Medical Specialties Commons^™

Cost Of Acute Stroke Care At A Tertiary Care Hospital In Karachi, Pakistan, B. A. Khealani, Z. F. Javed, N. A. Syed, Saad Shafqat, Mohammad Wasay

Section of Neurology

Objective:To evaluate cost of acute stroke care and its determinants at a tertiary care hospital in Karachi and to find out predictors of high cost care. Acute stroke is a leading cause of morbidity and mortality. Cost of care is the single most important determinant in availability of acute stroke care at a tertiary care hospital in Pakistan.It is also an important factor in development of public health policies and medical insurance plans. Average nnual income in Pakistan is 4881 rupees (U$ 85).
Methods: Medical and billing records of 443 patients with acute stroke were retrospectively reviewed from …

Moyamoya Disease: An Elusive Diagnosis, K. B. Asumal, N. Akhtar, N. A. Syed, Saad Shafqat, S. M. Baig

Section of Neurology

Moyamoya disease is an idiopathic vasculopathy, affecting vessels of Circle of Willis.1 It usually manifests as stroke, but can also cause seizures and cognitive impairment.2 Ischemic strokes are common in children and hemorrhagic strokes in adults.1 We describe our experience with moyamoya disease in four patients who presented with ischemic strokes, at an academic tertiary care center and emphasize that this diagnosis should be considered in young patients, especially children, who present with stroke.

Prenatal Chromosomal Diversification Of Leukemia In Monozygotic Twins, Helena Kempski, Karen A. Mensa- Bonsu, Lyndal Kearney, G. Reza Jalali, Ian Hann, Mohammad Khurshid, Mel Greaves

Section of Haematology/Oncology

Previous studies on concordant acute lymphoblastic leukemia (ALL) in identical twins have identified the leukemia as monoclonal with MLL or ETV6-RUNX1 gene fusion as early or initiating events in utero. In the latter case, postnatal latency is associated with secondary genetic events such as ETV6 deletion. We describe here a pair of infant twins with concordant acute monoblastic leukemia (AML). They are a unique pair in that their leukemia blasts display extensive intraclonal chromosomal diversity. Comparison of the leukemic cells between the two twins by karyotype and fluorescence in situ hybridization identifies a common or shared stem line …

District Hospital Based Injury Data-Are They An Option In A Developing Country?, Junaid Abdul Razzak, David Marsh, S. Stansfield

Department of Emergency Medicine

No abstract provided.

Post-Chemotherapy Residual Mass In Stage Iic Seminomatous Testicular Tumor, N A. Ahmad, S R. Biyabani, Farhat Abbas

Section of Urology

Introduction

The management of patients with residual masses following chemotherapy for advanced seminoma remains a difficult problem with no clear guidelines. While most patients with advanced seminoma achieve a complete or partial response with cisplatin based chemotherapy¹, a significant number will reveal a residual mass on follow up CT scan or MR imaging^2,3. Management options for post chemotherapy residual mass in a case of seminoma include close observation, radiation therapy and excisional surgery. While 80 to 85% of residual masses represent either fibrosis or necrotic tissue needing no further therapy, 10 to 15% may contain viable …

Symptomatic Granulomatous Prostatitis Following Bacillus Calmette-Guerin Immunotherapy For Bladder Cancer, M A. Noor, S R. Biyabani, I A. Burney, J Talatia

Section of Urology

No abstract provided.

Cancer Patterns In Quetta (1998-1999), Yasmin Bhurgri, Hadi Bhurgri, A. Ajam, Shahid Pervez, S. H. Hasan, A. Usman, J. A. Khan, Q. Kasi, I. Kasi, A. G. Rasool, A. Bhurgri, N. Faridi, J. Malik

Department of Pathology and Laboratory Medicine

Introduction: Quetta, the capital of Baluchistan, is located at latitude 30,25; longitude 67.00. It has a population of 759,245; 425,474 males (56%) and 333,771 females (44%); Census 1998. The majority of residents are Persian or Baluchi speaking Baluchs.

