Medical Specialties Commons^™

Renal Involvement In Systemic Lupus Erythematosus In Pakistan, Malik Anas Rabbani, Muhammad Hammad Tahir, Bilal Karim Siddiqui, Bushra Ahmad, A Shamim, Syed Mansoor Shah, Aasim Ahmad

Section of Nephrology

Objective: To find the prevalence of lupus nephritis, delineate its clinical, immunological and therapeutic characteristics and compare them with the data worldwide.PATIENTS AND Methods: Between 1985 and 2001, 198 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association (ARA) admitted to the hospital were studied by means of a retrospective review of their records.Results: Renal involvement was found in 89 (45%) patients. Biopsy showed lupus nephritis in 42 patients; there were 9 male and 33 females. Mean age at initial presentation was 27 years and mean duration of follow-up was 2 .3 years. The histological …

Suicidal Bus Bombing Of French Nationals In Pakistan: Physical Injuries And Management Of Survivors, Hasnain Zafar, Rifat Rehmani, Tabish Chawla, Masood Umer, Mohsin-E-Azam

Department of Surgery Docs

Abstract

BACKGROUND:

Suicidal bombing is particularly devastating and an increasingly common form of terrorist violence. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the suicidal bombing attack in the context of the limited medical resources of a developing nation.

METHODS:

The management of individual patients was reviewed from a preprinted trauma form. Information on the nature of injuries, operative management and hospital course was recorded and data analyzed using the Trauma Registry.

RESULTS:

Twelve survivors out of 36 bomb blast victims brought to the Aga Khan University Hospital were transferred from primary …

Prevention Of Deep Vein Thrombosis And Pulmonary Embolism In The Perioperative Period: A Review, Aliya Ahmed

Department of Anaesthesia

No abstract provided.

Extent Of Lymphadenectomy In Radical Cystectomy For Bladder Cancer, Muhammad Hammad Ather, Sadaf Fatima, Orhun Sinanoglu

Section of Urology

Background: The benefit of pelvic lymphadenectomy in patients with cancer of the urinary bladder remains controversial. Though the inclusion of lymph node dissection in conjunction with radical cystectomy for patients with clinically negative nodes is well accepted, however, the extent of the nodal dissection remains contentious, particularly in patients with gross disease and T1G3 cancer. The extent of the primary bladder tumor, number of lymph nodes removed and the lymph node tumor burden are important prognostic variables in patients undergoing cystectomy. We analyzed the impact of the extent of lymphadenectomy during radical cystectomy on survival in the contemporary literature.
Methods: …

Rapidly Developing Optic Neuritis Secondary To Ethambutol: Possible Mechanism Of Injury, Sajjad Ali, Uzma Usman, Mohammad Wasay

Department of Medicine

Optic neuritis has been described among the toxic effects of Ethambutol. This side effect is dose related. The mean duration of Ethambutol induced optic neuritis (EON) is three months. We report a case of EON after few days of exposure to Ethambutol and the symptoms resolved after discontinuation of Ethambutol. This most likely represents an idiosyncratic reaction which is different as compared to dose related optic neuritis.

Pulmonary Embolism In Pemphigus Vulgaris, The Need For Judicious Immunotherapy, Omer Ashraf, Hasanat Sharif

Section of Cardiothoracic Surgery

Pemphigus vulgaris is a serious chronic mucocutaneous ailment. In recent decades advances in diagnostic and therapeutic measures have led to a significant decline in morbidity and mortality. However, with the advent of active and prolonged immunotherapy involving corticosteroids, there has been a rise in steroid-associated complications. This has led to significant concern globally over the sensible use of treatment regimen in pemphigus patients. We present a patient who underwent a massive pulmonary embolism following over usage of corticosteroid therapy for pemphigus vulgaris. Whilst the patient survived owing to timely assessment and aggressive surgical intervention, the need for cautious and judicious …

Leiomyosarcoma Of Thelarynx: A Case Report, Akbar Abbas, Mubasher Ikram, Nausheen Yaqoob

Section of Otolaryngology, Head & Neck Surgery

Leiomyosarcoma of the larynx is an extremely rare neoplasm; only about 50 cases have been reported in the English-language literature. We report a new case of laryngeal leiomyosarcoma in a 65-year-old man. The metastatic work-up was negative, and the patient underwent total laryngectomy. He remained disease-free 12 months postoperatively.

