Medical Specialties Commons^™

Prevalences Of Giardia Lamblia And Cryptosporidium Parvum Infection In Adults Presenting With Chronic Diarrhoea, Javed Yakoob, Zaigham Abbas, M. Asim Beg, Shagufta Naz, Rustam Khan, Muhammad Islam, Wasim Jafri

Section of Gastroenterology

iardia lamblia and Cryptosporidium parvum are both waterborne pathogens associated with diarrhoea in developing countries. In a recent study based at the Aga Khan University in Karachi, 334 adults aged 16–83 years (178 patients with chronic diarrhoea and 156 diarrhoea-free volunteers who acted as controls) were checked for infection with these parasites, using stool microscopy and/or PCR. Overall, 21 (6.3%) and 29 (8.7%) of the subjects were found positive for G. lamblia by microscopy and PCR, respectively, while the corresponding values for C. parvum were 13 (3.9%) and 14 (4.2%). Although, compared with the diarrhoea-free controls, the patients with diarrhoea …

Percutaneous Cholecystostomy (Pc) In The Management Of Acute Cholecystitis In High Risk Patients, Shaista Afzal Saeed, Imrana Masroor

Department of Radiology

OBJECTIVE: To determine the role of ultrasound-guided percutaneous cholecystostomy (PC) regarding complications and outcome in the management of acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management.

STUDY DESIGN: Observational case series.

PLACE AND DURATION OF STUDY: The study was carried out at The Aga Khan University Hospital, Karachi, from January 2003 to December 2007.

METHODOLOGY: The study included patients admitted with acute cholecystitis considered unfit for immediate surgery but not responding to conservative management. Percutaneous cholecystostomy was conducted under ultrasound guidance. The studied variables included patients' demographics, co-morbid, ultrasound findings of biliary …

Imminent Epidemic Of Diabetes Mellitus In Pakistan: Issues And Challenges For Health Care Providers, Waris Qidwai, Tabinda Ashfaq

Department of Family Medicine

No abstract provided.

Pattern Of Drugs Of Abuse Identified In Chemical Samples, Farhan Javed Dar, Aysha Habib Khan, Imran Siddiqui, Farooq Ghani

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the pattern of drugs of abuse in urine and blood samples processed at referral laboratory in Pakistan so that information on the type of drugs used can be identified and used for ready reference for future strategy. Study Design: Observational study.

PLACE AND DURATION OF STUDY: Clinical Laboratory of The Aga Khan University Hospital, Karachi, from July 2006 to March 2008. Methodology: Retrospective review of records were done for the common drugs that are used for screening at the Clinical Laboratory include alcohol, amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine and opiates. Alcohol was tested in blood and others …

Inducible Clindamycin Resistance Due To Expression Of Erm Genes In Staphylococcus Aureus: Report From A Tertiary Care Hospital Karachi, Pakistan, Naima Fasih, Seema Irfan, Afia Zafar, Erum Khan, Rumina Hasan

Department of Pathology and Laboratory Medicine

OBJECTIVE: To assess the frequency of phenotypic expression of inducible resistance of clindamycin due to expression of erm genes, in clinical isolates of Staphylococcus aureus (S. aureus), by double disk diffusion test (D-test).

METHOD: This was a cross sectional study conducted in the clinical laboratory of Aga Khan University Hospital, Karachi. A total of 2432, non duplicate clinical isolates of S. aureus, consisting of 1562 methicillin sensitive S. aureus (MSSA) and 870 methicillin resistant S. aureus (MRSA), were selected from February 2007 to January 2008. One hundred and thirty eight isolates of S. aureus were selected based on discordant resistance …

Examining The "Urban Advantage" In Maternal Health Care In Developing Countries, Zoe¨ Matthews, Amos Channon, Nyovani Madise, William Stones

Obstetrics and Gynaecology, East Africa

Although recent survey data make it possible to examine inequalities in maternal and newborn health care in developing countries, analyses have not tended to take into consideration the special nature of urban poverty.

Using improved methods to measure urban poverty in 30 countries, we found substantial inequalities in maternal and newborn health, and in access to health care.