Methodology: The cancer cases from Quetta reported to the Karachi Cancer Registry were reviewed. The data included cases from the Aga Khan University Hospital (AKUH), Pathology Department (Quetta collection point) and health care facilities in Karachi. The residents of Baluchistan were ascertained and cancer cases residents of Quetta identified with the help of recorded addresses and retraceable telephone numbers.

Results: During a …

View Box Case--12 Osteomyelitis, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Leiomyosarcoma Presenting As A Spontaneously Ruptured Renal Tumor-Case Report, Mohammad Moazzam, M Hammad Ather, Akber S. Hussainy

Department of Pathology and Laboratory Medicine

Background:
Ruptured renal neoplasms can be a catastrophic clinical presentation. Angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50-60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall.
Case presentation:
A 70 years old male, with hypertension and ischemic disease, developed acute left flank pain. The general physician evaluated this using ultrasound, which showed a solid left renal …

View Box Case-11 Synovial Osteochondromatosis With Osteoarthrosis, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Radiologic Features Of Hallervorden Spatz Disease, K B. Asumal, M Wasay, S N. Ali

Section of Neurology

Hallervorden Spatz Disease is a rare familial neurodegenerative disorder, which primarily affects children but also can occur in adults1 . Major clinical features are abnormal involuntary movements and cognitive impairment2 . Diagnosis is based on clinical and radiological features. The radiological features are hypointense signals in globus pallidus and substantia niagra on MR! of brain3 . Occasionally the pallidal hypointense signals surround hyperintense signals, this is known as “tigereye-sign”4 and is postulated to be specific for Hallervorden Spatz Disease. We report two brothers with such MRI findings.

Morbidity And Outcome Of Low Birthweight Babies Of Adolescent Mothers At Kenyatta National Hospital, Nairobi, A. Wasunna, K. Mohammed

Paediatrics and Child Health, East Africa

Objective: To compare the morbidity and outcome of low birthweight babies (birthweight < 2000gm) of adolescent (age < 20 years) and older mothers.

Design: Cross sectional descriptive study.

Setting: The newborn Unit of the Kenyatta National Hospital. Main outcome measures: All babies weighing less than 2000gm at birth whose mothers consented to the study had their gestational age verified using the Dubowitz scoring system. They were then followed up by daily clinical assessment untill discharge, death or up to one month in the ward. The babies were divided into two groups according to their mother's age and then compared with respect to episodes of illness, duration of hospital stay, and overall …

Thalidomide Prevents Donor Corneal Graft Neovascularization In An Alkali Burn Model Of Corneal Angiogenesis, A. Abbas, Aga Hassan Feroze, G. F. Hyman, B. Khan

Section of Ophthalmology

Objective: Thalidomide is a potent inhibitor of angiogenesis. We evaluated the effects of Thalidomide on corneal angiogenesis and on tissue survival of grafts in rabbit eyes with pre-existing neovascularization secondary to alkali burn.
Methods: Sixteen rabbits received alkali burns to one cornea. One month post-injury, assessments of corneal neovascularization were performed followed by corneal transplantation. Four rabbits received oral Thalidomide and ten got placebo (powdered sugar) for thirty days. Total corneal neovascularization (NV), clock hours (CH) involved in (NV), longest (NV) pedicle length (NVP) and the duration of time required for NV to develop were assessed.
Results: Thalidomide significantly decreased …

Clinical And Demographic Characteristics Of Psychiatric Inpatients Admitted Via Emergency And Non-Emergency Routes At A University Hospital In Pakistan, E U. Syed, S Mehmud, R Atiq

Department of Psychiatry

Objective: To examine the differences in the demographic and clinical characteristics of patients admitted through emergency versus non-emergency routes and see if these two groups of patients were significantly different from each other with respect to criteria mentioned in the title.Methods: Retrospective data was analysed in all 2576 patient records were reviewed and these patients were divided in two groups with respect to their mode of admission (emergency vs non emergency). These groups were then compared with respect to sex, age, length of stay, discharge status and diagnostic categories. Statistical package for social sciences version 8.0 (SPSS 8.0) was used …

