Medical Specialties Commons^™

Life Style Related Risk Factors For Cardiovascular Disease Among Patients At A Teaching Hospital In Karachi, Waris Qidwai, Ar Mangi, R Bux

Department of Family Medicine

BACKGROUND: Cardiovascular disease is a leading cause for morbidity and mortality all over the world. It is important to study life style related, modifiable cardiovascular risk factors among patients, in order to devise preventive strategies.
METHODS: We surveyed family practice patients visiting the out-patient clinics of Aga Khan University Hospital, Karachi. The interview was questionnaire-based and recorded the demographic profile of the patients, in addition to information on life style related cardiovascular risk factors. The ethical requirements for the study were met. SPSS computer software was used for data management. RESULTS: Fifty patients were surveyed and included …

Characteristics Of Smokers And Their Knowledge About Smoking At A Teaching Hospital In Karachi, Waris Qidwai, N Zahid

Department of Family Medicine

Objective: To study the characteristics of smokers and their knowledge about smoking, among Family Practice Patients, at a teaching hospital in Karachi, Pakistan. Main outcome measures: Age at starting smoking, duration and number of cigarettes smoked, started smoking under influence of friends, colleagues, family members or self motivation, number of friends and colleagues who smoked, whether smoking is unhealthy, and actual chance of harm to an individual due to smoking is very rare or not.
Results: One hundred patients who visited Family Practice Center were interviewed. Sixty one percent were young married men, well educated and either student, …

A Systematic Review Of Existing National Priorities For Child Health Research In Sub-Saharan Africa, George Swingler, James Irlam, William Macharia, Felix Tietche, Martin Meremikwu

Paediatrics and Child Health, East Africa

Background: We systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them.

Methods: Collaborators from a purposive sample of 20 WHO-AFRO Region countries, assisted by key informants from a range of governmental, non-governmental, research and funding organisations and universities, identified and located potentially eligible prioritisation documents. Included documents were those published between 1990 and 2002 from national or nationally accredited institutions describing national health research priorities for child health, alone or as part of a broader report in which children were a clearly identifiable group. Laboratory, clinical, public health and policy research …

Management Outcome Of Residual Common Bile Duct Stones At Aga Khan University Hospital, Muhammad Rizwan Khan, Sameera Naureen, Dildar Hussain, Rizwan Azami

Department of Surgery Docs

Background: The frequency of residual common bile duct (CBD) stones in patients with previous cholecystectomy ranges from 2-10%, and a minimally invasive approach is generally recommended for these patients. This study reviews the experience in the management of residual CBD stones at the Aga Khan University Hospital.Methods: All adult patients diagnosed to have residual CBD stones, from 1993 to 2001, were identified and analyzed in terms of the treatment modality utilized and its associated complications. The role of endoscopic sphincterotomy was particularly analyzed in our set-up.Results: The study population consisted of 66 patients. The mean age was 52 (range:18-84 years) …

Frequency Of Irregular Red Cell Alloantibodies In Patients With Thalassemia Major: A Bicenter Study, Fareena Bilwani, Ghulam Nabi, Salman Adil, Mohammad Usman, Farrukh Hassan, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To provide frequency and distribution pattern of various types of irregular red cell alloantibodies in patients with thalassemia major.
Methods: This is a descriptive study conducted at two centers from January to December 2001. Purposive sampling was done and all patients diagnosed to have thalassemia major were included in the study. Antibody identification was carried out on serum employing commercial two-cell panel using standardized blood bank methods. If patients were found to have an irregular red cell alloantibody then the antibody identification was performed using 16 panel cells. Results: A total of ninety-seven patients were included …

Anaphylactic Reaction After Intramuscular Injection Of Cyanocobalamin (Vitamin B12): A Case Report, Fareena Bilwani, Salman Adil, Usman Sheikh, Ayesha Humera, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

We report a case of anaphylactic reaction to intramuscular injection of cyanocobalamin. This 52-year-old lady was diagnosed as a case of megaloblastic anemia secondary to dietary vitamin B12 deficiency. She had severe anaphylactic reaction after the parenteral administration of cyanocobalamine. Later she received oral vitamin B12 with no adverse effects. The purpose of this case report is to draw attention to the hypersensitive reaction to injectable vitamin B12, which is rarely seen. This could be due to sensitization to the vitamin B12 molecule itself or an IgE mediated reaction. We concluded that anaphylactic reaction to vitamin B12 is a rare …

