Medical Specialties Commons^™

Pulmonary Infiltrates During Chemotherapy-Induced Febrile Neutropenia: Incidence, Patterns And Outcomes, N. Gangat, M.A.A. Khan, M. Mujib, Mohammad Khurshid

Section of Haematology/Oncology

OBJECTIVE: To analyze the incidence, etiologies, radiographic patterns, and clinical outcomes of adult leukemics with prolonged febrile neutropenia and pneumonia.
METHODS: A retrospective study was conducted at a tertiary care hospital. The medical records of adult patients with acute myeloid leukemia diagnosed between January 1989 and June 2000 and undergoing induction chemotherapy were included. Only the patients who presented with a pulmonary infiltrate, secondary leukemia (e.g., transformed chronic myeloid leukemia underlying myelodysplastic syndrome, or disease following alkylating agent therapy) were included and those developing infiltrates following consolidation chemotherapy were excluded.
RESULTS: A total of 124 patients were admitted …

Congenital Duodenal Diaphragm In Eight Children, Akhtar Nawaz, Hilal Matta, Alic Jacobsz, Omar Trad, Ahmed H. Al Salem

Department of Obstetrics & Gynaecology

Background: Congenital duodenal obstruction (CDO) is a common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is a duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm.
Methods: The medical records of 22 children with the diagnosis of congenital intrinsic duodenal obstruction were reviewed for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes.
Results: Eight of the 22 children (36.4%) …

Attitudes Of Preventive Care Specialists And Registered Dietitians Toward Their Obese Patients, Maryanna Gabriel

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to compare preventive care specialists and registered dietitians regarding attitudes toward obese patients, to compare both groups with Canadian and American nurses previously studied, and to determine whether relationships exist between personal characteristics and attitudes toward obese patients. Questionnaires were sent to members of the American Preventive Care Association and 1,000 randomly selected members of the California Dietetic Association. Sixty-seven preventive care specialists and 579 registered dietitians participated in the study. A modified version of the Attitudes Toward Obesity scale, developed by Bagley, et al. was used to measure attitudes. Preventive care specialists and …

Reversible Obstructive Sleep Apnea And Right Heart Failure Due To Massive Tonsillar Hypertrophy, Mehnaz Atiq, Fatima Masood, Mubasher Ikram, Raana Haqqee

Section of Otolaryngology, Head & Neck Surgery

Obstructive sleep apnea is a relatively common but under diagnosed clinical entity in children. Adenotonsillar hypertrophy is the most common cause for upper airway obstruction in pediatric patients. If the obstruction to upper airways is not relieved, then the child can develop obstructive sleep apnea and its consequences. Treatment is simply to remove the obstruction thereby restoring patency of upper airways

Analysis Of Cervical Smears In A Muslim Population, Shahnaz Wasti, Waleed Ahmed, Abbas Jafri, Behram Khan, Rizwan Sohail, Sheema Hassan

Department of Obstetrics & Gynaecology

Background: Screening for cancer of the cervix remains a neglected health care issue in Pakistan. To provide baseline data for future efforts to improve screening, we conducted a retrospective analysis of cervical smears taken in the obstetrics and gynaecological clinics of the Aga Khan University Hospital, Karachi, Pakistan.
Method: We collected data on cervical smear cytology for cervical smears taken from January 1, 1990 to December 31,1996. We assessed risk factors for dysplasia, including age, age at first marriage, and number of pregnancies.
Results: The overall prevalence of abnormal smears in our study was 0.5%. Of 20,995 cervical smears, 12,451 …

Patients' Views About Physicians' Spiritual Role In Medical Practice, Waris Qidwai, Arsalan Tayyab

Department of Family Medicine

OBJECTIVE: To study patient perceptions with regard to spirituality in medical practice.
DESIGN: A questionnaire-based survey.
PLACE AND DURATION OF STUDY: Family Practice Center of Aga Khan University Hospital, Karachi, Pakistan, during July 2003.
SUBJECTS AND METHODS: Family practice patients were interviewed using a questionnaire which included data on demographic profile of the patient and perceptions on spirituality in medical practice. The study investigators administered the questionnaire without using systematic randomization. Ethical requirements including the administration of a written informed consent and the provision of confidentiality were ensured. SPSS computer software was used for data management.
RESULTS …

Knowledge, Attitude And Practice Regarding Obesity Among Patients, At Aga Khan University Hospital, Karachi, Waris Qidwai, Iqbal Azam

Department of Family Medicine

BACKGROUND: Obesity is a major public health problem and responsible for significant morbidity and mortality among our patients. It is important to study the knowledge, attitude and practices with regard to obesity among patients, in order to devise interventional strategies.
METHODS: Patients visiting the out-patient clinics of Aga Khan University Hospital, Karachi, were included in the study. The interview was questionnaire-based and recorded the demographic profile of the patients and questions relevant to the objective of the study. The ethical requirements for the study were met. SPSS computer software was used for data management. A hundred patients were surveyed. …

