Medical Specialties Commons^™

Magnetic Resonance Imaging Findings In Patients With Schizophrenia, Waseem Akhtar, Haider A Naqvi, Sajjad Hussain, Arif Ali, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging (MRI).

STUDY DESIGN: Comparative study.

PLACE AND DURATION OF STUDY: The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008.

METHODOLOGY: Thirty-three cases of schizophrenia (n=33) and thirty-three age-matched controls, (n=33) were enrolled for this study. Screening Magnetic Resonance Imaging (MRI) of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p < 0.05.

RESULTS: Among the total of 66 (n=66) …

Qrs Duration And Echocardiographic Evidence Of Left Ventricular Dyssynchrony In Patients With Left Ventricular Systolic Dysfunction, Hafeez Ahmed, Javed Tai, Sohail Abrar Khan, Muniza Yousuf

Department of Medicine

Objective: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.
Study Design: A cross-sectional study.
Place and Duration of Study: The Aga Khan University, Karachi, from June to September 2007.
Methodology: All patients with LVEF < 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer’s exact test was used to determine the association between QRS duration and left ventricular dyssynchrony.
Results: A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference …

Differences In Reporting Of Violence And Deliberate Self Harm Related Injuries To Health And Police Authorities, Rawalpindi, Pakistan, Umar Farooq, Mudassir Majeed, Junaid Ahmad Bhatti, Jahangir Sarwar Khan, Junaid Razzak, Muhammad Mussadiq Khan

Department of Emergency Medicine

Background:

The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan.

Methods/Principal Findings:

Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital's ED, or both in Rawalpindi city from July 1, 2007 to June 30, …

Evaluation Of Solid Breast Masses Using Sonographic Acr Bi-Rads Lexicon Descriptors, Brian N. Bwombuna

Master of Medicine in Imaging and Diagnostic Radiology

Purpose of the study: To which of the ACR sonographic BIRADS lexicon descriptors can be used reliably to differentiate benign from malignant solid breast masses. Objectives: 1.Main Objective: To determine the association of sonographic ACR BI-RADS descriptors and solid breast masses 2. Specific Objective: To determine the predictive probabilities of sonographic BI-RADS lexicon descriptors Methodology: This was a 15 months prospective cross sectional study in which 125 consecutive patients who met the inclusion criteria were enrolled. The study was carried out at theAga KhanUniversity hospitalradiology department between October 2008 and December 2009 inclusive. The scans were performed in ourradiology department …

International Migration Of Doctors, And Its Impact On Availability Of Psychiatrists In Low And Middle Income Countries, Rachel Jenkins, Robert Kydd, Paul Mullen, Kenneth Thomson, James Sculley, Susan Kuper, Joanna Carroll, Oye Gureje, Simon Hatcher, Sharon Brownie, Christopher Carroll, Sheila Hollins, Mai Luen Wong

School of Nursing & Midwifery, East Africa

Background: Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration.

Methods: In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries.

Findings: We document large numbers of psychiatrists currently …

Antibiotics In Acute Necrotizing Pancreatitis: Perspective Of A Developing Country, Afrasyab Khan, Sadaf Khan

Section of General Surgery

Prophylactic antibiotics in acute necrotizing pancreatitis is controversial. The mortality of acute necrotizing pancreatitis is 8-25% in the western world. In view of the limited resources available for managing the complications of infected pancreatitis in developing countries, the use of prophylactic antibiotics may be recommended in selected cases.
Various antibiotics show good penetration into the pancreatic tissue; imipenem and quinolones have better penetration. Clinical trials on the use of prophylactic antibiotics in necrotizing pancreatitis have been reviewed.
Prophylactic antibiotics have been considered if greater than 30% pancreatic necrosis as documented by CT scan. Imipenem can be given for a duration …

Emergency Evaluation Of Acute Chest Pain, Aysha Almas, Om Parkash, Aamir Hameed, Muhammad Islam

Section of Cardiology

OBJECTIVE: To determine the sensitivity and specificity of initial clinical assessment about the diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain by a cardiology resident in the emergency room and assess the 30-day outcome of patients with ACS and non ACS.

STUDY DESIGN: Cohort study.

PLACE AND DURATION OF STUDY: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.

