Medical Specialties Commons^™

Prevalence Of Hepatitis C Virus In Lymphoproliferative Disorders, F. Bilwani, Y. Zaidi, G. N. Kakepoto, Salman Adil, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To study the prevalence of hepatitis C virus in lymphoproliferative disorders.
Methods: A case control prospective study was performed on 143 patients with lymphoproliferative disorders and 29 patients with non-hematological malignancies were taken as controls. All the patients in both groups were analyzed for various risk factors for infection with hepatitis C virus and were tested for the presence of hepatitis C virus antibody (anti HCV), cryoglobulins and rheumatoid factor antibody. Hepatitis C viremia was documented by detection of HCV RNA by polymerase chain reaction.
Results: There was no significant difference for risk factors for hepatitis …

Hematologic And Cytogenetic Findings In Eleven Chronic Myelogenous Leukemia Patients Treated With Imatinib Mesylate At A Tertiary Care Hospital, M. Usman, G. N. Kakepoto, Salman Adil, R. Sajid, S. Arain, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To evaluate the response of Imatinib mesylate in patients with myeloid leukemia in chronic ,accelerated and blast phase.
Methods:Eleven patients with established diagnosis of chronic myeloid leukemia were treatedwith Imatinib mesylate. Adverse events were documented with regular follow ups. Hematological and cytogeneticresponses were assessed according to established criteria. Patients with zero percent Philadelphia positivemetaphases were labeled as complete cytogenetic response while patients with 1% to 35% Philadelphia positive metaphases were termed as partial responders.
Results: Of 11 cases there were 7 males and 4 females with a mean age of 39.5 years and median age 51 years(range 21-69). …

Expression Of Ps2 In Prostate Cancer Correlates With Grade And Chromogranin A Expression But Not With Stage, Hammad Ather, Farhat Abbas, Nuzhat Faruqui, M Israr, Shahid Pervez

Department of Pathology and Laboratory Medicine

Background: The biological potential of prostate cancer is extremely variable. Particular interest is focused on markers not expressed in normal prostatic tissues. pS2 protein expression has been demonstrated in a range of malignant tissues in an oestrogen-independent pathway. Recently, it has been demonstrated that pS2, in prostate cancer, is closely associated with neuro-endocrine differentiation. In the present study, we have analyzed, the potential of Neuro-endocrine and pS2 (TFF1) expression in human prostate cancer determined by immunohistochemistry, in primary adenocarcinoma of the prostate and attempted to correlate this with the clinico-pathologic features of the patient and neuroendocrine expression.

Methods: Ninety-five malignant …

Neonatal Extra-Renal Wilm's Tumour, S Hussain, S Nizami, F Tareen

Section of Paediatric Surgery

No abstract provided.

Peri-Operative Management Of A Patient With Uncontrolled Polycythemia Vera For Above Knee Amputation, A Ahmed, K A. Shah

Department of Anaesthesia

No abstract provided.

Rare, Highly Pyrimethamine-Resistant Alleles Of The Plasmodium Falciparum Dihydrofolate Reductase Gene From 5 African Sites, S.J. Bates, P.A. Winstanley, W.M. Watkins, A. Alloueche, J. Bwika, T.C. Happi, P.G. Kremsner, J.G. Kublin, Zul Premji, C.H. Sibley

Pathology, East Africa

In eastern and southern Africa, there has been a rapid increase in the prevalence of alleles with mutations in the Plasmodium falciparum dihydrofolate reductase gene (dhfr) associated with increased risk of clinical failure of sulfadoxine-pyrimethamine (S/P). Molecular methods for surveillance of these mutations are now widespread, but the usual analysis detects only the most prevalent allele in a polyclonal sample. We used a yeast-expression system to identify rare, highly pyrimethamine-resistant alleles of dhfr in isolates from 5 African countries-Kenya, Tanzania, Malawi, Gabon, and Nigeria. Only the isolates from Nigeria yielded significant numbers of novel resistant alleles, and only 1 of …

Averting A Malaria Disaster In Africa - Where Does The Buck Stop?, C.J.M. Whitty, R. Allan, V. Wiseman, S. Ochola, M.V. Nakyanzi-Mugisha, B. Vonhm, M. Mwita, C. Miaka, A. Oloo, Zul Premji, C. Burgess, T.K. Mutabingwa

Pathology, East Africa

The serious threat posed by the spread of drug-resistant malaria in Africa has been widely acknowledged. Chloroquine resistance is now almost universal, and resistance to the successor drug, sulfadoxine-pyrimethamine (SP), is growing rapidly. Combination therapy has been suggested as being an available and potentially lasting solution to this impending crisis. However, the current cost of combination therapy, and especially that of artemisinin combination therapy (ACT), is potentially a serious drawback, even if a significant part of its cost is passed on to the end-user. If the question of cost is not successfully addressed this could lead to adverse results from …

