Medical Specialties Commons^™

Thoracic Multidisciplinary Clinic (Tmdc) And The Treatment Of Stage Iii Non-Small Cell Lung Cancer, Eliot L. Friedman Md, Michael F. Szwerc Md, Robert Kruklitis Md, Michael J. Weiss

Department of Medicine

No abstract provided.

Photo Quiz: Young Girl With Cough, Headache, And Visual Loss., Aisha Ilyas, Naima Fasih, Kauser Jabeen, Ehsan Bari, Syed Faisal Mahmood

Department of Medicine

No abstract provided.

Clinical Reasoning And Dual Mental Processing In Diagnostic Competence., M. Tariq, Syed Ahsan Ali

Department of Medicine

No abstract provided.

Case Series And Literature Review Of Multiple Nodular Sarcoidosis., Hira Shahzad, Sameer Ur-Rehman, Kulsoom Fatima, Nadia Sharif, Ali Bin Sarwar Zubairi

Department of Medicine

Background: Nodular lung disease is a rare presentation of sarcoidosis. Radiologically it can present as multiple pulmonary masses or solitary lung nodule.

Case presentation: We report three cases of nodular sarcoidosis in young females of Asian origin who had initially presented with dry cough and worsening dyspnea non-responsive to initially administered antibiotics. Pulmonary nodules were discovered upon radiographic imaging in all three cases which raised concern for the possibility of neoplastic processes. Subsequent biopsies revealed granulomatous inflammation indicative of sarcoidosis. All cases responded very well to systemic corticosteroids.

Conclusion: Sarcoidosis may present as nodular infiltrates which alerts the treating physician …

Load: A Pilot Study Of The Safety Of Loading Of Aspirin & Clopidogrel In Acute Ischaemic Stroke And Transient Ischaemic Attack. Is The Loading Dose Of Aspirin And Clopidogrel A Good Alternative For Patients With Acute Ischaemic Stroke And Tia? How This Will Impact Our Clinical Practice?, Fauzia Nomani,, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Left Atrial Volumes And Associated Stroke Subtypes., Quratulain Shaikh,, Bilal Ahmed, Maryam Ahmed,, Jamal Hussain Mahar,, Masood Ahmad,, Ayesha Ahmed,, Farzin Majeed, Fariha Sadiq Ali,, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

Background: Cardio embolism and cerebrovascular atherosclerosis are two major mechanisms of stroke. Studies investigating associations between advanced echocardiographic parameters and stroke mechanisms are limited.

Methods: This study is a standardized review of 633 patients admitted to the stroke service of a tertiary care hospital following a standardized stroke investigation and management pathway. Stroke subtypes were characterized using the Causative Classification System, using the hospitals online radiologic archival system with CCS certified stroke investigators. Patients with two mechanisms were excluded.

Results: Patients with cardioembolic stroke had a higher proportion of atrial fibrillation (p < 0.001), acute myocardial infarction (p < 0.001) and ischemic heart disease (p < 0.001). On electrocardiogram (ECG) and transthoracic Echo (TTE), patients with cardioembolic stroke had a greater atrial fibrillation (p < .00), left ventricular thrombus (p < .00), left ventricular ejection fraction <30% (p >< .00) and global hypokinesia (p < .00) Patients with cardioembolic stroke had higher mean left atrial volume indices (LAVi) (p < 0.001), mean left ventricular mass indices (LVMi) (p < 0.05) and mean left atrial diameters (LAD) (p < 0.05). At LAVi of 29–33 ml/m2 , the risk of atherothrombotic stroke increased. The risk of cardioembolic stroke increased with LAVi of 34 ml/m2 and above.

Conclusion: Left atrial volume indices may be linked …

Stroke Radiology And Distinguishing Characteristics Of Intracranial Atherosclerotic Disease In Native South Asian Pakistanis., Maria Khan, Asif Rasheed, Saman Hashmi, Moazzam Zaidi, Saba Akhtar, Lajpat Bansari, Nabi Shah, Maria Samuel, Sadaf Raza, Umer Rais Khan, Bilal Ahmed, Bilawal Ahmed, Naveeduddin Ahmed, Jamal Ara, Tasnim Ahsan, S. M. Munir, Shoukat Ali, Khalid Mehmood, Karim Ullah Maki, Muhammad Masroor Ahmed, Niaz Sheikh, Abdul Rauf Memon,, Philippe M. Frossard, Ayeesha Kamran Kamal

Department of Medicine

Background: There are no descriptions of stroke mechanisms from intracranial atherosclerotic disease in native South Asian Pakistanis.

