Medical Specialties Commons^™

Zinc Supplementation For The Prevention Of Pneumonia In Children Aged 2 Months To 59 Months, Zohra S. Lassi, Batool A. Haider, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Pneumonia is a leading cause of morbidity and mortality in children younger than five years of age. Most deaths occur during infancy and in low-income countries. Daily regimens of zinc have been reported to prevent acute lower respiratory tract infection and reduce child mortality.
Objectives: To evaluate the effectiveness of zinc supplementation in the prevention of pneumonia in children aged two to 59 months.
Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to January Week 2, 2010), EMBASE …

Microdiscectomy For Lumbosacral Disc Herniation And Frequency Of Failed Disc Surgery, Muhammad Shahzad Shamim, Maria Adnan Parekh, Muhammad Ehsan Bari, Ather Enam, Faraz Khursheed

Section of Neurosurgery

Background: Microdiscectomy for lumbosacral disc herniations is one of the most commonly performed neurosurgical procedures. The Patient demographics, symptomatology, and recovery are highly variable, and surgical outcomes depend on several factors, including Patient demographics. Failed disc surgery refers to failure of improvement in Patient's symptoms following microdiscectomy, and has been observed to occur in up to 12% of Patients. To date, no study form Pakistan has looked into Patient demographics and failed disc surgery rates within the local context.
Objective:The aim of this study was to review the demographics of the Patient population presenting for surgical treatment of lumbosacral …

Biliary Stones: An Atypical Cause Of Abdominal Pain In Paediatric Age Group, Amber Mehmood, M. Arif Mateen Khan

Department of Emergency Medicine

OBJECTIVE: To identify Paediatric patients with biliary stone disease presenting to a tertiary care hospital in order to determine the etiology, presentation and management.

METHODS: Retrospective study of all cases of ultrasonographically proven biliary stones under the age of 15 years from January 1988 to December 2008. Data included their risk factors, complications, management and outcome.

RESULTS: Total 32 patients were identified with biliary stones, treated in the hospital. Mean age at presentation was 8.25 +/- 3.33 years. Sixteen patients underwent cholecystectomy.

CONCLUSION: Paediatric cholelithiasis is an atypical and under-diagnosed cause of abdominal pain in childhood. True prevalence of the …

Pemetrexed With Or Without Matuzumab As Second-Line Treatment For Patients With Stage Iiib/Iv Non-Small Cell Lung Cancer, Joan Schiller, Joachim Von Pawel, Philipp Schütt, Rafat Ansari, Michael Bijoy Thomas, Mansoor Saleh, Robert D. Mccroskey, Wolfgang Pfeife, Thomas Marsland, Goetz Kloecker

Haematology and Oncology, East Africa

Introduction: This randomized phase II study investigated pemetrexed in combination with the epidermal growth factor receptor (EGFR)-targeting monoclonal antibody matuzumab compared with pemetrexed alone as second-line therapy for patients with advanced non-small cell lung cancer.

Methods: Patients received pemetrexed 500 mg/m2 every 3 weeks either alone (n = 50) or in combination with matuzumab at either 800 mg weekly (n = 51) or 1600 mg every 3 weeks (n = 47). The primary end point was objective response, as assessed by an independent review committee.

Results: Tumor EGFR expression was detected in 87% of randomized patients. The objective response rate …

Ultrasonographic Diagnosis Of Placenta Accreta, Shaista Afza, Imrana Masroor, Gulnaz Shafqat

Department of Radiology

Placenta accreta is the abnormal adherence of placenta to myometrium due to defect in decidua basalis. This type of placenta could not remove manually after delivery and lead to severe hemorrhage that may result in emergency cesarean hysterectomy. Prenatal diagnosis of placenta accreta is important because it reduces the fetal and maternal morbidity and mortality as appropriate pre-operative and per operative procedures are possible. Grey scale ultrasonography along with color Doppler imaging proves to be the non invasive, real time, readily available modality with high sensitivity and high positive predictive value.