The ‘‘urban advantage’’ is, for some, non-existent. The urban poor do not necessarily have better access to services than the rural poor, despite their proximity to services.

There are two main patterns of urban inequality in developing countries: (1) massive exclusion, in …

Traumatic Dural Venous Sinus Thrombosis In High-Risk Acute Blunt Head Trauma Patients, W. Akhtar

Department of Radiology

No abstract provided.

What Is The Best Antiplatelet Agent For Prevention Of Recurrent Stroke In Pakistani Patients? Do Combinations Offer Significant Advantages In The South Asian Context?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Contrast-Induced Nephropathy In Patients Undergoing Percutaneous Coronary Intervention, Sajid H. Dhakam, Saqib A Gowani, Asif Jafferani, Sajid H Dhakam

Department of Medicine

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose Patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk Patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been …

Acute Lymphoblastic Leukemia Subsequent To Temozolomide Use In A 26-Year-Old Man: A Case Report., Asim Jamal Shaikh, Nehal Masood

Section of Haematology/Oncology

Introduction: We report the development of acute lymphoblastic leukemia in a Patient in whom temozolomide was used for the treatment of a brain tumor. Unlike that of other alkylating agents, the leukemogenic potential of temozolomide is considered to be very low, and very rarely are such cases reported. Case Presentation: A 26-year-old Pakistani man who was treated for glioblastoma with temozolomide in an adjuvant setting was diagnosed to have acute lymphoblastic leukemia one year after stopping temozolomide. Conclusion: Temozolomide is a highly active agent, used in the management of high-grade brain neoplasms. The agent is generally regarded to be safe, …

Prevalence Of Urinary Tract Infections In Febrile Children And Role Of Urine Interleukins In Diagnosis, Anne J. Rerimoi

Master of Medicine in Paediatrics and Child Health

Background: Urinary tract infections (UTI) are common in the paediatric age group and can contribute to permanent renal damage. Urine culture takes a minimum of 48 hours, thus delaying treatment in suspect cases. It is also expensive and requires training of laboratory technologists. Early diagnosis is important in prevention of serious sequelae such as hypertension and end stage renal disease. Determination of burden of the problem within a population allows appropriate allocation of diagnostic and management resources. Urine interleukins are postulated to be useful adjuncts in diagnosis of UTI. Objectives: The primary objective was to determine the prevalence of UTI …

Losartan Associated Anaphylaxis And Angioneurotic Oedema, Syed Faraz Kazim, Muhammad Shahid

Section of General Surgery

A case of anaphylaxis and angioedema induced by angiotensin II receptor blocker (ARB), losartan is reported. A 37 years old hypertensive female presented to the Emergency Department with swelling over the face especially the lips, urticarial rash all over the body, and dyspnoea within an hour of losartan administration. She did not have any previous history of drug allergies. The patient was managed with epinephrine. Although angioneurotic oedema and anaphylaxis are well documented adverse effects of angiotensin converting enzyme (ACE) inhibitors, very few cases of these adverse reactions with ARBs have been reported in medical literature.

Pediatric Disease Burden And Vaccination Recommendations: Understanding Local Differences, Angela Gentile, Zulfiqar Ahmed Bhutta, Lulu Bravo, Aly Gamal Samy, R. Dennis J. Garcia, Anwar Hoosen, Tazul Islam, Abdollah Karimi, Mona Salem, Sriluck Simasathien, Amir Sohail, Veerachai Watanaveeradej, Karin Wiedenmayer, Heinz-J. Schmitt

Woman and Child Health

Background:Diphtheria (D), tetanus (T), pertussis (P), hepatitis B (HepB), invasive Haemophilus influenzae type b (Hib) disease, and measles cause substantial global morbidity and mortality.
Methods: This unique review highlights geographic differences in disease burden across certain countries in the African, Americas, Mediterranean, South-East Asian, and Western Pacific World Health Organization (WHO) regions, and relates this to vaccination coverage and local vaccine recommendations using the authors' countries as illustrations.
Results: Substantial differences were observed in the incidence of these diseases and in vaccination coverage between the countries studied. Disease incidence often reflected inadequate surveillance, but also variable or poor vaccination …

Treatment Of Intracranial Aneurysms Using Detachable Coils; Initial Results At A University Hospital In Pakistan, Rana Shoaib Hamid, Tanveer-Ul-Haq, Ishtiaq Chishti, Muhammad Azeemuddin, Zafar Sajjad, Basit Salam

Department of Radiology

OBJECTIVE: To evaluate the technical success, safety and outcome of endovascular coiling procedure in intracranial aneurysms.