Comparison Of Fentanyl And Nalbuphine In Total Intravenous Anaesthesia (Tiva), F A. Khan, Hameedullah

Department of Anaesthesia

Objective: To compare Nalbuphine and fentanyl as total intravenous anaesthesia with propofol infusion in laproscopic cholecystectomy cases.STUDY Design: Double blind randomised.Methods: Changes in haemodynamic variables greater than twenty percent above or below the baseline and recovery profile were observed.Results: Blood pressure remained within 20% of baseline in either group. Nine patients in fentanyl and fifteen in nalbuphine group required an additional bolus of propofol intraoperatively. Heart rate response after tracheal intubation was significantly higher in the nalbuphine group (25%). No difference was observed in the incidence of nausea and vomiting in the recovery room. Twenty-seven percent patients in the nalbuphine …

Low Birthweight Babies: Socio-Demographic And Obstetric Characteristics Of Adolescent Mothers At Kenyatta National Hospital, Nairobi, A. Wasunna, K. Mohammed

Paediatrics and Child Health, East Africa

Objective: To compare some socio-demographic and obstetric factors between adolescent mothers (aged below 20 years) and older mothers of low birthweight (birthweight <2000gm) babies.

Design: Cross sectional descriptive study.

Setting: The Newborn Unit of the Kenyatta National Hospital.

Results: Sixty nine adolescent mothers and 73 older mothers were studied. Adolescent mothers were more likely to be unmarried (p 0.0001) have less formal education (p

Respiratory Arrest In A Child After Flushing Of Pancuronium From The Dead Space Of Intravenous Cannula, Robyna Irshad Khan, Fazal Hameed Khan, Hamid Iqil Naqvi

Department of Anaesthesia

It is common practice for patients admitted to Intensive Care Units to have indwelling intravenous cannulae. Sometimes these cannulae are used only for the administration of drugs and are closed otherwise. Residual drugs in the deadspace of these intravenous cannulae as well as connected stoppers or 3-way stopcocks can later be flushed unknowingly. We would like to report a case in which inadvertent flushing of residual pancuronium caused complete muscle paralysis and respiratory arrest in a young child.

Comparative Study--Efficacy, Safety And Compliance Of Intravenous Iron Sucrose And Intramuscular Iron Sorbitol In Iron Deficiency Anemia Of Pregnancy, A Wali, A Mushtaq, Nilofer

Department of Obstetrics & Gynaecology

Objective: (1) To determine an alternative iron supplementation with better efficacy, compliance & safety in treatment of iron deficiency anemia during pregnancy, (2) to reduce blood transfusion during pregnancy, labor and puerperium.
Material and Method: A prospective comparative study. A total number of 60 pregnant women with the gestational age of 12 - 34 weeks were included in the study who were suffering from iron deficiency anemia. They were divided in 3 groups (A, B and C). Group A (n15) received intravenous iron sucrose according to recommended dose containing 500 mg of iron sucrose for storage, in group B (n=20) …

Role Of Imaging In The Evaluation Of Renal Trauma, M H. Ather, M A. Noor

Section of Urology

No abstract provided.

Transitional Cell Carcinomas Of The Urinary Bladder. A Histopathological Study, Z. Ahmed, S. Muzaffer, M. Khan, N. Kayani, Shahid Pervez, A. S. Husseini, S H. Hasan

Department of Pathology and Laboratory Medicine

Objective:

To determine the histological grading and muscle invasion in Transitional Cell Carcinomas of the Urinary Bladder; and to evaluate whether any correlation exists between tumour grade and muscle invasion.

Method:

A Retrospective study of all consecutive cases of Transitional Cell Carcinomas of the Urinary Bladder diagnosed at Aga Khan University Hospital between 1st Jan 1997 and 31st Dec 2000.

