Medical Specialties Commons^™

Ischemic Strokes: Observations From A Hospital Based Stroke Registry In Bangladesh., Nirmalenduk Bikash Bhowmik, Aamir Abbas, Mohammad Saifuddin, Md. Rashedul Islam, Rumana Habib, Aminur Rahman, Md. Amirul Haque,, Zahid Hassan, Mohammad Wasay

Department of Medicine

Background. Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh. Methods. Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded. Results. Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected …

Glucose Monitoring In Pregnancy Complicated By Diabetes., Aisha Sheikh, Abdul Jabbar

Department of Medicine

Diabetes in pregnancy is associated with adverse maternal and neonatal outcomes. Due to variations in insulin resistance throughout pregnancy there is a continuous need to implement Medical Nutrition Therapy (MNT), exercise and pharmacological treatments which have to be escalated. Self-monitoring of blood glucose (SMBG) is integral to the management of diabetes in pregnancy. Proper implementation of SMBG in pregnant women with diabetes requires patient education and understanding of its applications and limitations. Real-time results enable individuals to make informed daily self-care decisions regarding diet, exercise, and insulin. Retrospective analysis of SMBG data enables clinicians to develop individualized care plans, informing …

Nutrition In Intensive Care In Adults Review Of The Literature And Development Of Evidence Based Feeding Protocols., Sarah Ikram, Erfan Hussain,, Ali Bin Sarwar Zubairi

Department of Medicine

The subject of nutrition in intensive care is broad.Thenutrition support therapy plays a crucial role in the management of critically ill patients. This review was carried out to address the existing controversies and to recognise the current practice guidelines for the management of nutrition in intensive care units (ICUs) in adults. A PubMed search was carried out for clinical trials addressing the current nutrition practice in ICUs, recommendations for calculating energy requirements and efficacy of an algorithmic approach to nutritional delivery in an ICU setting. Algorithms were developed and modified for the practice of nutrition in an adult ICU in …

An Unusual Case Of Igg4 Associated Marginal Zone B-Cell Lymphoma Presenting As Subcutaneous Nodules Mimicking Lipomas, Ryan Mayo Md, Ranjit R. Nair Md, Shereen M F Gheith Md, Phd

Department of Medicine

No abstract provided.

Obscure Gastrointestinal Bleeding: A Case Series, Eric Nellis Md, Patrick Hickey Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Adrenal Incidentaloma In Young – A Gray Zone?, Ranjit R. Nair Md, Stacey Smith Md, Facp

Department of Medicine

No abstract provided.

A Predictive Model For Intensive Chemotherapy Outcomes In Newly Diagnosed Elderly Patients With Aml, Sameer Tolay Md, David F. Claxton Md, Junjia Zhu Md

Department of Medicine

No abstract provided.

Peritoneal Lymphomatosis: The Failure Of Occam’S Razor, Ranjit R. Nair Md, Nicole M. Agostino Do, Shereen M F Gheith Md, Usman Shah Md

Department of Medicine

No abstract provided.

Standard Post-Stroke Care: Far From Reality In Pakistan., Shahvaiz Magsi, Adeel Khoja, Mansoor Ali Merchant Rameez

Department of Medicine

No abstract provided.

Interferon Lambda-3 Rs12979860 Variants And Response To Pegylated Interferon In Chronic Hepatitis-C Genotype-3, Zaigham Abbas, Javed Yakoob, Muhammad A. Umer, Ali A. Azeem, Saeed S. Hamid, Wasim Jafri

Department of Medicine

Objective: To assess the role of single nucleotide polymorphisms (SNPs) near the interferon lambda-3 (IFNλ3) (formal IL-28B) gene rs12979860 in predicting sustained virologic response (SVR) in hepatitis-C virus genotype-3 (HCV-3).

Study Design: Descriptive, analytical study.

Place and Duration of Study: Department of Medicine, The Aga Khan University Hospital, Karachi, from July 2012 to June 2014.

