Medical Specialties Commons^™

Genotyping And Drug Resistance Patterns Of M. Tuberculosis Strains In Pakistan., Mahnaz Tanveer, Zahra Hasan, Amna R Siddiqui, Asho Ali, Akbar Kanji, Solomon Ghebremicheal, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:The incidence of tuberculosis in Pakistan is 181/100,000 population. However, information about transmission and geographical prevalence of Mycobacterium tuberculosis strains and their evolutionary genetics as well as drug resistance remains limited. Our objective was to determine the clonal composition, evolutionary genetics and drug resistance of M. tuberculosis isolates from different regions of the country.

Methods:

M. tuberculosis strains isolated (2003-2005) from specimens submitted to the laboratory through collection units nationwide were included. Drug susceptibility was performed and strains were spoligotyped.

Results:

Of 926 M. tuberculosis strains studied, 721(78%) were grouped into 59 "shared types", while 205 (22%) were identified …

Splenic Rupture, Secondary To G-Csf Use For Chemotherapy Induced Neutropenia: A Case Report And Review Of Literature., Nehal Masood, Asim Jamal Shaikh, Wasim Ahmed Memon, Romana Idress

Section of Haematology/Oncology

Introduction: Chemotherapy Induced neutropenia is a frequent and serious complication of cytotoxic cancer treatment. Granulocyte colony stimulating factors (G-CSF) are frequently used to counter neutropenia, attempt rapid recovery of Patients and allow for continuation of treatment without compromise on dose, especially in curative malignancies. Generally regarded as safe, G-CSF use has been very rarely reported to have resulted in serious side effects, such as, splenic rupture. Case Presentation: We are reporting a case of a twenty years old man, who was being treated for T cell acute lymphoblastic leukemia and received colony stimulating factors for treatment of severe neutropenia and …

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 …

Bullying Of Medical Students In Pakistan: A Cross-Sectional Questionnaire Survey., Syed Ahmer, Abdul Wahab Yousafzai, Naila Bhutto, Sumira Alam, Amanullah Khan Sarangzai, Arshad Iqbal

Department of Psychiatry

Background: Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country. Methodology/Principal Findings: We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment …

Mesenteric Panniculitis With Pedal Edema In A 33-Year-Old Pakistani Man: A Case Report And Literature Review., Abdul M Zafar, Muhamad A Rauf, Tabish Chawla, Gule Khanda

Department of Radiology

Introduction:Mesenteric panniculitis is a rare pathology of unknown etiology characterized by inflammation and fibrosis in the mesentery. Its protean clinical and radiological manifestations make it a diagnostic challenge. There is no established treatment available for its management. The clinical outcome is inconsistent, with the prognosis ranging from complete resolution without any treatment to rapid progression culminating in death. Case Presentation: A 33-year-old Pakistani man presented with vague abdominal pain, an ill-defined epigastric mass and bilateral pedal edema. A detailed review of his history and laboratory investigations did not point to any diagnosis. The Patient underwent an exploratory laparotomy based …

Fatal Transfusion Related Acute Lung Injury Following Coronary Artery By-Pass Surgery: A Case Report., Fauzia Ahmad Bawany, Hasanat Sharif

Section of Cardiothoracic Surgery

Background:Transfusion related acute lung injury (TRALI) is a potentially fatal Acute Lung Injury following transfusion of blood components. Hypotheses implicate donor-derived anti-human leukocyte antigen or granulocyte antibodies reacting with recipients' leukocytes, releasing inflammatory mediators. Lack of agreement on underlying cellular and molecular mechanisms renders improving transfusion safety difficult and expensive.

Case Presentation:

Literature search has not revealed any case of TRALI from Pakistan. We report the case of fatal TRALI in a 68 year old male who received blood products after coronary artery by-pass surgery.

Conclusion:

This article aims to create awareness about this complication and suggests that post …

Pathological Sub-Types, Risk Factors And Outcome Of Stroke At The Nairobi Hospital, Kenya, James Jowi, Peter Mativo

Internal Medicine, East Africa

Background: Stroke is one of the most common causes of morbidity and mortality the world over. Established risk factors such as arterial hypertension, diabetes mellitus, cigarette smoking, hyper-lipidaemia, micro-vascular rupture, male gender, age and observed co-morbities such as sickle cell disease, HIV/AIDS infection and cerebral malaria are increasingly being encountered in the tropics.

