Medical Specialties Commons^™

Labrad : Vol 33, Issue 3 - September 2008, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Vitamin D Deficiency: Are We Still Ignoring the Evidence?
• Collection and Transport of Urine for Culture
• Understanding and Interpreting Serum Protein Electrophoresis
• Cystic Fibrosis at a Glance
• What you need to know about Dengue Infection
• CT Colonoscopy: Introduction
• CT Enteroclysis: A New Technique to Evaluate Small Bowel
• CSF-DR: An Important Diagnostic Tool
• G6PD Quantification
• Quality Assurance
• Clinical Laboratory Continuing Medical Education (CME) Seminars
• Meeting Reports

Anaesthetic Management Of A Pregnant Patient For Aortic Valve Replacement, Khalid M Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Cardiac disease can be encountered during pregnancy with the frequency being 1% to 2% of all pregnant women. Because of the high foetal and relative maternal mortality during surgery, medical management is the first line of treatment. Nevertheless, when medical treatment fails, cardiac surgery becomes necessary. We present the anaesthetic management of a case of Aortic valve disease in a pregnant woman undergoing surgery.

Down-Regulation Of Dnmt3b In Pc3 Cells Effects Locus-Specific Dna Methylation, And Represses Cellular Growth And Migration., Ahmed Yaqinuddin, Sohail A. Qureshi, Romena Qazi, Farhat Abbas

Section of Urology

BACKGROUND:

Aberrations in DNA methylation patterns promote changes in gene expression patterns and are invariably associated with neoplasia. DNA methylation is carried out and maintained by several DNA methyltransferases (DNMTs) among which DNMT1 functions as a maintenance methylase while DNMT3a and 3b serve as de novo enzymes. Although DNMT3b has been shown to preferentially target the methylationof DNA sequences residing in pericentric heterochromatin whether it is involved in gene specific methylation remains an open question. To address this issue, we have silenced the expression of DNMT3b in the prostate-derived PC3 cells through RNA interference and subsequently studied the accompanied cellular …

Perinatal Outcomes In Pregnancy With Asthma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Department of Obstetrics & Gynaecology

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort.

Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths.

Resluts: The mean age of asthmatics and nonasthmatics were 28.0 …

Spot Urine Protein: Creatinine Ratio Versus 24 Hour Urine Protein At Various Levels Of Gfr Patients Referred To A Tertiary Care Hospital Of Pakistan, Absar Ali, Naila Asif, Sonia Yaqub, Waqar Kashif, Diamond Merchant, Iffat Yazdant

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the correlation of "random single voided urine protein: creatinine ratio" to "twenty four hour urine protein" at different levels of glomerular filtration rate (GFR) in Pakistani population.

METHODS: A total of 107 patients were included in this cross section study. Patients were divided into five groups according to the GFR. Spot urine protein: creatinine ratio and 24 hour urine protein was measured by the standard methods. The correlation coefficient ( r) between the two was calculated in each group separately.

RESULTS: The GFR in groups 1 to 5 was > or =90, 60-89, 30-59, 15-29, and /minute/1.73 m2 …

Effect Of Diclofenac Suppository On Tramadol Consumption In Posthysterectomy Pain, Aziza Mohammad Hussain, Fauzia A Khan, Lumaan Sheikh

Department of Anaesthesia

OBJECTIVE: To determine reduction in dose of tramadol and side effects in posthysterectomy patients on addition of diclofenac on rectal suppository.

STUDY DESIGN: Randomized double blinded placebo controlled study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, Pakistan, from August 2004 to January 2006. Methodology: Seventy ASA I and II females, aged 20 and above, who underwent elective abdominal hysterectomy, were included in this study. Patients received identical looking suppository of either 100 mg diclofenac sodium or placebo after induction of anaesthesia and then 12 hourly for 24 hours. General anaesthesia was standardized and tramadol was given …

Role Of Psoas Compartment And Caudal Epidural Steroid Injection In Spinal Stenosis Patients Associated With Low Back Pain And Lower Limb Radiculopathy, Mueen Ullah Khan, S. Zaki Hussain

Department of Anaesthesia

OBJECTIVE: To study the efficacy, safety and patient satisfaction of psoas compartment and caudal epidural steroid injection in patients with spinal stenosis and lumbosaccral radiculopathy.

