Medical Specialties Commons^™

Comparison Of Different Phenotypic Methods Of Detection Of Methicillin Resistance In Staphylococcus Aureus With The Molecular Detection Of Mec-A Gene, M Zeeshan, K Jabeen, E Khan, S Irfan, S Ibrahim, Z Parween, Afia Zafar

Department of Pathology and Laboratory Medicine

OBJECTIVE: To evaluate accuracy, cost-effectiveness and ease to perform different phenotypic methods i.e. Cefoxitin 30 microg disc, Oxacillin 1microg disc and Oxacillin agar screening plate (6microg/ml ) for early and accurate identification of MRSA by comparing with the detection of mec-A gene in our clinical isolates.
DESIGN: A comparative study.
PLACE AND DURATION OF STUDY: Clinical samples submitted in the Clinical Microbiology Laboratory at Aga Khan University Hospital, Karachi, from 1st August to 31st October 2006.
MATERIAL AND METHODS: Out of 200 clinical samples, conventional Polymerase chain reaction (PCR) was done on 62 pure biochemically identified S. aureus …

Evaluation Of Immune Response To Hepatitis B Vaccine In Health Care Workers At A Tertiary Care Hospital In Pakistan: An Observational Prospective Study, Mohammad Zeeshan, Kauser Jabeen, Anita Nausheen Akbar Ali, Ailia Wilayat Ali, Saadia Z Farooqui, Vikram Mehraj, Afia Zafar

Department of Pathology and Laboratory Medicine

Background: Seroconversion rates reported after Hepatitis B virus (HBV) vaccination globally ranges from 85–90%. Health care workers (HCWs) are at high risk of acquiring HBV and non responders' rates after HBV vaccination were not reported previously in Pakistani HCWs. Therefore we evaluated immune response to HBV vaccine in HCWs at a tertiary care hospital in Karachi, Pakistan.
Methods: Descriptive observational study conducted at Aga Khan University from April 2003 to July 2004. Newly HBV vaccinated HCWs were evaluated for immune response by measuring serum Hepatitis B surface antibody (HBsAb) levels, 6 weeks post vaccination.
Results: Initially 666 employees were included …

Antimicrobial Resistance In Neisseria Gonorrhoeae And Limited Treatment Options, Afia Zafar, Kauser Jabeen

Department of Pathology and Laboratory Medicine

No abstract provided.

Nosocomial Buffalopoxvirus Infection, Karachi, Pakistan, Afia Zafar, Robert Swanepoel, Roger Hewson, Mazhar Nizam, Altaf Ahmed, Akhtar Husain, Antoinette Grobbelaar, Kevin Bewley, Valerie Mioulet, Barry Dowsett, Linda Easterbrook, Rumina Hasan

Department of Pathology and Laboratory Medicine

During 5 months in 2004–2005, buffalopoxvirus infection, confirmed by virus isolation and limited nucleic acid sequencing, spread between 5 burns units in Karachi, Pakistan. The outbreak was related to movement of patients between units. Control measures reduced transmission, but sporadic cases continued due to the admission of new patients with community-acquired infections.

Frequency Of Primary Solid Malignant Neoplasms In Both Sexes, As Seen In Our Practice, Zubair Ahmad, Najamul Sahar Azad, Nausheen Yaqoob, Akhtar Husain, Aamir Ahsan, Ambreen Nasir Khan, Rashida Ahmed, Naila Kayani, Shahid Pervez, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

Background: To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopdies.

Method: A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital (AKU), Karachi, in 2004.

Results: Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin's lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. …

Comparative Predictive Value Of Three Prognostic Markers--S-Phase Fraction, Pcna And Mitotic Count On Axillary Lymph Node Metastasis In Carcinoma Breast, Shahid Pervez, Muhammad Nadeem Khan, Muhammad Israr Nasir

Department of Pathology and Laboratory Medicine

Background: Axillary lymph node metastasis is the single most important prognostic factor in carcinoma of the breast. Therefore, prognostic markers that may reliably predict probability of lymph node (LN) metastases are of great value. This study was conducted to compare the predictive value of two novel prognostic / proliferative markers i.e. S-phase fraction (SPF) and proliferating cell nuclear antigen (PCNA) in parallel with mitotic index.