Frequency Of Fab Subtypes In Acute Myeloid Leukemia Patients At Aga Khan University Hospital Karachi, Mahadev Sajanmal Harani, Salman Adil, Mohammad Usman Shaikh, G N Kakepoto, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

BACKGROUND: Acute myeloid leukemia (AML) is a heterogeneous disease. Therefore, various parameters are needed to classify this disease into subtypes, so that specific treatment approaches can be utilized effectively. The commonly used method for diagnosis and classification is based on FAB criteria using morphology and cytochemical stains. For some of the categories, immunophenotyping is necessary. The aim of present study is to determine the frequency of various sub types in acute myeloid leukemia using FAB criteria in our population. This will aid in the correct diagnosis of acute leukemia and hence proper management of the patients.
MATERIALS AND METHODS …

Cephalosporin Resistant Shigella Flexneri From A Clinical Isolate--A Rare Finding, Nasim Sabir, Afia Zafar

Department of Pathology and Laboratory Medicine

Shigellosis is an important public health problem, especially in developing countries. Antibiotic treatment of dysentery aimed at resolving diarrhea or reducing its duration, and to prevent transmission to other close contacts. Isolates with resistance to first line drugs have been reported throughout world, third generation cephalosporins and quinolones are mainstay of treatment. Shigella flexneri resistant to third generation cephalosporins in a clinical isolate is a rare finding, and this has been reported for the first time in Pakistan.

Frequency And Sensitivity Pattern Of Extended Spectrum Beta Lactamase Producing Isolates In A Tertiary Care Hospital Laboratory Of Pakistan, Kauser Jabeen, Afia Zafar, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: To determine frequency, distribution and sensitivity pattern of Extended-Spectrum ß Lactamase (EBSL) producing organism at a tertiary care hospital in Pakistan.
Methods: All members of enterobacteriacae isolated between April and August 2002 were studied. Isolates were speciated according to standard biochemical tests. Susceptibility testing was performed by Kirby-Bauer method. ESBL was detected using double disc method using cefotaxime versus cefotaxime plus clavulanate according to NCCLS. Statistical analysis was performed by SPSS version 10. Test of significance were calculated using chi-square test.
Results: During the study period, 1137/2840 (40%) of the isolates tested were found to be ESBL producing. …

Nalidixic Acid Screening Test In Detection Of Decreased Fluoroquinolone Susceptibility In Salmonella Typhi Isolated From Blood, Afia Zafar, Ng Ibrahim, T Ahsan, Z Abbas, A Zaidi, Rumina Hasan

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the validity of nalidixic acid screening test in the detection of high MICs of fluoroquinolone against Salmonella(S.) typhi isolated from blood and correlate zone diameters of ofloxacin with that of MIC value for nalidixic acid sensitive and resistant strains.
DESIGN: Cross-sectional analytical study.
PLACE AND DURATION OF STUDY: Clinical Microbiology Laboratory of the Aga Khan Hospital, Karachi from January 2002 to December 2003.
METHODS: Two hundred S. typhi isolates from blood were included for nalidixic acid screening and ofloxacin susceptibility. Antibiotic susceptibilities for both the antibiotics were obtained by disc diffusion method whereas MICs were determined …

Vi Antigen Expression In Salmonella Enterica Serovar Typhi Clinical Isolates From Pakistan, John Wain, Deborah House, Afia Zafar, Stephen Baker, Satheesh Nair, Claire Kidgell, Zulfiqar Bhutta, Gordon Dougan, Rumina Hasan

Department of Pathology and Laboratory Medicine

The accurate identification of Salmonella enterica subsp. enterica serovar Typhi variants that fail to express the capsular polysaccharide, Vi, is an important and much discussed issue for medical microbiology. We have tested a multiplex PCR method which shows the presence or absence of the genetic locus required for Vi expression. Of 2,222 Salmonella serovar Typhi clinical isolates collected from patients' blood over a 4-year period in a region of Pakistan where typhoid is endemic, 12 tested negative for Vi expression by serological agglutination. However, only 1 of these 12 was Vi negative by the multiplex PCR method. This result was …