Methods: Men and women aged ≥ 18 years with acute stroke presenting to four tertiary care hospitals in Karachi, Pakistan were screened using magnetic resonance angiography/transcranial Doppler scans. Trial of ORG 10172 in Acute Stroke Treatment criteria were applied to identify strokes from intracranial atherosclerotic disease.

Results: We studied 245 patients with acute stroke due to intracranial atherosclerotic disease. Two hundred thirty scans were reviewed. Also, 206/230 (89.0%) showed acute ischaemia. The most frequent presentation was with cortically based strokes in 42.2% (87/206) …

Vitamin B12 Supplementation In Trea Ting Major Depressive Disorder: A Randomized Controlled Trial, Ehsan Ullah Syed, Mohammad Wasay, Safia Awan

Department of Medicine

Recent literature has identified links between vitamin B12 deficiency and depression. We compared the clinical response of SSRI-monotherapy with that of B12-augmentation in a sample of depressed patients with low normal B12 levels who responded inadequately to the first trial with the SSRIs. Methods: Patients with depression and low normal B12 levels were randomized to a control arm (antidepressant only) or treatment arm (antidepressants and injectable vitamin B12 supplementation). Results: A total of 199 depressed patients were screened. Out of 73 patients with low normal B12 levels 34 (47%) were randomized to the treatment group while 39 (53%) …

My Patient Has Carotid Stenosis. Should He Get Stenting Or Endarterectomy?, Quratulain Shaikh,, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Desmoplastic Fibroblastoma (Collagenous Fibroma), Filomena Scolas Do, Tanya Ermolovich Do, Sean Branch Do, Alan J. Shienbaum Do, Sidney Jacoby

Department of Medicine

No abstract provided.

Trigeminal Trophic Syndrome, Ryan Owen Do, Joshua M. Levin Md, Stephen M. Purcell Do

Department of Medicine

No abstract provided.

Illuminating The Dark Side--Vitamin D Status In Different Localities Of Karachi, Romaina Iqbal, Lena Jafri, Ali Haroon, Aysha Habib Khan

Department of Medicine

This study was conducted to determine the association between place of residence (grouped into neighbourhoods), and 25-hydroxy D (25[OH]D) levels of individuals of Karachi. Addresses of 4788 individuals tested for 25[OH]D at the clinical laboratory of the Aga Khan University (AKU), Karachi, from January 2007 to June 2008 were reviewed. The neighbourhoods were categorized into ten, based on locality attributes. A high overall prevalence (74%) of vitamin D deficiency (VDD) was observed. There was a significant difference (p-value < 0.01) between mean log 25[OH]D levels amongst neighbourhoods grouped according to distinct housing structure attributes and localities. A high frequency of VDD in all the studied localities of an urban city warrant dietary vitamin D supplementation and food fortification.

Unintentional Childhood Poisoning, Epidemiology And Strategies For The Prevention And Policy Change In Pakistan, Omer Ul Hassan, Hasana Qadri, Umer Mir, Bilal Ahmed

Department of Medicine

Poisoning is the fifth leading cause of unintentional injuries among young children. Agents most commonly ingested by young children include medicines, cleaning substances, hydrocarbons, pesticides and cosmetics. Children with less educated fathers, living in more crowded conditions and from lower income families are more predisposed to unintentional poisoning. Unsafe storage of medicines, chemicals and other hazardous substances is one of the leading reasons for childhood poisoning. Knowledge of parents and caregivers about prevention of poisoning may be the basis to prevent subsequent injuries. This paper is a review of the epidemiology of unintentional poisonings among young children (less than five …

Wilson's Disease: Experience At A Tertiary Care Hospital., Om Parkash, Adil Ayub, Wasim Jafri, Syed H Shah, Saeed Hamid

