to assess IUD discontinuation rates and associated factors, including switching behavior and level of satisfaction with this type of service delivery.
Methods: Using a cross-sectional approach, we contacted 681 women who had …

Complex Biological Reconstruction After Wide Excision Of Osteogenic Sarcoma In Lower Extremities, Kashif Abbas, Masood Umer, Haroon Ur Rashid

Section of Orthopaedic Surgery

Wide margin resection of extremity tumor sometimes leaves a huge soft tissue and bony defects in limb salvage surgery. Adequate management of these defects is an absolute requirement when aiming for functional limb. Multidisciplinary management in such cases is an answer when complex biologic reconstruction is desired. We aim to present cases of osteogenic sarcoma of lower extremity requiring combined surgical approach to achieve effective musculoskeletal reconstruction. Patients and Methods. From 2006 to 2010 ten patients were operated on for osteogenic sarcoma of lower extremity requiring complex musculoskeletal reconstruction. Results. Six patients had pathology around knee joint, whereas one each …

Autoclaved Tumor Bone For Skeletal Reconstruction In Paediatric Patients: A Low Cost Alternative In Developing Countries, Masood Umer, Hafiz Muhammad Umer, Irfan Qadir, Haroon Rashid, Rabia Awan, Raza Askari, Shamvil Ashraf

Section of Orthopaedic Surgery

We reviewed in this series forty patients of pediatric age who underwent resection for malignant tumors of musculoskeletal system followed by biological reconstruction. Our surgical procedure for reconstruction included (1) wide en bloc resection of the tumor; (2) curettage of tumor from the resected bone; (3) autoclaving for 8 minutes (4) bone grafting from the fibula (both vascularized and nonvascularized fibular grafts used); (5) reimplantation of the autoclaved bone into the host bone defect and fixation with plates. Functional evaluation was done using MSTS scoring system. At final followup of at least 18 months (mean 29.2 months), 31 patients had …

Traumatic Pancreatic Injury: An Elusive Diagnosis: Experience From A Developing Country Urban Trauma Referral Centre, Ayaz Ahmed Memon, Hasnain Zafar, Rushna Raza, Ghulam Murtaza

Section of General Surgery

Objective: To determine the frequency of pancreatic injury in patients presenting with trauma and to review the mechanism of injury, management, subsequent complications and in-hospital mortality rate associated with these patients.
Methods: The retrospective study included all patients over 18 years of age presenting with pancreatic injury due to trauma at the Aga Khan University Hospital, Karachi, between January 1990 and December 2009. Patients with iatrogenic pancreatic injury were excluded. The severity of the injury was assessed using the Injury Severity Score, while it was graded according to the scale defined by the American Association for the Surgery of Trauma. …

Scientific Rationale For Study Design Of Community-Based Simplified Antibiotic Therapy Trials In Newborns And Young Infants With Clinically Diagnosed Severe Infections Or Fast Breathing In South Asia And Sub-Saharan Africa., Anita K. M. Zaidi, Abdullah H. Baqui, Shamim Ahmad Qazi, Rajiv Bahl, Samir Saha, Adejumoke I. Ayede, Ebunoluwa A. Adejuyigbe, Cyril Engmann, Fabian Esamai, Antoinette Kitoto Tshefu, Robinson D. Wammanda, Adegoke G. Falade, Adetanwa Odebiyi, Peter Gisore, Adrien Lokangaka Longombe, William N. Ogala, Shiyam Sundar Tikmani, A. S. M. Nawshad Uddin Ahmed, Steve Wall, Neal Brandes, Daniel E. Roth, Gary L. Darmstadt

Paediatrics and Child Health, East Africa

Background: Newborns and young infants suffer high rates of infections in South Asia and sub-Saharan Africa. Timely access to appropriate antibiotic therapy is essential for reducing mortality. In an effort to develop community case management guidelines for young infants, 0–59 days old, with clinically diagnosed severe infections, or with fast breathing, 4 trials of simplified antibiotic therapy delivered in primary care clinics (Pakistan, Democratic Republic of Congo, Kenya and Nigeria) or at home (Bangladesh and Nigeria) are being conducted.

Methods: This article describes the scientific rationale for these trials, which share major elements of trial design. All the trials are …

Risk Of Childhood Asthma In A Tropical African Urban Setting: A Case - Control Study At The Aga Khan Hospital, Dar-Es-Salaam, Tanzania, Lynda C. Koech

Master of Medicine in Family Medicine

Objective: To determine the modifiable and non-modifiable risk factors for childhood asthma in children aged between two and 15years in a tropical urban East-African setting. Methods: Hospital based case-control study matched for age + two months and sex. Data were obtained from parents of cases and controls using a structured interviewer-administered questionnaire. The study sample consisted of 226 cases of two to 15years old, with physician-confirmed asthma, who met a set of defined clinical criteria and 226 controls with no previous diagnosis or symptoms of asthma matched by sex and age (+two months). The Risk Factors included in this study …

Perception Of Final Year Undergraduate Medical Students Towards Family Medicine In Dar Es Salaam, Tanzania, Eric Luggar Aghan

