Medical Specialties Commons^™

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

Department of Medicine

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.

A Family With Acute Intermittent Porphyria, Abdul Gaffar Billoo, Saira Waqar Lone

Department of Paediatrics and Child Health

Porphyrias are inherited defects in heme metabolism that result in excessive secretion of porphyrins and porphyrin precursors. Porphyrias can be classified into acute, (neuropsychiatric), cutaneous and mixed forms. There are seven main types of porphyrias; acute intermittent porphyria and plumboporphyria are predominantly neuropsychiatric; congenital erythropoietic porphyria, porphyria cutanea tarda and erythropoietic protoporphyria have predominantly cutaneous manifestations and hereditary coproporphyria and variegate porphyria are classified as mixed as they both have neuropsychiatric and cutaneous features. They cause life-threatening attacks of neurovisceral symptoms that mimic many other acute medical and psychiatric conditions. Lack of clinical recognition often delays effective treatment, and inappropriate …

Clinical Profile And Outcome Of Cyanotic Congenital Heart Disease In Neonates, Khadija N Humayun, Mehnaz Atiq

Department of Paediatrics and Child Health

OBJECTIVE: To determine the clinical profile and assess the outcome of all neonates diagnosed with cyanotic congenital heart disease.

STUDY DESIGN: A case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital from January 1998 to December 2000.

PATIENTS AND METHODS: Neonates admitted with diagnosis of cyanotic congenital heart disease were evaluated for clinical diagnosis, survival and mortality.

RESULTS: Forty four neonates met the inclusion criteria. Eleven babies (25%) had Tetralogy of Fallot or its variants. Other malformations were d-transposition of great arteries, tricuspid valve anomalies (tricuspid atresia and Ebstein's anomaly), hypoplastic left heart syndrome, truncus arteriosus, total …

Making A Difference - Drug Resistant Infections In Poor Countries - A Major Burden On Children, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Drug Resistant Infections In Poor Countries: A Major Burden On Children, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Primary Care: A Mandatory Requirement For Effective Health Care, Waris Qidwai

Department of Family Medicine

No abstract provided.

Short-Course Versus Long-Course Antibiotic Therapy For Non-Severe Community-Acquired Pneumonia In Children Aged 2 Months To 59 Months, Batool A. Haider, Muhammad Ammad Saeed, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Pneumonia is the leading cause of mortality in children under five years of age. Treatment of pneumonia requires an effective antibiotic used in adequate doses for an appropriate duration. Recommended duration of treatment ranges between 7 and 14 days, but this is not based on any empirical evidence. Shorter duration of therapy, if found to be effective, could be particularly important in resource-poor settings where there is a high risk of death, poor access to medicines and health care, and limited budgets for medicines.
Objectives: To evaluate the efficacy of short- course versus long-course therapy with the same antibiotic …

Predictive Factors For Early Aspiration In Liver Abscess, Rustam Khan, Saeed Hamid, Shahab Abid, Wasim Jafri, Zaigham Abbas, Mohammed Islam, Hasnain Shah, Shaalan Beg

Department of Medicine

Aim: To determine the predictive factors for early aspiration in liver abscess.

Methods: A retrospective analysis of all Patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 (68%) Patients, pyogenic in 200 (21%), indeterminate in 73 (8%) and mixed in 32 (3%). Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess.

Results: A total of 966 Patients, 738 (76%) male, mean age 43 17 years, were evaluated: 540 Patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 Patients. Predictive factors for aspiration …

Neuroradiology, Zafar Sajjad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Retinopathy Of Prematurity: Frequency And Risk Factors In A Tertiary Care Hospital In Karachi, Pakistan, Ather M. Taqui, Reema Syed, Tanveer Anjum Chaudhry, Khabir Ahmad, Muhammad S. Salat

