Medical Specialties Commons^™

Chinese Coal Mines--The Industrial Death Trap, Amber Mehmood

Department of Emergency Medicine

No abstract provided.

Staging Of Endometrial Carcinoma By Magnetic Resonance Imaging: Correlation With Surgery And Histopathology, Fatima Mubarak, Mirza Waseem Akhtar, Gul-E-Khanda, Yusuf A Husen

Department of Radiology

OBJECTIVE: To evaluate the accuracy of MRI in staging of endometrial carcinoma, and comparison with surgery and histopathological findings.

METHODS: A one year prospective cross-sectional study was conducted from 10/3/2005 to 31/5/2006, at the Radiology department, Aga Khan University Hospital (AKUH) Karachi. Fifty two patients with diagnosis of endometrial carcinoma, referred to radiology department for preoperative staging by MRI and had undergone surgery were included.

RESULTS: MRI was found to be 79% sensitive, 85% specific and 80% accurate for staging endometrial carcinoma while PPV and NPV were 97% and 66% respectively.

CONCLUSION: Magnetic resonance imaging is a good, safe, accurate …

Classic Virilizing Congenital Adrenal Hyperplasia Presenting Late: Case Series From Pakistan, Aysha Habib Khan, Muniba Aban, Rameez-Ul-Hassan, Naeem-Ul-Haq, Jamal Raza, Abdul Jabbar, Tariq Moatter

Department of Pathology and Laboratory Medicine

Deficiency of 21 hydroxylase enzyme deficiency (21OH) activity accounts for 90% cases of congenital adrenal hyperplasia (CAH). This results in deficient cortisol, increased ACTH, adrenal hyperplasia and increased adrenal androgen secretion. There is marked virilization in genetic females which is the hallmark of this disorder. Genetic heterogeneity in 21 OHD is well recognized, and both severe and mild forms occur. We present three cases of adult females with the disease from a larger study to establish genotype, phenotype correlation of Pakistani patients with congenital adrenal hyperplasia (CAH) and to highlight issues such as diagnostic delay, inappropriate gender assignment at birth, …

Congenital Cystic Adenomatoid Malformation: Case Report, K. C. Wafula, S. Waa

Imaging & Diagnostic Radiology, East Africa

Congenital cystic adenomatoid malformation of the lung is a rare lesion that typically manifests as severe progressive respiratory distress in the neonate secondary to expansion of the affected lung. We present a neonate in whom this condition was diagnosed and managed at the Aga Khan University Hospital. In presenting this patient, we hope to highlight the radiological aspects of this condition which, with prompt recognition and management and in the absence of pulmonary hypoplasia, foetal hydrops or other congenital anomalies, has a favourable prognosis.

Multicenter Randomized Phase Ii Study Of Weekly Or Twice-Weekly Bortezomib Plus Rituximab In Patients With Relapsed Or Refractory Follicular Or Marginal-Zone B-Cell Lymphoma, Sven De Vos, André Goy, Shaker R. Dakhil, Mansoor Saleh, Peter Mclaughlin, Robert Belt, Christopher R. Flowers, Mark Knapp, Lowell Hart, Dipti Patel-Donnelly

Haematology and Oncology, East Africa

Purpose: To determine overall response rate (ORR), time to progression (TTP), and duration of response (DOR) with twice-weekly/weekly bortezomib plus rituximab, and evaluate safety/tolerability, in patients with relapsed or refractory CD20+ follicular lymphoma (FL) or marginal-zone lymphoma.

Patients and Methods: Patients were randomly assigned (minimization method) to bortezomib 1.3 mg/m2 twice weekly (days 1, 4, 8, and 11; 21-day cycle, five cycles; arm A) or bortezomib 1.6 mg/m2 weekly (days 1, 8, 15, and 22; 35-day cycle, three cycles; arm B) plus rituximab 375 mg/m2 weekly for 4 weeks (both arms). Response/progression was determined by International Workshop Response Criteria using …

Esophageal Polypoidal Mass: Presentation Of An Uncommon Pleomorphic Carcinoma, Javed Yakoob, Z Abbas, Wasim Jafri, Najamul Sahar Azad