Ponderal Index, Jabeen Fayyaz

Department of Emergency Medicine

No abstract provided.

Prescription Pattern Of Benzodiazepines For Inpatients At A Tertiary Care University Hospital In Pakistan, Muhammad Rizwanulhaq Khawaja, A Majeed, F Malik, K A. Merchant, M Maqsood, R Malik, S Mazahir, H Naqvi

Department of Psychiatry

Objective: To determine the point prevalence of benzodiazepine prescriptions for inpatients at a tertiary care university hospital in Pakistan and to correlate it with prescription patterns of various specialties, indications and demographic variables of the patients.Methods: This 24-hours point prevalence study was done at The Aga Khan University Hospital, Karachi. By convenient random sampling, 208 inpatients were interviewed. Patients' files were also studied to record the drugs administered. Data was entered into questionnaires and analyzed by SPSS 10.0.Results: The point prevalence of the benzodiazepines was 21.2%. It was higher among males than females and among surgical than non-surgical patients. Midazolam …

Apache Ii Score As A Predictor Of Length Of Stay And Outcome In Our Icus, Shahla Siddiqui, Saad Ahmed, Roshan Manasia

Department of Anaesthesia

The APACHE II (acute physiology and chronic health evaluation) is used widely for predicting probability of hospital mortality and length of stay in the ICU. APACHE II forms were available to all ICU residents within 24 hours of admission, and a score was assigned to them. Based on our results the APACHE II score has reliably predicted an outcome of the least amount of length of stay (LOS) in the ICU as well as a 100% probability of being shifted out of the ICU for a score of < 10 (according to international benchmarks). This reliable scoring system can be used for predicting mortality and length of stay and therefore, resource allocation, antibiotic use and ethical decisions regarding counseling families about end of life decisions--all within 24 hours of admissions.

Unanticipated Hospital Admission After Ambulatory Surgery, Mueenullah Khan, Aliya Ahmed, Laila Abdullah, Azmeena Nizar, Aslam Fareed, Fauzia Anis Khan

Department of Anaesthesia

The unplanned admission rate is considered to be an important measure of the quality of ambulatory surgical units. The objective of our study was to evaluate the unanticipated hospital admission rate from the Surgical Day Care (SDC) unit of our university affiliated teaching hospital and to analyze the reasons for admission. A review of all unanticipated admissions over a one-year period was done. The admission rate was calculated and the reasons for admission were analysed. The overall admission rate was 4.93%. Most of the admissions were ordered by the surgeons (97%). The main reasons for admission were patient observation indicated …

To Compare The Total Cholesterol And Hdl-Cholesterol Before And After Ultra-Centrifugation In Lipemic Samples, Jawaid Jabbar, Imran Siddiqui, Syed Qaiser Raza, Ayaz Baig

Department of Pathology and Laboratory Medicine

Objective: It is an everyday routine in laboratories to encounter interference in the analysis of lipids. These likely interferences (hemolysis, icterus and lipemia) are countered by asking physicians and patients to send fresh and properly collected samples. At the Aga Khan University (AKU) Laboratory, we receive 2-3 lipemic/turbid samples per day. Previously it was our departmental policy to advise these patients to go for lipoprotein electrophoresis, which though accurate was time consuming and not cost effective. We therefore studied ultra centrifugation/airfuge as an alternate method to clear lipid interference and provide accurate, reliable and cost effective results.
Methods: Daily 2-3 …

Prevalence And Predictors Of Smoking In Pakistan: Results Of The National Health Survey Of Pakistan, Khabir Ahmed, Fahim Jafary, Imtiaz Jehan, Juanita Hatcher, Abdul Qayum Khand , Khan, Nish Chaturvedi, Tazeen Jafar

Department of Surgery Docs

No abstract provided.