Section of Ophthalmology

Introduction: To determine the frequency of Retinopathy of Prematurity (ROP) in the premature infants born in a tertiary care hospital and to determine the risk factors associated with it.
Methods: This was a retrospective analysis of premature infants with birth weight < or = 1500 grams or gestational ago < or = 32 weeks, admitted to the Neonatal Intensive Care Unit of a tertiary care hospital in a three year period. The infants underwent eye examinations between their 4th and 7th week of life. Univariate and multiple logistic regression analysis were performed to determine the association between risk factors and ROP development.
Results: Sixty eight infants were included in the analysis. Out of these, 22 (32.4%) developed ROP (inclusive of all stages) and 14 (20.6%) developed threshold disease. Multiple logistic regression analysis revealed that low gestational age, sepsis and respiratory distress syndrome were independent predictors for the development of ROP.
Conclusion: The frequency of ROP in our hospital was on the …

Cardiopulmonary Resuscitation: Outcome And Its Predictors Among Hospitalized Adult Patients In Pakistan., Nadeem Ullah Khan, J. Razzak, Humaid Ahmed, Muhammad Furqan, Ali Faisal Saleem, Hammad Alam, Anwar Ul Huda, Uzma R. Khan, Rifat Rehmani

Department of Emergency Medicine

Introduction:Our aim was to study the outcomes and predictors of in-hospital cardiopulmonary resuscitation (CPR) among adult Patients at a tertiary care centre in Pakistan.
Methods:We conducted a retrospective chart review of all adult Patients (age > or =14 years), who underwent CPR following cardiac arrest, in a tertiary care hospital during a 5-year study period (June 1998 to June 2003). We excluded Patients aged 14 years or less, those who were declared dead on arrival and Patients with a "do not resuscitate" order. The 1- and 6-month follow-ups of discharged Patients were also recorded.
Results:We found 383 cases …

Laparoscopic Management Of An Ovarian Ectopic Pregnancy: Case Report, Y. Patel, Sikolia Wanyonyi, F. S. Rana

Obstetrics and Gynaecology, East Africa

Ovarian pregnancy is a rare variant of ectopic gestation.The diagnosis is often made at surgery and requires histological confirmation. The condition has not been reported locally and its diagnosis is easily missed. A case of an ovarian ectopic pregnancy in a 41year old para 1+ 1with secondary infertility is reported. The patient presented with lower abdominal pain and vaginal bleeding at six weeks gestation with a semm B-hCG of 79.12mlU/L. An ultrasound showed a complex left adnexal mass. She underwent a diagnostic and operative laparoscopy. A left oophorectomy was performed due to difficulty in achieving haemostasis.

Increased Prevalence Of Helicobacter Pylori 23s Rrna Gene Mutations In, Javed Yakoob, Wasim Jafri, Z Abbas, Shahab Abid, Rustam Khan, Nida Jafri, Zubair Ahmad

Section of Gastroenterology

No abstract provided.

Day Care Surgery At A New University Teaching Hospital: A Review Out Of The Aga Khan University Hospital, Nairobi, Edwin Mogere

Master of Medicine in General Surgery

Introduction: Day Care Surgery (DCS) is the surgical care of patients on a planned non-residential basis. The objective of the study was to assess the performance of DCS in the context of a developing country within the private sector. Data from a new DCS unit was compared to internationally accepted indicators of the quality of care. Methodology: A hospital based retrospective chart review of all patients operated on within 10 surgical subspecialties was performed. The review period was the June 2006 to July 2007(12 months). Analysis (SPSS version 11.5): Outcome measures included in-patient to DCS ratio in the various specialties; …

Analysis Of Sustained Virological Response To Pegylated Interferon & Ribavirin Treatment In Compensated Cirrhosis Due To Hepatitis C Virus, Genotype 3 Infection, Amna Subhan Butt, Wasim Jafri, Khalid Mumtaz, Saeed Hamid, Shahab Abid, Syed H Shah, Nida Jafri, Javed Yakoob, Zubair Ahmad

Section of Gastroenterology

No abstract provided.