Higher Il-10 Levels Are Associated With Less Effective Clearance Of Plasmodium Falciparum Parasites, E. Hugosson, S.M. Montgomery, Zul Premji, M. Troye-Blomberg, A. Bjorkman

Pathology, East Africa

The implications of high levels of the immune regulatory cytokine IL-10 in Plasmodium falciparum malaria are unclear. IL-10 may down-regulate pro-inflammatory responses and also exacerbate disease by inhibiting anti-parasitic immune functions. To study possible inhibiting effects on parasite clearance, IL-10 plasma levels were determined in 104 Tanzanian children, 1 to 4 years old, with acute uncomplicated P. falciparum malaria, and analysed for association with parasite densities during 3 days of anti-malarial treatment. Higher baseline IL-10 plasma levels were associated with statistically significantly higher parasite densities after 24, 48 and 72 h of treatment. These associations could not be explained by …

Unenhanced Helical Ct Of Ureterolithiasis: Incidence Of Secondary Urinary Tract Findings, J Yaqoob, M U. Usman, V Bari, K Munir, F Mosharaf

Department of Radiology

Objective: To determine the incidence of secondary signs of obstruction in patients with ureteral stones on unenhanced helical CT scans.MATERIAL AND Methods: Three hundred consecutive patients with suspected renal colic referred by the emergency department for an unenhanced helical CT scan were evaluated. One hundred and thirty two patients with ureteric calculi were viewed prospectively for the secondary signs of obstruction, which include hydronephrosis, hydroureter, perinephric stranding, nephromegaly, periureteral edema and difference in attenuation between acutely obstructed kidney and unobstructed kidney.Results: In the evaluated 132 patients, calculi were present in the proximal, mid and distal ureter in 12, 18 and …

Ischemic Stroke Subtypes In Pakistan: The Aga Khan University Stroke Data Bank, N. A. Syed, B. A. Khealani, S. Ali, A. Hasan, H. Brohi, T. Mozaffar, N. Ahmed, A. Hameed, S. M. Baig, M. Wasay

Department of Medicine

Objective: Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital.

Methods: We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi.

Results: A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 …

Spectrum Of Complications And Mortality Of Bacterial Meningitis: An Experience From A Developing Country, M. A. Rabbani, A. A. Khan, S. S. Ali, B. Ahmad, Mohammad Asim Beg, M. A. Khan, Mohammad Wasay

Department of Medicine

Objective:

The aim of this study was to obtain data on predisposing factors, causative organisms and their associated mortality and complications related to acute bacterial meningitis.

Methods:

The chart review of all patients in whom acute bacterial meningitis was diagnosed at The Aga Khan University Hospital from January 1995 through December 2001.

Results:

One hundred ninety-four patients were included in study. There were 146 males and 48 females. The mean age of our study population was 41±12.3 years. One hundred and ninety (97.9%) patients had community acquired meningitis; only 4 (2.0%) patients developed meningitis nosocomially. The two most common predisposing …

Neurological Care In Pakistan: Actions Are Needed, M. Wasay

Department of Medicine

No abstract provided.

Socio-Economic And Diagnostic Aspects Of Tuberculosis In Pakistan, Saba Sohail

Department of Radiology

No abstract provided.

Status Epilepticus In Children: A Five-Year Experience At Aga Khan University Hospital, S H. Ibrahim, M A. Yezdan, S Q. Nizami

Department of Paediatrics and Child Health

Objective: Status epilepticus is an under diagnosed entity in Pakistan. It is a potentially reversible condition but has a high mortality, if it is not recognized and managed on time. The purpose of this study was to determine the clinical profile and the relationship of mortality of status epilepticus with its known risk factors.
Methods: This was a retrospective study. Medical records of all the patients admitted in the last five years (1998-2002) with a diagnosis of status epilepticus (ICDcode 345.30, 345.31) were reviewed. Data was recorded on a Performa and analyzed by using the statistical programme SPSS, chi square …

Giant Choroid Plexus Papilloma Of The Third Ventricle, Ashfaq A. Razzaq, Khalid N. Chishti

Section of Neurosurgery

Abstract are not provided by the author/publisher

Situs Ambiguous, Saba Sohail, Mukhtiar Ahmed Memon, Allah Rakhiyo

Department of Radiology

The case of a female child is described who presented with recurrent respiratory infections and "recurrent right subphrenic abscess." Detailed radiological work-up identified situs ambiguous abdominis with bronchiectasis, duodenal malrotation, umbilical hernia and spina bifida.