Section of Gastroenterology

Pleomorphic carcinomas are primary malignant tumours that are known to arise in the lungs, pancreas, gall bladder and intestine. A patient with polypoid tumour of the esophagus is described in this report. The patient presented with dysphagia. Diagnostic and therapeutic intervention required endoscopic evaluation and treatment. Benign esophageal tumours are rarely seen and originate from the upper third of esophagus. We observed an esophageal tumour which was interpreted as spindle cell carcinoma of the esophagus that caused obstruction. We present the clinical picture and histopathological findings of the tumour. To our knowledge this is the first local report of spindle …

Negative Predictive Value Of Mammography And Sonography In Mastalgia With Negative Physical Findings, Imrana Masroor, Shaista Afzal, Saima Sakhawat, Nadir Khan, Mirza Amanullah Beg, Darakhshan Kawal

Department of Radiology

OBJECTIVE: To determine the negative predictive value of mammography and sonography in patients with focal/ diffuse breast pain with negative physical examination of the breasts.

METHODS: A descriptive study, conducted at Radiology Department ofAga Khan University Hospital from 2006-2007 for a period of 2 years. A total of 207 women were referred for mammography and sonography because of focal or diffuse breast pain. Complete follow-up was available only in 55 patients. The outcome or gold standard was mammograms or ultrasound after an average follow-up period of 18 months with negative/benign findings or histopathology of the suspicious lesion or imaging which …

Furazolidone, Co-Amoxiclav, Colloidal Bismuth Subcitrate, And Esomeprazole For Patients Who Failed To Eradicate Helicobacter Pylori With Triple Therapy, Z Abbas, Javed Yakoob, Shahab Abid, Wasim Jafri, Muhammad Islam, Zahid Azam, Imran Hilal

Department of Medicine

There is increasing evidence of Helicobacter pylori (H. pylori) resistance to the classical triple therapy consisting of a proton-pump inhibitor and clarithromycin with either amoxicillin or metronidazole. This study is aimed at establishing the efficacy and safety of a 14-day regimen to eradicate H. pylori in patients who have failed with the classical triple therapy given for 14 days. One hundred seventy-six patients diagnosed to have H. pylori infection were given triple therapy for 14 days. Fifty-two patients who failed to respond as evident from positive 14C-urea breath test (UBT) done 4–6 weeks after the completion of triple therapy were …

Low Prevalence Of The Intact Cag Pathogenicity Island In Clinical Isolates Of Helicobacter Pylori In Karachi, Pakistan, Javed Yakoob, Wasim Jafri, Zaigham Abbas, Shahab Abid, R. Khan, N. Jafri, Z. Ahmad

Department of Medicine

Clinical diseases that follow Helicobacter pylori infection are associated with expression of the cagA gene, a part of cytotoxin-associated gene pathogenicity island (cag-PAI). This study aims to determined whether or not the presence of cagA is associated with the presence of complete cag-PAI and to evaluate inflammatory changes associated with the five loci in the cag-PAI of H. pylori comprising cagA, cagA promoter region (cagAP), cagE, cagT and the left end of the cagA gene (LEC). H. pylori isolates were obtained from patients with dyspeptic symptoms. Clinical strains of H. pylori were screened by the polymerase chain reaction (PCR) for …

Foreign Body Or Foreign From Body--Congenital Unilateral Lobar Hypoplasia Of Lung, Heeramani Lohana, Syed Rehan Ali, Shakeel Ahmed

Department of Paediatrics and Child Health

We report a rare case of congenital unilateral hypoplasia of the lung without any other anomaly at Aga Khan University Hospital. A 7-month-old male infant presented in emergency room with respiratory distress. There was no history of cough and wheeze. X-ray revealed left sided non homogenous opacity along with right sided hyperinflation. A suspicion of foreign body was made on chest X-ray but bronchoscopy was deferred in view of bilateral equal air entry and absence of wheeze. CT scan showed left upper lobe hypoplasia. Child recovered with supportive therapy and was discharged home. To the best of our knowledge unilateral …

A Comparative Study Of The Genotype Mtbdrplus® Assay Against A Standard Culture Method For Diagnosis And Drug Susceptibility Testing Of Tuberculosis, Peris W. Thamaini

Master of Medicine in Clinical Pathology

Background: Nearly one-third of the global population, i.e. two billion people, is infected with Mycobacterium tuberculosis and is at risk of developing the disease. More than eight million people develop active tuberculosis (TB) every year, with about two million dying from the disease annually. Diagnosis of tuberculosis inKenya remains dependent on smear microscopy. New methods of TB diagnosis are needed which have better accuracy and are still cost effective. Molecular methods of TB diagnosis have come under investigation in a lot of studies recently. However, they have their own limitations including the inability to differentiate between active organisms and dead …