Chylopericardium--A Rare Complication After Ventricular Septal Defect Repair, Saqib A Gowani, Ameer A Khowaja, Asmatullah Khan, Saulat H Fatimi

Section of Cardiothoracic Surgery

Chylopericardium is a rare complication of cardiac surgery. It may be caused by a lesion in the thoracic duct or its tributaries or by thrombosis in the confluence of the jugular and left subclavian veins, obstructing the drainage of the thoracic duct. The treatment may be conservative or surgical, depending on the duration and on the volume of the effusion. We report the case of a 1 1/2 year-old male, who, in the late postoperative period of VSD repair, was hospitalized with low-grade fever and breathlessness for one week due to the presence of chylopericardium. The clinical findings and treatment …

Intracytoplasmic Sperm Injection Outcome Using Ejaculated Sperm And Retrieved Sperm In Azoospermic Men., Tahira Naru, M. Nasir Sulaiman, Atiya Kidwai, M. Hammad Ather, Sana Waqar, Saadia Virk, Javed H Rizvi

Department of Obstetrics & Gynaecology

Introduction:We aimed to determine pregnancy and miscarriage rates following intracytoplasmic sperm injection (ICSI) cycles using retrieved epididymal and testicular sperm in azoospermic men and ejaculated sperm in oligospermic and normospermic men. Materials And
Methods: This retrospective study was carried out on 517 couples who underwent ICSI. They included 96 couples with azoospermia and 421 with oligospermia or normal sperm count in the male partner. Of the men with azoospermia, 69 underwent percutaneous epididymal aspiration (PESA) and 47 underwent testicular sperm extraction (TESE). In the 421 men with oligospermia or normal sperm count, ejaculated sperm was used for ICSI. The …

Frequency Of Various Types Of Headaches Inpostgraduate Medical Students Of A Tertiary Care Hospital, Sidra Aurangzeb, Muhammad Tariq, Ayesha Gul, Mehwish Hameed

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Seasonal Variation And Sex Distribution Inpatients With Guillain-Barre Syndrome, Mohsin Zaheer, Muhammad Naeem, Muhammad Nasrullah

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Hyperacute Extradural Hematoma Mimickingacute Subdural Hematoma, Amit Agrawal

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Neurosurgery, Manzar Hussain

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

An Audit Of The Quality Of Care Indicators For The Management Of Diabetes In Family Practice Clinics In Karachi, Pakistan, Raheem H Dhanani, Mohammad Mustafa Qureshi, Ali Khan Khuwaja, Badar Sabir Ali, Riaz Qureshi

Department of Family Medicine

BACKGROUND: Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month.

METHODS: For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least …

Chediak-Higashi Syndrome, Emaduddin Siddiqui, Shaheena Hanif

Department of Emergency Medicine

Chediak Higashi Syndrome is a rare inherited autosomal recessive disorder of immune system. Susceptibility to infection due to phagocyte dysfunction ranges from recurrent skin infection to over whelming fatal systemic infection. A five years old male child was admitted on 31st March 2006 with the complaints of pallor, fever & ear discharge for 6 month. He was treated by several medications but had temporary relief. The ear discharge was bilateral, foul smelling and of yellowish color. Past history was significant with episodes of abscess involving the different parts of body. Myeloid precursors shows giant, purple stained granules mainly in metamyelocytes, …

Knowledge About Osteoporosis Among Healthy Women Attending A Tertiary Care Hospital, Mehmood Riaz, Naushad Abid, Muhammad Junaid Patel, M. Tariq, Muhammad Shoaib Khan, Lubna Zuberi

Section of Internal Medicine

INTRODUCTION: To determinate the knowledge on osteoporosis-risk factors and disease in three age groups of Pakistani women.METHODS: In this exploratory cross-sectional study, an osteoporosis knowledge assessment questionnaire (OKAT) was used to collect data and it was delivered through a face-to-face interview. Questions were asked about symptoms of osteoporosis, knowledge of risk factors, preventive factors and treatment. A convenience sample (n =320) comprising of three groups of healthy women aged 25-35 years, 36-45 years, and over 45 years was taken. The scoring range was 0 to 20. Among-group comparisions of means were analyzed by two-way ANOVA. To determine the overall influence …

Clear Cell Papillary Cystadenoma Of Epididymis, A Mimic Of Metastatic Renal Cell Carcinoma, Nausheen Yaqoob, Aamir Ahsan, Zubair Ahmad, Ambreen Nasir Khan

Department of Pathology and Laboratory Medicine

We discuss a case of 25 year old male who was evaluated for primary infertility following marriage. He had no previous history of urogenital complaints or abnormalities. In fact, his past medical history was unremarkable. On examination epididymal masses were found. Semen analysis showed azoospermia. Right epididymal mass was surgically excised. Histopathology showed an epididymal neoplasm composed of simple and complex papillary processes lining and filling the ducts. The tumor cells were clear and positive for cytoplasmic glycogen. Immunohistochemistry was also supportive. Diagnosis of clear cell papillary cystedenoma was made based on histopathological and immunohistochemical features.

