Medical Specialties Commons^™

Instituting An Undergraduate Core Clerkship In Radiology: Initial Experiences In Pakistan, Naila Nadeem, Abdul Mueed Zafar, Muhammad Nadeem Ahmad

Department of Radiology

Utilization of radiology as an educational resource carries great potential. Accreditation bodies, physicians and medical students deem it important for a well rounded medical curriculum. Unfortunately this resource is yet to be developed and implemented to an optimal extent. We share the experiences from the first radiology core clerkship in Pakistan at the undergraduate level. An overview of clerkship objectives and structure is followed by discussion on lessons learnt during the initial three years of institution. Development of assessable objectives, integration of radiology with other specialties, and supervised andragogical learning tailored for undergraduate students are emphasized.

Educating And Informing Patients Receiving Psychopharmacological Medications: Are Family Physicians In Pakistan Up To The Task?, Hammad Ashraf Ganatra, Hadi Bhurgri, Roomasa Channa, Fauzia Ahmad Bawany, Syed Nabeel Zafar, Rafia Ishfaq Chaudhry, Syeda Hina Batool, Abdul Basit, Mehmood Asghar, Sarah Saleem, Haider Naqvi

Community Health Sciences

Introduction: Studies have shown a high prevalence of psychiatric illnesses among Patients in primary health care settings. Family physicians have a fundamental role in managing psychiatric illness with psychopharmacological medications. Providing information about the disease, its management and the potential adverse effects of the medications is an important part of the management of mental illnesses. Our objective was to determine if Patients who were prescribed psychopharmacological drugs by family physicians at a community health center in Karachi, Pakistan were provided adequate education about their disease and its management.
Methods: A cross-sectional study was conducted at the Community Health Centre (CHC), …

Well-Being Of Medical Students And Their Awareness On Substance Misuse: A Cross-Sectional Survey In Pakistan., Abdul Wahab Yousafzai, Syed Ahmer, Ehsanullah Syed, Naila Bhutto, Saman Iqbal, Mohammed Naim Siddiqi, Mohammed Zaman

Department of Psychiatry

Objective: To investigate psychological well-being and substance abuse among medical students in Pakistan. Methods: A cross-sectional questionnaire-based survey was conducted in six medical colleges across Pakistan. Final-year medical students were interviewed by either a postgraduate trainee in psychiatry or a consultant psychiatrist. Results: A total of 540 medical students were approached, 342 participated and the response rate was 64.5%. Mean age was 23.73 years (SD 2.45 years), 52.5% were male and 90% single. Two out of every five respondents reported that work/study at medical school affected their personal health and well-being. A considerable proportion of students were aware of alcohol …

Non-Invasive Prediction Of St Elevation Myocardial Infarction Complications By Left Ventricular Tei Index, Nasir Rahman, Khawar Abbas Kazmi, Muniza Yousaf

Section of Cardiology

OBJECTIVE: To investigate association between the Tei index and cardiac complications of ST elevation of Myocardial Infarction.

PATIENTS AND METHODS: A total of a 202 adult consecutive patients with first ST elevation MI (STEMI) were studied. Tei index was obtained as: (a _ b)/b, where "a" is the interval between the cessation and onset of mitral flow and "b" is the ejection time of aortic flow measured with the help of pulsed Doppler echocardiography. Subsequent complications, included Death, Congestive Heart Failure (CHF), Cardiogenic shock, Atrial Flutter/ Atrial Fibrillation, Sustained ventricular tachycardia, Advanced Atrio- Ventricular Clock (AV Block), Myocardial Infarction (MI), …

Risks For Preterm Delivery And Low Birth Weight Are Independently Increased By Severity Of Maternal Anaemia, Hussein Kidanto, Ingrid Mogren, Gunilla Lindmark, Siriel Massawe, Lennarth Nystrom

Faculty of Health Sciences, East Africa

OBJECTIVE: To estimate the effect of the severity of maternal anaemia on various perinatal outcomes.