Department of Medicine

Wilson's disease (WD) is a rare autosomal recessive disorder of copper metabolism. Data regarding WD is not available from Pakistan. A cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, and all patients admitted with primary and secondary diagnosis of Wilson's disease were added. A total of 47 patients were seen; 68% (n = 32) were male. The mean age was 26.6 ± 9.97 years. Most of the patients presented with hepatic, (n = 22, 46.8%), neurological, (n = 17, 36.2%) and psychiatric (n = 8, 17%) symptoms. Mean ceruloplasmin level was 0.17 ± 0.13 g/dl; it was < 0.25 g/dl in 39 (86.6%) patients. Serum copper (Cu) was reduced in 32 (68.1%) patients and 24-hr-urinary Cu was raised in 22 (47.6%) patients. Slit lamp examination for Kayser-Fleischer (KF) rings was done on 15 (31.9%) patients and 9 (60%) of them had KF rings. Mean serum aspartate transaminase (AST) / alanine transaminases (ALT) ratio was 1.92 and median alkaline phosphatase / total bilirubin ratio was 79.30 (IQR 35.05; 166.50).

Clear: The Intraventricular Haemorrhage Thrombolysis Trial., Anjum Akhtar, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Self-Perceived Health Among School Going Adolescents In Pakistan: Influence Of Individual, Parental And Life Style Factors?, Asad Ali Khan Afridi, Komal Motwani, Saleem Khawaja, Adeel Khoja, Zafar Fatmi, Iqbal Azam Syed, Muhammad Masood Kadir

Department of Medicine

BACKGROUND: Adolescents are at substantial risk of acquiring behaviors which might influence their health status. This study was aimed to assess the proportion of school going adolescents (both males and females) with poor self-perceived health and its associated factors.

METHODOLOGY: A cross-sectional study was conducted in three major cities of Pakistan i.e. Karachi, Lahore and Quetta. From each city, six (6) secondary schools were randomly selected (3 public and 3 private). Pre-tested, self-administered questionnaire was distributed to students. Binary logistic regression analysis was conducted to determine independent factors associated with poor self-perceived health.

RESULTS: Approximately 29% adolescents (119/414) reported poor …

Post-Prandial Upright Exercise Echocardiography In Hypertrophic Cardiomyopathy, Ellina C. Feiner Md, Milla Arabadjian Fnp, Glenda Winson Rn, Bette Kim Md, Farooq Chaudhry Md, Mark V. Sherrid Md

Department of Medicine

No abstract provided.

A Descriptive Study To Find Possible Correlation Between Mri Findings Of Pituitary Gland And Serum Prolactin Level, Muhammad Azeemuddin, Rohana Naqi, Mohammad Wasay

Department of Medicine

Objective: To explore equation, if any, between findings of magnetic resonance imaging of pituitary gland and serum prolactin level.

Methods: The retrospective, descriptive study was conducted at the Department of Radiology, Aga Khan University Hospital, Karachi, and related to patients\' records from April 19, 2006 to April 23, 2009. Seventy patients underwent magnetic resonance imaging of brain for pituitary gland. Inclusion criteria were all patients referred with relevant clinical symptoms or deranged serum prolactin level. Patients who were claustrophobic or had a pacemaker, aneurysm clip, metallic foreign body in the orbit or with no laboratory investigation were excluded from the …

Patients' Insight Of Interpreting Prescriptions And Drug Labels--A Cross Sectional Study., Muhammad Junaid Patel, Muhammad Shoaib Khan, Farheen Ali, Zehra Kazmi, Safia Awan, Ayesha Sorathia

Department of Medicine

Background: Errors in consuming drugs are associated with significant morbidity and mortality, besides an impact on the already overburdened health-care system. Misunderstanding drug labels and prescriptions plays an important role in contributing to adverse drug events.

Objective: To evaluate abilities to understand prescriptions and drug labels among patients attending tertiary care hospital in Karachi.