METHODOLOGY: A total of 202 patients, who presented to the emergency room with chest pain, were given an initial ECG and troponin check. Patients were assigned …

Acute Necrotizing Encephalopathy Of Childhood: A Fatal Complication Of Swine Flu, Muhammad Rehan Khan, Prem Kumar Maheshwari, Syed Asad Ali, Anwarul Haque

Department of Paediatrics and Child Health

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition characterized by the presence of multifocal symmetrical brain lesions involving mainly thalami, brainstem, cerebellum and white matter. ANEC is a serious and life threatening complication of simple viral infections. We present a case of a young child who developed this condition with classical clinical and radiological findings consistent with ANEC, secondary to swine flu (H1N1). He needed ventilatory support and had profound motor and intellectual deficit on discharge. We report this case with aim of raising awareness about this fatal complication of swine flu which has become a global health …

Irritable Bowel Syndrome: Is It Associated With Genotypes Of Blastocystis Hominis., Javed Yakoob, Wasim Jafri, Mohammad Asim Beg, Z Abbas, Shagufta Naz, Muhammad Islam, Rustam Khan

Section of Gastroenterology

Blastocystis hominis is the most common intestinal parasite in humans. An extensive genetic variability has been described recently in B. hominis isolates. The aim of this study was to analyze genotypes of B. hominis isolates obtained from the healthy individuals and patients with irritable bowel syndrome-diarrhea (IBS-D). The patients with IBS-D were enrolled from gastroenterology outpatient department at the Aga Khan University Hospital. History and physical examination was done. Stool microscopy, culture, and polymerase chain reaction for B. hominis genotyping were carried out. The study included 158 patients with IBS-D, mean age 41 +/- 15, age range 16-83 years, and …

Factor Vii Deficiency And Pregnancy: A Case Report And Review Of Literature, Syed Mohammad Asad Zaidi, Rahat Qureshi, Salman Naseem Adil

Department of Obstetrics & Gynaecology

Factor VII deficiency is one of the 'rare inherited disorders of coagulation.' Few cases of Factor VII deficiency have been reported during pregnancy, a state which could potentially cause fatal haemorrhage. Here we report a case of a pregnant lady with a history of heavy menorrhagia and multiple first pregnancy failures. Delivery was carried out via Caesarean section due to non-reassuring foetal heart monitoring. Patient was treated with Fresh Frozen Plasma (FFPs) and Factor VII concentrates, however, the patient developed bleeding postoperatively. Literature indicates that whilst Factor VII levels rise during pregnancy in normal women, no increase is seen in …

Ganglionic Plexus Ablation During Pulmonary Vein Isolation--Predisposing To Ventricular Arrhythmias?, Faizel Osman, Suman Kundu, Jiun Tuan, Jeilan Mohamed, Peter J. Stafford, G. Andre' Ng

Internal Medicine, East Africa

Catheter ablation is increasingly used to treat patients with atrial fibrillation (AF). Ablation of ganglionic plexi is often performed to reduce vagal innervation and has been shown to confer a better long-term outcome in terms of AF recurrence. We report a case of a patient having AF ablation with a profound vagal response, suggesting ganglionic plexus ablation, who subsequently developed ventricular fibrillation after programmed ventricular stimulation. Reduced vagal modulation is known to predispose to ventricular arrhythmias and vagal denervation following AF ablation may predispose to ventricular arrhythmias and requires further study.

Factors Associated With Recurrent Nasal Polyps: A Tertiary Care Experience, Shabbir Akhtar, Mubasher Ikram, Iqbal Azam, Tariq Dahri

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To assess the factors associated with recurrence of nasal polyps in operated patients by endoscopic surgery.

METHODS: A retrospective study was conducted on 192 patients operated for nasal polyps in a hospital set-up between 2001 and 2007. The median follow-up period was 24 months (range 12 months to 60 months). Ten variables were analyzed to study their association with polyp recurrence namely; age, gender, history of purulent nasal discharge, facial pain, anosmia, post nasal dripping (PND), headache, nasal allergy, asthma and computed tomography (C.T) staging. Analysis of recurrences was accomplished using independent sample t-test, chi-square and Fishers exact test. …

Improving Schizophrenia Diagnosis Through Biomarkers: An Upcoming Prospect, Syed Mohammad Asad Zaidi, Abdul Latif Bikak, Rameez-Ul Hassan

Medical College Documents

No abstract provided.

Emergency Evaluation Of Acute Chest Pain., Aysha Almas, Om Parkash, Aamir Hameed, Muhammad Islam

Department of Medicine

Objective: To determine the sensitivity and specificity of initial clinical assessment about the diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain by a cardiology resident in the emergency room and assess the 30-day outcome of patients with ACS and non ACS.

Study Design: Cohort study.

Place and Duration of Study: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.

