Medical Specialties Commons^™

Perfusion Imaging In Ischaemic Stroke, Zafar Sajjad

Department of Radiology

Perfusion imaging allows the blood flow to the tissue to be imaged. It is currently widely applied to the management of acute ischaemic stroke. Using either Computerised Tomography or Magnetic Resonance Imaging techniques, perfusion maps can be created in a short enough time to allow their routine use in clinical practice. Perfusion Imaging enables the physician to directly estimate the tissue at risk which can be salvaged with reperfusion, enabling appropriate patient selection. Perfusion imaging however has its limitations which need to be kept in mind when these studies are interpreted. Although perfusion imaging is widely used, the evidence to …

Hypotension At Presentation Is An Indicator Of Poor Prognosis In Acute Intracerebral Haemorrhage, Mohammad Wasay, Bhojo A Khealani, Saad Shafqat, Ayesha Kamal, Nadir Ali Syed

Section of Neurology

OBJECTIVE: To identify frequency of hypotension in a large cohort of patients with intracerebral haemorrhage and its prognostic significance.

METHODS: We retrospectively reviewed medical records of 920 patients with spontaneous intracerebral haemorrhage (ICH). Patients were divided in three groups based on Diastolic blood pressure (DBP); hypotensive group (DBP < 70 mmHg), normotensive group (DBP; 71-90 mmHg) and hypertensive group (DBP > 90 mmHg).

RESULTS: Of the total patients with ICH, 7% (64) presented with hypotension, 13% (120) were normotensive and 80% (736) were hypertensive. In the hypotensive group, 37% (24) patients died as compared to 25%(30) in normotensive group and 25% (182) in hypertensive group (p = 0.03). Hypotension at presentation, thalamic and …

Helicobacter Pylori Gastritis And Risk Of Ischaemic Stroke, Mohammad Wasay, Wasim Jafri, Bhojo Khealani, Iqbal Azam, Akber Hussaini

Section of Neurology

OBJECTIVE: To identify the association between H. Pylori gastritis and stroke.

METHOD: Patients with biopsy proven H. Pylori gastritis and non H. Pylori gastritis were enrolled. Patients were followed for a period of two years.

RESULTS: A total of 326 patients were included in the study. 162 patients were with H. Pylori gastritis. There was no significance difference in age, sex and duration of symptoms in the two groups. Three patients in H. Pylori group had stroke or TIA as compared to one in non H. Pylori group. Patients with H. Pylori gastritis were more likely to die or have …

Brain Death: Concepts And Knowledge Amongst Health Professionals In Province Of Sindh, Pakistan, Mughis Sheerani, Mian Zainul Sajadeen Urfy, Bhojo A Khealani, Junaid Patel, Qamarunnisa, Suresh Rath

Section of Neurology

OBJECTIVE: Last few decades have seen improved resuscitative measures and use of life saving machines like ventilators. Due to these dramatic interventions, end of life decisions, including brain death and organ transplantation, have become more complex and a major problem in our clinical practice. This study was done to find the opinion and awareness of physicians regarding issues surrounding brain death in this region.

METHODS: A total of 259 questionnaires were analyzed that encompassed physicians at different level of training and students in the final year of their training, from five major tertiary care centres, located at Karachi and Hyderabad …

Diagnostic Yield Of Transthoracic Echocardiography For Stroke Patients In A Developing Country, Muhib Alam Khan, Bhojo A Khealani, Bilal Hameed, Ayeesha Kamal, Mohammad Wasay, Nadir Ali Syed

Section of Neurology

OBJECTIVE: To assess the utility and cost effectiveness of transthoracic echocardiography (TTE) as part of stroke workup in a developing country.

METHODS: All patients over the age of 14 years with acute stroke were prospectively enrolled in Aga Khan University stroke databank from August 1999 to May 2001 (22 month period). All patients were evaluated by a consultant neurologist and underwent standard stroke work up such as neuroimaging, TTE, carotid doppler sonography and blood tests e.g. serum glucose, lipid profile, blood urea nitrogen and serum creatinine. For the purpose of this study, patients with ischemic stroke were identified and their …

Stroke In Pakistan, Bhojo A Khealani, Bilal Hameed, Uzma U Mapari

Section of Neurology

Stroke is the most common cause of disability and a leading cause of mortality world wide. Though the incidence is falling in West but probably is rising in Asia. The burden of stroke risk factors in Pakistan is enormous e.g. by 2020 Pakistan will be 4th most populous country in terms of diabetic patients. Similarly every 3rd person above age of 45 years has hypertension. Ironically a great majority of these patients are unaware of their diagnosis. This is further complicated by the fact that most of diagnosed patients have uncontrolled hypertension, as a result of poor compliance on patients …

Post Stroke Seizures: Descriptive Study From A Tertiary Care Centre In Pakistan, Bhojo A Khealani, Sajjad Ali, Shahid M Baig

Section of Neurology

OBJECTIVE: To determine the frequency, mode of onset and outcome of post stroke seizures in a local setting.

