Medical Specialties Commons^™

Bleomycin Induced Pneumonitis: A Case Successfully Managed With High-Dose Steroids, Shahid Javed Husain, Ali Bin Sarwar Zubairi, Muhammad Irfan

Department of Medicine

No abstract provided.

Prevalence Of Gastric Varices And Results Of Sclerotherapy With N-Butyl 2 Cyanoacrylate For Controlling Acute Gastric Variceal Bleeding., Mumtaz J Khan, Shahid Majid,, Syed H Shah, Kashif Hameed, Ashfaq Ahmed, Saeed Hamid, Wasim Jafri

Department of Medicine

Aim: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV).

Methods: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed.

Results: The prevalence of GV in patients with portal hypertension was …

Non-Cardiac Surgery In Patients With Prosthetic Heart Valves: A 12 Years Experience, Raja Parvez Akhtar, Abdul Rehman Abid, Hasnain Zafar, Syed Javed Raza Gardezi, Abdul Waheed, Jawad Sajid Khan

Section of General Surgery

Objective: To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures.
Study Design: It was a cohort study.
Place and Duration of Study : The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006.
Patients and Methods: Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded.
Results: In this study, 507 consecutive patients with a mechanical …

Three Pregnancies With Mechanical Heart Valve And No Follow-Up In 10 Years, Raja Parvez Akhtar, Abdul Rehman Abid, Hasnain Zafar

Section of General Surgery

Anticoagulation and proper INR (International Normalized Ratio) monitoring is essential for patients having mechanical heart valves; it is vital in these patients in order to prevent lethal complications such as valve thrombosis and systemic embolism. In pregnancy, it becomes even more important as pregnancy itself is a hypercoagulable state. This report describes a female patient having undergone mitral valve replacement with a Starr Edward metallic prosthesis. She came back to the operating surgeon after 10 years of valve replacement with a history of three uneventful healthy deliveries and no follow-up and INR monitoring during this period.

Spectrum Of Intracranial Pathology: Tumors Versus Infections At A Tertiary Care Hospital, Muhib Alam Khan, Sukaina Aijazali Panju, Ather Enam

Section of Neurosurgery

Introduction: Aga Khan University Hospital Neurosurgery Department has evolved into a high-volume centre for treatment of neurosurgical diseases. We aimed to compare the relative outcomes of intracranial tumors and CNS infections seen at our facility.
Methods: Hospital records of patients admitted under the neurosurgery service between 1994-2003 were evaluated. Cases with a principal diagnosis of an intracranial lesion were identified for further study. Demographic, clinical,and surgical variables were extracted from the medical record. Length of hospital stay, ICU utilization, and in-hospital mortality were the primary outcome indicators. Data were analyzed through descriptive statistics and comparisons of meansand proportions. …

Awareness About Reproductive Health And Rights Among Students Of A Public University In Karachi, Pakistan: A Cross Sectional Study, Naheed Nabi, Waris Qidwai, Farhat Batool,, Iqbal Azam

Department of Family Medicine

Objective: To determine the knowledge, attitude and practices of Karachi University students about reproductive health and rights.
Design: Cross sectional study Methods: A survey was conducted from February to May 2005 to determine the understanding and knowledge related to reproductive health and rights among the students of the department of Biochemistry, University of Karachi, Pakistan. A pre-coded questionnaire was developed and pre-tested. The questionnaire was introduced to those students, who agreed to participate in the study. Data collected was double entered and analyzed on SPSS and Epi-info latest version.
Results: Fifty five percent (55%) of participants believed …

Neurosurgeons And Electrocautery, S. Ather Enam

Section of Neurosurgery

Abstract are not provided by the author/publisher

Psychiatric Rating Scales In Urdu: A Systematic Review, Syed Ahmer, Rafey A. Faruqui, Anita Aijaz

Department of Psychiatry

Background: Researchers setting out to conduct research employing questionnaires in non-English speaking populations need instruments that have been validated in the indigenous languages. In this study we have tried to review the literature on the status of cross-cultural and/or criterion validity of all the questionnaires measuring psychiatric symptoms available in Urdu language.Methods: A search of Medline, Embase, PsycINFO and http://www.pakmedinet.com was conducted using the search terms; Urdu psychiatric rating scale, and Urdu and Psychiatry. References of retrieved articles were searched. Only studies describing either cross-cultural or criterion validation of a questionnaire in Urdu measuring psychiatric symptoms were included.Results: Thirty two …

Mapping Exercise Of Mental Health Research And Researchers In Pakistan, Haider A. Naqvi, Murad M. Khan

Department of Psychiatry

Objective: To systematically identify mental health research and researchers in Pakistan. Subsidiary objectives were to identify methodologies of studies published in the indexed journals along with their country wide mean impact factor.
Methods: A systematic search strategy using key words related to neuropsychiatry was carried out to identify various studies published in Indexed and Non-indexed databases.
Results: We identified 108 studies from Indexed data bases (77.8% Medline; 22.2% PsychInfo). Beside these, 51 studies were also identified from non-indexed databases. Among the indexed articles, 97 (89.8%) were Journal articles while 10 were other type of documents--there were 3 clinical trials of …

Primary Care Research: Opportunities And Challenges, Waris Qidwai

Department of Family Medicine

No abstract provided.