Risk Of Contrast Induced Nephropathy In Hiv Patients Receiving Radiographic Contrast At Three Aga Khan Hospitals, Sitna A. Mwanzi

Master of Medicine in Internal Medicine

Aim: To study the influence of HIV infection on the development of contrast induced nephropathy in patients receiving radio contrast material Design: Prospective cohort study Patients and setting:One hundred and twenty five (125) HIV positive patients and one hundred and fifty five (155) HIV negative patients selected from in and out patient departments of the Aga Khan University Hospital, Nairobi and Aga Khan Hospitals in Mombasa and Kisumu, were evaluated for the study between August 2008 and August 2009. Methodology: Eligible patients undergoing radiological evaluation requiring the use of radio contrast material were consecutively recruited for the study after which …

Relating Visual To Verbal Semantic Knowledge: The Evaluation Of Object Recognition In Prosopagnosia, Jason J. S. Barton, Hashim-M Hanif, Sohi Ashraf

Section of Neurology

Assessment of face specificity in prosopagnosia is hampered by difficulty in gauging pre-morbid expertise for non-face object categories, for which humans vary widely in interest and experience. In this study, we examined the correlation between visual and verbal semantic knowledge for cars to determine if visual recognition accuracy could be predicted from verbal semantic scores. We had 33 healthy subjects and six prosopagnosic Patients first rated their own knowledge of cars. They were then given a test of verbal semantic knowledge that presented them with the names of car models, to which they were to match the manufacturer. Lastly, they …

Incomplete, Atypical Kawasaki Disease Or Evolving Systemic Juvenile Idiopathic Arthritis: A Case Report., Shakeel Shaikh, Sidra Ishaque, Taimur Saleem

Department of Paediatrics and Child Health

Kawasaki disease is an acute febrile condition seen in children. However, it is also well recognized that some Patients do not fulfill the classic diagnostic criteria for the diagnosis of kawasaki disease. The incomplete form of kawasaki disease is termed as 'Incomplete KD' or 'Atypical KD'. We present a case of a 6 year old child with a history of prolonged fever, periorbital, oral and lip changes, changes in the extremities and an erythamatous, maculopapular rash. Based on the physical exam and her echocardiogram that showed right coronary artery dilatation, Intravenous immune globulin was administered in this Patient. This Patient …

Median Values For Second-Trimester Maternal Serum Αlpha Fetoprotein And Human Chorionic Gonadotrophin (Double Test) At Aga Khan University Hospital-Nairobi, Nancy A. Okinda

Master of Medicine in Clinical Pathology

Aim To establish median values for second trimester maternal serum human chorionic gonadotrophin (HCG) and alpha fetoprotein (AFP) at Aga Khan University Hospital- Nairobi (AKUH-N) using the Abbott Micro particle Enzyme immunoassay. Specific objectives •To perform measurements of second trimester maternal serum human chorionic gonadotrophin (HCG) and alpha fetoprotein (AFP) and to establish observed and regressed median values. •To establish regression coefficients for regressed medians of AFP and HCG. •To compare these data with data obtained from other geographical regions. Methodology 330 serum samples from women of gestational ages 15 to 20 weeks were analyzed for AFP and HCG. Observed …

Use Of Magnetic Resonance Spectroscopy (Mrs) To Improve Magnetic Resonance Imaging (Mri) In The Diagnosis Of Intracranial Pathology, Done At Aga Khan University, Joyce Sande

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Magnetic Resonance Spectroscopy (MRS)is a potentially useful adjunct to Magnetic Resonance Imaging (MRI) in thecharacterization of focal brain lesions. This study was aimed at showing that by the additional use of MRS (MRI, MRS), the characterization of a focal brain lesion into neoplastic, or non- neoplastic (infective, or degenerative) can be improved, as compared to the use of MRI alone. Study question: Does the additional use of MRS improve MRI differentiation of neoplastic from non- neoplastic (infective or degenerative) focal brain lesions? Methods: The design was prospective, analytical and comparative. 80 consecutive patients were enrolled. Conventional MRI of the …

Evaluating The Diagnostic Performance Of An Initial Transvaginal Sonogram (Tvs) In Patients With Suspected Ectopic Pregnancy, Zablon Bett