METHODS: The retrospective (Aug 1999 to July 2001) and prospective (August 2001 to July 2002) data of patients aged 14 years and above, with post stroke seizures was collected from a tertiary care centre in a metropolitan city. The demographic, clinical, radiological, laboratory, neurophysiologic and outcome data was recorded and analyzed.

RESULTS: During the three year period 1548 patients with stroke were admitted to the hospital. Four hundred thirty one (28%) had intracerebral haemorrhage (ICH) and 1117 (72%) had ischaemic stroke. One …

A Non-Randomized Study Of Safety And Efficacy Of Heparin For Dvt Prophylaxis In Intracerebral Haemorrhage, Mohammad Wasay, Saqibuddin Khan, Khawaja S. Zaki, Bhojo A. Khealani, Ayeesha Kamal, Iqbal Azam, Ismail A. Khatri

Department of Medicine

Objective: To evaluate the safety and efficacy of subcutaneous heparin for deep venous thrombosis (DVT) prophylaxis in patients with intracerebral haemorrhage (ICH) during acute phase in comparison to elastic stockings.

Methods: The diagnosis of ICH was based on imaging (CT or MRI) and DVT was based on Doppler ultrasound.

Results: A total of 458 patients were identified over a period of 5 years (1997-2001). Median age was 59 years (range:12-99 years). Two hundred (44%) patients received heparin (heparin group) in addition to elastic stockings and 258 (56%) patients were only given elastic stockings (stockings group). These two groups were not …

Perinatal Arterial Ischaemic Stroke: An Update With Literature Review, S. H. Ibrahim, Zafar Abdul Mueed

Department of Paediatrics and Child Health

Perinatal arterial ischaemic strokes are a major cause of morbidity in the neonatal period and leads to significant neurological morbidity. It is however under recognized as an entity and usually missed till the baby is 3-4 months of age when they first present with hemiplegia. Perinatal arterial ischaemic strokes are not reported from our country and this may be due to the fact that neurodiagnostic modalities were not available until the last few years. Even now this is not available in the smaller cities of our country. In this review we will discuss the common issues related to etiology and …

Estrogen Replacement Therapy Induces Functional Asymmetry On An Odor Memory/Discrimination Test, Richard L. Doty, Mehreen Kisat, Isabelle Tourbier

Section of Otolaryngology, Head & Neck Surgery

The secondary afferents of the olfactory system largely project to the ipsilateral cortex without synapsing in the thalamus, making unilateral olfactory testing a useful probe of ipsilateral hemispheric activity. In light of evidence that lateralized performance on some perceptual tasks may be influenced by estrogen, we assessed left:right nostril differences in two measures of olfactory function in 14 post-menopausal women receiving estrogen replacement therapy (ERT) and 48 post-menopausal women receiving no such therapy. Relative to women not taking ERT, those receiving ERT exhibited better performance in the left nostril and poorer performance in the right nostril on an odor memory/discrimination …

Emergence Of Carbapenem Resistant Gram Negative And Vancomycin Resistant Gram Positive Organisms In Bacteremic Isolates Of Febrile Neutropenic Patients: A Descriptive Study., Seema Irfan, Faiza Idrees, Vikram Mehraj, Faizah Habib, Salman Adil, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:This study was conducted to evaluate drug resistance amongst bacteremic isolates of febrile neutropenic Patients with particular emphasis on emergence of carbapenem resistant Gram negative bacteria and vancomycin resistant Enterococcus species.

Methods:

A descriptive study was performed by reviewing the blood culture reports from febrile neutropenic Patients during the two study periods i.e., 1999-00 and 2001-06. Blood cultures were performed using BACTEC 9240 automated system. Isolates were identified and antibiotic sensitivities were done using standard microbiological procedures.

