Medical Specialties Commons^™

Prosthetic Valve Thrombosis Despite Seemingly-Adequate Anticoagulation: The Dangers Of Transient Lapses In Anticoagulation, Fahim H. Jafary, K. Hassan

Section of Cardiology

We report a 19-year-old woman with thrombosis of a prosthetic mitral valve that was most likely due to a short dip in anticoagulation in the days preceding the event. Interestingly, at presentation the Patient was super-therapeutic, most likely a result of hepatic congestion as the heart began to fail, creating an illusion of thrombosis despite adequate anti coagulation.

Interferon Associated Retinopathy, Hassan Khan, Kamran Hamid, Aga Hassan Feroze

Section of Ophthalmology

We describe a case of retinopathy with swollen optic nerve head (ONH) in a hepatitis C patient treated with combination of interferon and ribavirin. A 33-years old man presented with sudden bilateral visual loss and headache. On examination, the Visual Acuity of right eye and left eye was hand movement and counting fingers respectively. Right fundus showed ONH swelling, healthy macula, with tortuous dilated vessels and small scattered, intra retinal haemorrhages. Retinopathy was only present in the right eye, however, poor vision in both eyes suggested neurovisual involvement.

Infiltrating Syringomatous Adenoma Of Nipple, Nazia Riaz, Shaista Masood Khan, Romana Idress, Naila Kayani

Section of General Surgery

Infiltrating syringomatous adenoma of the nipple is a rare, benign lesion with distinct clinical and histological features. Origin from ducts of dermal sweat glands has been postulated. Important differential diagnosis include nipple adenoma, tubular carcinoma and adenosquamous carcinoma. Appropriate local management includes accurate diagnosis and complete excision to avoid local recurrences. This report describes the condition in a 39-year-old parous lady.

Frequency Of Abnormal Pap Smears And Assessment Of Risk Factors For Cervical Cancer In An Out-Patient Clinic, Firdous Jahan, Naheed Nabi, Waris Qidwai, Iqbal Azam

Department of Family Medicine

No abstract provided.

Endovascular Stenting For Carotid Artery Stenosis: Results Of Local Experience At Aga Khan University Hospital, Karachi, Muhammad Azeem Uddin, Tanveer Ul Haq, Ishtiaque Ahmed Chishty, Zafar Sajjad, Basit Salam

Department of Radiology

Objective: To evaluate the results, complications and initial follow-up of patients after percutaneous stent placement for carotid artery disease.Methods: A retrospective study was carried out on patients treated with carotid artery stenting at the Radiology Department of Aga Khan University Hospital, Karachi, from September 2002 to December 2005. The patients were selected according to the institutional guidelines for Carotid Angioplasty and stenting. Preliminary angiogram was performed in all patients followed by stent deployment. Distal protection device was used in 12 patients. All patients underwent pre and post procedure independent neurological examinations. Follow-up consisted of serial duplex ultrasonography and clinical assessment.Results: …

Labrad : Vol 33, Issue 1 - January 2008, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Diagnosis of Malaria
• Imaging Feature of Synovial Sarcoma in Pediatrics Patients
• Fine Needle Aspiration Biopsy: The best test to differentiate benign from malignant thyroid nodules
• HLA-B27 and Disease Association
• Bacterial Contamination of Blood Components
• Pathology Quiz
• Biochemical Investigations
• Leishmaniasis
• Answers to Quiz
• CD55 and CD59 for the Diagnosis of PNH
• Meeting Report

Waiting For Child Developmental And Rehabilitation Services: An Overview Of Issues And Needs, Anton R. Miller, Robert Armstrong, Louise C. Mâsse, Anne F. Klassen, Jane Shen, Maureen E. O’Donnell

Paediatrics and Child Health, East Africa

Concern about the length of time that children, young people, and families may have to wait to access assessment, diagnostic, interventional, therapeutic, and supportive child developmental and rehabilitation (CDR) services is widespread, but adequate data collection and research on this issue remain limited. We review key concepts and issues relevant to waiting for CDR services from the published literature, a national workshop devoted to this topic, and international experience. We conclude that gaps in data, evidence, and consensus challenge our ability to address the issue of waiting for CDR services in a systematic way. A program of research coupled with …