Objectives: To determine pathological sub-types, risk factors, in-hospital period prevalence and in-hospital outcome of stroke.

Design: Hospital-based retrospective study.

Setting: The Nairobi Hospital, Nairobi, Kenya.

Subjects: Patients with recorded diagnosis of stroke/cerebral vascular accident; as per WHO criteria for diagnosis of stroke, …

Silencing Of Mbd1 And Mecp2 In Prostate-Cancer-Derived Pc3 Cells Produces Differential Gene Expression Profiles And Cellular Phenotypes, Yaqinuddin Ahmed, Farhat Abbas, Syed S. Naqvi, Mohammad U. Bashir, Romena Qazi, Sohail A. Qureshi

Section of Urology

Alterations in genomic CpG methylation patterns have been found to be associated with cell transformation and neoplasia. Although it is recognized that methylation of CpG residues negatively regulates gene expression, how the various MBPs (methyl-binding proteins) contribute to this process remains elusive. To determine whether the two well characterized proteins MeCP2 (methyl-CpG-binding protein 2) and MBD1 (methyl-CpG-binding domain 1) have distinct or redundant functions, we employed RNAi (RNA interference) to silence their expression in the prostate cancer-derived PC3cell line, and subsequently compared cell growth, invasion and migration properties of these cell lines in addition to their respective mRNA-expressionprofiles. Cells devoid …

Awareness Of The Risk Factors, Presenting Features And Complications Of Hypertension Amongst Hypertensives And Normotensives, Syed Nabeel Zafar, Saqib A. Gowani, Faria Amber Irani, Mohammad Ishaq

Section of Cardiology

OBJECTIVES: To assess the level of awareness with regards to risk factors, presenting features and complications of hypertension. Moreover, to Compare the level of awareness amongst patients (hypertensives) and nonpatients (normotensives) in Karachi, Pakistan.METHODS: This cross-sectional study was carried out on a random sample of 440 people (220-normotensives/220-hypertensives) using an interview based questionnaire. Data entry was performed on Epi-info v 6 and managed and analyzed on SPSS v 14. Proportions were calculated for categorical data, means and standard deviations were calculated for continuous data.RESULTS: Hypertensives had a higher mean awareness score than the normotensives (p

Use Of Anticonvulsants Drugs For Neuropathic Painful Conditions, Aziza Mohammad Hussain, Gauhar Afshan

Department of Anaesthesia

Neuropathic pain, a form of chronic pain initiated and sustained by an insult to the peripheral or central nervous system, is a challenge to clinicians as it does not respond well to traditional pain therapies. However exact pathophysiology is not known but considering similarities between epilepsy models and in neuropathic pain models justify the rationale for use of anticonvulsant drugs in the symptomatic management of neuropathic pain disorders. The role of anticonvulsant drugs in the treatment of neuropathic pain is evolving and various clinical trials have used these anticonvulsants and shown positive results in the treatment of trigeminal neuralgia, painful …

Response Of Imitanib Meysylate In Patients With Gastrointestinal Stromal Cell Tumour, Abdullah Ladha, Mohammad Usman Shaikh

Department of Pathology and Laboratory Medicine

In this study, the response of Imitanib Mesylate in patients with Gastro-intestinal stromal cell tumour (GIST) was assessed. GIST results from a mutation in one of the receptor protein tyrosine kinases. Imitanib Mesylate, a tyrosine kinase inhibitor, has emerged as a promising new treatment for GISTs. Total 16 cases were reviewed. Diagnosis was based on biopsy and immunohistochemistry. Response assessment was done using CT scans, at a median duration of 4 months. The median age of the patients was 52 years, Majority were male (n=14). Most common presenting complaint was abdominal pain (n=7). Commonest primary site was stomach (n=7), Liver …

A Comparison Of Treatments Offered To Patients With Nonalcoholic Steatohepatitis, Saleem Perwaiz Iqbal, Sadia Mahmud, Saeed Hamid, Omrana Pasha, Khabir Ahmad

Department of Paediatrics and Child Health

OBJECTIVE: To compare various treatment options provided to patients with Nonalcoholic Steatohepatitis (NASH) and assess improvement in liver status via reduction in serum Alanine Aminotransferase (ALT) levels.

STUDY DESIGN: Retrospective cohort study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from April 2000 to April 2007.