Results:

Seven twenty six febrile neutropenic Patients were admitted during the study period. A total of 5840 blood cultures were received, off …

Drug Overdose: A Wake Up Call! Experience At A Tertiary Care Centre In Karachi, Pakistan, Muhammad Junaid Patel, Muhammad Shahid, Mehmood Riaz, Waqaruddin Kashif, Syed Imran Ayaz, Muhammad Shoaib Khan, A. Jawwad Samdani, Ayesha L Sorathia, Muhammad Furqan

Department of Emergency Medicine

OBJECTIVE: To study the characteristics of patients admitted with drug overdose caused either by accidental overdose of the prescribed medications or as an act of deliberate self harm (DSH) at a tertiary care hospital in Karachi, Pakistan.METHODS: A retrospective case series review was conducted at the Aga Khan University Hospital from January 2002 to October 2006. Three hundred and twenty four adult patients admitted with drug overdose were included in the study.RESULTS: Our sample group revealed mean age of 36.2 +/- 17.0 years, more females (59%), housewives (34%), and students (20%). Fifty six percent of patients committing DSH were married …

Syncope: Experience At A Tertiary Care Hospital In Karachi, Pakistan., Muhammad Junaid Patel, Nadeem Ullah Khan, Abdul Jawwad Samdani, Muhammad Furqan, Aamir Hameed, Muhammad Sohaib, Syed Imran Ayaz, Muhammad Omer Jamil

Department of Emergency Medicine

Introduction:Our aim was to determine the characteristics of Patients presenting with syncope at a tertiary care hospital in Karachi, Pakistan.
Methods: A review of medical records was conducted retrospectively at the Department of Medicine, Aga Khan University Hospital, Karachi. Patients aged 16 and above, admitted from January 2000 to December 2005 with the diagnosis of syncope made by the attending physician were included.
Results:A total of 269 Patients were included (75% males, mean age: 57.4 years). Neurogenic (vasovagal) syncope was the most common cause (47%), followed by cardiogenic syncope (18%) and orthostatic syncope (9%). A total of 24% …

Primary Cerebral Angitis Of The Central Nervous System: Case Report, S. Das, J. O. Jowi, K. Hameed, F. S. Rana

Pathology, East Africa

We report a case of a 28 year old female who presented with variedly progressive stroke like illness and raised intracranial pressure. Brain MRI scans revealed pericallosal and periventricular hyperintensities with oedema. Various medications like intravenous immunoglobulin, antibiotics, acyclovir, methyl prednisolone and management for raised intracranial pressure were instituted. She rapidly deteroriated and died on tenth hospital day. Only at autopsy was the diagnosis of primary angitis of central nervous system established.

Does Choice Of Therapy Save Costs And Improve Outcomes In Hyperthyroid Patients, Lubna M Zuberi, Safia Awan, Najmul Islam, J. Akhter, Abdul Jabbar

Section of Internal Medicine

OBJECTIVE: To compare cost of treating hyperthyroidism with antithyroid medications (ATD) versus radioactive iodine (RAI). As secondary outcome we also analyzed data in terms of remission rates.

METHODS: This was a retrospective comparative analysis of hyperthyroid patients treated with ATD or RAI from January 2000 to December 2005. Cost of ATD, TSH. FT4, doctors visits; thyroid technetium scan and RAI treatment were calculated for the duration of treatment and for one year of follow-up after remission.

RESULTS: A total of 143 patients were included, with an average duration of follow-up of 32 months. Mean age was 41 +/- 15.5 years …

A Randomised Comparative Clinical Trial Of Prokinetic Agents And Proton Pump Inhibitors In H. Pylori Negative Non-Ulcer Dyspepsia, Mzee Ngunga

Master of Medicine in Internal Medicine

Aim: To compare the efficacy of prokinetic agents and proton pump inhibitors in symptom relief of patients with non-ulcer dyspepsia. Design: Comparative prospective single blind clinical trial. Patients and setting: Fifty four cases of non-ulcer dyspepsia in whom H. pylori has been eradicated were seen in the specialist gastroenterology clinic of a tertiary care hospital. Methodology: Patients with dyspepsia and negative endoscopy for peptic ulcer disease, gastro-oesophageal reflux disease, hiatus hernia and upper gastrointestinal malignancy in whom H pylori has been eradicated but still had dyspepsia were assessed and scored using the modified Glasgow dyspepsia severity score (GDSS) at baseline. …

Triple Test Assessment And A Scoring System To Predict The Presence Of Breast Cancer At Aga Khan University Hospital, Nairobi, Aideed A. Kahie

