Medical Specialties Commons^™

Adult Onset Stills Disease In A Tertiary Care Hospital Of Pakistan., Naushad Abid, A. B. Khalid

Department of Medicine

Objective: To study the clinical characteristics of Stills disease in a tertiary care hospital of Pakistan and compare it with similar published studies.

Materials and Methods: (Retrospective descriptive study) Thirteen patients with Adult onset stills disease were identified by chart review of last ten years from 1995 to 2005 at Aga Khan University Hospital (AKU), a tertiary care private medical university in Karachi Pakistan. Demographic and other specific information was recorded on standardized data sheet and analyzed by SPSS 11.5 software.

Results: Mean age of patients was 26.54±10.34 years, of which 8 (61.5%) were males. The most common presenting features …

The Karachi Intracranial Stenosis Study (Kiss) Protocol: An Urban Multicenter Case-Control Investigation Reporting The Clinical, Radiologic And Biochemical Associations Of Intracranial Stenosis In Pakistan., Ayeesha Kamran Kamal, Fawad Taj,, Babar Junaidi, Asif Rasheed, Moazzam Zaidi, Muhammed Murtaza, Naved Iqbal, Fahad Hashmat, Syed Vaqas Alam, Uzma Saleem, Shahan Waheed, Lajpat Bansari, Nabi Shah, Maria Samuel, Madiha Yameen, Sobia Naz, Farrukh Shahab Khan, Naveeduddin Ahmed, Khalid Mahmood, Niaz Sheikh, Karim Ullah Makki, Muhammad Masroor Ahmed, Abdul Rauf Memon, Mohammad Wasay, Nadir Ali Syed, Bhojo A Khealani, Philippe M. Frossard, Danish Saleheen

Department of Medicine

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner.

Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due …

Classification And Clinical Features Of Headache Disorders In Pakistan: A Retrospective Review Of Clinical Data, Muhammed Murtaza, Mehreen Kisat, Haroon Daniel, Aziz Sonawalla

Department of Medicine

Background: Morbidity associated with primary headache disorders is a major public health problem with an overall prevalence of 46%. Tension-type headache and migraine are the two most prevalent causes. However, headache has not been sufficiently studied as a cause of morbidity in the developing world. Literature on prevalence and classification of these disorders in South Asia is scarce. The aim of this study is to describe the classification and clinical features of headache patients who seek medical advice in Pakistan.

Methods and Results: Medical records of 255 consecutive patients who presented to a headache clinic at a tertiary care hospital …

Clinical Characteristics, Management And Outcome Of Major Pulmonary Embolism: An Experience From A Tertiary Care Center In Pakistan, Shahid Javed Husain, Ali Bin Sarwar Zubairi, Kulsoom Fatima, Muhammad Irfan, Muhammad Atif, Muhammad Ammad Saeed

Department of Medicine

Objective: To evaluate the clinical characteristics, risk factors, management and outcome of major pulmonary embolism (PE) in a tertiary care center of Karachi.
Methods: Medical records of all patients who underwent a spiral CT scan of the chest for suspected pulmonary embolism were reviewed between January 2000 and June 2007 at the Aga Khan University Hospital, Karachi. Patients having evidence of major pulmonary embolism on spiral CT scan were selected.
Results: A total of 30 patients (10 males, 20 females) with mean age 52 ± 14.59 years were identified who fulfilled our predefined criteria for major pulmonary embolism. Risk factors …

Does Admission Hyperglycemia Predict Intracranial And Extracranial Vasculopathy?, Ather Mohammed Taqui, Ayeesha Kamran Kamal, Saqib Ali Gowani, Bhojo A. Khealani, Shafquat Rozi

Department of Medicine

Objective: To study the association between admission hyperglycaemia and the presence and pattern of intracranial and extracranial vascular disease.
Methods: This retrospective study was conducted at a major tertiary care hospital in Karachi, Pakistan. Patients who had presented with acute stroke and had undergone a carotid ultrasound doppler of the carotids and/or Magnetic Resonance Angiography (MRA) of the brain were included in the study. A multiple logistic regression analysis of variables was done for an abnormal finding on each investigation.
Results: Out of the total of 216 patients, the age of majority of the patients (83.3%) was >50 years …