Evaluation Of Quality And Patient Satisfaction During Endoscopic Procedure: A Cross Sectional Study From South Asian Country, Shahid Rasool, Shahid Ahmed, Shaheer Siddiqui, Mohammad Salih, Wasim Jafri, Saeed Hamid

Section of Gastroenterology

OBJECTIVE: To assess the quality of gastrointestinal (GI) endoscopic procedures and patient satisfaction in endoscopy suite of South Asian country.

METHODS: Patients coming to the endoscopic suite of Aga Khan University Hospital (AKUH) were interviewed and assessed in this cross-sectional study. Quality of GI endoscopic procedures was evaluated using assessment tools as suggested by The American Society of Gastroenterology. Patient satisfaction after the procedure was assessed using a modified GHAA-9 questionnaire. The questionnaire was statistically evaluated using Pareto analysis and Spearman rank correlation.

RESULTS: In this study, 323 patients were evaluated with a mean age of 43 +/- 14.36 years. …

The Epidemiology Of Bacterial Vaginosis In Relation To Sexual Behaviour, Hans Verstraelen, Rita Verhelst, Mario Vaneechoutte, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic microorganisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.

Discussion: G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced …

Self-Glucose Monitoring And Glycaemic Control At A Tertiary Care University Hospital, Karachi, Pakistan, Khurshid Khowaja, Humaira Waheed

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To explore the association between Self Monitoring of Blood Glucose (SMBG) levels and improved glycemic control (HbA1c level) among type 2 diabetic patients, receiving oral hypoglycaemic agents and insulin, and to ascertain the factors influencing SMBG.

METHOD: Using Comparative cross sectional study design five hundred Type 2 diabetes patients through convenient sampling between 30-70 years were interviewed through a structured questionnaire in year 2006 and 2007 at AKUH Ambulatory setting. These 500 subjects were divided as 250 in case (doing SMBG) and 250 in control (not doing SMBG) groups.

RESULTS: We identified that HbA1c value was maintained at good …

Concomitant Gastric And Lung Uptake Of Tc-99m Mdp On Bone Scan In A Patient With Diffuse Large B-Cell Non-Hodgkin’S Lymphoma, Maseeh Uz Zaman, Riffat Hussain Riffat Hussain, Zafar Sajjad, Mansoor Naqvi Mansoor Naqvi, Khalil Khan, Gufran Khan, Zohra I Pirani

Department of Radiology

Extra osseous uptake of Tc-99m Methylene Di Phosphonate (MDP) is not an uncommon finding on skeletal scintigraphy. However, concomitant lung and gastric uptake is a rare presentation. We presented a case report of a young male whose bone scan revealed lung and stomach uptake with a cold lesion over T7 vertebra. CT guided biopsy revealed diffuse large B-cell Non-Hodgkin’s lymphoma. Lung and gastric uptake of Tc-99m MDP on bone scan guides the reporting physician about the soft tissue calcinosis due to hypercalcemia associated with either malignant or non-malignant conditions.

What Are The Current Therapeutic Options For Haemorrhagic Strokes?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

What Are The Current Therapeutic Options For Haemorrhagic Strokes?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Homozygous Frame Shift Mutation In Ecm1 Gene In Two Siblings With Lipoid Proteinosis., Azam J. Samdani, Abid Azhar, Syed M. Shahid, Syeda N. . Nawab, Rozeena Shaikh, Shah A. Qader, Qaisar Mansoor, Bahram K. Khoso, Muhammad Ismail

Department of Medicine

Background: The extracellular matrix protein 1 (ECM1) is a glycoprotein, expressed in skin and other tissues. Loss-of-function mutation in ECM1 causes a rare autosomal recessive disorder called lipoid proteinosis. Lipoid proteinosis is presented by varying degrees of skin scars, beaded papules along the eyelid margins, variable signs of hoarseness of voice and respiratory disorders. More than 250 cases of this disorder have been described in the literature, but occurrence of lipoid proteinosis in siblings is very rare. This study was designed to investigate the possible mutation causing lipoid proteinosis in a Pakistani family and to elaborate the scope of possible …

Controversies Of Treatment Modalities For Cerebral Venous Thrombosis, Maria Khan, Ayeesha Kamran Kamal, Mohammad Wasay