Solid And Cystic Epithelial Neoplasm Of Pancreas With Metastasis: Report Of A Highly Unusual Case, Zubair Ahmad, Nausheed Yaqboob, Suhail Muzaffar, Nadeem Ahmad

Department of Pathology and Laboratory Medicine

Solid and cystic papillary epithelial neoplasms of the pancreas are uncommon tumors occurring predominantly in young women. These tumors have excellent prognosis and after complete surgical resection, more that 95% patients are cured. Occasionally, they invade the surrounding pancreatic parenchyma. These tumors can recur even many years after resection, so long-term follow up is essential. Very few cases metastasize. We present a case of a middle aged woman with metastases to liver and omentum

The Pervasive Triad Of Food Security, Gender Inequity And Women's Health: Exploratory Research From Sub-Saharan Africa, A.A. Hyder, S. Maman, J.E. Nyoni, S.A. Khasiani, N. Teoh, Zul Premji, S. Sohani

Pathology, East Africa

Objectives: This study was designed to explore the interactions between food securing activities, health and gender equity from the perspective of rural east African women. The specific objectives were to document the critical interaction among these three issues - food security, gender inequity, women's health within the context of sub-Saharan Africa; to describe the nature of this triad from the perspective of women farmers in Africa; and to propose a framework for linking available interventions to the vicious nature of this triad.

Setting: In-depth interviews and focus group discussions were conducted with rural women farmers in Kwale District, Kenya and …

Outcome Of Home Mechanical Ventilation, N Salahuddin, K Haider, Sj Husain, S Siddiqui, Fazal Hameed Khan, R. Manasia

Department of Anaesthesia

OBJECTIVE: To determine the outcome of patients discharged home on portable ventilator.
DESIGN: Descriptive study.
PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi from January 2000 to December 2004.
PATIENTS AND METHODS: All ventilator-dependent patients discharged home were contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. SPSS version 13 was used to analyze data.
RESULTS: Eleven patients were discharged home on invasive ventilation. Mean age was 49 years (range 10-98 years). Cause of ventilatory failure were cervical spine trauma in 36%, primary neurological disease in 27%, critical illness neuropathy and respiratory failure in 18% …

Frequency Of Isolation Of Shigella Serogroups/Serotypes And Their Antimicrobial Susceptibility Pattern In Children From Slum Areas In Karachi, Afia Zafar, Nasim Sabir, Zulfiqar Bhutta

Department of Pathology and Laboratory Medicine

Objectives: To assess the frequency of serogroups and serotypes, as well as the antimicrobial susceptibility pattern of Shigella species isolated from known cases of diarrhoea and dysentery from Karachi, Pakistan.
Methods: A cross-sectional study was conducted between January 2002 and March 2003 at Aga Khan University on stool samples received from children with diarrhoea and dysentery from four low socio-economic areas (Sultanabad, Rehri Goth, Hijrat and Sherpao colony) of Karachi. Stool samples yielding growth of Shigella species, were further identified for serotypes by slide agglutination. Antibiotics susceptibility was performed by Kirby Bauer disk diffusion method
Results: …

Elevated Ex Vivo Monocyte Chemotactic Protein-1 (Ccl2) In Pulmonary As Compared With Extra-Pulmonary Tuberculosis, Zahra Hasan, Irfan Zaidi, Bushra Jamil, M Aslam Khan, Akber Kanji, Rabia Hussain

Department of Pathology and Laboratory Medicine

Background: Tuberculosis causes 3 million deaths annually. The most common site of tuberculosis is pulmonary however; extra-pulmonary forms of the disease also remain prevalent. Restriction of Mycobacterium tuberculosis depends on effective recruitment and subsequent activation of T lymphocytes, mononuclear and polymorphonuclear cells to the site of infection. Tumor necrosis factor (TNF)-α is essential for granuloma formation and is a potent activator of monocyte chemotactic protein (MCP-1, CCL2). CCL2 is essential for recruitment of monocytes and T cells and has been shown to play a role in protection against tuberculosis. Interleukin -8 (CXCL8) is a potent activator of neutrophils. Increased …