Perioperative Anaesthetic Management Of A Patient With Relapsed Aplastic Anaemia, Aliya Ahmed, Abdul Monem

Department of Anaesthesia

Aplastic anaemia occurs due to failure of blood cell production by bone marrow. All blood cell counts are low. Untreated patients may die within one year mainly due to uncontrolled infection due to neutropenia. Anaemia and thrombocytopenia cause troublesome symptoms and necessitate frequent red cell and platelets transfusions. Surgery poses a very high risk for these patients because of the several complications that can occur in the perioperative period. In this paper we report on a patient with relapsed aplastic anaemia who was optimized preoperatively and underwent a total abdominal hysterectomy under general anaesthesia.

Prevalence Of Non-Helicobacter Pylori Duodenal Ulcer In Karachi, Pakistan., Javed Yakoob, Wasim Jafri, Nadim Jafri, Muhammad Islam, Shahab Abid, Saeed Hamid, Syed H Shah, Hizbullah Shaikh

Section of Gastroenterology

AIM:

To determine the prevalence of non-Helicobacter pylori (H pylori)-related duodenal ulcer in patients with acid-peptic diseases.

METHODS:

Medical records of patients who attended the Gastroenterology Department at Aga Khan University Hospital from 1999 to 2001 and had endoscopic diagnosis of duodenal ulcers were reviewed. Duodenal ulcer associated with H pylori was diagnosed on the basis of endoscopy, rapid urease test and histopathology whereas histories of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) related duodenal ulcers. Non-H pylori, non-NSAID duodenal ulcers were those without H pylori infection and history of NSAID intake. Co-morbid conditions associated were noted.

RESULTS:

Of 2 …

Serum Creatinine As Marker Of Kidney Function In South Asians: A Study Of Reduced Gfr In Adults In Pakistan, Tazeen H. Jafar, Christopher H. Schmid, Andrew S. Levey

Section of Nephrology

Migrant populations of South Asian origin have a higher risk for chronic kidney disease than the native whites. Several formulas have been developed to estimate kidney function from serum creatinine concentration. However, none of these has been validated in the South Asian population, which generally has different muscle mass composition than whites. A population-based cross-sectional study was performed on 262 individuals who were aged > or = 40 yr in Karachi, Pakistan. Reduced GFR was defined as creatinine clearance (Ccr) measured in 24-h urine collection of /min per 1.73 m2. Creatinine excretion was compared with age- and gender-matched white individuals by …

Primary Splenic Hydatid Cyst: A Case Report With Characteristic Imaging Appearance, Yousuf A. Husen, Naila Nadeem, Fawad Aslam, Imran Bhaila

Department of Radiology

A middle-aged lady presented with pain, tenderness and swelling in the left hypochondrium since one month. She had a history of contact with dogs and grazing animals. Sonography and computed tomography showed the pathognomonic signs of hydatid disease. The patient refused surgical treatment. She was discharged on Albendazole therapy and did not return for a follow up.

Self-Rated Health In Pakistan: Results Of A National Health Survey, Khabir Ahmed, Tazeen Jafar, Nish Chaturvedi

Department of Surgery Docs

Abstract Background: Self-rated health (SRH) is a robust predictor of mortality. In UK, migrants of South Asian descent, compared to native Caucasian populations, have substantially poorer SRH. Despite its validation among migrant South Asian populations and its popularity in developed countries as a useful public health tool, the SRH scale has not been used at a population level in countries in South Asia. We determined the prevalence of and risk factors for poor/fair SRH among individuals aged ≥15 years in Pakistan (n = 9442). Methods: The National Health Survey of Pakistan was a cross-sectional population-based survey, conducted between 1990 and …