Consequences Of A Medical Emergency Among Emergency Room Patients, Waris Qidwai, Ali Ss, M Baqir, Shahana Ayub

Department of Family Medicine

Objective: To study the consequences of a medical emergency among Emergency Room patients, at a teaching hospital in Karachi, Pakistan.
Design: A questionnaire-based survey
Settings: Emergency Room of Aga Khan University Hospital in Karachi, Pakistan. Main outcome measures: Consequences of a medical emergency in terms of impact on employment, financial position, family life, social life, recreational life, self-confidence and psyche.
Results: A hundred patients were surveyed. Emergency Room patients feel that they will not have a major impact on their job or employment, as a result of the medical emergency but it will have adverse financial consequences. The …

Co-Regulation Of Expression Of Phase Ii Metabolizing Enzymes And Multidrug Resistance-Associated Protein 2, Viviana A. Catania, Enrique J. Sánchez Pozzi, Marcelo G. Luquita, María L. Ruiz, Silvina S. M. Villanueva, Brett Jones, Aldo D. Mottino

Toxicology and Cancer Biology Faculty Publications

Treatment of experimental animals with prototypical enzyme inducers represents a useful tool to characterize the role of different isozymes in drug metabolism and to improve our knowledge on factors regulating their synthesis at the transcriptional level. The effect of model enzyme inducers on phase II (conjugating) enzyme families, including UDP-glucuronosyltransferase’s and glutathione-S-transferase’s, has been well characterized in rodent liver. More recently, the effect of inducers on the expression of canalicular multidrug resistance-associated protein 2 (Mrp2) has been focused upon. The identification of a number of conjugated drugs as Mrp2 substrates suggests that both the conjugation and transport systems act coordinately …

A Need To Change Behavior And Attitudes In Medical Practice, Waris Qidwai

Department of Family Medicine

No abstract provided.

Perception About Family Physicians: Results Of A Survey Of Patients Visiting Specialist Clinics For Treatment, S. A. Huda, Z. A. A. Samani, Waris Qidwai

Department of Family Medicine

Objective: To study the perceptions about Family Medicine among patients visiting Specialist Physicians for treatment.
Methods: A questionnaire based survey was conducted at the Specialist Clinic, Aga Khan University Hospital, Karachi, Pakistan, in June 2004. Trained volunteers administered the questionnaire among patients visiting Specialist Physicians for treatment. Confidentiality was ensured to all patients and written informed consent was taken as part of the ethical requirements for the conduct of the study. SPSS computer software and Microsoft Excel were used for data management.
Results: A total of 100 patients visiting the Specialist Clinic were interviewed, of which fifty four …

Ever Increasing Need For Family Physicians, Waris Qidwai

Department of Family Medicine

No abstract provided.

Awareness Of The Process Of Informed Consent Among Family Practice Patients In Karachi, H. Bhurgri, Waris Qidwai

Department of Family Medicine

Objective: To study the awareness of 'Informed Consent', among patients presenting to Family Physicians.
Methods: A cross-sectional study was carried out at the Community Health Centre, Aga Khan University Hospital, Karachi in July 2002. Written Consent was taken and confidentially was assured
Results: Out of the 100 patients interviewed, 80 agreed to participate in the study, forty-four men and thirty-six women. Approximately half the participants (45%) were graduates and 40% had less than five years of school education. The awareness of the process of 'informed consent' was observed in only 20% of the respondents, all in the educational …

The Hippocratic Oath: Has It Ceased To Be Relevant?, Waris Qidwai

Department of Family Medicine

The Greek physician Hippocrates (460-377 B.C) is traditionally regarded as the founder of medicine, scientific discipline and medical ethics.The Hippocratic Oath, taken by ancient and medieval doctors, requires high ethical standards from medical doctors. Its principles are considered important in professional and ethical education of medical doctors even today. The Hippocratic Oath has survived, with over-riding power, the test of time since it addresses the intrinsic nature of medicine. Even those who know little of it or reject parts of it acknowledge it to be a symbol of the values of medicine. It has been argued that it is its …

Distribution Of Lower Urinary Tract Symptoms (Luts) In Adult Women, M Andrades, R Paul, A Ambreen, S Dodani, Rh Dhanani, Waris Qidwai

Department of Family Medicine

OBJECTIVE: To determine the distribution of lower urinary tract symptoms in adult women and the frequency with which the women consulted a health care provider for their symptoms.
DESIGN: Cross-sectional analytical study.
PLACE AND DURATION OF STUDY: Community Health Center of Aga Khan University Hospital from November 1st to 30th, 2002.
SUBJECTS AND METHODS: A trained interviewer administered a structured questionnaire to women patients or attendants aged 18 years and older coming to the center.
RESULTS: Fifty-two percent of the study subjects reported having at least one or more urinary complaints in the past. Stress incontinence …