The Long Shadow Of Cerebral Localization, Saad Shafqat

Section of Neurology

In 1995, during my first week as a neurology resident at Massachusetts General Hospital, I had the privilege of meeting the late Raymond Adams. He was an established octogenarian by then, but the years had made no difference to his air of professionalism and academic authority. His reputation was made in the 1950s and 1960s, when he developed Boston as a major centre of clinical neurology. Among other things, he is immortalized through a famous textbook that has appeared in multiple editions. Our meeting took place at a clinical conference in which I was required to present a case. He …

Development Of A Comprehensive Epilepsy Surgery Programme In Pakistan, Mughis Sheerani

Section of Neurology

No abstract provided.

Survival Of Patients Treated With Intra-Aortic Balloon Counterpulsation At A Tertiary Care Center In Pakistan - Patient Characteristics And Predictors Of In-Hospital Mortality., Fahim H. Jafary, Sohail A. Khan, Haresh Kumar, Numaan F. Malik, K. Kazmi, Sajid Dhakam, Azam Shafquat, Aamir Hameed, Javed Tai, Najaf Nadeem

Department of Medicine

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan.

METHODS: Hospital charts of 95 patients (mean age 58.8 (+/- 10.4) years; 78.9% male) undergoing IABC between 2000-2002 …

Surgical Palliation For Unresectable Pancreatic Carcinoma, Dildar Hussain, Muhammad Rizwan Khan, Rizwan Azami

Department of Surgery Docs

Objectives: To review the results of surgical palliation for unresectable pancreatic carcinoma, and to analyze the morbidity and mortality associated with the surgical procedure. The reasons for readmission after discharge from the hospital were also analyzed.Methods: A retrospective study from 1995 to 2001 was done on 30 patients with pancreatic cancer operated with palliative intent, or those explored with curative intent but histopathology revealed positive resection margins or lymph node metastasis.Results: Twenty-five (83.25%) patients were above 50 years of age. There were 16 (53.28%) male, and 14 (46.62%) females, 8 (26.64%) had diabetes mellitus, 2 (6.66%) chronic pancreatitis and 4 …

Case Of Inhaled Prostaglandin E1 Used To Improve Hypoxia In Ards, Shahla Siddiqui, Salwa Zubair, F Hameed Khan

Department of Anaesthesia

No abstract provided.

Signs And Symptoms Of Urethritis And Cervicitis Among Women With Or Without Mycoplasma Genitalium Or Chlamydia Trachomatis Infection, Rita Verhelst, Hans Verstraelen, Geert Claeys, Gerda Verschraegen, Joris Delanghe, Leen Van Simaey, Catharine De Ganck, Marleen Temmerman, Mario Vaneechoutte

Obstetrics and Gynaecology, East Africa

Objectives: To study the prevalence, symptoms, and signs of Mycoplasma genitalium and Chlamydia trachomatis infections in women attending a Swedish STD clinic, accessible for both sexes, and in a group of young women called in the cervical cancer screening programme.

Methods: A cross sectional study among female STD clinic attendees in Örebro and a study among women called for Papanicolaou smear screening. Attendees were examined for urethritis and cervicitis. First void urine and endocervical samples were tested for M genitalium and C trachomatis.

Results: The prevalence of C trachomatis and M genitalium in the STD clinic population was 10% …

Clinical Study On The Use Of Nozovent In A Tertiary Care Setting, M Sohail Awan, M Mubarik Ali, Manzoor Ahmed, Asim Iqbal, M Javed Aslam

Section of Otolaryngology, Head & Neck Surgery

Objective: To assess the effectiveness of the Nozovent device in Pakistani subjects at Aga Khan University Hospital, Karachi and Sir Ganga Ram Hospital, Lahore from 15 January 2001 to 15 January 2002.Methods: Sixty males and 40 females were selected by non probability purposive sampling, from OPD of ENT Department, complaining of nasal obstruction due to various reasons, e.g. vasomotor rhinitis, allergic rhinitis, congestion during pregnancy and menstruation, common cold, traumatic nose and nasal valve problem.Results: All patients benefited subjectively but the degree of relief varied in individuals.CONCLUSION: The Nozovent provides a unique method to relieve nasal obstruction with no side …