Department of Medicine

Cerebral vein thrombosis has been well recognized for nearly two centuries. However, therapeutic options for the condition are limited due to lack of large randomized trials. The various modalities reportedly used include antiplatelets, anticoagulation, fibrinolysis, and mechanical thrombectomy. Of these, antiplatelets are the least studied, and there are only anecdotal reports of aspirin use. Anticoagulation is the most widely used and accepted modality with favorable outcomes documented in two randomized controlled trials. Various fibrinolytic agents have also been tried. Local infusions have shown more promise compared to systemic agents. Similarly, mechanical thrombectomy has been used to augment the effects of …

Effect Of Zinc In Tablet And Suspension Formulations In The Treatment Of Acute Diarrhoea Among Young Children In An Emergency Setting Of Earthquake Affected Region Of Pakistan, Muhammad Atif Habib, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

A longitudinal cohort study was conducted at Camp Hospital Batagram in August 2006 to ascertain the effect of Zinc utilization in tablet and suspension formulations on the frequency and recovery rates of diarrhoea among young children in the emergency settings of earthquake affected region of Pakistan. Two hundred patients were recruited and followed up, the patients were allocated either of the 2 groups i.e. A (zinc in tablets form) and B (zinc in suspension form). Both groups also received WHO recommended treatment for diarrhoea. Most of the cases recovered from the illness within 3 days after presentation. Significant p-values were …

Evaluation Of Health Workforce Competence In Maternal And Neonatal Issues In Public Health Sector Of Pakistan: An Assessment Of Their Training Needs, Shabina Ariff, Sajid B. Soofi, Kamran Sadiq, Asher B. Feroze, Shuaib Khan, Sadiqua N. Jafarey, Nabeela Ali, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. Methods: …

Supernumerary, Ectopic Tooth In The Maxillary Antrum Presenting With Recurrent Haemoptysis., Taimur Saleem, Umair Khalid, Anam Hameed, Shehzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

Ectopic eruption of teeth in non-dental sites is a rare phenomenon and can present in a variety of ways such as chronic or recurrent sinusitis, sepsis, nasolacrimal duct obstruction, headaches, ostiomeatal complex disease and facial numbness. However, presentation of such Patients with recurrent haemoptysis has not been described in the literature so far. We have described a case of an ectopic, supernumerary molar tooth in the maxillary antrum in a Patient who initially presented with haemoptysis. A 45-year-old male presented with a 2-month history of episodic haemoptysis. A pedunculated growth from the inferior nasal turbinate was seen with fibre-optic visualization. …

Intracranial Cavernous Angiomas, Syed Faraz Kazim, Atta-Ul-Aleem Bhatti, Ather Enam

Section of Neurosurgery

Objective: To describe the clinical presentation, diagnosis, and management of patients presenting with intracranial cavernous angiomas (CAs) at a tertiary care hospital in Pakistan.
Study Design: Case series. Place and Duration of Study: Section of Neurosurgery, The Aga Khan University Hospital (AKUH), Karachi, from January 1990 to September 2008.
Methodology: A retrospective case note review of all patients diagnosed with intracranial CAs at AKUH during the study period. The studied variables included patient demographics, clinical presentation, family history of intracranial CAs or other space occupying lesions, modality of diagnosis, management, and outcome. Results were described as frequency percentages.
Results: During …

Cardiac Surgery In Octogenarians, Asmatullah Khan, Hassan Khan, Saulat H. Fatimi, Asadullah Khan

Section of Cardiothoracic Surgery

In Europe and North America, cardiac surgery can be done successfully on octogenarians, but differences in patient selection, surgical and bypass techniques prevent us from concluding similarly in Pakistan. This study investigated the short and long-term outcomes of cardiac surgery in octogenarians operated over a 5 years period at The Aga Khan University Hospital, from January 2001 to December 2006. Seventeen octogenarians, (mean age 81.7 ± 2.3) underwent coronary artery bypass graft (CABG). Thirty-days hospital mortality was reported in only 1 patient. Surgical complication of any kind was reported in 13 (76.5%) patients with pleural effusion being the commonest in …