DESIGN: A cross-sectional study.

SETTING: Labour Ward, Muhimbili National Hospital, Dar es Salaam, Tanzania.

METHOD: The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measured. Data on socio-demographic characteristics, iron supplementation, malaria prophylaxis, blood transfusion during current pregnancy, and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal - Hb >11.0 g/dl; mild - Hb 9.0 - 10.9 g/dl; moderate - …

Prevalence Of Gastric Mucosal Interleukin-1 Polymorphisms In Kenyan Patients With Advanced Gastric Cancer, Kimang’A Nyerere, Shahin Sayed, Gunturu Revathi, Peter Ojwang, Viviene Matiru, Smita Devani, Mahesh Shah, Samuel Kariuki

Pathology, East Africa

Helicobacter pylori is the main cause of peptic ulceration, distal gastric adenocarcinoma, and gastric lymphoma.1 Worldwide, gastric cancer is the second most common malignancy in men and women.1 According to data from the Nairobi Cancer Registry, gastric cancer is the fourth most common malignancy in adult males and the fifth most common in adult females. However, this may not represent the true situation because of under-reporting of cases. In the development of gastric cancer, environmental factors such as smoking, diet and, in particular, infection with H. pylori are significant.1 Based on epidemiological studies, the International Agency for Research on Cancer …

Doptaus - A Simple Criterion For Improving Sonographic Diagnosis Of Acute Appendicitis, Saba Sohail, Kausar Jehan Siddiqui

Department of Radiology

Objective: To determine the efficacy of 'Detection Of Pin-point Tenderness on the Appendix on abdominal UltraSound' (DOPTAUS) for improving sonographic diagnosis by junior and senior ultrasound operators.
Methods: An analytical study was done at the Radiology Department, Dow University of Health Sciences and Civil Hospital Karachi from March 2005 to December 2006. Adult patients of either gender with clinically suspected acute appendicitis referred to the department during regular working hours and later operated in the same hospital were included. Each patient was scanned by a junior and a senior ultrasound operator using the conventional criteria first and later focused ultrasound …

Secondary Prevention Of Heart Disease - Knowledge Among Cardiologists And Omega-3 (Omega-3) Fatty Acid Prescribing Behaviors In Karachi, Pakistan, Saqib A. Gowani, Sana Shoukat, Ather M. Taqui, Hashim M. Hanif, Wasiq F. Rawasia, Zeeshan Qadri, Sajid H. Dhakam

Section of Cardiology

Background: The use of omega-3 fatty acids is a currently proven strategy for secondary prevention of heart disease. The prescription practices for this important nutraceutical is not currently known. It is imperative to assess the knowledge of cardiologists regarding the benefits of omega-3 fatty acids and to determine the frequency of its prescription. The aim of the study was to determine the practices and associations of dietary fish prescribing among cardiologists of Karachi and to assess their knowledge of fish oil supplementation and attitudes toward dietary practices. Methods: A cross sectional survey was conducted during the period of January to …

Shoulder Impingement Syndrome: Outcome Of Arthroscopic Subacromial Decompression, Attiq Ur Rehman, Muhammad Abdul Wajid, Tashfeen Ahmad

Section of Orthopaedic Surgery

Objective: To describe the outcome of cases with subacromial impingement syndrome managed with arthroscopic subacromial decompression.
Study Design: Quasi-experimental study.
Place and Duration of Study: Section of Orthopaedics, Department of Surgery, The Aga Khan University Hospital, Karachi from April 2005 to March 2006.
Methodology: Thirty patients with impingement syndrome who underwent arthroscopic subacromial decompression after failed conservative treatment were included. The Constant and Murley shoulder scoring system was used for the clinical assessment of pain and function pre-operatively and 1, 6 and 24 weeks postoperatively.
Results: The postoperatively significant improvement was observed in the Constant and Murley scores in all …

Rhizopus Necrotizing Fasciitis Of Caesarean Wound: A Rare Life Threatening Condition, Abdul Rehman Alvi, Ghina Shamsi

Section of General Surgery

Mucormycosis is a rare cause of necrotizing fasciitis in immunocompromised patients. We report a young female, who developed rhizopus necrotizing fasciitis of caesarean wound. The lady died secondary to non-responding sepsis and irreversible multi-organ failure. High index of suspicion can lead to early diagnosis by frozen section of histopathology and fungal culture technique. Aggressive surgical debridement and intravenous anti-fungal medication is the main stay of treatment. A delay in diagnosis and treatment may cause multi-organ failure leading to high mortality.