Methods: Data of consecutive cases of infiltrating ductal carcinoma (IDC) breast diagnosed from July 2003 to July 2004 at the section of the Histopathology, The Aga Khan University Hospital, Karachi, were reviewed. A total of …

Pulmonary Artery Catheter Knotting In A Coronary Artery Bypass Surgery Patient, Mohammad Irfan Akhtar, Mohammad Hamid, Fazal Hameed Khan, Hamid Iqil Naqvi, Amar Gangwani

Department of Anaesthesia

A fifty seven years old female patient came to operating room for coronary artery bypass grafting (CABG) surgery. After induction, invasive monitoring lines were placed. Pulmonary artery catheter (PAC) floated after three attempts and it was wedged at 60cm. Intra operative course was smooth and patient transferred to cardiac intensive care unit (CICU). First chest X-ray revealed PAC knotting in the right ventricle. Vascular surgeon was involved and he removed it through right internal jugular vein under fluoroscopic guidance. Pulmonary arterial catheterization is an invasive procedure. Knotting usually occurs due to excessive advancement of the pulmonary artery catheter beyond the …

Biliary Tract Obstruction In Chronic Pancreatitis, Abdallah Abdulkarim, Jake E. J. Krige, Philippus C. Bornman

General Surgery, East Africa

Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct stricture is conservative in patients in whom it is an incidental finding as the risk of secondary biliary cirrhosis is negligible.

Initial conservative treatment is advised in …

Reverse Sural Island Flap In Coverage Of Defects Lower Third Of Leg: A Series Of Nine Cases, S. O. Khainga, B. Githae, V. M. Mutiso, Ronald Wasike

General Surgery, East Africa

The distally based sural island flap was first described by Masquelet, et al, in 1992. It is a skin island flap supplied by the vascular axis of the sural nerve. lhe aim of this paper is to demonstrate that it can be applied in coverage of difficult wound in the lower third of the leg. We treated nine patients with nine distally based sural island flaps. All the flaps survived, most of the flaps had venous congestion. The largest flap was 10 x 8 em and Doppler was used in only one flap. This technique is easy and quick to …

Premedication In Surgical Day Care Patients, Saminal Ismail, Fauzia A. Khan, Aliya Ahmed, Khalid A. Shah

Department of Anaesthesia

The purpose of this audit was to find out the efficiency
of our system in providing premedication to surgical day
care patients. This audit was conducted in the Surgical Day
Care (SDC) Unit of a University Hospital. All patients
anaesthetised in the SDC unit on day care basis were included
in this audit. Nursing notes and preoperative orders of all
patients to be anaesthetised were checked to see whether
premedication was given or not and was the timing according
to the orders written. The result showed that out of 205
patients scheduled, twenty (9.7%) patients did not receive
premedication. Only …

Mid Aortic Syndrome Correction: Anaesthetic Considerations And Management, Mohammad Irfan Akhtar, Mohammad Hamid, Muneer Amanullah, Mubashar Khan, Shahabuddin, Mansoor Ahmed Khan

Department of Anaesthesia

A twelve years old female patient presented with headache off and on and disparity between upper and lower limb pressures. On the basis of history, physical examination and magnetic resonance angiography, the patient was diagnosed as mid aortic syndrome and planned for elective aorto aortic bypass graft surgery through left thoracotomy. Double lumen endotracheal tube was placed for lung isolation and episodes of hypertension during proximal and distal cross clamp were controlled with sodium nitropruside infusion (SNP). Extra pleural catheter was put in at the end of surgery before chest wall closure for postoperative pain control. Both upper and lower …

Impact Of Antibiotic Restriction On Broad Spectrum Antibiotic Usage In The Icu Of A Developing Country, Shahla Siddiqui, Kashif Hussein, Roshan Manasia, Aijaz Samad, Nawal Salahuddin, Afia Zafar, M. Qamarul Hoda

Department of Anaesthesia

Objective: To reduce rates of nosocomial pneumonia and cost of antibiotic therapy.
Methods: By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime, Meropenem, Imipenem, Tazocin, Polymixin B and Vancomycin, after an institutional based pharmacy and therapeutic committee approval. The ICU pharmacist would alert the ICU residents or consultants after 48 hours of the computer based antibiotic entry that the order would expire within hours. Telephone approval was obtained followed by a formal consultation if deemed necessary by the ID specialist or primary team. Antibiotic usage was …

Anaesthesia For Interventional Neuroradiology, Aliya Ahmed

Department of Anaesthesia

There have been rapid and significant advances in diagnostic and interventional radiology, including interventional neuroradiology, in recent years. Many intracranial vascular pathologies are being successfully managed by endovascular interventional neuroradiology techniques. These techniques include procedures like embolization of vascular tumours and arterio-venous malformations, coiling of cerebral aneurysms. etc. The support of anaesthesia team is requested for these therapeutic endovascular neuroradiological procedures. The main aims of the anaesthesiologist during any interventional neuroradiology procedure are provision of a physiologically stable and immobile patient, alteration of arterial blood pressure as necessary, and appropriate and timely management of complications. Provision of anaesthesia in remote …