Master of Medicine in Imaging and Diagnostic Radiology

Purpose of the study: To evaluate the diagnostic performance of an initial transvaginal sonogram (TVS) in patients with suspected ectopic pregnancy (EP). Objectives: 1) To determine the accuracy, sensitivity, specificity, positive and negative predictive values of an initial TVS scan in patients with suspected EP. 2) To determine the diagnostic utility of TVS findings as predictors of EP. Methodology: This was a descriptive, prospective study of 131 consecutive mothers who had TVS for clinical suspicion of EP at the Aga Khan University hospital over a 12 month period between November 2007 and October 2008. The scans were performed in our …

Tuberculous And Cryptococcal Meningitis In A Setting With High Tb And Low Hiv Prevalence, Afrasyab Khan, Bushra Jamil, Rahmat Ali, Sana Sultan

Section of Pulmonary & Critical Care

OBJECTIVE: To compare the differences in presentation and outcome of patients with tuberculous meningitis (TBM) and cryptococcal meningitis (CCM).

STUDY DESIGN: Case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from December 1995 to December 2005.

METHODOLOGY: Patients with a confirmed diagnosis of TBM or CCM were included in this study. The signs and symptoms, laboratory findings and other variables of patients were entered and analyzed by Statistical Package for Social Sciences (SPSS) Software version 14.

RESULTS: We compared 16 patients of TBM with 11 of CCM. None of the patients with TBM were Human Immunodeficiency …

A Large Chorioangioma Causing Intrauterine Foetal Demise, Aamer Imdad, Lumaan Sheikh, Ayesha Malik

Department of Obstetrics & Gynaecology

Chorioangioma is a benign tumour of the placenta consisting of blood vessels and stroma that proliferates beyond normally developing chorionic villi. Most of the small tumours are asymptomatic but large placental tumours are associated with unfavourable outcomes for foetus and mother. We present a case of a 23 year old primigravida who had a large chorioangioma that lead to intrauterine foetal demise. Major complications and diagnostic tools for chrioangioma have been discussed.

Clinical Profile And Outcome In A Paediatric Intensive Care Unit In Pakistan, Anwarul Haque, Surraiya Bano

Department of Paediatrics and Child Health

Paediatric critical care medicine is a relatively new subspecialty in Pakistan. The clinical profile and outcomes of children admitted in the PICU (paediatric intensive care unit) were retrospectively reviewed from January to December 2007. Mean age of the studied 314 patients was 24 months; 37% were less than one-year-old and 66% was male. Mean PRISM score was 13.2. There were almost equal distribution of medical (46%) and surgical (54%) cases. Ninety percent of patients received mechanical ventilation, while more than 50% received vasoactive drugs. The rate of nosocomial infection was 4.7%. The average length of PICU stay was 3.2 (1-49) …

Solar Water Disinfection In Household Settings:Hype Or Hope?, Zulfiqar Ahmed Bhutta

Woman and Child Health

No abstract provided.

Associations Of The Plasticity Region Ofh. Pyloriin Patients With Gastroduodenal Diseases, Javed Yakoob, Z Abbas, Shagufta Naz, Shahab Abid, Wasim Jafri

Section of Gastroenterology

No abstract provided.

Clinical Radiology Research In Pakistan: From Evidence To Practice, Waseem Akhtar, Arif Ali, Mubashir Aslam, Gul-E-Khanda

Department of Radiology

OBJECTIVE: To assess the clinical radiology research productivity in Pakistan by type of publication, sources of funding and name of journals.

METHODS: A systematic search strategy using key words related to techniques and type of clinical radiology was carried out to identify various studies published in Indexed (Medline) and non-indexed (Pakmedinet) medical journals.

RESULTS: Total of 397 studies were identified out of which 173(43%) from Medline (indexed database) and 220 (57%) from pakmedinet (Indexed and non- indexed database of Pakistan Medical journals). Original articles were 294 (74%) but most of them (68%) were published in non-indexed journals and significantly different …

Predictors Of Lymph Node Involvement In Bladder Cancer Treated With Radical Cystectomy, Zaheer Alam, Muhammad Hammad Ather, Anila Jamshaid, Khurram Muhammad Siddiqui, Muhammad Nasir Sulaiman