METHODS: From April 2003 to April 2009, 43 patients (23 males and 20 females), age range 11 to 70 years, mean age 46.67 +/- 11.57 years were treated for intracranial aneurysms by detachable coil deployment at Radiology Department of Aga Khan University Hospital. Aneurysm rupture with subarachnoid haemorrhage was the cause of presentation in 39 patients while 4 patients were diagnosed with un-ruptured aneurysms. At time of presentation, grading of subarachnoid haemorrhage was done according to Hunt and Hess grading system. Eleven patients presented …

Cystic Artery Pseudo-Aneurysm: A Complication Of Xanthogranulomatous Cholecystitis, I. Ahmed, U. H. Tanveer, Z. Sajjad, B. Munazza, U. D. Azeem

Department of Radiology

A 54-year-old man presented for radiology with pain and a feeling of fullness in the upper abdomen and an epigastric mass. Ultrasound revealed a large cystic mass with internal echoes, lying posterior and inferior to left lobe of the liver. The gallbladder was thick-walled and contracted, and contained a calculus and echogenic sludge. A cystic structure that produced swirling flow signals on colour Doppler was demonstrated within the gallbladder. The CT scan showed a thickened gallbladder with adjacent inflammation and a 2-cm pseudo-aneurysm in its wall. High-density material was present in the gallbladder lumen, in the extra-hepatic bile ducts and …

Childhood Injuries In Pakistan: Results From Two Communities, Seema Zainulabdin Lasi, Ghazala Rafique, Habib Peermohammad

Human Development Programme

The study aimed at determining the incidence, nature, and extent of childhood injuries in two suburban and rural communities of Pakistan. The findings of the study are based on a cross-sectional survey of 2,292 children aged 1-8 years. Information was sought retrospectively from the primary caregiver on the occurrence of injury that required formal or informal medical consultation during the past three months. The incidence rate of non-fatal injuries that required care outside home for children aged 1-8 years was 19.7 injuries per 100 person (child)-years of exposure [95% confidence interval (CI) 16.41-23.51]: 26.5 injuries per 100 person (child)-years of …

Precipitating Factors And The Outcome Of Hepatic Encephalopathy In Liver Cirrhosis, Khalid Mumtaz, Umair Syed Ahmed, Shahab Abid, Noshaba Baig, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Objective: To determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality.

Study Design: Cross-sectional, analytical study. Place and Duration of Study: The Aga Khan University Hospital, from January 2005 to December 2007.

Methodology: Consecutive patients admitted with different grades of HE were evaluated between January 2005 and December 2007. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p < 0.05.

Results: Of the 404 patients 252 (62%) …

Quebec Platelet Disorder, Anwar Hussain Abbasi, Quratulain Shaikh, Syed Ather Hussain

Department of Pathology and Laboratory Medicine

A case of Quebec platelet disorder is hereby reported. A 33 years old woman presented with history of epistaxis and gum bleeding since childhood and menorrhagia and bleeding per vaginum after puberty, also had history of excessive blood loss after birth of child. Her coagulation profile was normal but platelet function testing by platelet aggregation assay showed abnormal aggregation of platelet with epinephrine. This type of response is seen in "Quebec platelet disorder" which is a rare autosomal dominant disorder of platelet function characterized by increased bleeding after any injury or trauma.

Trends In Undergraduate Teaching Of Parasitology In Medical Schools Of Pakistan, Vikram Mehraj, Taimur Saleem, Saima Lalani, Nadia Sani, Imran Khan, Fatima Afridi, Hina Irfan, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

OBJECTIVE: Parasitic diseases are a major public health problem in the tropical and sub tropical countries including the subcontinent region. We aimed to assess methods of Parasitology education in medical schools of Karachi Pakistan.