METHODS: Patients with a diagnosis of spinal stenosis and lumbosaccral radiculopathy having visual analogue score (VAS) less than five were included in the study. Bilateral psoas compartment and caudal epidural injection was given to all patients. In group-A patients haemodynamics and complications were examined immediately after injection. In group-B the same patients were examined through a questionnaire after eight weeks, for pain relief, duration of pain relief, reduction in painkillers and overall improvement in activities …

Changing Patterns And Outcome Of Dengue Infection; Report From A Tertiary Care Hospital In Pakistan, Mohammad Wasay, Roomasa Channa, Maliha Jumani, Afia Zafar

Department of Medicine

Objective: To identify predictors of outcome in patients with Dengue Infections at a tertiary care hospital and to analyze that if pattern of Dengue infection is changing in the past two years.

Methods: We reviewed 225 cases of confirmed dengue virus infection. The diagnosis was confirmed by presence of IgM antibodies against Dengue by ELISA in addition to fever according to WHO criteria.

Results: From years 2000-2004, 30(73%) had Dengue Fever (DF), 10(24%) had Dengue Haemorrhagic Fever (DHF) and 1(2.4%) had Dengue shock syndrome (DSS) while after 2005, 107(58%) had DF, 71(39%) had DHF and 6(3%) had DSS. Six …

Perinatal Outcomes In Pregnancy With Asthma., Rashid Jooma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Department of Medicine

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort.

Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths.

Results: The mean age of asthmatics and nonasthmatics were 28.0±4.9 …

Factor Xiii Deficiency In Children--Clinical Presentation And Outcome, Zehra Fadoo, Ali Faisal Saleem

Department of Paediatrics and Child Health

OBJECTIVE: To determine the demographic features and clinical outcome of children with Factor XIII deficiency.

STUDY DESIGN: Observational case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 1996 to December 2006.

METHODOLOGY: Records of all hospitalized pediatric patients with discharge diagnosis of FXIII D, on the basis of factor XIII assay 5 mol/L urea test were retrospectively reviewed and abstracted on a pre-specified proforma. Demographic features, coagulation profile, family history and outcomes were noted.

RESULTS: A total of 10 charts were reviewed. There were 5 boys and 5 girls. Almost all the children (9/10) …

Characteristics Of Tia And Its Management In A Tertiary Care Hospital In Pakistan, Ayeesha Kamal, Farhad Khimani, Rushna Raza, Sahar Zafar, Salman Bandeali, Sayeedullah Jan

Section of Neurology

Background:Transient ischemic attack (TIA) is described as a brief episode of neurological dysfunction caused by focal brain ischemia, with clinical symptoms typically lasting less than an hour, and without evidence of acute infarction. Recent studies depict TIA as a particularly unstable condition. Risk of stroke is greater than 10% in the first 90 days after an index TIA. The presentation, prognosis and intervention for TIA have not been reported in South-Asians in a developing country. Method: A retrospective chart review was done for 158 Patients who were admitted with the diagnosis of TIA, as defined by ICD 9 code …

Misoprostol In Addition To Routine Treatment Of Postpartum Hemorrhage: A Hospital-Based Randomized-Controlled Trial In Karachi, Pakistan., N. F. Zuberi, Jill Durocher, Rozina Sikander, Neelofur Baber, Jennifer Blum, Gijs Walraven

Department of Obstetrics & Gynaecology

Background:Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment.