Methodology: A total of 202 patients, who presented to the emergency room with chest pain, were given an initial ECG and troponin check. Patients were assigned …

Efficacy And Safety Of Procedural Sedation And Analgesia By Paediatric Intensivist In Paediatric Oncology Unit, Anwarul Haque, Zahra Fadoo

Department of Paediatrics and Child Health

Children with cancer especially acute leukaemia undergo multiple painful procedures like bone marrow biopsy (BM) and lumber puncture (LP) for intrathecal chemotherapy during their first year of treatment. The purpose of this study is to report safety and efficacy of Procedural Sedation and Analgesia (PSA) by paediatric intensivist for oncology procedures in controlled setting in paediatric oncology unit. During 20 months, 124 children received PSA for 499 procedures. 324 LP alone, 175 BM alone and 40 combined LP and BM were done. The most common diagnosis was acute leukaemia and lymphoma. All procedures were in compliance with American Society of …

Analysis Of The Uk Recommendations On Obesity Based On A Proposed Implementation Framework, Amudha S. Poobalan, Lorna S. Aucott, Sheraz Ahmed, W. Cairns S. Smith

Department of Paediatrics and Child Health

Background: There is considerable expertise in the obesity field in identifying, appraising, and synthesising evidence to develop guidelines and recommendations for policy and practice. The recommendations, while based on evidence, are not formulated in a way that readily leads to implementation. This paper analyses the recent UK recommendations on obesity using a proposed implementation framework. Methods: Two bibliographic databases (Medline and Embase) and various health related and government websites were systematically searched for obesity recommendations published between 1996 and 2007. All the documents published on recommendations for either prevention or treatment of obesity in the UK were assessed. A proposed …

Clinical Profile And Treatment Of Infantile Spasms Using Vigabatrin And Acth - A Developing Country Perspective, S. H. Ibrahim, Shamshad Gulab, Sidra Ishaque, Taimur Saleem

Department of Paediatrics and Child Health

Background: Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of Patients with infantile spasms from Pakistan. Methods: All Patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned …

Incidence Of Post Dural Puncture Headache Following Caesarean Section Under Spinal Anaesthesia At The Aga Khan University Hospital, Nairobi, Edna Gisore, Vitalis Mung’Ayi, Sharif T.

Anaesthesiology, East Africa

Background: Post dural puncture headache can be a debilitating complication of subarachnoid anaesthesia for a new mother. Successful management of post dural puncture headache requires adherence to clear policies and protocols with close follow up of patients by an experienced obstetric anaesthetist.

Objectives: To examine the cumulative incidence and severity of post dural puncture headache in obstetric patients who consented for spinal anaesthesia for Caesarean section.

Design: Prospective cohort study.

Subjects: All women who underwent Caesarean sections under spinal anaesthesia and fulfilled the inclusion criteria.

Setting: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya.

Results: …

Intussusceptions In Adults: Clinical Features And Operative Procedures, Ziaur Rehman, Abdul Rehman Alvi, Salma Khan

Section of General Surgery

Objective: To determine the clinical presentation and treatment outcomes of adult patients with intussusceptions.
Study Design: Case series.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 1988 to December 2008.
Methodology: Medical records of patients with diagnosis of intussusceptions in adults (above 15 years of age) from January 1988 to December 2008 were retrieved through ICD 9 coding system. Patients with complete records were included in the study and those with incomplete medical record or under 30 days follow-up were excluded. Data was analyzed on SPSS version 16. The treatment outcomes were hospital stay, 30 …

Hepatic Vein And Inferior Vena Caval Thrombus Extending Into The Right Atrium: A Rare Complication Of Amoebic Liver Abscess, Ziaur Rehman, Abdul Rehman Alvi, Shahida Bibi

Section of General Surgery

Amoebic liver abscess is an endemic in developing countries but few cases of associated vascular complications have been reported. The authors report a very rare vascular complication of hepatic veins and inferior vena caval (IVC) thrombosis extending into the right atrium in a young male with large amoebic liver abscess. Optimal result was achieved with early diagnosis on CT scan, percutaneous drainage of abscess, intravenous metronidazole, peri-operative anticoagulation, sternotomy and thrombectomy.

Prevalence Of Hepatitis B And C Viral Infections In Pakistan: Findings Of A National Survey Appealing For Effective Prevention And Control Measures, H Qureshi, K M. Bile, Rashid Jooma, S E. Alam, H U R. Afridi

Section of Neurosurgery

A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease (CLD). There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, …

The Global Pediatrician: Is There Such A Person, Or Can There Be?, Robert Armstrong

Paediatrics and Child Health, East Africa

As pediatricians, our concern for the health of children and youth starts with our individual encounters with patients and their families and extends to the community in which they live and the broader systems of society that influence their health. This concept of a pediatrician is captured in one of the “bibles” of our profession and in the words of Richard Behrman when he defines pediatrics as being “concerned with the health of infants, children, and adolescents, their growth and development, and their opportunity to achieve full potential as adults.”¹ Health, growth and development, and opportunity as adults encompass …

Predictors Of Emotional Problems And Physical Aggression Among Children Of Hong Kong Chinese, Mainland Chinese And Filipino Immigrants To Canada, Morton Beiser, Hayley Hamilton, Joanna Anneke Rummens, Jacqueline Oxman-Martinez, Linda Ogilvie, Chuck Humphrey, Robert Armstrong

Paediatrics and Child Health, East Africa

Background and study aims: Data from the New Canadian Children and Youth Study (NCCYS), a national study of immigrant children and youth in Canada, are used to examine the mental health salience of putatively universal determinants, as well as of immigration-specific factors. Universal factors (UF) include age, gender, family and neighbourhood characteristics. Migration-specific (MS) factors include ethnic background, acculturative stress, prejudice, and the impact of region of resettlement within Canada.