Chest Radiographs In Acute Pulmonary Embolism, Ali Bin Sarwar Zubairi, Shahid Javed Husain, Muhammad Irfan, Kulsoom Fatima, Muhammad Atif Zubairi, Muhammad Islam

Section of Pulmonary & Critical Care

Background: Pulmonary embolism (PE) is a serious clinical entity carrying significant morbidity and mortality. Clinically, it is a difficult condition to diagnose and remains under treated condition in Pakistan due to non-availability of objective tests and lack of awareness among physicians.This study was conducted to determine the chest radiographic presentation in known cases of acute PE presenting to a tertiary care hospital.
Methods: Hospital records of patients with a diagnosis of acute PE were reviewed from June 2000 until June 2004. Fifty diagnosed cases of acute PE on Spiral Computed tomography (CT) of the chest demonstrating an intraluminal-filling defect were …

Chest Radiographs In Acute Pulmonary Embolism, Ali Bin Sarwar Zubairi, Shahid Javed Husain, Muhammad Irfan, Kulsoom Fatima, Muhammad Atif Zubairi, Muhammad Islam

Department of Medicine

Background: Pulmonary embolism (PE) is a serious clinical entity carrying significant morbidity and mortality. Clinically, it is a difficult condition to diagnose and remains under treated condition in Pakistan due to non-availability of objective tests and lack of awareness among physicians. This study was conducted to determine the chest radiographic presentation in known cases of acute PE presenting to a tertiary care hospital.
Methods: Hospital records of patients with a diagnosis of acute PE were reviewed from June 2000 until June 2004. Fifty diagnosed cases of acute PE on Spiral Computed tomography (CT) of the chest demonstrating an intraluminal-filling defect …

The "Incidental" Episode Of Ventricular Fibrillation: A Case Report, Fahim H. Jafary

Section of Cardiology

Polymorphic ventricular tachycardia and ventricular fibrillation (VF) carry important prognostic implications, especially in the post myocardial infarction period. However, artifact on the electrocardiographic tracing can mimic VF particularly on routinely recorded rhythm strips in hospitals. Such misinterpretation can lead to expensive (and potentially risky) diagnostic and therapeutic steps. We report on such a case and highlight the need for careful inspection of the tracing.

Influence Of Consecutive-Day Blood Sampling On Polymerase Chain Reaction-Adjusted Parasitological Cure Rates In An Antimalarial-Drug Trial Conducted In Tanzania, Andreas Martensson, Johan Ursing, M. Isabel Veiga, Lisa Wiklund, Christopher Membi, Scott M. Montgomery, Zul Premji, Anna Farnert, Andres Bjorkman, Billy Ngasala

Pathology, East Africa

We assessed the influence that consecutive-day blood sampling, compared with single-day blood sampling, had on polymerase chain reaction (PCR)-adjusted parasitological cure after stepwise genotyping of merozoite surface proteins 2 (msp2) and 1 (msp1) in 106 children in Tanzania who had uncomplicated falciparum malaria treated with either sulfadoxine-pyrimethamine or artemether- lumefantrine; 78 of these children developed recurrent parasitemia during the 42-day follow-up period. Initial msp2 genotyping identified 27 and 33 recrudescences by use of single- and consecutive-day sampling, respectively; in subsequent msp1 genotyping, 17 and 21 of these episodes, respectively, were still classified as recrudescences; these results indicate a similar sensitivity …

Periosteal Desmoid, Moazzam Murad, Vaqar Bari, M Zafar Rafique, Kashif Ashraf

Department of Radiology

Periosteal desmoid is a benign tumor like reactive fibrous lesion developed by repeated micro trauma. We describe the case of a 14 year old boy with pain in his right knee who underwent plain radiography followed by radionuclide bone scan. The final diagnosis was that of periosteal desmoid.