Practice Of Use Of Antiemetic In Patients For Laparoscopic Gynaecological Surgery And Its Impact On The Early (1st Two Hrs) Postoperative Period, Samina Ismail

Department of Anaesthesia

There is no agreed technique for minimizing PONV (Postoperative Nausea and Vomiting) although some techniques are associated with low rate. Best practice involves identifying high risk patients and surgeries and use of prophylactic antiemetic where appropriate. Laparoscopic gynaecological surgery has high incidence of PONV (54-92%). An audit on the practice of antiemetic use in diagnostic laparoscopic gynaecological surgery was done in the department of anaesthesia of Aga Khan University Hospital from 1st January to 30th June 2006. We included all the patients scheduled for this procedure lasting less than 90 minutes. Anaesthetist involved in the audit identified the patient falling …

High Prevalence Of Helicobacter Pylori Infections By Multiple Strains In Patients With Dyspepsia From A Developing Country, Shahab Abid, Javed Yakoob, Wasim Jafri, Khalid Mumtaz, Nida Jafri, Z Abbas, Syed H Shah, Saeed Hamid, Rashida Ahmed

Section of Gastroenterology

No abstract provided.

Effectiveness Of Assigning Bi-Rads Category-3 To Breast Lesion With Respect To Follow-Up, Imrana Masroor

Department of Radiology

OBJECTIVE: To determine the effectiveness of assigning BI-RADS category-3 to breast lesion with respect to follow-up.STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: Radiology Department, the Aga Khan University Hospital, Karachi, from January 2002 to December 2004.

PATIENTS AND METHODS: Women undergoing X-ray mammography and assigned BI-RADS category-3 and recommended short-term (6-monthly) follow-up were included. Out of these, 44 patients were lost to follow-up and were excluded from the study. The lesions that remained stable after short-term follow-up were recommended routine (annual) follow-up. Needle localization and open surgical biopsy was performed, if the lesion progressed or calcifications increased …

Factors Influencing In-Hospital Length Of Stay And Mortality In Cancer Patients Suffering From Febrile Neutropenia, Amar Lal, Yasmin Bhurgri, Nida Rizvi, Mohni Virwani, Rasheed Uddin Memon, Wajeeha Saeed, Muhammad Rizwan Sardar, Pawan Kumar, Asim Jamal Shaikh, Salman Adil, Nehal Masood, Mohammad Khurshid

Section of Haematology/Oncology

Introduction: Febrile neutropenia (FN) is a major complication of chemotherapy, costly in terms of morbidity, mortality and associated financial expenditure. The present study was conducted with the goal of highlighting FN as a serious problem in Pakistan, with the longer term objective of improved cancer survival, reduction in length of stay (LOS) in hospital, morbidity, mortality and costs in our existing developing country scenario. Methods: A cross-sectional descriptive study was conducted on Patients, > or =18 years, admitted with FN as a consequence of chemotherapy at a referral hospital in Karachi from 1st September 2006 to 30th April 2007. Results: A …

Gastric Juice For The Diagnosis Of H Pylori Infection In Patients On Proton Pump Inhibitors, Javed Yakoob, Shahid Rasool, Z Abbas, Wasim Jafri, Shahab Abid, Muhammad Islam, Zubair Ahmad

Section of Gastroenterology

Aim:To determine the efficacy of gastric juice polymerase chain reaction (PCR) for the detection of H pylori infection in comparison with histology and gastric antral biopsy PCR in Patients on a proton pump inhibitor (PPI).

Methods:

Eighty-five consecutive Patients with dyspeptic symptoms were enrolled. Gastric biopsies for histology, PCR and gastric juice were collected at endoscopy for PCR of the H pylori urease C gene (ure C). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive and negative likelihood ratio for PCR of gastric juice for the H pylori ure C gene was compared to histology …