METHODS: Ten medical schools in Karachi, Pakistan were sent a structured questionnaire collecting information on different aspects of Parasitology education. The collected data was analyzed using SPSS version 14.0.

RESULTS: The response rate of this study was 90%. Majority of the schools in Karachi, Pakistan (78%) taught Parasitology concurrently with Microbiology, Pathology, Pharmacology and Forensic medicine in third and fourth year of undergraduate training. More than …

Comparison Of Three Mixed Dentition Analysis Methods In Orthodontic Patients At Akuh, Sarwat Memon, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare the actual sum of canine and premolars and that predicted from three mixed dentition prediction methods in orthodontic patients at the Aga Khan University Hospital (AKUH), Karachi.

STUDY DESIGN: Cross-sectional comparative study.

PLACE AND DURATION OF STUDY: Orthodontic clinic at the Aga Khan University Hospital from June 2002 to December 2007.

METHODOLOGY: Data were collected using pretreatment records including orthodontic files and plaster casts of 121 orthodontic patients. Digital caliper was used to measure the mesiodistal widths of permanent teeth from 1st molar to 1st molar in mandibular arch, and central incisors and 1st molars in maxillary …

Single Lung Ventilation In A Young Child For Repair Of Coarctation Of Aorta, Mohammad Hamid, Mansoor Ahmed Khan, Muneer Amanullah

Department of Anaesthesia

Single lung ventilation in small children is extremely challenging. In this case, a paediatric bronchial blocker was successfully inserted in a 19-month-old child to provide single lung ventilation using a modified insertion technique. It provided excellent working conditions during thoracotomy and our method of insertion may help in reducing the cost.

The Challenge Of Head & Neck Squamous Cell Carcinoma Control In Pakistan, Syed Mohammad Asad Zaidi, Nauman Fazal Manzoor, Shabbir Akhtar

Section of Otolaryngology, Head & Neck Surgery

No abstract provided.

Blastocystis Hominis And Dientamoeba Fragilis In Patients Fulfilling Irritable Bowel Syndrome Criteria., Javed Yakoob, Wasim Jafri, Mohammad Asim Beg,, Z Abbas, Shagufta Naz,, Muhammad Islam, Rustam Khan

Section of Gastroenterology

Studies have suggested a possible role for Blastocystis hominis and Dientamoeba fragilis in the etiology of irritable bowel syndrome (IBS). We studied the prevalence of B. hominis and D. fragilis in patients with IBS-diarrhea (IBS-D). Three hundred and thirty patients were enrolled, 171 (52%) with IBS-D and 159 (48%) were controls, respectively. Stool microscopy, culture, and polymerase chain reaction (PCR) for B. hominis and D. fragilis were done. B. hominis was positive by stool microscopy in 49% (83/171) of IBS compared to 24% (27/159) in control (p < 0.001). B. hominis culture was positive in 53% (90/171) in IBS compared to 16% (25/159) in control (p < 0.001). B. hominis PCR was positive in 44% (75/171) in IBS compared to 21% (33/159) in control (p < 0.001). D. fragilis microscopy was positive in 3.5% (6/171) in IBS-D compared to 0.6% (1/159) in control (p = 0.123). D. fragilis culture was positive in 4% (7/171) in IBS compared to 1.3% (2/159) in control (p = 0.176). D. fragilis PCR was positive in 4% (6/171) in IBS-D compared to 0% (0/159) in control (p = 0.030). B. hominis is common, while D. fragilis was less prevalent in our patients with IBS-D. B. hominis and D. fragilis culture had a better yield compared to stool microscopy and PCR.