Haemodynamic Response To Tracheal Intubation Via Intubating Laryngeal Mask Airway Versus Direct Laryngoscopic Tracheal Intubation, Naveed Tahir Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Objective: To compare the haemodynamic response to tracheal intubation using either direct larygoscopy or Intubating Laryngeal Mask Airway.
Methods: This was a prospective randomized controlled trial. One hundred adult ASA-I and ASA - II patients coming to the Anaesthesia Department of Aga Khan University Hospital were randomly divided into two groups. In group- I endotracheal intubation was done with the help of Macintosh laryngoscope while in group-II patients were intubated with the help of the Intubating Laryngeal Mask Airway. Systolic, diastolic, mean arterial blood pressure and heart rate were recorded at baseline, at laryngoscopy and at 1 minute interval for …

Use Of Self Home-Made Diaphragm For Protection Against Pregnancy And Sexually-Transmitted Infections: Case Report., Andrew W. Schroth, Stanley Luchters, M F. Luchters, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

No abstract provided.

Solitary Infantile Myofibromatosis Of The Skull, Farah Naz, Zafar Nazir, Khalid Chishti, Nadeem Aslam, Salman Siddiqui

Department of Surgery Docs

This is the report of a 6 months old boy presenting with a firm, solitary mass on the temporal region, associated with lysis of local bone. Investigations lead to a diagnosis of infantile myofibromatosis (IM). Wide local excision was performed. At one year follow-up, no recurrence was noted.

Successful Outcome Of A Pregnancy In A Woman With Advanced Cirrhosis Due To Hepatitis B Surface Antigenemia, Delta Super-Infection And Hepatitis C Co-Infection: A Case Report, Amna Subhan, Shahab Abid, Wasim Jafri

Section of Gastroenterology

Pregnancy in women with advanced liver disease is rare. In this paper we described the case of a successful pregnancy in a young woman with advanced cirrhosis due to hepatitis B surface antigenemia, hepatitis delta super-infection and Hepatitis C co-infection. A brief review of the medical literature on pregnancy in women with cirrhosis is also presented.

Variant Merozoite Protein Expression Is Associated With Erythrocyte Invasion Phenotypes In Plasmodium Falciparum Isolates From Tanzania, A.K. Bei, C.D. Membi, J.C. Rayner, M. Mubi, B. Ngasala, A.A. Sultan, Zul Premji, M.T. Duraisingh

Pathology, East Africa

[No abstract available]

Cost Of Diabetes Care In Out-Patient Clinics Of Karachi, Pakistan, Liaquat A. Khowaja, Ali K. Khuwaja, Peter Cosgrove

Community Health Sciences

Background: Diabetes Mellitus (DM) is a growing epidemic and the cost of treating diabetes is largely increasing. The objective of this study was to estimate the cost-of-illness of DM among attendees of out-patient clinics in Karachi, Pakistan. This is the first study conducted from a societal perspective to estimate the cost of managing diabetes in Pakistan.Methods: A prevalence-based 'Cost-of-Illness' study for diabetes care was conducted in six different out-patient clinics of Karachi, Pakistan from July to September 2006. A pre-tested questionnaire was administered to collect the data from 345 randomly selected persons with diabetes.Results: The annual mean direct cost for …

Prevalence And Predictors Of Smokeless Tobacco Use Among High-School Males In Karachi, Pakistan, S Rozi, S Akhtar

Community Health Sciences

A cross-sectional study was conducted in 3 towns in Karachi, Pakistan to investigate the prevalence of and factors associated with the use of smokeless tobacco among 772 high-school adolescent males. A structured questionnaire collected data on sociodemographic factors and history of cigarette and smokeless tobacco use. Prevalence of smokeless tobacco use (gutka, snuff, niswar) was 16.1% (95% CI: 13.5%-18.9%). On multiple logistic regression analysis, the factors significantly related to smokeless tobacco use among the sample were: attending government school [adjusted odds ratio (OR) 6.3], smoking cigarettes (OR 3.2), not seeing anti-tobacco advertisements (OR 1.5), family history of tobacco use (OR …

Poor Glycaemic Control Is The Major Factor Associated With Increased Frequency Of Gastrointestinal Symptoms In Patients With Diabetes Mellitus, Shahab Abid, Wasim Jafri, Firdous Jahan, Fauziah Rabbani, Najmul Islam, Masood H. Khan, Rana Masood