Correlation Of Three Immunohistochemically Detected Markers Of Neuroendocrine Differentiation With Clinical Predictors Of Disease Progression In Prostate Cancer, Hammad Ather, Farhat Abbas, Nuzhat Faruqui, Mohammad Israr, Shahid Pervez

Section of Urology

Background: The importance of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade is gaining acceptance. There is limited literature on the relative significance of three commonly used markers of NE differentiation i.e. Chromogranin A (CgA), Neuron specific enolase (NSE) and Synaptophysin (Syn). In the current work we have assessed the correlation of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade and to determine the relative value of various markers.
Materials and Methods: Consecutive samples of malignant prostatic specimens (Transurethral resection of prostate …

Focus On The Profession: Academic And Clinical Departments, Robert Armstrong

Paediatrics and Child Health, East Africa

The departments within the Faculty of Medicine at UBC play a central role in achieving the goals of the expanded medical school, and the goals of the broader health care system. Four strategies are needed for success: make professionalism the tie that binds the Faculty of Medicine and the health authorities; engage clinical and academic de­partments as key drivers of professionalism; ensure knowledge development and continuous learning are recognized as central to professionalism; challenge government to focus on supporting professionalism.

Reducing Hiv/Aids In Young People In Sub-Sahara Africa: Gaps In Research And The Role Of Theory, Kristien Michielsen, Marleen Bosmans, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

This paper discusses the role of education in preventing HIV in children and young people in sub-Sahara Africa and presents the results of policy advisory research conducted on behalf of the Belgian Development Cooperation. The research consisted of a literature review and a field study in Rwanda. Relative to the high number of HIV prevention activities in sub-Sahara Africa, there is a limited number of scientific data on HIV risk reduction interventions for young people in this region. Longitudinal studies are especially scarce. Preliminary results show that many interventions have only a marginal impact on reducing sexual risk behaviour. Factors …

Successful Pregnancy Outcome Following Laparoscopic Myomectomy: Case Report, R. B. Parkar, Sikolia Wanyonyi, W. J. Kamau, D. Otieno

Obstetrics and Gynaecology, East Africa

Laparoscopic myomectomy is now widely used as an alternative to laparotomy in the management of symptomatic uterine fibroids. The advantages of this minimal access approach outweigh those of the open techniques. The pregnancy outcomes between the two methods have been studied and are comparable, but there still exists a lot of scepticism locally concerning this. It is against this background that we present a 31 year old nulliparous lady who had a two year history of primary infertility secondary to multiple uterine fibroids, the largest being fundal and measuring 6.6cm. She underwent a successful laparoscopic myomectomy in November, 2006 and …

Prevalence, Risk Factors And Outcome Of Acute Kidney Injury At The Aga Khan University Hospital Nairobi, Peter W. Munyu

Master of Medicine in Internal Medicine

Introduction: Acute kidney failure (acute kidney injury, AKI) is a group of syndromes that result in a decline in the glomerular filtration rate. In 2002, the Acute Dialysis Quality Initiative (ADQI) group proposed the RIFLE criteria to standardize the definitions of AKI severity and outcome. This criterion has been validated in several studies. AKI is frequently encountered in hospitalized patients; it has a negative impact on mortality and morbidity. A lot of work has been done to describe the epidemiology of AKI in developed countries. The same does not apply for developing countries. This study was designed to evaluate AKI …

Comparison Of Doppler Studies In Obstetrics With Fetal Outcome, Sheila Waa

Master of Medicine in Imaging and Diagnostic Radiology

Purpose: to compare umbilical artery and middle cerebral Doppler ultrasound values in normal and high risk pregnancies with fetal outcome. Method: 121 consecutive pregnancies (at or over 28 weeks gestation), stratified into low and high risk pregnancies based on clinician information were prospectively examined with doppler ultrasound of UA and MCA. Results: outcome was available for 100 of the 121 patients. 26% of pregnancies had poor outcome. Of these 73% (19) and 27% (7) were classified as high risk and low risk respectively. UA alone or in combination with MCA was shown to have 100% specificity for predicting fetal outcome. …

Knowledge, Attitude And Use Of Labour Pain Relief Methods Among Women Attending Antenatal Clinic In Nairobi, Vitalis Mung’Ayi, David Nekyon, Robinson Karuga

Anaesthesiology, East Africa

Background: Labour analgesia has rapidly gained popularity in obstetric practice. Low usage in the developing world has raised concern.