Section of General Surgery

Objective: To identify the clinical variables associated with prevalence of lymph node metastasis in patients with bladder cancer treated by radical cystectomy and lymphadenectomy for primary bladder cancer.
Methods: Review of records of Ninety-five patients who underwent radical cystectomy and pelvic lymph node (LN) dissection during the period of 1995-2008 from a prospectively maintained database. Eighteen patients were excluded due to lack of data on the nodal status, leaving 77 evaluable patients. Associations between LN metastasis and age, gender, duration of disease, number of transurethral resection (TUR) prior to cystectomy, pathological grade and tumour stage was analyzed. Data was analyzed …

Old Disease, New Targets. Part-Ii, Haematological Malignancies, Shiyam Kumar, Nehal Masood, Salman Naseem Adil

Department of Pathology and Laboratory Medicine

In last two decades newer therapies in cancer treatment have emerged and have opened new horizons. New term of targeted therapy has emerged and for certain malignancies the paradigm has really changed after the introduction of these agents. We have learnt and have seen the outcome of some diseases after the addition of these monoclonal antibodies (MoABs) and tyrosine kinase inhibitors (TKIs). Rituximab a MoAB against CD-20 has really paved its role in the treatment of B-cell lymphomas and become the sort of standard therapy. The TKIs are newer agents available in a pill form and have inhibited many pathways …

Vaginal Clear Cell Adenocarcinoma With Associated Mullerian Duct Anomalies, Renal Agenesis And Situs Inversus: Report Of A Case With No Known In-Utero Exposure With Diethyl Stilboestrol, Zeeshan-Ud-Din, Aamir Ahsan

Department of Pathology and Laboratory Medicine

A 27 year old female presented with two months history of continuous vaginal bleeding. On evaluation, she was diagnosed as a case of vaginal clear cell adenocarcinoma (VCCA) along with associated Mullerian duct anomalies including didelphys uterus with double vagina; left sided renal agenesis and situs inversus. Although VCCA is strongly linked to in-utero exposure with Diethyl stillboestrol (DES), this patient had no known history regarding such exposure. Also, only a few cases have been described in the literature in which this tumour was seen in association with Mullerian duct anomalies and renal agenesis; in the absence of known DES …

High-Dose Imatinib In Newly Diagnosed Chronic-Phase Chronic Myeloid Leukemia: High Rates Of Rapid Cytogenetic And Molecular Responses, Jorge E. Cortes, Hagop M. Kantarjian, Hagop M. Kantarjian, Stuart L. Goldberg, Bayard L. Powell, Francis J. Giles, Meir Wetzler, Luke Akard, John M. Burke, Mansoor Saleh

Haematology and Oncology, East Africa

Purpose: Long-term clinical outcome data have established imatinib 400 mg/d as standard front-line treatment for newly diagnosed patients with chronic myeloid leukemia (CML).

Patients and Methods: The Rationale and Insight for Gleevec High-Dose Therapy (RIGHT) trial is a multicenter study of imatinib 400 mg twice a day as initial therapy in 115 patients (70% Sokal low risk) with newly diagnosed CML in chronic phase who were observed for both molecular and cytogenetic responses for up to 18 months. Eighty-three patients (72%) completed the study, 10 patients (9%) discontinued the study because of adverse events, and six patients (5%) discontinued because …

Cancellation Of Surgery In Patients Attending The Preoperative Anaesthesia Assessment Clinic: A Prospective Audit, Tauseef Ahmed, Mueenullah Khan, Fauzia Khan

Department of Anaesthesia

OBJECTIVE: To find the causes of operating room cancellation in patients attending preoperative anaesthesia clinic and scheduled for surgery at our institution.

METHODS: This audit included all those patients who presented to the pre anaesthesia clinic with their surgeries planned in the main operating rooms of our hospital. The duration of this audit was two months. Cancelled cases were identified from the operating room lists and the reasons for cancellations were categorized into above mentioned four factors.

RESULTS: Fifty five (55) cancellations were identified; patient related factors (58%) were the most frequent cause followed by anaesthetic (22%), surgical (18.2%) and …

Arterio-Venous Fistula Of Upper Arm Observed With Injection Abscess, Saba Sohail, Misbah Talpur

Department of Radiology

No abstract provided.

H. Pylori Infection In Children: Population-Based Age-Specific Prevalence And Risk Factors In A Developing Country, Wasim Jafri, Javed Yakoob, Shahab Abid, S Siddiqui, Nasim Jafri, Safia Awan, Shaikh Qamaruddin Nizami

Section of Gastroenterology

No abstract provided.