Methodology: Patients with HCV-3 were classified as sustained virologic response (SVR), relapsers and non-responders. SNP rs12979860 was determined by PCR-RFLP protocol. Differences between categorical variables were assessed by chi-square or Fisher's exact test, while those between continuous variables were evaluated using the Mann-Whitney U-test. Binary …

Bomb Blast And Its Consequences: Successful Intensive Care Management Of Massive Pulmonary Embolsim., Faisal Shamim, Muhammad Rizwan, Adil Aziz

Department of Medicine

A suicide bomb blast in 2013 at a distant city of Pakistan killed 84 and wounded more than 150 people. Some patients were transferred to our tertiary care hospital because of extreme load on medical services there. This patient arrived at the Aga Khan Hospital, 2 days after the bomb blast injury and underwent an orthopedic procedure. Next day, he developed sudden tachypnea, desaturation, and circulatory collapse. After initial cardiopulmonary resuscitation, he was immediately transferred to surgical intensive care unit. Based on history, echocardiography findings and patient parameters, a clinical diagnosis of massive pulmonary embolism was made and immediate thrombolytic …

Amyloidosis Masquerading As Suspected Angioedema: Delay In Diagnosis, Grace Berlin Do, Marie S. O’Brien Do

Department of Medicine

No abstract provided.

Field Cancerization With Multiple Keratoacanthomas Successfully Treated With Topical And Intralesional 5-Fluorouracil, Stephen Hemperly Do, Sean Branch Do, Stephen M. Purcell Do

Department of Medicine

No abstract provided.

Role Of Prophylactic Magnesium Supplementation In Prevention Of Postoperative Atrial Fibrillation In Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis Of 23 Randomized Controlled Trials (Poster)., Jalaj Garg Md, Rahul Chaudhary Md, Parasuram Krishnamoorthy Md, Neeraj Shah Md, Babak Bozorgnia Md

Department of Medicine

No abstract provided.

Transcatheter Aortic Valve Replacement Is Associated With A Higher Rate Of Permanent Pacemaker Implantation Compared To Surgical Aortic Valve Replacement: A Propensity Matched Analysis (Poster)., Neeraj Shah Md, Achint Patel Mbbs, Nileshkumar Patel Md, Vratika Agarwal Md, Jalaj Garg Md, Nainesh C. Patel Md, Facc, David A. Cox Md, Facc, Fscai

Department of Medicine

Presenting Features, Treatment Patterns And Outcomes Of Patients With Breast Cancer In Pakistan: Experience At A University Hospital, Kumar S, Shaikh A. J, Rashid Ya, Masood N, Mohammed Atv, Malik Uz, Ghulam H

Department of Medicine

BACKGROUND:

Breast cancer is the most common cancer in Pakistani women. We report the presenting features, treatment patterns and survival of breast cancer from a University Hospital in Southern Pakistan and compare the data with international population based studies.

MATERIALS AND METHODS:

Medical records of patients diagnosed to have breast cancer between January 1999 and November 2008 were reviewed retrospectively.

RESULTS:

A total of 845 patients were identified. Median age of diagnosis was 48 years (range 18-92). Clinical stage was as follows: Stage I 9.9%; Stage II 48.5%; Stage III 26.2%; Stage IV 13.8%; data not available 1.5%. Approximately, half …

Quality Of Life Of Stroke Survivors And Their Primary Caregivers In Pakistan., Wardah Khalid, Shafquat Rozi, Tazeen S. Ali, Iqbal Azam Syed, Michael T. Mullen

Department of Medicine

No abstract provided.

A Case Report Of Ruxolitinib Induced Hypocalcemia: A Stochastic Or Deterministic Effect?, Arsha Sreedhar Md, Ranjit R. Nair Md, Gretchen A. Perilli Md

Department of Medicine

Ruxolitinib is a novel selective JAK 1/2 inhibitor approved for the treatment of myelofibrosis (MF) and polycythemia vera (PCV). Hypocalcemia associated with ruxolitinib has not been reported in early trials or in literature.