Labrad : Vol 32, Issue 1 - January 2007, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• T-Cell Receptor (TcR) Gene Rearrangement Studies: A Useful Adjunct for the Diagnosis of T-Cell Lymphoproliferative Disorders
• Vitamin D Measurement
• Quiz
• Ristocetin Cofactor Activity
• Portal Biliopathy- An Uncommon Cause of Biliary Obstruction
• Laboratory Diagnosis of Hepatitis C: Transition from Serological to Molecular Methods
• Answer to Quiz
• Dengue Fever
• Bone Densitometry (DEXA Scanning) in the Diagnosis of Osteoporosis
• Western Blot for HIV 1 Virus
• 8th Sheffield International Conference - Diagnostic Imaging

Attenuation Of Hypotension Using Phenylephrine During Induction Of Anaesthesia With Propofol, Muhammad Imran, Fazal Hameed Khan, Mansoor Ahmed Khan

Department of Anaesthesia

Objective: To observe if phenylephrine mixed with propofol can attenuate hypotensive effects of propofol during induction of anaesthesia.
Methods: A total number of 135 adult ASA-I and ASA-II patients were divided into three groups. (Group A, B and C). All patients were induced with propofol 2.5 mg per kg. In Group A (control group) patients received propofol mixed with 2cc of 0.9% normal saline. Group B (study group) patients received propofol mixed with 2cc of a solution containing phenylephrine 25µg/cc (total 50µg); Group C (study group) patients received propofol mixed with 2cc of a solution containing phenylephrine 50µg/cc …

Emergency Airway Management Of A Patient With Mediastinal Mass, Anwar Ul Huda, Khalid Maudood Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Appropriate airway management is an essential part of anaesthesiologist's role. Extrinsic airway compression by rapidly growing mediastinal masses represents a therapeutic challenge to anaesthesiologists. We report a case of successful airway management in a patient with obstructed airway. The patient was a middle aged female who presented with severe respiratory distress secondary to a huge mediastinal mass. CT scan showed widened superior mediastinum with circumferential narrowing of trachea and left main bronchus. Her condition continued to deteriorate during her hospital admission, so emergency intubation and tracheostomy was planned. She was intubated with the help of a bougie using size 6 …

Rare Relapsed Extrapulmonary Hydatid Disease, Saulat H. Fatimi, Mj Schuuring, S. Sheikh

Section of Cardiothoracic Surgery

Hydatid cysts are rarely seen at the extrapulmonary sites. We report relapsed hydatid cysts with abdominal origin in a 25 years old woman. Over 1000 Hydatid cysts were removed through right posterolateral thoracotomy without any complications. Only very few cases are reported in the literature.

Single Instillation Of Mitomycin C Reduces 1st Year Recurrence Following Transurethral Resection Of Non-Muscle Invasive Bladder Cancer, M Hammad Ather, S Aziz, M N. Sulaiman

Section of Urology

Objective: To study the impact of single instillation of 40 mg Mitomycin C (MMC-40) within first hour of transurethral resection (TUR), on first year recurrence of non-muscle invasive bladder cancer.
Methods: In this study of two groups of patients with similar demographics and tumour profile were compared to assess first year tumour recurrence pattern. Group A received MMC-40 within 30 minutes of TUR. Group B patients only had TUR of bladder tumour. Patients' charts were reviewed for demographic profile, preoperative diagnosis and imaging used, cytological work up, tumour profile both during cystoscopy and imaging used, patients records were also reviewed …

Juvenile Ewing Sarcoma Presenting As A Pelvic Mass, Tahira Naru, Fauzia Haq Nawaz, Javed Rizvi

Department of Obstetrics & Gynaecology

A teen aged girl with rapidly developing pelvic mass, associated with weight loss and left leg weakness, was evaluated and found to have Ewing's sarcoma of non-osseous origin from pelvis, which is a rare situation. She was treated by a multidisciplinary approach by surgery, chemotherapy and rehabilitation by physiotherapy to effective response.

Knowledge And Beliefs Of Adolescents Regarding Sexually Transmitted Infections And Hiv/Aids In A Rural District In Pakistan, Hafsa Raheel, Franklin White, Muhammad Masood Kadir, Zafar Fatmi

Community Health Sciences

Objective:

To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS.

Methods:

A community based cross-sectional survey was conducted in October 2002 in a rural district (Mirpurkhas) of Sindh province, Pakistan.

Results:

A total of 428 adolescent girls and boys were interviewed. Only 44% correctly named at least one STI, while 55% knew at least two modes of transmission for HIV/AIDS. Adolescents with education greater than or equal to secondary level, those who were able to read the newspaper, possessed electricity in their homes and were allowed to meet their …

Resource Allocation Within The National Aids Control Program Of Pakistan: A Qualitative Assessment Of Decision Maker's Opinions, Sara Husain, Masood Kadir, Zafar Fatmi

Community Health Sciences

Background:

Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program.