Non-Traumatic Right Hepatic Artery Pseudoaneurysm: An Unusual Cause Of Hemobilia And Obstructive Jaundice, Abdul Rehman Alvi, Shahida Bibi, Ziaur Rehman, Salma Khan

Section of General Surgery

Most hepatic artery pseudoaneurysms (HAPA) are post traumatic, and non-traumatic pseudoaneurysm is rarely reported. It is a potentially life threatening vascular disorder and difficult to diagnose before rupture. Early diagnosis and prompt nonoperative intervention of this lesion could be life saving. The authors report the case of a patient with hemobilia caused by ruptured right hepatic artery pseudoaneurysm and subsequently developed right hepatic duct stricture, which has not been reported previously. This patient was successfully treated with endovascular stent graft of pseudoaneurysm and endoscopic stenting of right hepatic duct stricture.

Severe Road Traffic Injuries In Kenya, Quality Of Care And Access, William Macharia, F. Muli-Musiime, V. Nantulya, Erastus K. Njeru

Paediatrics and Child Health, East Africa

Background: Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services.

Objective: Determine access and quality of care for RTI casualties in Kenya.

Design: Cross-sectional survey

Setting: 53 large and medium size private, faith-based and public hospitals.

Participants: In-patient road traffic crash casualties and health personnel in the selected hospitals were interviewed on availability of emergency care and resources. Onsite verification of status was undertaken.

Results: Out of 310 RTI casualties interviewed, 72.3%, 15.6% and 12.2% were in public, faith-based and private hospitals, respectively. Peak age of the injured …

Four-Country Surveillance Of Intestinal Intussusception And Diarrhoea In Children, Shally Awasthi, Girdhar Agarwal, Vikas Mishra, Vijay Laxmi Nag, Hesham Fathey El Sayed, Antonio Da Cunha, Alvaro Madeiro, Dipty Jain, William Macharia, James Ndung'u, Saumya Awasthi, Ashish Wakhlu

Paediatrics and Child Health, East Africa

Aim: Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years.

Methods: In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1-2 million for reporting of intussusception. One large hospital per site also …

Characteristics Of Hiv-Infected Children Seen In Western Kenya, W Nyandiko, A. Mwangi, S. O. Ayaya, E. C. Nabakwe, C. N. Tenge, R. C. Vreeman, Peter Gisore

Paediatrics and Child Health, East Africa

Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya.

Design: A retrospective descriptive study.

Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya.

Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.

Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART).

Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive …

Dilemma In The Diagnosis Of Mediastinal Adenopathy In The South Asian Population-Role Of Ct Guided Biopsy, Mediastinoscopy And Video-Assisted Thoracoscopy (Vats), Marium Muzaffar, Hashim M Hanif, Saulat H. Fatimi

Section of Cardiothoracic Surgery

The diagnosis of mediastinal adenopathy is a dilemma amongst treating physicians especially in South Asia. This is because although tuberculosis is endemic in this region, many a times lymphoma and sarcoidosis cannot be excluded. Often patients are being treated with medications without a confirmed diagnosis. The Video-assisted thoracoscopy (VATS) has revolutionized the way mediastinal adenopathy is diagnosed and managed in this part of the world.