Diffusion Weighted Mr Imaging (Dwi) And Adc Values In Endometrial Carcinoma, Imrana Masroor, Muhammad Zeeshan, Shaista Afzal, Nadeem Ahmad, Gulnaz Shafqat

Department of Radiology

Objective: To determine the sensitivity of MR imaging utilizing diffusion weighted imaging (DWI) in detection of endometrial cancer and to compare the Apparent Diffusion Coefficient (ADC) values of malignant and normal endometrium.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Radiology Department, Aga Khan University Hospital Karachi, from January 2007 to December 2009. Methodology: Patients were defined as undergoing MRI for suspected endometrial malignancy, and the controls were female subjects who underwent MRI examination for indications other than endometrial malignancy. Studied variables included the signal characteristics of the endometrium and ADC values. The sensitivity of DWI for the …

Rhnull: A Rare Blood Group Phenotype, Adnan Qureshi, Muhammad Salman, Bushra Moiz

Section of Internal Medicine

Rhnull phenotype is a rare blood group characterized by the lack of expression of all Rh antigens (D, C, c, E and e) on the red cells. The phenotype is further classified into the regulator and amorph type based on underlying genetic defect. The clinical significance of its recognition is that such patients suffer from Rhnull syndrome associated with osmotically fragile red cells called stomatocytes with subsequent chronic haemolytic anaemia of varying degree. Another importance is that such subjects readily form alloantibodies on exposure to Rh antigens. We report herein rare Rhaull phenotype in a young pregnant female which was …

Frequency And Characteristic Features Of Portal Hypertensive Gastropathy In Patients With Viral Cirrhosis., Shahid Ahmed, Khalid Mumtaz, Umair Syed Ahmed, Hasnain Ali Shah, Shahab Abid, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

To determine the frequency and specific characteristic features of portal hypertensive gastropathy (PHG) in cirrhosis due to viral etiology. Cross-sectional descriptive study. The Aga Khan University Hospital, Karachi, from June 2006 till June 2008. Patients with hepatitis B and C cirrhosis were included who underwent screening esophago-gastroduodenoscopy (EGD) for varices. Baveno III consensus statement was used for diagnosing PHG on endoscopy and divided them into two subgroups i.e. mild and severe. Data related to platelet/spleen ratio, MELD score and Child Turcotte Pugh (CTP) score indicating severity of cirrhosis were recorded in all patients. Findings were compared by using independent sample …

Grown Up Congenital Heart Disease Patient Presenting For Non Cardiac Surgery: Anaesthetic Implications, Mohammad Hamid, Mansoor Ahmed Khan, Mohammad Irfan Akhtar, Hameedullah, Saleemullah, Khalid Samad, Fazal Hameed Khan

Department of Anaesthesia

Congenital heart disease patients surviving to adulthood have increased over the years due to various reasons. These patients are admitted in the hospital for non cardiac surgeries and other procedures more often than normal adult population. Management of grown up congenital heart disease patient presents a challenge during perioperative period for cardiologists, surgeons, intensivists and particularly for the anaesthetist. Management issues include psychological and physiological impact on the patient, complexity of defects, presence of previous palliative procedure, impact of anaesthetic agents on shunting and myocardium, endocarditis prophylaxis and associated extra cardiac anamolies.

Is Manual Reticulocyte Count A Reliable Option For Under Resourced Countries, Afsheen Farzand Ali, Bushra Moiz, Sadia Omer

Department of Pathology and Laboratory Medicine

OBJECTIVES: To establish the credibility of manual reticulocyte counts without compromising the quality of care, and to evaluate the degree of acceptability of manual reticulocyte counts in terms of accuracy and cost effectiveness in comparison with two automated haematology analyzers.

METHODS: Visual reticulocyte enumeration was evaluated for comparability, within-batch precision and costing with respect to Coulter STKS and Gen S haematology analyzers.