Objectives: To assess the knowledge, attitude and use of labour pain relief methods in women attending antenatal clinic in Nairobi.

Design: A prospective study.

Setting: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya.

Subjects: Two hundred and two consecutive expectant mothers attending antenatal clinic at the Aga Khan University Hospital, Nairobi.

Results: Fifty-six per cent of the participants had knowledge about labour pain relief methods. Friends, the antenatal clinic and books/leaflets were the major source on information. …

Evaluation Of Suspected Renal Colic Patients With Unenhanced Low-Dose Multidetector Computed Tomography (Mdct), Nebayosi Twahirwa

Master of Medicine in Imaging and Diagnostic Radiology

Acute renal colic is probably one of the most excruciatingly painful event a person can endure. [1]. Though this is typical of urinary tract calculi, it’s important to note that non-calculus and non-genitourinary conditions can present in a similar manner. Unenhanced helical CT (CT KUB), originally described by Smith et al [2] in 1995, is one single radiological test that has proven successful in the valuation of patients presenting with renal colic. This technique has been shown to be more accurate compared to abdominal radiography [3,4], ultrasound and has replaced excretory urography in the detection of urinary tract calculi in …

Primary Drug Resistance To Antituberculous Drugs In Nwfp Pakistan, Arshad Javaid, Abdul Ghafoor, Abdul Rab, Anila Basit, Zia Ullah, Shaukat Ali, Afia Zafar, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: To assess the prevalence of Primary drug resistance to Antituberculous drugs in NWFP
Method: A cross-sectional prevalence study was undertaken to evaluate the prevalence of drug resistance among new TB patients, using a non-probability convenience sampling methodology. Sample size was calculated according to the population and WHO's estimated incidence of smear positive tuberculosis in the province/country. Sputum samples were obtained from 122 newly diagnosed patients of pulmonary tuberculosis from centres in Peshawar and Abbotabad in NWFP.
Results: Sensitivities were performed by proportion method which showed the following resistance values in 118 eligible patients: 15 (12.7 %) …

Hepatic Angiosarcoma With Metastasis To Small Intestine, Zubair Ahmad, Azizun Nisa, Romana Idrees, Khurram Minhas, Shahid Pervez, Khalid Mumtaz

Department of Pathology and Laboratory Medicine

Hepatic angiosarcomas are rare tumours with poor prognosis, with patients usually dying within 6 months. Metastases mainly occur in lymph nodes, spleen, lungs, bones and adrenals. Metastasis to small intestine is even rarer. Similarly, primary or metastatic angiosarcomas in small intestine are extremely rare, often present with recurrent gastrointestinal bleeding and anemia, and have an extremely poor prognosis. Both primary or metastatic intestinal angiosarcomas may exhibit epithelioid morphology. It may be very difficult to differentiate between primary and secondary cases in intestine and especially when the tumour exhibits epithelioid morphology.

Pediatric Emergency Medicine--An Evolving Sub-Speciality In Pakistan, Emaduddin Siddiqui, Junaid Razzak

Department of Emergency Medicine

No abstract provided.

Beta-Hemolytic Streptococcus Group A Endocarditis: A Rare Clinical Presentation, Aysha Almas, M. Tariq

Section of Internal Medicine

A case report of an elderly gentleman is reported herein, who presented with one week history of fever, drowsiness and left lower limb weakness. Examination revealed left lower limb weakness with power of grade 3/5. His workup showed evidence of infection and multiple cerebral infarcts on the right side. Blood culture grew Streptococcus pyogens. Echocardiogram showed two vegetations on the aortic valve. Fever was the main presenting feature in this case but it was the presentation of patient with multiple cerebral infarcts that lead to the diagnosis of infective endocarditis. The organism causing Infective Endocarditis (IE) in this patient was …

Developmental Dysplasia Of Hip--Where Do We Stand?, Masood Umer, Haq Nawaz

Department of Surgery Docs

No abstract provided.