Methods: A cross sectional study was conducted at the Aga Khan University Hospital (AKUH), from January to March 2009. After informed consent, 181 adult patients and their healthy attendants were interviewed at AKUH using a standardized questionnaire, which ascertained patient demographics, factors that might increase exposure …

Benefit Of Neuroprotection In Acute Ischaemic Stroke, Shall We Dare To Hope?, Anjum Akhtar, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Crash Course In United States Pharmacopeia Standard 797 (Usp 797): Investigation Of Positive Sterility Cultures From A Hospital Pharmacy Preparation, Terry Burger Mba, Bsn, Rn, Ne-Bc, Cic, Deborah Fry Mt (Ascp), Mba, Cic, Gary Tallarita Mt (Ascp), Cindy L. Mitman Pharm D

Department of Medicine

No abstract provided.

Closing The Gap: Revising Sterility Testing Policies And Procedures Based On The United States Pharmacopeia (Usp) 797 Guidelines And A Near Miss, Cindy L. Mitman Pharm D, Terry Burger Mba, Bsn, Rn, Ne-Bc, Cic, Deborah Fry Mt (Ascp), Mba, Cic, Gary Tallarita Mt (Ascp)

Department of Medicine

No abstract provided.

Durability, Reliability, Viability: 48 Year-Survival Of A Starr-Edwards Mitral Valve, Bilal Ayub, Justin L. Guthier, James K. Wu

Department of Medicine

No abstract provided.

Spontaneous Coronary Artery Dissection: A Rare Cause Of Acute Coronary Syndrome., Abid Laghari, Aamir Hameed, K. Kazmi

Department of Medicine

We present a case of a 71-year-old man, with a history of hypertension and dyslipidaemia, who presented with typical cardiac chest pain and palpitations of 2 h duration. The examination revealed irregular pulse of 138 bpm, blood pressure 115/75 mm Hg, variable first and normal second heart sounds. The lungs were clear to auscultation. The ECG showed atrial fibrillation with a rapid ventricular rate. His heart rate was controlled with β blockers and the acute coronary syndrome treatment protocol was initiated. His baseline blood reports were within normal limits and two serial troponin I tests were negative. Coronary angiogram showed …

Heavily Thickened Pericardium With Constrictive Pericarditis., Abid Laghari, Javed Tai

Department of Medicine

A middle-aged male presented with symptoms of exertional shortness of breath and leg swelling for the past six months. Examination revealed raised jugular venous pressure (JVP), pitting pedal oedema, muffled heart sounds, bilateral pleural effusion and hepatomegaly. Echocardiogram showed features of constrictive pericarditis with heavily thickened pericardium, which was confirmed by cardiac computed tomography (CT). The patient underwent pericardiectomy following which echocardiographic features of constriction were reversed and the patient became asymptomatic.

My Patient Has Intracranial Stenosis, Does He Need An Intracerebral Stent? Results Of The Sammpris Study., Muhammad Faisal Wadiwala,, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Use Of An Ed-Based Observation Unit Followed By Outpatient Stress Testing In Chest Pain Patients With Prior Coronary Artery Disease History: Evaluation Of Safety And Prognostic Utility, Yasser Khalil Md, Prasant Pandey Md, Melvin H. Schwartz Md, Maida Abdul-Latif Md, Martin E. Matsumura Md

Department of Medicine

No abstract provided.

Comparison Of Chronic Persistent And Post-Operative Atrial Fibrillation On Long Term Survival In Patients Undergoing Cardiac Valve Surgery, Nasir Shariff, Ravi V. Desai Md, Sherrine Eid, Michael J. Weiss, Matthew W. Martinez, Sultan M. Siddique, Ronald S. Freudenberger Md

Department of Medicine

No abstract provided.

Pre-Operative Angiotensin Converting Enzyme Inhibitors And Angiotensin Receptor Blockers On The Occurrence Of Post Operative Atrial Fibrillation After Cardiac Valve Department Of Surgery, Nasir Shariff, Matthew W. Martinez Md, Ravi V. Desai Md, Michael J. Weiss, Vadim Levin Md, Larry E. Jacobs Md, Martin E. Matsumura Md, Ronald S. Freudenberger Md

Department of Medicine

No abstract provided.

Small Changes Now, Big Impact Later: “Non -Attendance” For Appointments In A Patient Centered Medical Home Model--Impact Of A Personalized Appointment Reminder In A Vulnerable Population, Veronica Sanchez-Medina, Sheyla M. Torres, Orlando J. Penaloza Md, Facp

Department of Medicine

No abstract provided.