Comparison Of Double Disc And Combined Disc Method For The Detection Of Extended Spectrum Beta Lactamases In Enterobacteriaceae, K Jabeen, A Zafar, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective:
/="/">To compare double disc approximation and combined disc method for their ability to detect extended spectrum b lactamase (ESBL) production in enterobacteriaceae and determine the percentage of isolates which are falsely reported as sensitive in absence of ESBL detection, in a clinical microbiology laboratory of a tertiary care hospital between September-October 2002.
/="/">Methods:
/="/">Selected isolates were identified according to standard biochemical tests. Disc susceptibility tests were performed according to NCCLS. ESBL detection by combined disc [cefotaxime (30 ug) versus cefotaxime plus clavulanate (30+10 ug)] was compared with detection using double discs [amoxy-clavulanic acid (20+10 ug) and …

Midazolam And Thiopentone Co-Induction: Looking For Improvement In Quality Of Anaesthesia, M A. Khan, F A. Khan

Department of Anaesthesia

Objective: To evaluate improvement in quality of anaesthesia induction using thiopentone and midazolam for co-induction of anaesthesia. An additional end point was taken as loss of response to a tetanic stimulation (50 Hz) delivered for 5 seconds after the loss of verbal contact and eyelash reflex.Methods: Ninety ASA I and II patients, within the age range of 20-60 years were studied. Patients were randomly divided into three equal groups; A, B and group C.Results: Onset of induction and loss of response to a tetanic stimulation was achieved earlier in group B as compared to the other study groups (p < 0.05).CONCLUSION: Co-induction with midazolam 0.02 mg x kg(-1) followed by thiopentone 3 mg x kg(-1) was superior to other two groups. Induction of anaesthesia in this group was found to be smoother and faster, provided better hemodynamic stability, better airway maintenance and with lesser incidence of untoward effects.

Septic Arthritis Of The Hip In Children: Aga Khan University Hospital Experience In Pakistan, Muhammad Umer, Pervaiz Hashmi, Tashfeen Ahmad, M Ahmed, Masood Umer

Section of Orthopaedic Surgery

Objective: To present clinical, radiological and bacteriological features and short term outcome of septic arthritis of the hip in children.
Methods: There were 23 male and 16 female children, including 6 neonates and 10 infants with a mean age of 3.9 years. Diagnosis of septic hip was made on clinical grounds, supplemented by X-rays, leukocyte count and the erythrocyte sedimentation rate (ESR). Thirty nine patients with 40 hips were followed for a mean time period of 76 weeks. All patients had a positive joint aspirate (pus) and underwent surgical decompression along with intravenous antibiotic therapy.
Results: Symptoms of pain, fever …

Consanguineous Marriage Resulting In Homozygous Occurrence Of X-Linked Retinoschisis In Girls, Azam Ali, Agha Hassan Feroze, Zulfiqar H. Rizvi, Tausif- Ur -Rehman

Section of Ophthalmology

Purpose: To investigate a family afflicted with X-linked retinoschisis and to determine the pedigree leading to such an occurrence.Design: Observational case series.
Methods: Visual acuities were measured at The Aga Khan University Hospital Ophthalmology clinic. Slit-lamp examination, direct and indirect ophthalmoscopies were performed on each of the seven members of this family. The pedigree was established by appropriate questioning about the rest of their family.
Results: The pedigree revealed the homozygosity of the four daughters for the XLRS mutations borne out of the consanguineous marriage between an affected father and a carrier mother.
Conclusions: This is the first report showing …

Helicobacter Pylori Infection And Micronutrient Deficiencies., Javed Yakoob, Wasim Jafri, Shahab Abid

Section of Gastroenterology

It is known that deficiencies of micronutrients due to infections increase morbidity and mortality. This phenomenon depicts itself conspicuously in developing countries. Deficiencies of iron, vitamins A, E, C, B12, etc are widely prevalent among populations living in the third world countries. Helicobacter pylori (H pylori) infection has a high prevalence throughout the world. Deficiencies of several micronutrients due to H pylori infection may be concomitantly present and vary from subtle sub-clinical states to severe clinical disorders. These essential trace elements/micronutrients are involved in host defense mechanisms, maintaining epithelial cell integrity, glycoprotein synthesis, transport mechanisms, myocardial contractility, brain development, cholesterol …

Topographical Expression Of Class Ia And Class Ii Phosphoinositide 3-Kinase Enzymes In Normal Human Tissues Is Consistent With A Role In Differentiation, Soha Salama El Sheikh, Jan Domin, Prakitpunthu Tomtitchong, Paul Abel, Gordon Stamp, El-Nasir Lalani

Department of Pathology and Laboratory Medicine

Background: Growth factor, cytokine and chemokine-induced activation of PI3K enzymes constitutes the start of a complex signalling cascade, which ultimately mediates cellular activities such as proliferation, differentiation, chemotaxis, survival, trafficking, and glucose homeostasis. The PI3K enzyme family is divided into 3 classes; class I (subdivided into IA and IB), class II (PI3K-C2α, PI3K-C2β and PI3K-C2γ) and class III PI3K. Expression of these enzymes in human tissue has not been clearly defined.