Diagnostic Value Of Fine Needle Aspiration Cytology In Parotid Tumors, Muhammad Sohail Awan, Zafar Ahmad

Section of Otolaryngology, Head & Neck Surgery

Objective: To evaluate the usefulness and accuracy of fine needle aspiration cytology in the diagnosis of parotid gland tumors.Methods: We reviewed files of all patients who underwent parotidectomy for various parotid pathologies at Aga Khan University Hospital. Study design included a comparison between results of preoperative FNAC with final histopathological diagnosis. Galen & Ganbino method was used to calculate sensitivity and specificity of FNAC.Results: Among 50 patients reviewed, there was one false positive and 3 false negative results reported on FNAC. This gives a sensitivity of FNAC for reporting malignancy to be 74% and specificity to rule out malignancy 97%. …

Preventing Neural Tube Defects By Folic Acid Fortification Of Flour, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Effectiveness Of Early Pregnancy Ultrasound In Diagnosing Fetal Abnormalities In High Risk Women, S Munim, N Khowaja

Department of Obstetrics & Gynaecology

Objective: To assess the efficacy of 11-14 weeks ultrasound in the diagnosis of fetal abnormalities in high risk women.
Methods: Prospective study conducted at a teaching hospital in Karachi, Pakistan. One hundred ultrasound (mini-anomaly) scans were performed on 97 high-risk women, between 11-14 weeks of gestation.
Results: The most common indication for the ultrasound scan in the study, was previous history of structural or chromosomal abnormalities (40%) followed by advanced maternal age (22%). Out of 100 ultrasounds performed, two were found to have structural abnormalities at the time of mini-anomaly scan performed at 11-14 weeks. None of the ultrasound scans …

Anaesthesia For Surgical Correction Of Scoliosis With Spinal Cord Monitoring--A Case Series, M Q. Hoda, S U. Zafar

Department of Anaesthesia

Objective: To share our experience of anaesthetic management of scoliosis with intra-operative somatosensory evoked potential monitoring and wake up test.Methods: All the cases of scoliosis surgery scheduled during a period of two years in which SSEP and intra-operative wake-up test was planned were included in the study. The patient in which intra-operative wake-up test was not planned were excluded from this case series.Results: We managed a series of sixteen cases of scoliosis in our hospital. Eleven patients were female and five were male with the age ranging from six to twenty two years. SSEPs were monitored throughout the procedure and …

Knowledge And Awareness Of Pregnant Women About Ultrasounsd Scanning And Prenatal Diagnosis, S Munim, N A. Khawaja, R Qureshi

Department of Obstetrics & Gynaecology

Objective: Antenatal screening and ultrasound scan has become an integral part of the antenatal care in the present time. The aim of this study is to accurately describe the background knowledge and awareness of pregnant women about ultrasound scan and prenatal diagnosis.
Methods: It is a clinic based cross sectional study. Four hundred women, attending the antenatal clinics, were asked to fill in a pre tested structured questionnaire. Different variables of interest were collected. Statistical Program for the social sciences (SPSS) was used for the data management.
Results: Over 93.5% of the women were aware that ultrasound examination is an …

Maternal Anaemia And Its Impact On Perinatal Outcome In A Tertiary Care Hospital In Pakistan, F W. Lone, R N. Qureshi, F Emmanuel

Department of Obstetrics & Gynaecology

Maternal anaemia is a common problem in pregnancy, particularly in developing countries. We investigated the relationship between maternal anaemia and perinatal outcome in a cohort of 629 pregnant women from October 2001 to 2002. Of these, 313 were anaemic (haemoglobin < 11 g/L). Perinatal outcomes included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low Apgar scores and intrauterine fetal death. Univariate and multivariate analyses were performed. The risk of preterm delivery and low birth weight among the anaemic women was 4 and 1.9 times more respectively than the non-anaemic women. The neonates of anaemic women also had 1.8 times increased risk having low Apgar scores at 1 minute and there was a 3.7 greater risk of intrauterine fetal death among the anaemic women than the non-anaemic women.

Demystifying Health Care, Khabir Ahmed

Department of Surgery Docs

No abstract provided.