RESULTS: The results of reticulocyte estimation for 80 samples as obtained by 3 modes were correlated using Pearson's correlation coefficient (r) which were computed as 0.884, 0.875, and 0.793 for manual-Gen.S, Gen.SSTKS and manual-STKS respectively thus showing positive …

Neonatal Mortality And Prevalence Of Practices For Newborn Care In A Squatter Settlement Of Karachi, Pakistan: A Cross-Sectional Study., Afsheen Ayaz, Sarah Saleem

Department of Pathology and Laboratory Medicine

Background: During the past two decades there has been a sustained decline in child and infant mortality, however neonatal mortality has remained relatively unchanged. Almost all neonatal deaths (99%) occur in developing countries, where the majority are delivered at homes. Evidence suggests that these deaths could be prevented by simple, inexpensive practices and interventions during the pregnancy, delivery and postnatal period. In Pakistan over the last decade extensive efforts have been made by the international donors and government to implement these practices. However, limited attempts have been made to explore if these efforts have made a difference at the grass …

Chronic Gastritis And Helicobacter Pylori: A Histopathological Study Of Gastric Mucosal Biopsies, Mohammad Yawar Yakoob, Akbar Shah Hussainy

Department of Pathology and Laboratory Medicine

The aim of this study was to observe the histological features of chronic gastritis and associated effects due to Helicobacter pylori infection in 176 randomly selected antral biopsy specimens of chronic gastritis cases. The specimens were reviewed for the presence or absence of H.pylori. The activity (neutrophilic infiltration) of gastritis and the presence or absence of mucosa-associated lymphoid tissue (MALT) were also noted. Chi-square test (Pearson value) was used to analyze categorical variables. H.pylori was detected in 110 (62.5%) cases of chronic gastritis. There was a significant association between H.pylori infection and activity of chronic gastritis (p=0.002). Lymphoid aggregates were …

Acute Administration Of Rt-Pa For Acute Stroke In Pakistani Patients--What Does The Available Evidence Teach Us?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Acute Administration Of Rt-Pa For Acute Stroke In Pakistani Patients--What Does The Available Evidence Teach Us?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Investment In Paediatric Tuberculosis Prevention In Pakistan: Loss Or Gain, Emad Uddin Siddiqui, Kiran Ejaz, Saira Lone, Syed Jamal Raza

Department of Paediatrics and Child Health

OBJECTIVE: To assess the effectiveness of paediatric tuberculosis prevention, by reevaluation factors in children exposed to tuberculosis from less privileged strata of Pakistan.

METHODS: This cross sectional descriptive study was conducted at National Institute of Child Health, from January 2004 to December 2005. Paediatric patients under 15 years of either gender, diagnosed with active tuberculosis were enrolled. Interviews were conducted with parents regarding common preventive measures and factors advocating tuberculosis spread. Later factors leading to non-compliance to safety recommendations were also evaluated.

RESULTS: Fifty five (70%) children younger than 5 years, had index cases in direct contact within their own …

Successful Management Of Invasive Aspergillosis With Voriconazole And Amphoteracin B Therapy In A Patient With Acute Mycloid Leukemia (Aml-M2), Nauman Fazal Manzoor, Sidra Azim, Zehra Fadoo

Department of Paediatrics and Child Health

An eleven-year-old boy presented with one month's history of fever and weight loss. He was diagnosed with Acute Mycloid Leukemia (AML-M2). During treatment he developed recurrent infections with neutropenia requiring prolonged antibiotics and subsequently developed invasive aspergillosis. He was treated with amphotericin B and Voriconazole. This case shows the efficacy and safety of combined antifungal therapy, including voriconazole, for invasive aspergillosis complicating AML.

Research-Retreat-Recovery: A Potential Model For Organization And Completion Of Research Projects. Experience From A Neurosurgery Department In A Developing Country, Saniya Siraj Godil, Syed Faraz Kazim, Muhammad Shahzad Shamim

Medical College Documents

Background: In the current era of biomedical research, it is imperative that every research study at an institution is properly organized, and frequently audited to streamline efforts and maintain standards. Recently, a research retreat was organized by the Section of Neurosurgery at Aga Khan University Hospital, Karachi, Pakistan, and following that a recovery team was made with the aim of recovering "lost in translation" research projects. In the realm of our experience, the current model is being proposed as a means for organization of departmental research.
Methods: The "research" component of the model comprised compilation of an abstract book of …