Methods: A randomized controlled trial was conducted in four Karachi hospitals from December 2005 - April 2007 to assess the benefit of a …

Association Between Antipsychotics And Weight Gain Among Psychiatric Outpatients In Pakistan: A Retrospective Cohort Study., Syed Ahmer, Rashid A. M Khan, Saleem Perwaiz Iqbal

Department of Psychiatry

Background: It has been known for a long time that use of antipsychotics, particularly atypical antipsychotics, is associated with weight gain and increase in risk of metabolic disturbances. In this study we have tried to find out if use of antipsychotics is associated with increase in weight and body mass index (BMI) in the Pakistani population. Methods: We performed a case note review of all Patients who had been prescribed antipsychotic medication at the psychiatry outPatient clinic of a tertiary care university hospital in Pakistan over a 4-year period. Results: A total of 50% of Patients had a BMI in …

Hyponatraemia: Etiology, Management And Outcome, Aasima Yawar, Abdul Jabbar, Naeem Ul Haque, Lubna M Zuberi, Najmul Islam, Jaweed Akhtar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To determine the etiology of hyponatraemia, the treatment instituted and the outcome of treatment in a tertiary care hospital setting.

STUDY DESIGN: Case series.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, between January and June 2004.

METHODOLOGY: Case records of 220 patients admitted to the medical service were identified through computerized hospital patients' data. All patients (3) 15 years with a sodium level on admission of (2) 130 mmol/litre were included. The records of those patients were reviewed for relevant demographic, clinical and laboratory data, in addition to the diagnosis, treatment and outcome of hospitalization. The …

Factors Associated With Non-Adherence Among Psychiatric Patients At A Tertiary Care Hospital, Karachi, Pakistan: A Questionnaire Based Cross-Sectional Study, Fawad Taj, Mansoor Tanwir, Zarmeneh Aly, Ameer Ali Khowajah, Asma Tariq, Fahd Khalid Syed, Fahd Waqar, Khezar Shahzada

Department of Psychiatry

OBJECTIVE: To elucidate predictors of non-adherence among psychiatric patients presenting at a tertiary care hospital of Pakistan, for follow-up with consultant psychiatrist.

METHODS: A convenient sampleof psychiatric patients from Aga Khan University Hospital was enrolled between April and May, 2005. An interviewer assisted, standardized questionnaire was used for data collection. Patients with cognitive deficit or psychosis and those presenting for the first time were not included in the study.

RESULTS: Out of 128 patients, those with co-morbidity (32.81%) were less adherent than those without comorbidity (p-value:0.002). Adherence among depressed was 61.53%; psychotic was 58.82%; bipolar disorder was 73.91%. Reasons for …

Migraine And Patent Foramen Ovale: Exploring The Association And A Possible Treatment Option, Muhammed Yaser Hasan

Department of Biological & Biomedical Sciences

Migraine is a very common type of headache. With a prevalence of 10-12%, migraine ranks 19th among diseases causing worldwide morbidity. Number of studies have shown a high prevalence of patent foramen ovale (PFO) in patients with migraine, especially migraine with aura. The right to left shunting of blood in a PFO could serve as a conduit for chemicals that would exert a trigger effect on hyper excitable neurons leading to the development of migraine. Furthermore patients with PFO and migraine also show a marked improvement in their symptoms after percutaneous closure of the PFO. This review is a close …

Enterocutaneous Fistulae In Children - A Management Challenge, Ali Imran Amjad, Saqib Hamid Qazi, Zafar Nazir

Department of Biological & Biomedical Sciences

No abstract provided.

Clinical Outcomes Of Sirolimus With Eluting Stent Implantation In Coronary Artery Disease, Munsif Ali, Syed Mumtaz Ali Shah, Zaman Shah, Islam Hussain, Khezar Shahzada Syed, Hadi Mohammad Khan

Section of Cardiology

OBJECTIVE: To evaluate the immediate post procedure, thirty-days, and six-months clinical outcomes of sirolimus-eluting stents (SES) implantation in patients with single and multivessel coronary artery disease (CAD).

METHODS: A case series of all consecutive patients undergoing percutaneous coronary interventions (PCI) with SES implantation at Shifa International Hospital, Islamabad, were evaluated at early post-procedure, 30-days and six-months clinical follow-up for the incidence of major adverse cardiac event (MACE). This included death, nonfatal myocardial infarction (MI) and repeat revascularization.