Diffusion Weighted Image (Dwi) Findings In Methanol Intoxication., Humera Ahsan,, Muhammad Akbar, Aamir Hameed

Department of Medicine

Methanol is a toxic substance with extremely devastating effects upon exposure. The case described suffered from such kind of poisoning. MRI brain demonstrated necrosis bilaterally in the Putamen areas which is a classic hallmark finding. Additional Diffusion weighted imaging showed abnormal signal bilaterally in the putamen areas along with Diffusion positive bilateral lesions (possibly infarctions) in both the frontal and occipital lobes that were not evident on MRI with or without contrast.

Training Tomorrow’S Providers And Expanding Access To Peginterferon/Ribavirin Combination Therapyfor Chronic Hepatatis C In Underinsured/Uninsured Patients: Final Outcomes Of A Pilot, Resident-Initiated, Multidisciplinary, Hepatitis C Clinic, Nicole M. Agostino Do, Suzanne J. Templer Do, Edward Norris Md, Fapm, Charles M. Brooks Md, Eric J. Gertner Md, Mph, Joseph L. Yozviak Do, Facp

Department of Medicine

No abstract provided.

Defining An Emerging Epidemic: Hcv Seroprevalence In A Large, Tertiary-Care Health Network In Pennsylvania, Margaret Hoffman-Terry Md, Facp, Joseph L. Yozviak Do, Facp, K Nadeem Ahmed Md, Sherrine Eid Mph, Timothy J. Friel Md, Kimberly A. Pacella, Luther Rhodes Iii Md

Department of Medicine

No abstract provided.

Asian Cerebral Venous Thrombosis Registry: Study Protocolv, Mohammad Wasay, Ayeesha Kamal, Bhojo Khealani

Department of Medicine

Introduction:

Cerebral venous thrombosis (CVT) is a well known but poorly reported entity. Most of the studies and registries related to CVT are reported from European countries. No large multi-center or multi- national data base or registry has been reported from Asian countries. CVT is not uncommon in Asia especially in south Asian subcontinent including India, Pakistan and Bangladesh. One study reported from India that CVT accounted for half of all strokes in the young and 40% of strokes in women. Review of CVT cases from Asian countries is suggestive of differences in risk factors profile and outcome in these …

Moyamoya Disease: A Clinical Spectrum, Literature Review And Case Series From A Tertiary Care Hospital In Pakistan., Sana Shoukat, Ahmed Itrat, Ather M. Taqui, Moazzam Zaidi, Ayeesha Kamran Kamal

Department of Medicine

Background: Moyamoya is a rare cerebrovascular disease of unknown etiology. The data on moyamoya disease from Pakistan is sparse. We report a case series of 13 patients who presented with moyamoya disease to a tertiary care hospital in Pakistan with a national referral base.

Methods: We conducted a retrospective review of thirteen patients who presented to The Aga Khan University and diagnosed with "Moyamoya Disease" during the period 1988 – 2006. These patients were identified from existing hospital database via ICD-9 codes. A predesigned questionnaire containing information about clinical presentation, management and neuroimaging was administered to all identified patients. Results: …

Fight Against Chronic Diseases (High Blood Pressure, Stroke, Diabetes And Cancer) In Pakistan; Cost-Effective Interventions, Mohammad Wasay, Abdul Jabbar

Department of Medicine

No abstract provided.

Early Ischemic Stroke Presentation In Pakistan, Ayeesha Kamran Kamal, Bhojo A Khealani, Sajjad Ahmed Ansari, Maria Afridi, Nadir Ali Syed

Department of Medicine

Introduction: There are no studies from Pakistan that describe stroke presentation rates or factors associated with early or delayed presentation. This is important to know because current clinical protocols limit the use of recombinant tissue plasminogen activator (rtPA), the only available therapy for acute ischemic stroke, to a three-hour window from symptom onset.
Methods: All patients aged 14 years or above with acute ischemic stroke of < or = 48 hours duration were prospectively identified from the Aga Khan University Stroke Data Bank over a 22-month period ending May 2001.
Results: 269 ischemic stroke patients presented within 48 hours of stroke onset. 55 out of 269 (21%) presented within first three hours and 110 out of 269 (41%) within first six hours. Unawareness of …