Molecular Confirmation Of The Causes Of Inherited Visual Impairment In Northern Pakistan, Mehreen Adhi, Yasmin Rashid, Syed Hussain Jafri, Chris F. Inglehearn, Martin Mckibbin

Section of Ophthalmology

Families with inherited visual impairment were identified and examined from January 2000 to December 2005 and given a clinical diagnosis. Known genes and loci were screened for mutations or linkage at Institute of Ophthalmology and Neurosciences, University of Leeds, in order to provide molecular confirmation. Inherited retinal disease was the most common cause of inherited visual impairment in 38 of 57 families (66.6%) with Leber's congenital amaurosis, rod-cone dystrophy and cone-rod dystrophy being the most common diagnoses in 22, 8 and 3 families respectively. Anterior segment dysgenesis was diagnosed in 8 families (14%). Mutations in known genes or linkage to …

Incomplete Kawaski Disease: Are We Missing It, Abdul Gaffar Billoo, Saira Waqar Lone, Salman Siddiqui, Huba Atiq

Department of Paediatrics and Child Health

Kawasaki disease, also known as mucocutaneous lymph node syndrome or infantile polyarteritis nodosa is an acute febrile vasculitis of unknown etiology with a predilection for coronary arteries and potential for aneurysm formation. In Incomplete Kawasaki disease, children with fever lack the sufficient number of criteria to fulfill the epidemiologic case definition and are diagnosed when coronary artery disease is detected. We present a case report of a one and a half years old girl who came with features of incomplete Kawasaki disease, high grade fever, irritability, history of conjunctivitis and cracking of lips. She was investigated and had a platelet …

Factors Influencing Adherence To Referral Advice Following Pre-Referral Treatment With Artesunate Suppositories In Children In Rural Tanzania, Daudi Simba, Marian Warsame, Omari Kimbute, Deodatus Kakoko, Max Petzold, Goran Tomson, Zul Premji, Melba Gomes

Pathology, East Africa

Objective: WHO recommends artemisinin suppository formulations as pre-referral treatment for children who are unable to take oral medication and cannot rapidly reach a facility for parenteral treatment. We investigated factors influencing caretakers’ adherence to referral advice following pre-referral treatment of their children with rectal artesunate suppositories.

Methods: The study was nested within an intervention study that involved pre-referral treatment of all children who came to a community dispenser for treatment because they were unable to take oral medications because of repeated vomiting, lethargy, convulsions or altered consciousness. All patients who did not comply with referral advice were stratified by actions …

Cerebral Fungal Infection With Mycotic Aneurysm Of Basilar Artery And Subarachnoid Haemorrhage, H. Ahsan, F. Ajmal, M. F. Saleem, A. B. Sonawala

Department of Radiology

A 28-year-old Pakistani man was admitted with unresolved severe headaches for the past four weeks. Magnetic resonance (MR) imaging and MR angiography showed an enhancing mass in the sphenoid sinus, bilateral cerebellar infarcts and aneurysmal dilatation of the basilar artery. The differential diagnosis included fungal infection versus neoplastic lesion. The scrappings taken through the endoscope from the sphenoid sinus were initially negative for fungal infection. However, the second biopsy, done after putting him on antifungal, itraconazole 200 mg twice daily, revealed the presence of a fungal infection (aspergillosis). MR imaging revealed extension of the fungal infection from the sphenoid sinus …

Autoimmune Pancreatitis: Disease Evolution, Staging, Response Assessment, And Ct Features That Predict Response To Corticosteroid Therapy, Dushyant V. Sahani, Nisha I. Sainani, Vikram Deshpande, Mehrine S. Shaikh, Dmitry L. Frinkelberg, Carlos Fernandez-Del Castillo

Department of Radiology

Purpose:To evaluate the evolution of morphologic features of autoimmune pancreatitis (AIP) at computed tomography (CT) and to identify imaging features that can predict AIP response to corticosteroid therapy (CST). Materials and

Methods:

This HIPAA-compliant retrospective study had institutional review board approval. From among a cohort of 63 Patients with AIP, 15 Patients (12 men, three women, mean age, 64.7 years, age range, 30-84 years) who underwent sequential CT examinations before treatment were included to assess the evolution of disease by reviewing pancreatic, peripancreatic, and ductal changes. Of these Patients, 13 received CST and underwent posttreatment CT, these CT studies …

Utility Of Free To Total Psa Ratio In The Prediction Of Prostate Cancer In Patients With Intermediate Total Psa Levels And Negative Digital Rectal Examination, Muthoni .J .F. Kirimi

Master of Medicine in Anatomic Pathology

Background: Prostate carcinoma is among the top 5 cancers occurring in Kenyan men. Prostate-specific antigen (PSA) is currently the most important biochemical marker for the diagnosis of prostate cancer and its widespread use as a serum tumor marker has revolutionized the management of patients with prostate cancer. The identification of early prostate cancer is vital in the management of especially men who have mild or vague prostatic symptoms. The most basic and important proxy for determining the need for a biopsy in both symptomatic and asymptomatic(screened) patients is the serum prostatic specific antigen (PSA).If a patients PSA level is above …

Labrad : Vol 34, Issue 1 - January 2009, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• N-Telopeptide of Type I Collagen (NTx): A Biochemical Tool for Assessing Bone Turnover
• Automated Blood Grouping
• Leukocyte Alkaline Phosphatase (LAP Score)
• Pathology Quiz
• Synovial Fluid Analysis in Important Joint Diseases
• Intraductal Papillary Mucinous Tumor (IPMT) of the Pancreas: A Diagnostic Challenge
• Hepatitis Delta Virus (HDV)
• Answers to Pathology Quiz
• Thyroid Autoimmune Diseases and Thyroid Peroxidase (TPO) Antibody
• Therapeutic Monitoring of Tacrolimus
• Meeting Report: 32 Annual Conference of Pakistan Association of Pathologists
• AKU Clinical Laboratory Continuing Medical Education (CME) Seminar in Bahawalpur

Clinico-Pathologic Characteristics And Treatment Outcomes In Children With Neuroblastoma At The Kenyatta National Hospital, Nairobi., Grace Kitonyi, William Macharia, Otieno Walter Mwanda, R. Pamnani

Paediatrics and Child Health, East Africa

Objective: To determine clinical-pathologic characteristics, treatment modalities and treatment outcomes of children diagnosed with neuroblastoma.

Design: Cross- sectional descriptive study based on secondary data from patient records.

Setting: Records department of Kenyatta National Hospital (KNH), a tertiary teaching and referral hospital based in Nairobi.

Subjects: Children aged 15 years and below, admitted with the diagnosis of neuroblastoma, between January 1997 and December 2005.

Main outcome measures: Presenting clinical features, diagnostic modalities including laboratory and imaging data, treatment modalities, response to treatment and patient survival.

Results: Twenty six patients were eligible for the study; 13 males and 13 females giving a …

Kawashima Operation: Functional Modification Of Bidirectional Glen Shunt With Left Superior Vena Cava In Single Ventricular Morphology, Syed Shahabuddin, Saulat Fatimi, Mehnaz Atiq, Muneer Amanullah

Section of Cardiothoracic Surgery

Single ventricle physiology offers limited options with significant morbidity and mortality. The Glenn shunt is a mid-stage procedure for the Fontan circulation. With persistent left Superior Vena Cava (SVC) and Azygos continuation of the Inferior Vena Cava (IVC) to the SVC, needs the development of bilateral bidirectional Glenn shunts. Fifteen patients underwent Bidirectional Glen shunt procedure over a period of ten years. Of these two were found to have left SVC along with interrupted IVC and its Azygos continuation to the SVC. These two patients underwent the Kawashima operation. A seven years old girl was admitted via emergency with severe …