Results:

This study included 495 cases of Transitional Cell Carcinoma of the Urinary Bladder. M: F ratio was 4:1. Ages of patients ranged from 30 years to 87 years. Mean age in males was 59.1 years and in females 58.8 …

Histiocytosis X Of The Vulva, R M. Rizvi, C Nasreen, N Jafri

Department of Obstetrics & Gynaecology

No abstract provided.

Ischemic Stroke In Young Adults Of South Asia, A A. Razzaq, B A. Khan, S M. Baig

Section of Neurology

Objective: To study the risk factors, etiology and management of ischemic stroke in young adults in a South Asian population.

Methods: Retrospective study conducted at a large tertiary hospital in Karachi. One hundred and eighteen patients between fifteen and forty-five years admitted over a five year period with a diagnosis of ischemic infarct constituted the study population. The study variables included the full clinical spectrum, spanning historical, laboratory, radiological and outcome parameters.

Results: Forty-three percent of patients were hypertensive and 30% were diabetic. The combination of diabetes and hypertension was found in 19.5% of patients, intra-cranial and carotid …

View Box Case--9 Bronchiectasis, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

View Box Case-8 Ilio-Cecal Tuberculosis, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Faecal Empyema, R Layeeque, S Hussain, M Arshad, Farhat Moazam

Section of Urology

No abstract provided.

Csf Oligoclonal Bands In Multiple Sclerosis, I Siddiqui, S Aleem, N Kayani, S Baig

Department of Pathology and Laboratory Medicine

Objective:
To study the significance of oligoclonal bands in neurological disorders, specifically in Multiple Sclerosis (MS).
Methods:
The study was designed to assess the sensitivity and specificity of the test methodology of CSF electrophoresis by performing the retrospective analysis of CSF samples sent for oligoclonal bands (OCB). A total of 603 samples were received by the Clinical Laboratories, Department of Pathology of The Aga Khan University, during a period of 54 months (January 1993-June 1997). All of these samples were analyzed by performing CSF protein electrophoresis. One hundred thirty three out of 603 samples showed evidence of OCB. Out …

Nephropathy In Patients With Recently Diagnosed Type 2 Diabetes Mellitus Black Africans, F. W. Wanjohi, F. C. F. Otieno, E. N. Ogola, E. O. Amayo

Internal Medicine, East Africa

Background: Albuminuria is long recognised as a sign of renal disease in diabetes. In type 1 diabetes, renal disease occurs after a longer duration of diabetic state. In type 2 diabetes, it is more variable.

Objective: To determine the prevalence and any risk factors of albuminuria in short­ term (≤2 yrs) type 2 diabetes.

Design: Cross sectional, descriptive study. Microalbuminuria was assessed using micro II strips.

Setting: Outpatient diabetic clinic at Kenyatta National Hospital, Nairobi.

Subjects: Patients who were newly diagnosed or had had type 2 diabetes for two years or less.

Main outcome measures: Microalbuminuria, lipids, glycated haemoglobin, fasting …

View Box Case--7 Salter-Harris Type-Ii Fracture, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Characterization Of Pathogenic Mutations In 21-Hydroxylase Gene Of Pakistani Patients With Congenital Adrenal Hyperplasia And Their Family Members--A Preliminary Report, A H. Khan, M I. Nasir, T Moatter

Department of Pathology and Laboratory Medicine

Objective:
To characterize specific mutations within the 21-hydroxylase gene (CYP21-B) using ARMS-PCR assay in patients with congenital adrenal hyperplasia (CAH) and to compare it with that reported in other populations.
Subjects and Methods:
Five families, having an index case with CAH diagnosed on the basis of clinical and biochemical findings volunteered to give blood samples for analysis. A strategy, based on ARMS-PCR (Amplified Refractory Mutation System) was employed for the detection of mutations in 21-hydroxylase gene. The products of ARMS-PCR were resolved on agarose gels and the PCR products were visualized over ultra violet illumination.
Results:
Twenty-six specimens were analyzed …

Macular Hemorrhage Secondary To Increased Intrathoracic Pressure And Difficult Intubation, A Abbas, G Hyman

Section of Ophthalmology

No abstract provided.