Po5.53 Critical Illness Polyneuropathy And Myopathy: Experience At A Tertiary Care Center In Pakistan, Ghulam Shabbir, Ali Mehmood Raufi, Mustafa Khan, Nawal Salahuddin, Saad Shafqat

Department of Medicine

Background: Polyneuropathy and Myopathy are frequently encountere in the setting of Critical illness patients. Up to 50% of intensive care unit (ICU) patients show electrophysiological features of either or both conditions. These conditions interfere with functional recovery and delay weaning from mechanical ventilation, resulting in excess morbidity,mortality and cost of care. This study was to define the clinical spectrum of critical illness Polyneuropathy (CIP) and Myopathy (CIM) in a setting of developing country.
Methods: Hospital records spanning the period 2000 through 2005 weresearched with ICD-9 codes to identify patients with CIP and CIM. Functional improvement was judged by (i) …

Po10.19 Clinical Spectrum Of Pseudo Seizures At A Tertiary Care Hospital Karachi: A Video Eeg Based Study, Nadeem Ahmed Memon, Bhojo A. Khealani, Fazal Karim, Mustafa Khan, Nadir Ali Syed, Saad Shafqat

Department of Medicine

Background: Nonepileptic seizures are involuntary episodes of movement, sensation, or behaviors (e.g., vocalization, crying and other expressions of emotion), that do not result from abnormal cortical discharges. The events typically occur in teenage patients with anxiety and affective disorders. Psychotherapy, behavioral therapy, drugs, hypnosis and placebo are mainstay of treatment. There is no published data on clinical characteristics of pseudo-seizures from Pakistan. The objective of our study is to describe the clinical characteristics of pseudoseizures in a tertiary care hospital in Karachi, Pakistan. Methods: This is a descriptive study. Patients with pseudo-seizures were identified from departmental Video EEG monitoring …

Outcomes In Culture Positive And Culture Negative Ascitic Fluid Infection In Patients With Viral Cirrhosis: Cohort Study, Lubna Kamani, Khalid Mumtaz, Umair S. Ahmed, Ailia W. Ali, Wasim Jafri

Department of Medicine

Background: Ascitic fluid infection (AFI) in cirrhotic Patients has a high morbidity and mortality. It has two variants namely, spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites (CNNA). The aim of this study was to determine the outcome in cirrhotic Patients with culture positive (SBP) and culture negative neutrocytic ascites. Methods: We analyzed 675 consecutive hepatitis B and/or C related cirrhosis Patients with ascites admitted in our hospital from November 2005 to December 2007. Of these, 187 Patients had AFI, clinical and laboratory parameters of these Patients including causes of cirrhosis, Child Turcotte Pugh (CTP) score were recorded. Results: …

Identifying People At High Risk For Developing Sleep Apnea Syndrome (Sas): A Cross-Sectional Study In A Pakistani Population, Fawad Taj, Zarmeneh Aly, Mahwash Kassi, Mansoor Ahmed

Department of Medicine

Background: Obstructive Sleep Apnea (OSA) is associated with many cardiovascular and psychiatric diseases. Day-time sleepiness is a common consequence of sleep apnea and correlates with road-traffic accidents (RTA). Pakistan has a high prevalence of factors which predispose an individual to OSA and death from RTAs are a huge burden. However there is a dearth of prevalence studies in this regard. We aim to understand local relevance of the disease and estimate the prevalence of individuals high-risk for OSA. Methods: This cross-sectional survey was conducted among 450 individuals at Aga Khan University Hospital (AKUH), which is a tertiary care teaching hospital …

Impact Of Afghan Refugees On The Infectious Disease Profile Of Pakistan: Beyond Economy, Ali Jawaid, Abdul Mueed Zafar, Syed Faisal Mahmood

Department of Medicine

No abstract provided.