Master of Medicine in General Surgery

Background: Breast cancer is an emerging health concern in Africa. It is the most common female cancer in Kenya. The accuracy of the diagnostic modalities in our institution has not been previously assessed, especially in cases where components of the Triple Test (TT) are non-concordant. Objectives: To retrospectively evaluate the accuracy of TT, its components and its modification; the Triple Test Score when the components are nonconcordant at Aga Khan University Hospital, Nairobi. Methods: Using ICD9 611.72 we identified patients with breast lump or mass in the period between January 2000 and July 2007. One hundred and thirty nine patients …

Vitamin B12 Deficiency Common In Primary Hypothyroidism, Abdul Jabbar, Aasma Yawar, Sabiha Waseem, Najmul Islam, Naeem Ul Haque, Lubna Zuberi, Ataullah Khan, J. Akhter

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To assess the prevalence and clinical features of B12 deficiency in hypothyroid patients and to evaluate clinical response in symptoms to B12 replacement therapy.

METHODS: One hundred and sixteen hypothyroid patients from our endocrine clinic were evaluated for signs and symptoms of vitamin B12 deficiency. Laboratory parameters including Haemoglobin (Hb), MCV, Vitamin B12 levels and presence of anti thyroid antibodies were analyzed. Patients with low B12 levels were treated with parenteral intramuscular vitamin B12 monthly, and monitored for improvement of symptoms.

RESULTS: A total of 116 patients (95 females and 21 males) were evaluated. Forty six (39.6%) hypothyroid patients …

St Segment Resolution Post Mi--A Predictor Of Better Outcomes, Shuja-Ur-Rehman, Sidrah Sheikh, Mohsin Nazeer

Section of Cardiology

OBJECTIVE: To compare, the post Myocardial Infarction in-patient outcome of patients with early ST resolution to those without ST resolution on ECG, in a South Asian population.METHODS: This was a prospective study done at the Punjab Institute of Cardiology, Lahore. Consecutive patients of ST elevation myocardial infarction, who were not treated with primary angioplasty but were thrombolysed were recruited at the time of arrival in the emergency department. Streptokinase was administered to all patients as the agent of thrombolysis. ECG was acquired at baseline and at 60 minutes post streptokinase administration. Patients were subsequently divided into two groups (A) Patients …

The Unifying Dilemma Of The Pakistani Science Journals, Saba Sohail

Department of Radiology

No abstract provided.

Labrad : Vol 33, Issue 2 - May 2008, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Tartrate Resistant Acid Phosphatase (TRAP): An Important Diagnostic Tool for Hairy Cell Leukaemia
• Heterotopic Pregnancy: A Case Report
• Biochemical Markers of Excessive Alcohol Use
• Osmotic Fragility
• Pattern of Drug Abuse in Patients Presenting at a Referral Lab
• Achondrogenesis
• Molecular Diagnosis of Human Papilloma Virus
• Diagnosis of Clostridium Difficile Associated Diarrhoea
• Pakistan Association of Pathologists – Meeting Report

Cleaning Methods For Ultrasound Probes, Waseem Akhtar Mirza, Syed Hadi Imam, Kharal Mohd Salim, Mubashir Aslam, Syed Arif Ali, I. Masroor, M. Nadeem Ahmad

Department of Radiology

Objective: To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections.

Study Design: Experimental study.

Place and Duration of Study: Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007.

Patients and Methods: A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning …

Practices Regarding Diagnosis And Management Of Third And Fourth Degree Perineal Tears, Raheela Mohsin Rizvi, Nasreen Chaudhury

Department of Obstetrics & Gynaecology

Objective: To review our practice of diagnosing and managing third and fourth degree perineal tears.

Method: Retrospective case series conducted by reviewing medical records of all women having singleton, full term vaginal delivery at Aga Khan University Hospital, Karachi from November 1990 to October 2005.

Results: The frequency of obstetric anal sphincter injury (OASI) in our department was 0.5% (135) out of a total of 26,844 vaginal deliveries. Seventy five percent were nulliparous (102). Forceps delivery was performed in 86 patients out of 135 (63.7%). In only 28 patients (20.7%), the diagnostic criterion for classification of third degree tears was …

Extensive Primary Malignant Thymoma Involving Pericardium, Pleura, Diaphragm And Lungs--A Case Report, Rubina Abuali Sajwani, Saqib Ali Gowani, Ameer Ali Khowaja, Asmatullah Khan, Saulat H Fatimi

Section of Cardiothoracic Surgery

Malignant thymoma is an extremely rare entity. According to a study, the annual incidence of malignant thymoma was estimated to be 0.15 per 100,000 person-years. We present the case of a 42-year-old female who came to us with a Type AB, Masaoka stage III malignant (invasive) thymoma with widespread involvement of the mediastinum.