How Should Physicians Practically Approach Symptomatic And Asymptomatic Carotid Stenosis?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

How Should Physicians Practically Approach Symptomatic And Asymptomatic Carotid Stenosis?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Immunophenotypic Profile Of Acute Leukemias At Agakhan University Hospital, Nairobi, Beatrice M. Kabera

Master of Medicine in Clinical Pathology

Background: Reliable distinction between AML and ALL is important for the selection of appropriate therapy. The final diagnosis of acute leukemia should be based on clinico-pathological, morphological, cytochemical and molecular cytogenetics data, together with immunophenotypic information. Flow cytometry has become the preferred method for the lineage assignment and maturational analysis of malignant cells in acute leukemias. Immunophenotyping has also allowed the detection of aberrant antigen co expression and the analysis of heterogeneity and clonality of malignant cells in acute leukemias. It is insufficient to merely make a diagnosis of acute leukemia, or even AML or ALL. Further classification is essential …

The Efficacy Of Intravenous Hyoscine-N-Butylbromide (Buscopan®) For The Acceleration Of Labour In First Time Parturients: A Randomised, Double-Blind, Placebo-Controlled Trial, Mukaindo A. Mwaniki

Master of Medicine in Obstetrics and Gynecology

Objective: to establish the safety and efficacy of hyoscine-N-butylbromide (Buscopan®) in accelerating labour in first time parturients. Design: a randomised, double-blinded, placebo-controlled clinical trial. Setting: the antenatal clinic and maternity unit of the Aga Khan University Hospital Nairobi, Kenya. Population: first time parturients in spontaneous labour at term. Methods: women were randomised to receive 40mg of hyoscine-N-butylbromide or sterile water for injection intravenously once they were confirmed to be in active labour. The dose could be repeated once after four hours. Outcome measures: the main outcome measure was the duration of labour from diagnosis of active stage to delivery. Secondary …

Peripheral Arterial Disease In Hiv Positive And Negative Subjects At The Aga Khan University Hospital, Nairobi, Farida Kaittany

Master of Medicine in Internal Medicine

Aim: To determine the prevalence of peripheral arterial disease (PAD) amongst HIV positive patients and HIV negative subjects and associated risk factors at Aga Khan Hospital Nairobi Design: Cross-sectional descriptive study Patients and Setting: A group of 125 HIV positive and 120 HIV negative subjects aged between 40 – 70 years were included in the study. HIV negative subjects were sampled from HIV positive patients attending the HIV outpatient clinic while HIV negative subjects were sampled from blood donor unit at theAga KhanUniversityHospital. Methodology: Two separate convenient samples were selected for the study. The first sample was a group of …

Detection Of Extended Spectrum Beta Lactamases Genotypes And Their Association With Cephalosporin Susceptibility In Community Acquired Enterobacteriaceae Infections, Daniel W. Maina

Master of Medicine in Clinical Pathology

Background: Infections caused by Extended Spectrum Beta-Lactamases (ESBLs) producing enterobacteriaceae have become a global problem. Initially confined to the hospital set-up, they are increasingly being reported in the community. These infections are often resistant to a wide variety of B- lactams including extended spectrum cephalosporins, with clinical and epidemiological implications for healthcare systems and necessitate surveillance measures based on local data. Local information on the genotypes of ESBLs and their association with cephalosporin resistance in community acquired ESBL-producing Enterobacteriaceae isolates is scanty, hence the need for this study. Aim: To detect ESBLs genotypes and correlate these with susceptibility to cephalosporins …

Lung Carcinoma: Its Profile And Changing Trends, Saad Siddiqui, Mohammed Usman Ali, Mahrukh Ayesha Ali, Noreen Shah, Shagufta Nasreen

Section of Pulmonary & Critical Care

BACKGROUND: Lung Carcinoma is the leading causes of morbidity and mortality worldwide with an incidence of 1.3 million cases per year. This study was undertaken to determine prevalence of various histological types of lung carcinoma and to analyse their changing trends with time.

METHODS: This is a retrospective analytical study. A total of 330 cases of lung carcinoma were analysed from 2003 to 2008. Cases from Khyber Pakhtunkhwa and Federally Administered Tribal Area (FATA) were included in this study. Furthermore, only cases of lung carcinoma were considered while other malignancies were excluded.

RESULTS: Squamous Cell carcinoma was found in 42.7% …