Range For Normal Body Temperature In The General Population Of Pakistan., Mehreen Adhi, Rabia Hasan, Fatima Noman, Syed Faisal Mahmood, Anwar Naqvi, Adib-Ul-Hasan Rizv

Department of Medicine

OBJECTIVES:

To determine the range for normal body temperature in the general population of Pakistan and to determine if any age, sex and ambient temperature related variations exist in body temperature. Moreover, to compare how much axillary temperature differs from oral temperature measurements.

METHODS:

Oral as well as left and right axillary temperature recordings were made using an ordinary mercury-in-glass thermometer in 200 healthy individuals accompanying patients at various clinics at the Sindh Institute of Urology and Transplantation (SIUT) between mid-May to mid-June 2006. Data analysis was done using Epi Info version 3.3.

RESULTS:

The range for Normal Oral Temperatures …

Knowledge Of Coronary Artery Disease (Cad) Risk Factors And Coronary Intervention Among University Students, Aysha Almas, Aamir Hameed, Fateh Ali Tipoo Sultan

Department of Medicine

Objective: To elucidate knowledge of coronary artery disease (CAD) risks factors and coronary intervention in adult students of Karachi East. To calculate the mean knowledge score about CAD risk factors among them.
Methods: A multi center crossectional study was conducted in Universities and colleges of Karachi East from April-September 2005. Questionnaires were distributed to 200 adult students of different non-medical universities and colleges. The questionnaire contained assessment of knowledge of risk factors on CAD and awareness about coronary angiography. Those belonging to medical colleges and universities were excluded from the study. Knowledge was assessed as a continuous variable. Risk factors …

Answering The Cdc's Call For Universal Hiv Testing: Assesing The Impact On A Tertiary Care Referral Center Via A Blinded Seroprevalence Study, Margaret Hoffman-Terry Md, Facp, K Nadeem Ahmed Md, Joseph L. Yozviak Do, Facp, Sherrine Eid Mph, Timothy J. Friel Md, Kimberly A. Pacella, Luther Rhodes Iii Md

Department of Medicine

No abstract provided.

Perinatal Outcomes In Pregnancy With Asthma., Rashid Jooma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Department of Medicine

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort.

Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths.

Results: The mean age of asthmatics and nonasthmatics were 28.0±4.9 …

Changing Patterns And Outcome Of Dengue Infection; Report From A Tertiary Care Hospital In Pakistan, Mohammad Wasay, Roomasa Channa, Maliha Jumani, Afia Zafar

Department of Medicine

Objective: To identify predictors of outcome in patients with Dengue Infections at a tertiary care hospital and to analyze that if pattern of Dengue infection is changing in the past two years.

Methods: We reviewed 225 cases of confirmed dengue virus infection. The diagnosis was confirmed by presence of IgM antibodies against Dengue by ELISA in addition to fever according to WHO criteria.

Results: From years 2000-2004, 30(73%) had Dengue Fever (DF), 10(24%) had Dengue Haemorrhagic Fever (DHF) and 1(2.4%) had Dengue shock syndrome (DSS) while after 2005, 107(58%) had DF, 71(39%) had DHF and 6(3%) had DSS. Six …

A Non-Randomized Study Of Safety And Efficacy Of Heparin For Dvt Prophylaxis In Intracerebral Haemorrhage, Mohammad Wasay, Saqibuddin Khan, Khawaja S. Zaki, Bhojo A. Khealani, Ayeesha Kamal, Iqbal Azam, Ismail A. Khatri

Department of Medicine

Objective: To evaluate the safety and efficacy of subcutaneous heparin for deep venous thrombosis (DVT) prophylaxis in patients with intracerebral haemorrhage (ICH) during acute phase in comparison to elastic stockings.

Methods: The diagnosis of ICH was based on imaging (CT or MRI) and DVT was based on Doppler ultrasound.