Master of Medicine in Family Medicine

Primary health care was identified as the ideal model of health care delivery during the Alma Atta conference in USSR in 1978. The World Health Organization urged member countries to adopt it as a model of health care service delivery to their people. Since then many countries have adopted a primary health care model including Tanzania. In countries such as Cuba and Costa Rica where primary health care has successfully been implemented, access to affordable and quality health care service to all has resulted in lowered morbidity, mortality, improved quality and longevity of life. The success story behind primary health …

Generalized Anxiety Disorder: Can We Rest Now?, Aamir Abbas, Haider A. Naqvi

Pakistan Journal of Neurological Sciences (PJNS)

Generalized anxiety disorder is a complex psychiatric syndrome. Current understanding on the epidemiological risk factors, genetic vulnerability and neurobiology of the GAD is beginning to unfold the complexities behind this disorder. This narrative review has attempted to put together the recent advances in the area of GAD research with intent to identify the gaps requiring further research.

Novel Use Of An Ultrasonic Bone-Cutting Device For Endoscopic-Assisted Craniosynostosis Surgery, Chaichana Kl, Jallo Gi, Dorafshar Ah, Ahn Es

Pakistan Journal of Neurological Sciences (PJNS)

Endoscopic-assisted craniosynostosis surgery is associated with less blood loss and shorter operative times as compared to open surgery. However, in infants who have low circulating blood volumes, the endoscopic approach is still associated with significant blood loss. A major source of blood loss is the bone that is cut during surgery. We discuss the novel use of an ultrasonic bone-cutting device for craniosynostosis surgery, which decreases bone bleeding. This device, which has primarily only been used for spine and skull base surgery, may help reduce blood loss in these infants.

20th Annual Meeting Of Pakistan Society Of Neurology Bhurban, Islamabad April 2013, Aftab Leghari, Hazim Brohi

Pakistan Journal of Neurological Sciences (PJNS)

: Stroke is a major preventable public health challenge. Diabetic patients constitute a fair percentage of patients with stroke. Numerous epidemiological studies in the United States and Europe suggest that one fifth of stroke patients have diabetes.We evaluate the risk factors leading to stroke in Diabetic patients

Gut Modulator Effects Of Conyza Bonariensis Explain Its Traditional Use In Constipation And Diarrhea, I A. Bukhari, A J. Shah, R A. Khan, S A. Meo, A Khan, A H. Gilani

Department of Biological & Biomedical Sciences

BACKGROUND AND OBJECTIVES:

The current investigation was carried out to explore the pharmacological basis of the crude extract of Conyza bonariensis (Cb.Cr) for its use in constipation and diarrhea.

MATERIALS AND METHODS:

The plant extract of Conyza bonariensis (C. bonariensis) was prepared, isolated guinea-pig ileum and rabbit jejunum preparations were used to evaluate its gut modulator effects.

RESULTS:

The Cb.Cr (0.3-10 mg/mL) exhibited spasmogenic effect in isolated guinea-pig ileum preparation, which was about 19-84% of the acetylcholine maximum. Pretreatment of the tissues with atropine (0.1 µM) abolished the contractile effect, similar to acetylcholine. Among the fractions, only the butanol fraction …

Prevalence Of Acute Kidney Injury Using Urine Neutrophil Gelatinase Associated Lipocalin As An Early Biomarker In Neonates With Perinatal Asphyxia, Farida Essajee

Master of Medicine in Paediatrics and Child Health

Introduction: Perinatal asphyxia is a major cause of neonatal morbidity and mortality. Acute kidney injury (AKI) is a common complication of perinatal asphyxia occurring in up to 61% of the neonates. Currently the diagnosis of AKI is based on serum creatinine levels and clinically by oliguria, however these are late markers of the disease. More novel biomarkers are emerging that predict the diagnosis early. Current research indicates urine NGAL as an early marker for AKI, yet there is paucity of data about its use in term neonates with perinatal asphyxia. Objectives: This study aimed to investigate the prevalence of acute …

Simplified Regimens For Management Of Neonates And Young Infants With Severe Infection When Hospital Admission Is Not Possible, Antoinette Tshef, Adrien Lokangaka, Cyril Engmann, Fabian Esamai, Peter Gisore, Adejumoke Idowu Ayede, Adegoke Gbadegesin Falade, Ebunoluwa A. Adejuyigbe, Chineme Henry Anyabolu, Robinson D. Wammanda, William N. Ogala, Lu Gram, Simon Cousens, Rajiv Bahl, Nigel Rollins, Sachiyo Yoshida, Shamim Ahmad Qazi

Paediatrics and Child Health, East Africa

Background: In resource-limited settings, most young infants with signs of severe infection do not receive the recommended inpatient treatment with intravenous broad spectrum antibiotics for 10 days or more because such treatment is not accessible, acceptable or affordable to families. This trial was initiated in the Democratic Republic of Congo, Kenya and Nigeria to assess the safety and efficacy of simplified treatment regimens for the young infants with signs of severe infection who cannot receive hospital care.