Department of Medicine

Objective:To compare the GI symptoms in diabetic patients with controls and its relationship with the complications, duration of diabetes and glycaemic control. Methods:Consecutive patients were prospectively enrolled in to two groups. Group I (diabetic patients) and Group II (non-diabetic, Controls). Patient's characteristics, demographic profiles and GI symptoms were evaluated on a questionnaire. Groups were compared for differences in various GI symptoms. Group I was further analyzed for the relationship between GI symptoms with complications, duration of diabetes andglycaemic control.
Results:Atotal of 514 patients were enrolled 250 were diabetics (group I) and 264 were non-diabetics (groupII). Mean age …

Dengue Virus Serotype 3, Karachi, Pakistan, Bushra Jamil, Rumina Hasan, Afia Zafar, Kevin Bewley, John Chamberlain, Valerie Mioulet, Moira Rowlands, Roger Hewson

Department of Medicine

No abstract provided.

Towards A Cure For Traumatic Paraplegia - Is There Cause For Hope?, Rashid Jooma

Section of Neurosurgery

In the past decade, great strides have been made in the field of CNS tissue repair and expectations have been raised that a cure of spinal paralysis is at hand. The two broad categories of investigational approaches to spinal regeneration are: (1) Enhancing the Regenerative Milieu of the Cord and (2) Cellular and Tissue Transplantation. Amongst the latter approaches, the early use of foetal cord tissue has given way to the more sophisticated studies on stem cell therapy and the implants of olfactory ensheating cells. These have engendered considerable public interest and are being offered as commercially available therapies in …

Psychiatry, Syed Ahmer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Narcotic Analgesics For Acute Migraine In The Emergency Room: Are We Meeting Headache Societies' Guidelines?, Mohammad Wasay, Khawaja Slaman Zaki, Saqib Uddin Khan, Rifat Rehmani

Department of Emergency Medicine

We analysed 161 patients with acute migraine in our emergency room (ER) to identify the use of narcotic analgesics as first-line treatment. Twenty-four percent of patients were treated with opioid analgesics and 76% patients were treated with non-opioid analgesics. Pain was completely relieved in 100 (62%) patients, partially relieved in 50 (31%) patients and was not relieved in 11 (7%) patients at the time of discharge. Pain relief was not related to the use of opioids vs. non-opioids. The treatment of acute migraine in our ER is in line with the guidelines of the Headache Societies and needs further improvement.

Neuroradiology, Zafar Sajjad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

A Knowledge, Attitudes, And Practice Survey Among Obstetrician-Gynaecologists On Intimate Partner Violence In Flanders, Belgium, Kristien Roelens, Hans Verstraelen, Kathia Van Egmond, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) has consistently been found to afflict one in twenty pregnant women and is therefore considered a leading cause of physical injury, mental illness and adverse pregnancy outcome. A general antenatal screening policy has been advocated, though compliance with such guidelines tends to be low. We therefore attempted to identify potential barriers to IPV screening in a context where no guidelines have been instigated yet.

Methods: Questionnaire-based Knowledge, Attitude, and Practice survey among obstetrician-gynaecologists in Flanders, Belgium (n = 478).

Results: The response rate was 52.1% (249/478). Gynaecologists prove rather unfamiliar with IPV and therefore largely …

Antibiotic Susceptibility Of Atopobium Vaginae, Ellen De Backer, Rita Verhelst, Hans Verstraelen, Geert Claeys, Gerda Verschraegen, Marleen Temmerman, Mario Vaneechoutte

Obstetrics and Gynaecology, East Africa

Background: Previous studies have indicated that a recently described anaerobic bacterium, Atopobium vaginae is associated with bacterial vaginosis (BV). Thus far the four isolates of this fastidious micro-organism were found to be highly resistant to metronidazole and susceptible for clindamycin, two antibiotics preferred for the treatment of BV.

Methods: Nine strains of Atopobium vaginae, four strains of Gardnerella vaginalis, two strains of Lactobacillus iners and one strain each of Bifidobacterium breve, B. longum, L. crispatus, L. gasseri and L. jensenii were tested against 15 antimicrobial agents using the Etest.

Results: All nine strains of A. vaginae were highly resistant to …

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

Presentation And Features Of Conversion Disorder At A Tertiary Care Hospital In Karachi, Sameer Khan, Abdullah Ladha, Sarah Khalid Khan, Sana Farooq Khan, Awais Amjad Malik, Zehra Memon, Samiullah Ghulam Nabi, Hafiz Yasir Adnan, Haider Ali Naqvi

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.