Methods: In a sample of children from Hong Kong, the Philippines and Mainland China, the study examined the determinants of emotional problems (EP), and physical aggression (PA). A two-step regression …

Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome In A Pakistani Pedigree, Tanveer Anjum Chaudhry, Mirza Umair Khalid, Taimur Saleem, Khabir Ahmad

Section of Ophthalmology

Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare developmental ocular disorder. We report this condition affecting 4 members of a Pakistani family across three generations. A 2-year-old girl was brought to the clinic by her father for the correction of her shortened palpebral fissures. Examination findings were consistent with BPES. The girl's father, paternal grandfather and paternal aunt also had identical features. The distance between the medial canthi of the index case was 30 mm, and the lengths of vertical and horizontal palpebral fissure were 6 mm and 20 mm, respectively. BPES must be considered an important differential diagnosis in patients …

Overview Of Surgical Management Of Infectious Non-Suppurative Brain Lesions (Part 2), Muhammad Shahzad Shamim, Ather Enam, Syed Faizan Ali, Rushna Pervez Ali, Mohammad Wasay

Section of Neurosurgery

No abstract provided.

Essential Medicines Management During Emergencies In Pakistan, S. K. S. Bukhari, J.A.R. H. Qureshi, Rashid Jooma, K.M. Bile, G. N. Kazi, W. A. Zaibi, A. Zafar

Section of Neurosurgery

This paper illustrates the experiences of essential medicine management in providing cure and care to victims of Pakistan's 2005 earthquake in a safe, rational and effective mode. The health interventions assured access to essential medicine, sustained supply, inventory control through a computerized logistic support system and rational use of medicines. World Health Organization Pakistan outlined modalities for acceptance of donated medicines, assisted in speedy procurement of medicines and designed customized kits. Proper storage of medicines at controlled temperature was ensured in warehousing facilities in 12 locations. A steady supply of medicines and their consumption without stock-outs in the 56 first-level …

Knowledge Attitude And Practices Of Undergraduate Students Regarding First Aid Measures, Afrasyab Khan, Sumaira Shaikh, Fawad Shuaib, Ahsan Sattar, Saira Aziz Samani, Quratulain Shabbir, Ameer Zaighum Rasheed

Department of Emergency Medicine

OBJECTIVES: To assess knowledge, attitude and practices of first aid measures in undergraduate students of Karachi.

METHODS: A cross-sectional study was carried out at six colleges of Karachi, three of which were medical colleges and three non-medical colleges. Knowledge was assessed regarding various emergency situations with the help of a questionnaire. The target population size was 460, based on 50% prevalence and 95% confidence interval. The eventual sample size achieved was 446.

RESULTS: A total of 446 students were interviewed. Seventy eight students (17.5%) had formal First Aid (FA) training. The mean number of correct answers of students with FA …

Hepatitis C In Pakistan - A Neglected Challenge, Waris Qidwai, Ammad Fahim, Shahan Waheed

Department of Family Medicine

No abstract provided.

Self-Examination For Breast And Testicular Cancers: A Community-Based Intervention Study., Khairunnisa Shallwani, Rozina Ramji, Tazeen S. Ali, Ali Khan Khuwaja

Department of Radiation Oncology

The prevalence of cancers is growing rapidly in all parts of the word and Pakistan is no exception. Prevention is the best option to tackle this rising epidemic and screening, early detection and health awareness programs are cornerstones in this regard. A community-based interventional study was therefore her conducted to assess the effect of health education intervention about knowledge and practice of self-breast examination (SBE) among women and self-testicular examination (STE) among men. A total of 127 (70 females and 57 males) adults (>or=18 years) from an urban community of Karachi, Pakistan were included after giving informed consent. Interventions …

Postmortem Computed Tomography For Diagnosis Of Cause Of Death In Male Prisoners, Saba Sohail, Farhat Hussain Mirza, Qamar Salam Khan

Department of Radiology

Objective: To determine the utility of postmortem CT (PMCT) examination in establishing the cause of death among male prisoners dying in Karachi jails.
Methods: A descriptive study was carried out from February 2006 to September 2007, CT Scan section, Civil Hospital Karachi and the Mortuary, Dow Medical College, Dow University of Health Sciences, Karachi. Adult male prisoners dying in the Karachi central prison and referred to the study setting for determining the cause of death for medico legal purpose were included. Female prisoners and those cases where the final report of cause of death was not available were excluded. CT …