A Young Man With Hoarseness Of Voice, Waris Qidwai, S. Rehman

Department of Family Medicine

A 45 year-old driver presented with a two months history of hoarseness, fever, productive cough, anorexia and weight loss. He chewed tobacco. He was previously seen and treated without benefit by a family Physician and two ear, nose and throat consultants. Crackles were heard in the left scapular region. An X-Ray of the chest showed a right apical cavity, perihilar infiltrates and blunting of left costophrenic angle. His sputum smear showed acid fast bacilli. A high index of suspicion for tuberculosis is recommended while dealing with such cases. Complete recovery of patient's voice with anti-tubercular therapy confirmed it was a …

Increased Expression Of Hla Dr2 In Acquired Aplastic Anemia And Its Impact On Response To Immunosuppressive Therapy, M. Usman, Salman Adil, Tariq Moatter, F. Bilwani, S. Arian, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To study the frequency of HLA DR2 status of patients with aplastic anemia and their response to immunosuppressive therapy at a tertiary care hospital.
Methods: Thirty eight consecutive patients of acquired aplastic anemia were evaluated with respect to demographic features, severity of HLA DR2 status and response outcome to immunosuppressive therapy.
Results: The mean age of the patients was 24.6 years + 16.4 with a male to female ratio of 2.8:1. Positivity of HLA DR2 was markedly high in acquired aplastic anemia patients. Twenty four (65%) out of 38 patients as compared to 45 (15%) of …

Polycythemia Vera And Idiopathic Erythrocytosis: Comparison Of Clinical And Laboratory Parameters, M. Usman, F. Bilwani, G. N. Kakepoto, Salman Adil, R. Sajid, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To evaluate the various clinical and laboratory parameters of Polycythemia vera and idiopathic erythrocytosis in order to differentiate between two entities at the Aga Khan University Hospital.
Methods: Twenty six patients of polycythemia vera and 34 patients of idiopathic erythrocytosis were analyzed with respect to clinical features and laboratory findings.
Results: Patients with idiopathic erythrocytosis were males with a mean age of 41 years and no splenomegaly. Patients with polycythemia were older males and females with splenomegaly, red cell count of mor than 6.5 million/cmm, haematocrit 55%, leucocytosis, thrombocytosis and low erythropoietin level.
Conclusion: Based …

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 …

Social Interaction And The Health Insurance Choices Of The Elderly, Eldar Beiseitov, Jeffrey D. Kubik, John R. Moran

Center for Policy Research

Using data from the 1998 wave of the Health and Retirement Study, we examine the effect of social interactions on the health insurance choices of the elderly. We find that having more social interactions, as measured by contacts with friends and neighbors, reduces the likelihood of enrolling in a Medicare managed care plan relative to purchasing a medigap policy or having coverage through Medicare alone. Our estimates indicate that social networks are an important determinant of the health insurance choices of the elderly and provide suggestive evidence that "word-of-mouth" information sharing may have played a role in the preference of …

Cd46-Mediated Transduction Of A Species D Adenovirus Vaccine Improves Mucosal Vaccine Efficacy, Zenaido T. Camacho, Mallory A. Turner, Michael A. Barry, Eric A. Weaver

Nebraska Center for Virology: Faculty Publications

The high levels of preexisting immunity against Adenovirus type 5 (Ad5) have deemed Ad5 unusable for translation as a human vaccine vector. Low seroprevalent alternative viral vectors may be less impacted by preexisting immunity, but they may also have significantly different phenotypes from that of Ad5. In this study we compare species D Ads (26, 28, and 48) to the species C Ad5. In vitro transduction studies show striking differences between the species C and D viruses. Most notably, Ad26 transduced human dendritic cells much more effectively than Ad5. In vivo imaging studies showed strikingly different transgene expression profiles. The …

Phylogenetic Analyses Of Texas Isolates Indicate An Evolving Subtype Of The Clade B Feline Immunodeficiency Viruses, Eric A. Weaver, Ellen W. Collisson, Margaret Slater, Guan Zhu

Nebraska Center for Virology: Faculty Publications

Rigorous phylogenetic analyses were used to compare the nucleotide sequences of feline immunodeficiency virus strains isolated from Texas and throughout the world. The envelope V3-V4 sequences and capsid gene of the Texas isolates formed a cluster between subtypes B and E. Statistical comparisons with other published sequences confirmed that the Texas group is a unique cluster, possibly a new subtype, arising from subtype B.

Patient Expectations Of Full Body Ct Screening, Carole Tanenbaum Kolber

Seton Hall University Dissertations and Theses (ETDs)

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Income And The Use Of Prescription Drugs By The Elderly: Evidence From The Notch Cohorts, John R. Moran, Kosali Ilayperuma Simon

Center for Policy Research

We use exogenous variation in Social Security payments created by the Social Security benefits notch to estimate how retirees' use of prescription medications responds to changes in their incomes. In contrast to estimates obtained using ordinary least squares, instrumental variables estimates based on the notch suggest that lower-income retirees exhibit considerable income sensitivity in their use of prescription drugs. Our estimates are potentially useful for thinking about the health implications of changes in transfer payments to the elderly and for evaluating the benefits of the recently enacted Medicare prescription drug benefit.

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 …