Methods: This is a randomized, open-label equivalence trial in which 3600 young infants with signs of clinical severe infection will be enrolled. The …

A Rare Case Of Aeromonas Hydrophila Catheter Related Sepsis In A Patient With Chronic Kidney Disease Receiving Steroids And Dialysis: A Case Report And Review Of Aeromonas Infections In Chronic Kidney Disease Patients, Muhammad Abdul Mabood Khalil, Abdur Rehman, Waqar Uddin Kashif, Manickam Rangasami, Jackson Tan

Section of Nephrology

Aeromonas hydrophila (AH) is an aquatic bacterium. We present a case of fifty-five-year-old gentleman with chronic kidney disease (CKD) due to crescentic IgA nephropathy who presented to us with fever. He was recently pulsed with methyl prednisolone followed by oral prednisolone and discharged on maintenance dialysis through a double lumen dialysis catheter. Blood culture from peripheral vein and double lumen dialysis catheter grew AH. We speculate low immunity due to steroids and uremia along with touch contamination of dialysis catheter by the patient or dialysis nurse could have led to this rare infection. Dialysis catheter related infection by AH is …

Treatment Of Orbital Haemangiopericytoma With Surgery And Preoperative Embolization, Irfan Jeeva, B Y P Chang, L Bagdonaite, G Kalantzis Kalantzis, T E Fearnley Fearnley, A Ismail, T Patankar Patankar, T Goddard

Section of Ophthalmology

Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.

The Political Economy Of Undernutrition National Report: Pakistan, Shehla Zaidi, Zulfiqar Ahmed Bhutta, Shandana Khan Mohmand, Andres Mejia Acosta

Epidemiology and Biostatistics Section

No abstract provided.

Factors Associated Within 28 Days In-Hospital Mortality Of Patients With Acute Respiratory Distress Syndrome, Nadia Sharif, Muhammad Irfan, Javaid Hussain, Javaid Khan

Section of Pulmonary & Critical Care

Objective. To determine the factors leading to in-hospital mortality within 28 days in hospitalized patients with ARDS. It was a prospective observational cohort study conducted in Intensive Care Unit of Aga Khan University Hospital Karachi from March to August 2011. Methodology. Data was collected from patients admitted in the intensive care unit on the basis of inclusion and exclusion criteria. The patients were followed daily for 28 days to record any in-hospital complications and the outcome of patients. Results. Total of 46 patients were included during this period out of which 56% (26) were males and 43% (20) were females. …

Bronchial Carcinoid Presenting As Multiple Lung Abscesses, Zeeshan Waheed, Muhammad Irfan, Saulat Fatimi, Ruqaiya Shahid

Section of Pulmonary & Critical Care

Bronchial carcinoid tumours is a rare group of pulmonary malignant neoplasm that is derived from neuroendocrine system. Bronchial carcinoid usually present with hilar masses, atelactasis, bronchiectasis, or post-obstructive pneumonia. This case describes a very unusual presentation of bronchial carcinoid tumour with multiple lung abscesses involving the whole lung. This report is of an adult lady who presented with multiple lung abscesses involving her whole of the right lung. She was found to have an endo-bronchial lesion in her right main bronchus which eventually turned out to be carcinoid tumour. She responded to resection and antibiotic therapy.

Expression Of M. Tuberculosis-Induced Suppressor Of Cytokine Signaling (Socs) 1, Socs3, Foxp3 And Secretion Of Il-6 Associates With Differing Clinical Severity Of Tuberculosis, Kiran I. Masood, Martin E. Rottenberg, Naseem Salahuddin, Muhammad Irfan, Nisar Rao, Berit Carow, Muniba Islam, Rabia Hussain, Zahra Hasan

Section of Pulmonary & Critical Care

Background

Appropriate immune activation of T cells and macrophages is central for the control of Mycobacterium tuberculosis infections. IFN-γ stimulated responses are lowered in tuberculosis (TB), while expression of Suppressor of Cytokine Signaling (SOCS) molecules – 1 and 3 and CD4⁺CD25⁺FoxP3⁺T regulatory cells is increased. Here we investigated the association of these molecules in regard to clinical severity of TB.

Methods

Peripheral blood mononuclear cells (PBMCs) were isolated from patients with pulmonary TB (PTB, n = 33), extra-pulmonary TB (ETB, n = 33) and healthy endemic controls (EC, n = 15). Cases were classified …

Missing The Boat: Odds For The Patients Who Leave Ed Without Being Seen, Jabeen Fayyaz, Munawar Khursheed, Mohammed Umer Mir, Amber Mehmood

Department of Emergency Medicine

BACKGROUND:

A patient left without being seen is a well-recognized indicator of Emergency Department overcrowding. The aim of this study was to define the characteristics of LWBS patients, their rates and associated factors from a tertiary care hospital of Pakistan.

METHODS:

A retrospective patient record review was undertaken. All patients presenting to the Aga Khan University Hospital, Karachi, between April and December of the year 2010, were included in the study. Information was collected on age, sex, presenting complaints, ED capacity, month, time, shift, day of the week, and waiting times in the ED. A basic descriptive analysis was made …