Ductal Carcinoma In Situ (Dcis) In Karachi, Naila Kayani, Yasmin Bhurgri

Department of Pathology and Laboratory Medicine

Objective:
To study the frequency of ductal carcinoma in situ (DCIS) in a large pathology series. DCIS is a proliferation of non-invasive, malignant epithelial cells within the ductolobular system of the breast. It is a heterogeneous entity with several morphologic variants that differ in gross appearance, growth pattern, cytologic features, mammography, and malignant potential.
Methods:
The data of The Aga Khan University' Pathology Department, diagnosed on the basis of histopathology, during a 6-year period (1st January 1998 to 31st December 2003) was reviewed, all cases of DCIS studied, and data was analyzed with the help of analytical software SPSS.
Results: …

Comparison Of Pap Smear, Visual Inspection With Acetic Acid, Human Papillomavirus Dna-Pcr Testing And Cervicography, H De Vuyst, Patricia Claeys, S Njiru, L Muchiri, Sophia Steyaert, Petra De Sutter, E Van Marck, J Bwayo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To assess the test qualities of four screening methods to detect cervical intra-epithelial neoplasia in an urban African setting.

Method: Six hundred fiftythree women, attending a family planning clinic in Nairobi (Kenya), underwent four concurrent screening methods: pap smear, visual inspection with acetic acid (VIA), PCR for high risk human papillomavirus (HR HPV) and cervicography. The presence of cervical intra-epithelial neoplasia (CIN) was verified by colposcopy or biopsy.

Result: Sensitivity (for CIN2 or higher) and specificity (to exclude any CIN or cancer) were 83.3% (95% CI [73.6, 93.0]) and 94.6% (95% CI [92.6, 96.5]), respectively, for pap smear; 73.3% …

Trefoil Factor 2 (Tff2) Deficiency In Murine Digestive Tract Influences The Immune System, M. Baus- Loncar, J. Schmid, El-Nasir Lalani, I. Rosewell, R. A. Goodlad, H. G.W. Stamp, N. Blin, T. Kayademir

Department of Pathology and Laboratory Medicine

Background & Aims:

The gastrointestinal trefoil factor family (TFF1, TFF2, TFF3) peptides are considered to play an important role in maintaining the integrity of the mucosa. The physiological role of TFF2 in the protection of the GI tract was investigated in TFF2 deficiency.

Methods:

TFF2-/- mice were generated and differential expression of various genes was assessed by using a mouse expression microarray, quantitative real time PCR, Northern blots or immunohistochemistry.

Results:

On an mRNA level we found 128 differentially expressed genes. We observed modulation of a number of crucial genes involved in innate and adaptive immunity in the TFF2-/- mice. …

Gas-Producing Brain Abscess, Arshad A. Siddiqui, Khalid N. Chishti

Section of Neurosurgery

A case of a known psychiatric patient who presented with rapid neurological deterioration is reported. Neuroimaging revealed a gas-producing brain abscess in left parietal lobe with a contiguous focus of infection in the adjacent bone and scalp initiated by obsessive scalp scratching. On complete surgical excision of abscess, followed by culture-based antibiotic therapy, a good neurological recovery was achieved with minimal residual deficits at follow-up.

Variability In Lipid Profile Before And After Coronary Artery Bypass Grafting (Cabg), M Perwaiz Iqbal, Hasanat Mohammad Sharif, Naseema Mehboobali

Department of Biological & Biomedical Sciences

Objective: To investigate changes in total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, and triglycerides in serum of Pakistani patients before, immediately after and 5 days post CABG.
Method: Serum samples from 31 consecutive Pakistani angina patients undergoing CABG at the Aga Khan University Hospital were analyzed for total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides using kit methods.
Results: Immediately after CABG, there is a significant decline in the mean levels of serum cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. However, 5 days post CABG, there is a significant increase in the concentrations of total …

A Case Of Non-Resolving Cough And Weight Loss., Omer Ashraf, Ali Bin Sarwar Zubairi, Fawad Aslam, Kashif Ashraf, Suhail Muzaffar