A 65 year female with history of CKD stage 3, PCV since 1989, papillary thyroid carcinoma, total thyroidectomy and hypoparathyroidism since 1996 presented with complaints of severe myalgia, fatigue, paresthesia and critical hypocalcemia. Her corrected S. Ca 5.8 mg /dl (8.9-10.1 mg/dL) and Ionised Ca 2.9 mg/dl (4.5 - 5.4 mg/dL). Other labs showed stable creatinine 1.5 mg/dL, intact PTH 29 pg/ml(14-72pg/ml) and 25,OH vitamin D level …

Humoral Hypercalcemia Of Twin Pregnancy: Not A Laughing Matter, Areeb Zamir Md, Angela Manglitz Do, Gretchen A. Perilli Md

Department of Medicine

Background: Humoral hypercalcemia due to high serum levels of Parathyroid Hormone-Related Protein (PTHrP) is very rare in the setting of benign disease. PTHrP has a significant impact on developmental stages of life and is expressed in a variety of tissues including placental tissue and mammary glands. Therefore, PTHrP has a large role in the homeostasis of calcium between the mother and fetus.

Clinical case: A 25 year old female presented to the emergency department six days post-partum of spontaneous vaginal delivery of twins at 28 and 4/7 weeks. Her chief complaints included bilateral leg pain, weakness, and difficulty ambulating …

Predictors Of Coronary Artery Disease In Patients With Polycythemia Vera And Essential Thrombocytosis: Results From The National Inpatient Sample 2009-10., Parasuram Krishnamoorthy Md, Varun Mittal, Jalaj Garg Md, Neeraj Shah Md, Nainesh C. Patel Md

Department of Medicine

Background: Myelproliferative disorders (MPDs) including Polycythemia Vera (PCV) and Essential thrombocytosis (ET) are associated with increase in arterial and venous thromboembolic events. Chronic endothelial damage, hyperviscosity and platelet activation are possible mechanistic factors resulting in accelerated atherogenesis and coronary artery disease (CAD). However the differences in prevalence of CAD and traditional risk factors (TRFs) between PCV and ET are unknown. Hence, we aimed to determine the prevalence and predictors of CAD in PCV and ET patients using a national registry.

Methods: All patients ≥18 years diagnosed with PCV and ET were identified in the Nationwide Inpatient Sample (NIS) 2009-2010 …

Transcatheter Aortic Valve Replacement (Tavr) Is Associated With A Higher Rate Of Permanent Pacemaker Implantation Compared To Surgical Aortic Valve Replacement (Savr): A Propensity Matched Analysis, Neeraj Shah Md, Achint Patel Mbbs, Nileshkumar Patel Md, Vratika Agarwal Md, Jalaj Garg Md, Nainesh C. Patel Md, David A. Cox Md

Department of Medicine

Background

Occurrence of conduction abnormalities requiring permanent pacemaker implantation (PPI) is a serious complication after both transcatheter (TAVR) & surgical (SAVR) aortic valve replacement.

Methods

Nationwide Inpatient Sample was queried from August 2011 to December 2012 using ICD-9 codes 35.05 & 35.06 for TAVR and 35.21 & 35.22 for SAVR. Patients undergoing other valve surgeries, bypass grafting & those with prior pacemakers or defibrillators were excluded. Propensity matching was performed (1:1) to match TAVR & SAVR cohorts on age, gender, right bundle branch block (RBBB), first degree AV block, bifascicular or trifascicular block, hospital region, teaching hospital status & hospital …

Role Of Prophylactic Magnesium Supplementation In Prevention Of Postoperative Atrial Fibrillation In Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis Of 23 Randomized Controlled Trials, Jalaj Garg Md, Rahul Chaudhary Md, Parasuram Krishnamoorthy Md, Neeraj Shah Md, Babak Bozorgnia Md

Department of Medicine

Background

Several randomized clinical trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aim to determine the role of prophylactic Mg in 3 settings (intraoperative, postoperative, intraoperative + postoperative) in prevention of POAF.