RESULTS: Out of 206 consecutive patients, 324 had SES implanted. Cumulative MACE rate was 2.93% and 6% at 30-days and six-months follow-ups respectively. …

99mtc-Nannocolloid Localization Of Lymphorenal Fistula Causing Chyluria, Maseeh Uz Zaman, Riffat Parveen Hussain, Khalil Ahmed Khan, Gufran Khan, M. Nadeem Ahmad

Department of Radiology

Chyluria is an abnormal condition in which chyle appears in the urine because of a fistulous communication between the lymphatics and the urinary tract. It is not life-threatening and spontaneous regression is reported in 50% of cases. Lymphangiography has been the main imaging modality for localization of the site of fistula, but it is invasive and requires expertise. Lymphoscintigraphy using Tc-99m labelled colloid is a safe, non-invasive, reproducible technique, which bears less radiation exposure. A 67-year-old male presented with 7-month history of chyluria following a spinal surgery. Bilateral lower limb lymphoscintigram revealed sluggish lymph flow in the left lower limb …

Predictive Model Of Blood Transfusion During Cabg Surgery In Pakistan, Sana Shoukat, Saqib A Gowani, Farhad Khimani, Faraz A Khan, Mohammad Zaman, Hasanat Sharif

Section of Cardiothoracic Surgery

OBJECTIVE: To determine predictors of need for transfusion of blood and blood products and create a clinical predictive model to reduce indiscriminate use of blood products during surgery.

METHOD: We conducted a retrospective chart review of 485 patients who underwent coronary artery bypass surgery from January 2004 to December 2004 at a Tertiary Care Hospital in Karachi, Pakistan. Independent predictors associated with transfusion were identified and a clinical prediction model developed.

RESULTS: The transfusion rate was 37.1%. A predictive model was created based on the presence of pulmonary disease, diabetes mellitus, low ejection fraction and recent/ongoing myocardial infarction.

CONCLUSION: The …

Reducing The Rate Of Primary Caesarean Sections--An Audit, Lumaan Sheikh, Sara Tehseen, Saqib Ali Gowani, Hadi Bhurgri, Javed Rizvi, S Kagazwala

Department of Obstetrics & Gynaecology

Objective: To evaluate how the implementation of universally acceptable standards affects rates for primary caesarean sections, without compromising maternal or foetal safety.

Method: A complete audit cycle of all the primary caesarean sections performed in the maternity unit of Aga Khan University was conducted from 1st January to 31st March during years 2003 and 2004. New labour management guidelines were implemented after the first audit (appendix). The rates of caesarean section, induction of labour, failed induction, and maternal and foetal outcomes were compared before and after the implementation of the guidelines.

Results: Primary emergency caesarean section rate decreased from 16% …

A Case Of Histoplasmosis Mimicking Tuberculosis, Asim Qureshi

Department of Pathology and Laboratory Medicine

Drug resistance to Tuberculosis is an emerging problem but proper exhaustive workup needs to be done before confirming the diagnosis. The case of a 5 year old male child who presented with low grade fever and lymphadenopathy and was being treated with anti TB drugs with no satisfactory response is presented. A detail workup including a biopsy gave the diagnosis of histoplasmosis.

Anaesthetic Management Of Patient With Ellis Van Creveld Syndrome, Faisal Shamim, Fauzia N. Minai

Department of Anaesthesia

A known case of Ellis-Van Creveld Syndrome was scheduled for emergency repair of obstructed paraumblical hernia. We describe the anaesthetic management of the case with special reference to the classic physical and physiological manifestations of this syndrome present in our patient.

Frequency And Clinical Spectrum Of Rare Inherited Coagulopathies--A Tricenter Study, Safoorah Khalid, Fareena Bilwani, Salman Naseem Adil, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the frequency of rare inherited coagulopathies at three centers of haematology in Karachi and to study the clinical spectrum and laboratory data of these coagulopathies.