Antibiotic Susceptibility Of Pathogens Isolated From Patients With Community-Acquired Respiratory Tract Infections In Pakistan--The Active Study, Afia Zafar, Zahid Hussain, Eale Lomama, Sophie Sibille, Seema Irfan, Erum Khan

Department of Pathology and Laboratory Medicine

BACKGROUND: Respiratory tract infections (RTIs) are amongst the most wide spread and serious infections, accounting for over 50 million deaths globally each year. In developing countries, infants under 4 years of age are at greatest risk of lower RTIs, whereas in developed countries the severity of infection and rate of mortality are greater in elderly. The objective of the survey was to determine the in vitro susceptibility of antibiotics commonly prescribed RTIs against Streptococcus pneumoniae (SP), Haemophilus influenzae (HI) and Streptococcus pyogenes, isolated from patients with community-acquired RTIs globally. This survey involved 9 countries. In this study we present the …

Primary Drug Resistance To Anti-Tuberculous Drugs In Karachi, Arshad Javaid, Nadim Rizvi, Mosavir Ansari, Ashraf Sadiq, Iqbal Sher Burki, Nadeem Ur Rehman, Rumina Hasan, Afia Zafar

Department of Pathology and Laboratory Medicine

Objective: To assess the frequency of primary drug resistance among newly diagnosed tuberculosis cases in Karachi.
Study Design: Cross-sectional study.
Place and Duration of Study: Multicentric study involving various TB clinics and treatment centres of Karachi between April to December 2005.
Methodology: The frequency of drug resistance among new TB patients was evaluated using a non-probability convenient sampling methodology. Sputum sample was obtained from 140 newly diagnosed sputum smear-positive patients of pulmonary tuberculosis from various centres of Karachi. Sensitivities were performed by proportion method.
Results: Fifteen (11.5%) samples in 130 eligible patients showed primary resistance to one …

Willingness And Ability To Pay For Artemisinin-Based Combination Therapy In Rural Tanzania, E.C. Saulo, B.C. Forsberg, Zul Premji, S.M. Montgomery, A. Bjorkman

Pathology, East Africa

Background: The aim of this study was to analyse willingness to pay (WTP) and ability to pay (ATP) for ACT for children below five years of age in a rural setting in Tanzania before the introduction of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria. Socio-economic factors associated with WTP and expectations on anti-malaria drugs, including ACT, were also explored.

Methods: Structured interviews and focus group discussions were held with mothers, household heads, health-care workers and village leaders in Ishozi, Gera and Ishunju wards in north-west Tanzania in 2004. Contingent valuation method (CVM) was used with "take-it-or-leave- it" …

Neuronal Regeneration In Denervated Muscle Following Sensory And Muscular Neurotization, Shahryar Noordin, Mahmood Ahmed, Rasham Rehman, Tashfeen Ahmad, Pervaiz Hashmi

Section of Orthopaedic Surgery

Background and Purpose: Neurotization of denervated muscles has been shown to improve muscle bulk, but the neuronal regeneration response has not been compared previously in different surgical techniques of neurotization. Thus, using a rat model of experimental skeletal muscle denervation, we studied neuronal regeneration following sensory neurotization by two methods: sensory nerve to motor branch of muscle and direct sensory nerve implantation to muscle.
Material and Methods: The lateral head of the gas-trocnemius muscle was denervated in 36 rats, of which the first 12 served as denervated controls. In the second group of 12, the sural nerve was anastomozed to …

Inguinal Hernia Repair At The Aga Khan Hospital, Nairobi: Practice And Preference Discordance, Ronald Wasike, Abdulkarim Abdallah

General Surgery, East Africa

Objectives: To review the current hernia repair methods at the Aga Khan University Hospital (AKUH) and relate to the preferred method of choice for groin hernia repair among the practicing general surgeons.