METHODOLOGY: All available records of patients aged between 20-70 years, fatty liver on ultrasound, elevated serum ALT and having at least one follow-up, after a baseline visit were included. The patients had variable number of follow-ups and a maximum of 3 follow-ups were considered. Information was collected on demographic and clinical …

Pacemaker Patients' Perception Of Unsafe Activities: A Survey, Masooma Aqeel, Azam Shafquat, Nawal Salahuddin

Section of Cardiology

Background: Cardiac pacing is a recognized and widely used treatment for Patients presenting with bradycardia. Physicians expect Patients to return to normal activities almost immediately post implantation. However, Patients themselves may perceive interference to pacemaker function by various routine activities and devices, and hence continue to lead restricted, disabled lives. The aim of this study is to determine if routine activities are perceived by pacemaker Patients to interfere with their device function. Methods: A descriptive cross sectional survey was carried out on consecutive Patients at the pacemaker clinic at a public hospital in Karachi, Pakistan. A 47-question tool was developed …

Prevalence And Factors Associated With Intestinal Parasitic Infection Among Children In An Urban Slum Of Karachi., Vikram Mehraj, Juanita Hatcher, Saeed Akhtar, Ghazala Rafique, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Background:Intestinal parasitic infections are endemic worldwide and have been described as constituting the greatest single worldwide cause of illness and disease. Poverty, illiteracy, poor hygiene, lack of access to potable water and hot and humid tropical climate are the factors associated with intestinal parasitic infections. The study aimed to estimate prevalence and identify factors associated with intestinal parasitic infections among 1 to 5 years old children residing in an urban slum of Karachi Pakistan. Methods And Principal
Findings:A cross sectional survey was conducted from February to June 2006 in Ghosia Colony Gulshan Town Karachi, Pakistan. A simple random …

Predictors Of Gastrointestinal Lesions On Endoscopy In Iron Deficiency Anemia Without Gastrointestinal Symptoms, Shahid Majid, Mohammad Salih, Rozina Wasaya, Wasim Jafri

Section of Gastroenterology

Background:Iron deficiency anaemia (IDA) due to occult gastrointestinal (GI) blood loss usually remains unnoticed until Patient become symptomatic. There is sparse data in IDA Patients without gastrointestinal symptoms. This study was designed to find out the frequency and predictors of endoscopic lesions in IDA without gastrointestinal symptoms. Cross-sectional study performed on a convenience sample of consecutive subjects.

Methods: Ninety five consecutive Patients with laboratory based diagnosis of IDA having no gastrointestinal symptoms were interviewed and their clinical and biochemical variables were recorded. All the study Patients underwent esophago-gastroduodenoscopy (EGD) and colonoscopy. Endoscopic findings were documented as presence/absence of bleeding …

Blood Pressure Lowering And Vasomodulator Effects Of Piperine, Syed Intasar Husain Taqvi, Abdul Jabbar Shah, Anwar Gilani

Department of Biological & Biomedical Sciences

This study was aimed to explore underlying mechanism(s) of cardiovascular effects of piperine. Intravenous administration of piperine caused a dose-dependent (1 to 10 mg/kg) decrease in mean arterial pressure (MAP) in normotensive anesthetized rats, the next higher dose (30 mg/kg) did not cause any further change in MAP. The fall in blood pressure (BP) was followed by small increase in MAP after each dose. In Langendorrf's rabbit heart preparation, piperine caused partial inhibition and verapamil caused complete inhibition of force and rate of ventricular contractions and coronary flow. In rabbit aortic rings, piperine inhibited high K(+) (80 mM) precontractions and …

Surgical Management Of Blunt Pancreatic Trauma: A Modus Operandi Or Individualized Therapy?, Muhammad Rizwan Khan, Kiran Ejaz

Section of General Surgery

The overall rate of blunt pancreatic trauma observed in level one trauma centers is rather low compared to other injuries, with a reported prevalence of 0.4 per 100,000 hospital admissions. The situation may be further complicated by the presence of associated major visceral injuries in these patients. A number of previous reports indicate that blunt pancreatic trauma carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Many mandate prompt surgical explorations for organ-specific diagnosis on CT; however other literature and upcoming studies prove otherwise. Over the years, several technologic advances have increased the …

Vocal Fold Granuloma After Prolonged Neurosurgical Procedure With Wire Reinforced Endotracheal Tube, Muhammad Zubair Tahir, Muhammad Shahzad Shamim, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Hiv-Associated Pulmonary Hypertension: Case Report, Jay Shavadia, S. Das, Gerald Yonga