METHODS: This was a descriptive study conducted from September 2003 to December 2004 on subjects from Aga Khan University Hospital, Husaini Blood Bank and Fatimid Blood Transfusion Centre. All the subjects with bleeding tendency without any acquired causes of bleeding were selected for further investigation, and were asked relevant questions as present in the questionnaire. Screening tests including platelet count, PT, APTT and bleeding time were performed on all patients and subsequently, …

Perceptions About The Cause Of Schizophrenia And The Subsequent Help Seeking Behavior In A Pakistani Population - Results Of A Cross-Sectional Survey, Syed Nabeel Zafar, Reema Syed, Sarah Tehseen, Saqib A. Gowani, Sana Waqar, Amina Zubair, Wajeeha Yousaf, Akbar J. Zubairi, Haider Naqvi

Department of Psychiatry

Background: There is a cultural variability around the perception of what causes the syndrome of schizophrenia. Generally Patients with schizophrenia are considered dangerous. They are isolated and treatment is delayed. Studies have shown favorable prognosis with good family and social support, early diagnosis and management. Duration of untreated psychosis is a bad prognostic indicator. We aimed to determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behavior. Methods: This cross-sectional study was carried out on a sample of 404 people at the out Patient departments of Aga Khan University Hospital Karachi. Data was collected via a …

Drug-Prescribing Patterns During Pregnancy In The Tertiary Care Hospitals Of Pakistan: A Cross Sectional Study., Dileep K Rohra, Nirmal Das, Syed I Azam, Nazir A Solangi, Zahida Memon, Abdul M Shaikh, Nusrat H Khan

Department of Biological & Biomedical Sciences

Background: The rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan. Methods: This was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outPatient medicinal prescriptions given to pregnant Patients attending the antenatal clinics were collected. The drugs were classified according …

Role Of Neurosurgery In The Management Of Stroke, Gohar Javed, Muhammad Zubair Tahir, Ather Enam

Section of Neurosurgery

Stroke is the second leading cause of death worldwide. The aim of treatment in stroke patients is to prevent further neurologic deterioration and prevent recurrence. Despite all advances in medical treatment, morbidity and mortality in stroke patients is still very high. The other alternative is surgical treatment, which still lacks class 1 evidence. However there is recent reconsideration of this form of treatment and ongoing trials are showing some promising results. In this review the recent advances in surgical treatment of stroke will be discussed along with recommendations from the latest randomized trials.

Post-Infarct Cerebellar Cognitive Affective Syndrome: A Case Report, Ali Jawaid, Muhammad Ameen Rauf, Uzma Usman, Bhojo A Khealani

Section of Neurology

Post Infarct cerebellar cognitive affective syndrome is a rare disorder, characterized by cognitive impairment in the domains of memory, language, visuo-spatial functioning and affect after cerebellar stroke. We report a case of young female who developed mood alteration and cognitive disturbance following isolated cerebellar infarct. We, therefore, advocate a potential role of cerebellum in regulation of cognition and behaviour in humans.

Primary Health Care Providers’ Knowledge And Practices On Asthma Management Within Dar Es Salaam Region Health Facilities, John C. Rwegasha

Master of Medicine in Family Medicine

Background: Asthma is a common chronic health problem worldwide with considerable variation in the way it is managed. In the sub- Saharan Africa there is substantial gaps in asthma care; countries like Tanzania with inadequate health care structure are lagging far behind in both correct diagnosis and management of asthma. The increasing prevalence of asthma within populations is attributed to a number of the following factors; Patient behavior, Health service structure and access, Environmental factors and Provider's knowledge and practices. There is lack of required standard asthma care under provider's factors, hindering effective control of the disease. This could be …

Time Trends In The Incidence Of Cancer Cervix In Karachi South, 1995-2002, Yasmin Bhurgri, Shahid Pervez, Naila Kayani, Muneeza Afif, Imran Tahir, Kauser Nazir, Ahmed Usman, Naveen Faridi, Hadi Bhurgri, Jawaid Malik, Imtiaz Bashir, Asif Bhurgri, Rashida Ahmed, Sheema H Hasan, Mohammad Khurshid, S. M. H. Zaidi

Department of Pathology and Laboratory Medicine

Introduction:The objective of the study was to determine the trends of cancer cervix in Karachi South during an eight (1995-2002) year period. Methododology: Cancer cervix cases recorded at Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analyzed. Trends were studied by analyzing the age standardized incidence rates (ASR)s in 2 time periods, 1995-97 and 1998-2002.

Results:

Cancer cervix ranked sixth in the 1995-97 period the age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 and 3.22. It reached the fifth ranking in the 1998-2002 period with an ASR and …