Methods:

A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to …

Knowledge, Attitude And Practice Regarding Immunization Among Family Practice Patients, Waris Qidwai, Syed Sohail Ali, Semi Ayub, Salma Ayub

Department of Family Medicine

Objective: To determine the knowledge, attitude and practices about immunization among family practice patients.
Design: A questionnaire based survey.
Patients and Method: A questionnaire was developed in line with the study objectives. It was administered to patients visiting family physicians, after they were administered, informed consent and assurance with regards to confidentiality was provided. Epi-info and SPSS software was used for data management.
Results: A total of 97 patients were surveyed. The majority were men (59.8%) with a mean age of 29.69 years. Majority was unmarried (51.5%), with graduate and post-graduate education (73%), and in government and …

Metabolic Syndrome: Frequency And Gender Differences At An Out - Patient Clinic, Firdous Jahan, Riaz Qureshi, Tasneem Borhany, Hasan Bin Hamza

Department of Family Medicine

Objective: To determine the frequency of metabolic syndrome among patients attending an out-patient clinic of a teaching hospital and to compare the clinical features regarding metabolic syndrome among males and females.
Study Design: Cross-sectional study.
Place and Duration: Aga Khan University Hospital (AKUH), Executive and Family Medicine Clinics, from December 2004 to April 2005.
Patients and Methods: All adults, above 25 years, attending the clinics for an executive check-up and giving informed consent were included in the study. Data was collected through a structured questionnaire administered to those eligible to participate. Metabolic syndrome was defined according to ATP-III guidelines. …

Acquired Aplastic Anemia: Treatment In A Developing Country., Shaheena Hanif, Farah Naz, Emaduddin Siddiqui, Jamal Raza

Department of Emergency Medicine

Objective:

The aim of this study was to evaluate the clinical presentation of aplastic anemia as well as to assess the efficacy of Cyclosporin -A in patients with aplastic anemia.

Methodology:

This is a hospital based interventional study. During the three year study period, 44 children were enrolled. Mean age was 9.3 years and there was a male predominance.

Results:

Most common clinical presentation was anemia and bleeding. Four children died before therapy was started. Cyclosporin-A was started in 40 patients. Eleven patients died before completion of therapy and three patients were lost to follow-up. Out of 26 patients who …

Iatrogenic Insertion Of Impression Mould Into Middle Ear And Mastoid And Its Retrieval After 9 Years: A Case Report, Mohammad Sohail Awan, Moghira Iqbal, Zakariya Imam Sardar

Department of Surgery Docs

Abstract

The magnitude of hearing loss in Pakistan is enormous. One in twelve children of Pakistan suffers from some form of hearing impairment. Many of them are unable to afford surgical procedures and resort to the use of cheap hearing aids fitted by untrained individuals or people lacking the required expertise. This predisposes the patients to significant complications during a process that is otherwise considered safe.We report the case of a child, where the process of making the mould for a hearing aid led to the perforation of the tympanic membrane and pouring of mould material into the middle ear, …

Infective Endocarditis In Patients With Congenitally Malformed Hearts: Characterization Of The Syndrome In A Developing Country, Bilal K. Siddiqu, M. Tariq, Atif Jadoon, Ghulam Murtaza, Asim Syed, M. Bilal Abid, Maria Qamaruddin, Mehnaz Atiq, Raymond A. Smego

Section of Internal Medicine

Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world’s population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi.

We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004.

We identified 48 patients with endocarditis according to the modified Duke Criterions, with just …

Chronic Itp: Analysis Of Various Factors At Presentation Which Predict Failure To First Line Treatment And Their Response To Second Line Therapy, Naveen Naz Syed, Salman Adil, Muhamed Raihan Sajid, Mohammad Usman, Bushra Moiz, G N Kakepoto, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

OBJECTIVE: To observe the significance of various factors in chronic idiopathic thrombocytopenic purpura (ITP) which predict the response of first line (corticosteroids) and second line therapy (splenectomy) and to evaluate their response to second line therapy.
METHODS: This was a descriptive, prospective study conducted from August 2004 till January 2006. Patients of all age groups and both genders with diagnosis of chronic ITP were included. Treatment protocol and criteria for response assessment was explained.
RESULTS: During 17 months period, 86 patients with chronic ITP were analyzed. Non-responders to first line therapy were 74 patients who ultimately required splenectomy. …

Diagnostic Importance Of Bone Marrow Examination In Non-Hematological Disorders, Naveen Naz Syed, Bushra Moiz, Salman Adil, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To evaluate the frequency of involvement of bone marrow with non-haematologic disorders and to observe the significance of bone marrow examination in establishing primary diagnosis of the same.
Methods: It was a descriptive study that extended from January 2003 to September 2005. A total of 4569 bone marrow aspirate and trephines were reported during this period. Only the non-haematological disorders were analyzed for their clinical and laboratory parameter.
Results: During the study period, 63 patients (1.4%) were diagnosed to have non-haematological diseases detected primarily through bone marrow examination. The mean age of patients at time of …