Department of Medicine

Sarcoidosis is a chronic granulomatous multi-system disease with a clinical picture often mimicking tuberculosis. We present a case of a patient who presented with a clinical picture akin to both of these granulomatous disorders and was started on anti-tuberculous regimen despite the lack of any solid evidence pointing towards tuberculosis. As a result her clinical condition continued to deteriorate for months until finally a bronchoscopic biopsy established her disease process as sarcoidosis. She was then started on systemic corticosteroid therapy for sarcoidosis and during the ensuing period has shown marked improvement in her clinical picture with near normalization of the …

Psychomotor Skills For The Undergraduate Medical Curriculum In A Developing Country--Pakistan, Rashida Ahmed, Zoon Naqvi, Ineke Wolfhagen

Department of Pathology and Laboratory Medicine

Objective: To identify essential psychomotor skills for all the medical graduates of an undergraduate programme in Pakistan.
Materials and Methods: Twenty-five physicians practising in a tertiary care centre and ninety primary care physicians used a Likert's scale, ranging from "very essential" to"not required at all", to mark 99 psychomotor skills in the undergraduate medical curriculum in Pakistan.
Results: Overall the opinions of both the groups about the essential skills matched except for a few areas.
Conclusion: This study provides baseline data about psychomotor skills that a medical graduate in developing countries should be able to perform. Further studies will be …

Screening For Diseases In Family Practice, Ali Khan Khuwaja, Nadya Khan Khuwaja

Department of Family Medicine

The active check-over for disease among apparently healthy people is a fundamental aspect of prevention. This is perceivable by screening, which is a search of unrecognized disease or condition by means of rapidly applied test, examination or other procedures in apparently healthy individuals. This is carried out in the hope that earlier diagnosis and subsequent management favorably alters the natural history of the disease in a significant proportion of those who are identified as 'test-positive'. Family Practitioners have privilege to provide comprehensive and holistic health care services including preventive, curative and rehabilitative on continuous and long-term basis to all members …

Olfactory Neuroblastoma: A Case Report And Review Of The Literature, Shehzad Ghaffar, Iftikhar Salahuddin

Section of Otolaryngology, Head & Neck Surgery

Malignant tumors of the nasal cavity are rare. We report the case of an elderly woman who consulted us with a 4-year history of progressive nasal obstruction, occasional epistaxis, facial pain, and watering of the eyes. A diagnosis of olfactory neuroblastoma was established by histopathology and confirmed by immunohistochemistry. On staging, the mass was classified as a Kadish stage B tumor. The mass was excised via a lateral rhinotomy approach, and the tumor was peeled away completely from the cribriform plate with endoscopes. The patient underwent postoperative radiation, and she was free of recurrence at follow-up 15 months later.

Hemorrhagic Corpus Luteum Mimicking Heterotopic Pregnancy, Saba Sohail

Department of Radiology

Hemorrhagic corpus luteum (CL) is clinically known to simulate a number of medical, surgical and gynecologic conditions that cause acute abdomen. One such case is hereby presented that mimicked ectopic pregnancy clinically and heterotopic pregnancy on ultrasound. Laparoscopy was decisive.

Systemic Lupus Erythematosus Presenting As Hemolytic Uremic Syndrome: A Case Report, Malik Anas Rabbani, Bushra Ahmad, Sabeen Fatima Mekan, Suhail Muzaffar, Syed Sohail Ali

Section of Pulmonary & Critical Care

Associating systemic lupus erythematosus (SLE), with an initial presentation of hemolytic uremic syndrome (HUS) is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general …

Clinical And Echocardiographic Characteristics Of Patients With Significant Pericardial Effusion Requiring Pericardiocentesis, Ata Ur Rehman Quraishi, Arif Anis Khan, Khawar Abbas Kazmi, Syed Muhammad Najaf, M Najib Basir, Azam Shafquat, Fahim Jafary, Sajid Dhakan

Section of Cardiology

Objective: Clinical and echocardiographic features of significant pericardial effusion (PE) have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients.Methods: Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital (AKUH) between January 1988 and May 2001" re included in this review.Results: Most common presenting symptoms were dyspnea (89%) and fever (36%). Elevated JVP and pulsus paradoxus were documented in 59% and 41% of …