Methods

A systemic literature search was performed (until October 20, 2015) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in the POAF. For each study, the incidence of atrial fibrillation …

Paraneoplastic Pemphigus Presenting Like Toxic Epidermal Necrolysis, Huyenian Nguyen Do, Kelly L. Reed Do, Steven Oberlender Md, Phd, Stephen M. Purcell Do

Department of Medicine

No abstract provided.

Sepsis Management: An Evidence-Based Approach., Muhammad Akbar Baig, Hira Shahzad, Bushra Jamil, Erfan Hussain

Department of Medicine

The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are …

Significance Of Tumor Marker Ca15-3 In Metastatic Breast Cancer, Hoor Fatima, Amir Maqbool, Marium Siddiqui, Ghulam H, Habiba Sohail, Omema Saleem, Afarina Ahmed

Department of Medicine

Secondary spread of cancer to bones is commonest and frequent phenomenon and enhances the need of special care for sufferers. Bone metastases mostly are the first complication of different variety of cancers which increase the need of care and expensive facilities. Blood dissemination is another common route, might be due to the venous drainage from visceral organs directly into the axial bones. CA 15-3 is a mucinous tumor markers derived from MUC1 gene, provides better guide line about the treatment, recurrence and prognosis.

Aim: Aim of the study was to signify the role of tumor marker CA15-3 in metastatic breast …

Clinical Practice Guidelines On The Management Of Variceal Bleeding, Javed Iqbal Farooqi, Hasnain Ali Shah, Anwaar A. Khan, Amjad Salamat, Altaf Alam, Abbas Khan Khattak, Nazish Butt, Muhammed Salih, Sher Sher Rehman, Arif Amir Nawaz, Nasir Khokhar, Ghias-Un-Nabi Tayyab, Javed Aslam Butt, Kashif Malik, Shakeel Ahmad Mirza, Mohammad Akram

Department of Medicine

Gastroesophageal variceal bleeding occurs in 30 - 50% of patients of liver cirrhosis with portal hypertension, with 20-70% mortality in one year. Therefore, it is essential to screen these patients for varices and prevent first episode of bleeding by treating them with β-blockers or endoscopic variceal band ligation. Ideally, the patients with variceal bleeding should be treated in a unit where the personnel are familiar with the management of such patients and where routine therapeutic interventions can be undertaken. Proper management of such patients include: initial assessment, resuscitation, blood volume replacement, vasoactive agents, prevention of associated complications such as bacterial …

Translating Knowledge For Action Against Stroke--Using 5-Minute Videos For Stroke Survivors And Caregivers To Improve Post-Stroke Outcomes: Study Protocol For A Randomized Controlled Trial (Movies4stroke)., Ayeesha Kamran Kamal, Adeel Khoja, Bushra Usmani, Nargis Asad, Asma Ahmed, Iqbal Azam, Sarah Saleem, Saleem Sayani

Department of Medicine

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.

Methods: Movies4Stroke will be a randomized control, outcome assessor …

A Rare Cause Of Recurrent Wheeze And Seizures., Maryam Hassan,, Saher Quraeshi, Ali Bin Sarwar Zubairi

Department of Medicine

A 34-year-old woman presented with recurrent attacks of breathlessness and seizures. The patient's condition worsened during the course of her hospital stay, as a result of which she had to be intubated twice. Radiological studies showed a mass in the trachea and the subsequent biopsy of the mass revealed an infiltrating carcinoma with morphological features of adenoid cystic carcinoma.

Sotatercept Improves Anemia, Vascular Calcification, And Bone Loss In Patients With End-Stage Kidney Disease On Hemodialysis, John Havill, Nelson Kopyt Do, Fasn, Facp, Daniel Coyne, Michael Weiswasser, William T. Smith

Department of Medicine

No abstract provided.

A Descriptive Study Of Pulmonary Function Testing And Chest Computed Tomography In Survivors Of Veno-Venous Extracorporeal Membrane Oxygenation, Matthew Miles Do, Dorothea T. Watson Do, Rita Pechulis Md, Fccp

Department of Medicine

No abstract provided.