Outcome And Factors Associated With Hospital Mortality In Patients With Impaired Left Ventricular Function Undergoing Coronary Artery Bypass Grafting: Where Do We Stand?, Mubashir Zareen Khan, S Perveen, Ja Ansari, Sa Sami, S Furnaz, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Objective: Impaired ventricular function is a known risk factor for mortality after coronary artery bypass grafting however increasingly more patients with impaired ventricular function are referred for surgery. Currently no large data is available from Pakistan regarding this aspect of coronary surgery. Our objectives were to find out the hospital mortality and mid term functional improvement in patients with impaired ventricular function undergoing coronary artery by pass grafting and identify the risk factors for mortality.
Methodology: Retrospective analysis of preoperative, operative and postoperative variables of patients with impaired ventricular function who were operated for isolated first time coronary artery …

Assessment, Surgeon, And Society, John Norcini, Jamsheer J Talati

Section of Urology

An increasing public demand to monitor and assure the quality of care provided by physicians and surgeons has been accompanied by a deepening appreciation within the profession of the demands of self-regulation and the need for accountability. To respond to these developments, the public and the profession have turned increasingly to assessment, both to establish initial competence and to ensure that it is maintained throughout a career. Fortunately, this comes at a time when there have been significant advances in the breadth and quality of the assessment tools available. This article provides an overview of the drivers of change in …

Clinical Profile And Outcome Of Infective Endocarditis At The Aga Khan University Hospital, M. Tariq, Bilal Karim Siddiqui, Atif Jadoon, Mahboob Alam, Sohail Abrar Khan, Mehnaz Atiq, Raymond A Smego

Section of Internal Medicine

Background: The spectrum of infective endocarditis (IE) is significantly different in developed and developing countries. The present study was conducted to study the clinical profile and outcome of infective endocarditis in Pakistan.
Methods: A descriptive cross-sectional study with review of medical records for 188 patients admitted to our teaching hospital with a diagnosis of IE from January 1988 to December 2001. One hundred fifty-nine subjects fulfilled the modified Duke diagnostic criteria.
Results: Definite IE was found in 59.7% (95/159) patients, while the rest had possible IE. One-third of subjects had acute IE 55/159 (34.5%). Subacute IE was found in …

Transfusion Related Acute Lung Injury--Trali: An Under Diagnosed Entity, Bushra Moiz, Hasanat Sharif, Fauzia Ahmad Bawany

Department of Pathology and Laboratory Medicine

Transfusion related acute lung injury (TRALI) is a life-threatening complication of transfusion of blood and its components resembling acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). TRALI is a particular form of ARDS that follows blood transfusion and is caused by donor-derived antibodies present in the transfused products, reacting with the recipients' blood cells, inducing release of inflammatory mediators thus compromising lung functions. Anti-HLA antibodies are the most frequently indicted inducers in this category. Literature search has not revealed any documented case of TRALI from Pakistan. This in no way implies that TRALI is non existent in this …

Presentation Of A Patient With Palpable Purpuric Rash, Safoorah Khalid, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Henoch Shonlein purpura (HSP) is a form of systemic vasculitis characterized by deposition of IgA dominant immune complexes in the small vessels. The triad of palpable purpuric rash on lower extremities, abdominal or renal involvement and arthritis is the typical presentation in this condition. The disease primarily affects children and is less common in adults. We report a case of a young female who presented with palpable purpura on legs, classical symptoms of HSP i.e. arthritis and off and on abdominal pain.

Fibromatous Periorchitis, Khurram Minhas, Abrar Barakzai, Asim Qureshi

Department of Pathology and Laboratory Medicine

We report a case of diffuse fibrous pseudotumour/fibromatous periorchitis, in a 43 year old male, that completely encased the right testis and was adjacent to a hydrocoele cavity. Although fibrous pseudotumours of this region are uncommon, they are reported to be the second most common benign paratesticular lesion after adenomatoid tumours. These comprise approximately 6 percent of paratesticular lesions, and are accepted as reactive lesions secondary to trauma, hydrocoele, infections or inflammation. Fibrous pseudotumours have a peak incidence in the third decade of life but can occur at any age. Clinically these lesions mimic malignancy resulting in the treatment by …