Methods: In this study, we analysed the immunohistochemical topographical expression profile of class IA (anti-p85 adaptor) and class II PI3K (PI3K-C2α and PI3K-C2β) enzymes in 104 formalin-fixed, paraffin embedded …

Renal Carcinoid Tumour, Z Ahmad, N Yaqoob, S Muzaffar, A S. Hussainy, S H. Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Renal Teratoma: A Rare Entity, N Yaqoob, Z Ahmed, N Jafri, S Muzaffar, S H. Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Candida Esophagitis: Risk Factors In Non-Hiv Population In Pakistan, Javed Yakoob, Wasim Jafri, Shahab Abid, Nadim Jafri, Muhammad Islam, Saeed Hamid, Hasnain Ali Shah, Akbar S. Hussainy

Section of Gastroenterology

AIM:

Candida esophagitis is a frequent infection in immunocompromised patients. This study was designed to determine its characteristics in non- human immune deficiency virus (HIV) infected patients attending a teaching hospital.

METHODS:

Clinical records of all patients coded by international classification of diseases 9th revision with clinical modifications' (ICD-9-CM), with candida esophagitis diagnosed by esophagogastroduodenoscopy (EGD) and histopathology over a period of 5 years were studied.

RESULTS:

Fifty-one patients (27 males, 24 females, range 21-77 years old and mean age 52.9 years) fulfilled the criteria (0.34% of the EGD). The common predisposing factors were carcinoma (OR 3.87, CI 1.00-14.99) and …

The Transformative Effect Of Training In Counselling And Its Application, On The Community Counsellors Themselves, S Naeem, Badar S. Ali, S Mubeen, Iqbal Azam

Department of Psychiatry

Objective: To identify the changes in community counsellors' own level of anxiety and depression as a result of learning counselling skills and to explore their subjective experiences after learning and providing counselling.Design: Quantitative: Repeated Measures. / Qualitative: Focus Group Discussions.SETTING: A lower middle class semi urban community of Karachi, Pakistan.PARTICIPANTS: Twenty-one self selected women from the community.Results: Reduction was seen in the post training scores of anxiety and/or depression in the trainees. As a result of learning and then providing counselling the community counsellors' self esteem, self confidence and sense of competence were enhanced and they developed a more positive …

Rare Complication Of Sinus Venosus-Type Atrial Septal Defect Repair, M Murad, S A. Sami, R Hashmi, V Bari

Department of Radiology

No abstract provided.

Irritable Bowel Syndrome In Health Care Professionals In Pakistan, Wasim Jafri, Javed Yakoob, Nadim Jafri, Mahesh Maloni, Saeed Hamid, Hasnain Ali Shah, Shahab Abid

Section of Gastroenterology

Objective: To evaluate the symptomatology of irritable bowel syndrome (IBS) among health care professionals attending an IBS symposium in a tertiary care university hospital. Method: A questionnaire designed to incorporate Manning and Rome II criteria was distributed among participants of an IBS symposium, most of them were health care professionals. A total of 100 questionnaires were distributed, 41 had symptoms fulfilling criteria of IBS. In these patients male: female ratio was 28:13 with age range 18-68. Results: The predominant symptom was abdominal pain 87.8 % (36/41) which was aggravated post-prandially 72.2% (29/41), relieved following defecation in 87 % (35/41) with …

Extrarenal Wilms' Tumor, M Yunus, R Hashmi, S H. Hasan, H M. Brohi

Department of Radiology

No abstract provided.

Spectrum Of Cutaneous Appendage Tumors At Aga Khan University Hospital, N Yaqoob, Z Ahmad, S Muzaffar, M S. Gill, I N. Soomro, S H. Hasan

Department of Pathology and Laboratory Medicine

Objective: To determine the frequency of various types of cutaneous appendage tumors in our practice.
Method: This is a partly retrospective and partly prospective study conducted at the Department of Pathology, Histopathology Section, The Aga Khan University Hospital, Karachi between 1st January 1997 and 31st December 2001.
Results: One hundred sixty six skin appendage tumors were diagnosed during the study period. 87.3% were benign, while 12.6% were malignant. Male female ratio was almost equal. Mean age was 41.72 years. 37.34% showed eccrine differentiation, 14.45% showed apocrine differentiation and 41.56% showed pilosebaceous differentiation, 6.62% exhibited mixed differentiation. The 5 commonest tumors …