Results: A total of 458 patients were identified over a period of 5 years (1997-2001). Median age was 59 years (range:12-99 years). Two hundred (44%) patients received heparin (heparin group) in addition to elastic stockings and 258 (56%) patients were only given elastic stockings (stockings group). These two groups were not …

Cardiac Tamponade After Removal Of Temporary Pace Maker In Multidiscipinary Intensive Care Unit, Muhammad Faisal Khan, Ali Bin Sarwar Zubairi

Department of Medicine

Cardiac tamponade is a medical and surgical emergency, which needs early recognition and treatment. Myocardial perforation leading to cardiac tamponade is a rare complication after pace maker insertion. We are reporting a case of cardiac tamponade after removal of temporary pace maker in a multidisciplinary intensive care unit.

Predictive Factors For Early Aspiration In Liver Abscess, Rustam Khan, Saeed Hamid, Shahab Abid, Wasim Jafri, Zaigham Abbas, Mohammed Islam, Hasnain Shah, Shaalan Beg

Department of Medicine

Aim: To determine the predictive factors for early aspiration in liver abscess.

Methods: A retrospective analysis of all Patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 (68%) Patients, pyogenic in 200 (21%), indeterminate in 73 (8%) and mixed in 32 (3%). Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess.

Results: A total of 966 Patients, 738 (76%) male, mean age 43 17 years, were evaluated: 540 Patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 Patients. Predictive factors for aspiration …

Psychiatric Outcomes In A Resident-Run Multidisciplinary Hepatitis C Clinic, Nicole M. Agostino Do, Edward Norris Md, Fapm, Joseph L. Yozviak Do, Facp, Charles M. Brooks Md, Eric J. Gertner Md, Mph, Michael Kaufmann Md

Department of Medicine

No abstract provided.

Precipitating Factors And The Outcome Of Hepatic Encephalopathy In Liver Cirrhosis., Dileep K. Rohra, Jaipal, Ameer A. Khowaja, Khalid Mahmood, Kanya Lal Ahuja

Department of Medicine

No abstract provided.

Lung-Derived Macrophage Migration Inhibitory Factor In Adult Patients With Septic Shock, And Its Role In Cardiocirculatory Depression, Hans Lee, Kaie Ojamaa, Greg Ruskin, Erfan Hussain, Maowen Hu, Xinchun Lin, Christine Metz, Yousef Al-Abed, Edmund Mille

Department of Medicine

Migration inhibitory factor (MIF), a critical proinflammatory mediator in sepsis, has a profound affect on cardiovascular function. Our animal studies show that the lungs release MIF into the systemic circulation during late sepsis. MIF released in this way has direct and immediate access to cardiac cells. The purpose of our study was to assess the lung as a source of MIF in human septic shock patients and to further study the MIF-associated pathways involved in cardiovascular depression.

Idiopathic Epilepsy Of Childhood And Potassium Ion Channels, Alper I. Dai, Mohammad Wasay

Department of Medicine

Potassium can affect the development of common seizure type and can be defined seizure susceptibility allele. The existence of inward-rectifying potassium (Kir) channels was first recognized half a century ago. The biophysical fingerprint of Kir channels is inward rectification in the current-voltage relationship , which limits potassium efflux at depolarizing membrane potentials. Kir channels are essential in the control of resting membrane potential, coupling of the metabolic cellular state with membrane excitability, and maintenance of potassium homeostasis. The critical interval contains several candidate genes, one of which, KCNJ10, exhibits a potentially important polymorphism with regard to fundamental aspects of seizure …

Acute Stroke Secondary To Internal Carotid Artery Pseudoaneurysm: Mri Findingsand Treatment With Endovascularcoiling, Mohammad Wasay, Alper Dai, Neeraj Dubey, Saadat Kamran

Department of Medicine

Internal carotid artery pseudoaneurysms are uncommon. We report a young man with history of trivialtrauma who presented with middle cerebral artery stroke.Head CT scan revealed a right parapharyngeal mass. MRI confirmed the diagnosis of internal carotidpseudoaneurysm. Cerebral angiogram showed dissection of internal carotid artery with a large pseudoaneurysm and almost complete occlusion of vessel distal to aneurysm.Vessel was obliterated by fibercoiling and gluing byendovascular technique to diminish risk of furthere mbolization. MRI characteristics of carotid pseudoaneurysms and role of endovascular treatment arediscussed.