Design: An audit from retrospective practices.

Setting: A tertiary referral hospital, Aga Khan University Hospital, Nairobi.

Subjects: All elective adult hernia repairs performed at the Aga Khan University Hospital, Nairobi between 2004-5 by all surgeons with admitting privileges were reviewed. The methods of repair were noted. A questionnaire was also availed to the admitting surgeons to indicate their preferred method, and this was correlated with the audit results. …

Anaesthetic Management Of Tracheal Reconstruction Using Jet Ventilation, Khalid, Samad, Faisal Shamim, Muhammad Sohail Awan, Muhammad Qamarul Hoda

Department of Anaesthesia

No abstract provided.

Effect Of Single Dose Magnesium On Arrhythmias In Patients Undergoing Coronary Artery Bypass Surgery, M Hamid, Rs Kamal, Sa Sami, F Atiq, A Shafquat, Hi Naqvi, Fazal Hameed Khan

Department of Anaesthesia

OBJECTIVE: To evaluate the safety and role of prophylactic administration of magnesium in preventing arrhythmias.
METHOD: This double blind randomized placebo controlled clinical trial was conducted at Aga Khan University Hospital on coronary artery bypass surgery patients. All patients were connected to holter monitor before induction of anaesthesia and this monitoring continued for 24 hours. Study drug containing either 2-grams of magnesium or normal saline was given after intubation. Levels of serum magnesium was checked preoperatively and then in ICU at 0, 6, 12, and 24 hours. Independent t-test and chi square test were used for analysis. Statistical significance was …

Hiv, Hepatitis B And Hepatitis C Coinfection In Kenya, Reena Shah, Jane Karuru, Mark Nelson, Justin Stebbing

Internal Medicine, East Africa

There are few data regarding hepatitis and HIV coinfection in Africa. In 378 HIV seropositive individuals in Nairobi, 23 (6%) were hepatitis B virus (HBV) and HIV coinfected, four (1%) were hepatitis C virus (HCV) and HIV coinfected and one patient was infected with all three viruses. Coinfected individuals were more likely to be men and older; a lack of HBV vaccination was a risk factor for HIV/HBV coinfection (PU0.001) and tenofovir containing regimens appeared most effective at reducing HBV viral load.

P1: Effect Of Age, Oestradiol Levels And Endometrial Thickness On Determining Success Of Frozen Embryo Transfers, Alfred Murage, Maybeth Jamieson, Robin Yates, Isabel Traynor, Helen Lyall, Scott Nelson

Obstetrics and Gynaecology, East Africa

Introduction: Frozen-thawed embryo transfer (FET) is a widely used technique, with replacement of embryos during natural menstrual cycles or in cycles constructed by exogenous steroids having similar outcomes in many series. Multiple factors have been proposed to have a positive influence on the success rate of FET, including increased endometrial thickness, younger maternal age and lower circulating oestradiol. The impact of these variables in the context of constructed cycles, using GnRH agonists to facilitate suppression of ovarian function prior to exogenous steroid administration, is not known. The aim of this study was to determine the predictive ability of these indices …

Impact Of Training In Clinical And Microscopy Diagnosis Of Childhood Malaria On Antimalarial Drug Prescription And Health Outcome At Primary Health Care Level In Tanzania: A Randomized Controlled Trial, B. Ngasala, M. Mubi, M. Warsame, M.G. Petzold, A.Y. Massele, L.L. Gustafsson, G. Tomson, Zul Premji, A. Bjorkman

Pathology, East Africa

Background: Prescribing antimalarial medicines based on parasite confirmed diagnosis of malaria is critical to rational drug use and optimal outcome of febrile illness. The impact of microscopy-based versus clinical-based diagnosis of childhood malaria was assessed at primary health care (PHC) facilities using a cluster randomized controlled training intervention trial.

Methods: Sixteen PHC facilities in rural Tanzania were randomly allocated to training of health staff in clinical algorithm plus microscopy (Arm-I, n = 5) or clinical algorithm only (Arm-II, n = 5) or no training (Arm-III, n = 6). Febrile under-five children presenting at these facilities were assessed, treated and scheduled …