Unusual Presentation Of Idiopathic Retroperitoneal Fibrosis: Case Report, N. Twahirwa, J. Rees

Imaging & Diagnostic Radiology, East Africa

Idiopathic retroperitoneal fibrosis (IRF) is an uncommon entity described as progressive proliferation of connective tissues leading to a fibrous plaque-like lesions that encases the aorta and inferior vena cava inferior to the level of the renal arteries. Mass forming retroperitoneal fibrosis is rare. We present a rare case of a unilateral focal retroperitoneal mass simulating a tumour encasing the middle third of the left ureter, with involvement of the ipsilateral scrotum.

De Novo Primary Squamous Cell Carcinoma Of The Ovary: A Case Of A Rare Malignancy With An Aggressive Clinical Course, Ali Imran Amjad, Khawaja Muhammad Inam Pal

Section of General Surgery

Ovarian squamous cell carcinoma is a rare malignancy and the occurrence is attributable to malignant transformation of an existing ovarian dermoid cyst. The de novo occurrence of squamous cell carcinoma of the ovary, in the absence of an antecedent ovarian dermoid, is extremely rare. The case of a 31 year old Asian woman, evaluated for abdominal distension and discomfort is presented. Abdominal CT was suggestive of a malignant neoplastic process. Laparotomy confirmed a malignant tumour with involvement of the right adnexa and extension into the omentum and bowel. Surgical debulking, hysterectomy, bilateral salpingo-ophorectomy and total omentectomy and bowel resection was …

Cardiac Tamponade After Removal Of Temporary Pace Maker In Multidiscipinary Intensive Care Unit, Muhammad Faisal Khan, Ali Bin Sarwar Zubairi

Department of Anaesthesia

Cardiac tamponade is a medical and surgical emergency, which needs early recognition and treatment. Myocardial perforation leading to cardiac tamponade is a rare complication after pace maker insertion. We are reporting a case of cardiac tamponade after removal of temporary pace maker in a multidisciplinary intensive care unit.

Primary Cutaneous B Cell Lymphoma--Leg Type (New Eortc--Who Classification), With Nasal Sinuses Involvement, Asim Jamal Shaikh, Nehal Masood, Aamir Ahsan, Wasim Memon

Department of Radiation Oncology

Primary Cutaneous lymphomas of B cell origin are rare, there remains a controversy in truly classifying these lymphomas and an updated EORTC classification divides them on the basis of their distinct histopthological grounds rather than on the basis of their anatomic location as in WHO classification, while the new WHO- EORTC joint classification maintains some characteristics of both systems, We report an elderly gentleman who primarily had a typical Leg dominant Cutaneous lymphoma of B cell origin uniquely with involvement of nasal Sinusues, bearing the Immunohistochemical staining features of "Cutaneous lymphoma - Leg Type" befitting the new joint WHO-EORTC classification …

Laryngotracheal Trauma: Its Management And Sequelae, Shabbir Akhtar, Sohail Awan

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: Laryngotracheal trauma is a rare but clinically important injury. Complications are frequent. Early recognition, accurate evaluation and proper treatment is vital. In order to learn from our past experience and refine our management, we reviewed our cases.

METHODS: Fifteen patients with external laryngotracheal injuries were analyzed retrospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis.

RESULTS: Commonest cause of injury was cut throat injuries followed by road traffic accidents. The main presenting symptoms and signs were hoarseness, haemoptysis, odynophagia and stridor. Major laryngeal injuries (10 cases) outnumbered minor injuries …

Rhinosporidiosis Presenting As An Urethral Polyp, Najamul Sahar Azad, Zubairali Ahmad, Naila Kayani

Department of Pathology and Laboratory Medicine

Rhinosporidiosis is an inflammatory disease caused by Rhinosporidium seeberi, a protoctistan mesomycetozoa, member of a group of novel aquatic parasites, characterized by hyperplastic polypoid lesions of the nasal cavity and rarely other mucous membranes. We report an unusual presentation of rhinosporidiosis as an urethral polyp, which is only the second case of rhinosporidiosis reported from Pakistan.