Internal Medicine, East Africa

With the advent of highly active antiretroviral therapy, there has been a significant change in the epidemiology of pulmonary disease in HIV/AIDS. The relative prevalence of non-infectious manifestations is likely to rise. HIV associated pulmonary hypertension (HIV-PH), albeit low prevalence, is associated with significant morbidity and mortality. Presently, despite having scanty evidence on the management modalities of HIV-PH, evidence extrapolated from idiopathic pulmonary hypertension is being utilised to effectively manage some of these patients. Efforts should therefore be made to screen, diagnose and treat these patients. A case of a thirty year old female with HIV disease and severe pulmonary …

Factors Associated With Hydrocarbon Ingestion In Children, Emaduddin Siddiqui, Junaid Razzak, Farah Naz, Sabeena Jalal Khan

Department of Emergency Medicine

OBJECTIVE: To investigate the types of hydrocarbon ingested by children and identify factors associated with hydrocarbons ingestion.

PATIENTS AND METHODS: It was a hospital based case control study in which medical records of sixty seven children with hydrocarbon ingestion, admitted through emergency department between January 2001 to December 2005 of Aga Khan Hospital were reviewed. Variables such as age, sex, types of hydrocarbons, amount ingested, socioeconomic status, family size, number of children, type of containers, trend of ingestion during hot weather, length of stay at hospital along with the outcomes were evaluated.

RESULTS: Out of 67 patients, 53 (79%) were …

Fluoroquinolones For Treating Typhoid And Paratyphoid Fever (Enteric Fever), Durrane Thaver, Anita K. M. Zaidi, Julia A. Critchley, Asma Azmatullah, Syed Ali Madni, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Fluoroquinolones are recommended as first-line therapy for typhoid and paratyphoid fever (enteric fever), but how they compare with other antibiotics and different fluoroquinolones is unclear.
Objectives: To evaluate fluoroquinolone antibiotics for treating enteric fever in children and adults compared with other antibiotics, different fluoroquinolones, and different durations of fluoroquinolone treatment.
Search strategy: In November 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE, EMBASE, LILACS, mRCT, conference proceedings, and reference lists.
Selection criteria: Randomized controlled trials of fluoroquinolones in people with blood or bone marrow culture-confirmed enteric fever.
Data collection …

Follicular Thyroid Carcinoma Presenting As Solitary Skull Metastasis: Report Of Two Cases, Muhammad Shahzad Shamim, Faraz Khursheed, Muhammad Ehsan Bari, Khalid Naseem Chisti, Ather Enam

Section of Neurosurgery

We report two otherwise healthy patients with no prior history of thyroid cancer, who presented to us with a solitary scalp lump. Neuroimaging of both patients showed osteolytic lesions involving the cranium which were subjected to complete excision biopsy and cranioplasty. Histopathological examination revealed metastases from well differentiated follicular thyroid carcinoma (FTC). Subsequent workup confirmed occult primary carcinoma of the thyroid gland in both patients.

Extrapleural Hydatid Disease Of Chest: A Case Of Recurrent Hydatid Disease, Ameer Ali Khowaja, Saqib Ali Gowani, Asmatullah Khan, Saulat H. Fatimi

Section of Cardiology

Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. We present the case of 34-year-old female who complained of chest pain and had a past history of hydatid cyst resection four times in last 15 years. She was found to have extrapleural hyatid cysts of chest that were removed via thoracotomy. The patient fully recovered and experienced an uneventful follow-up.

The Trauma Centre: What It Should Mean, Rashid Jooma, Sabeena Jalal Khan, Junaid Razzak

Section of Neurosurgery

No abstract provided.

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

Section of Cardiology

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 …

Congenital Malaria, Emaduddin Siddiqui, Saira Lone, Seema Hashmi, Shahina Hanif

Department of Emergency Medicine

Congenital malaria is a rare disorder which is difficult to interpret as most of the clinical features are similar to other diseases e.g. neonatal sepsis. It is defined as the presence of malarial parasites in the peripheral smear of the newborn from twenty four hours to seven days of life. We report 12 days old newborn who presented with high grade fever, reluctant to take feed, increasing pallor, jaundiced, dehydrated and lethargic. He was hypotensive, hypoglycemic, convulsing with hepatospleenomegally. He had a clear history of maternal fever (intermittent) for last three weeks and increasing pallor. His MP test was positive. …

Assessment Of Menisci And Ligamentous Injuries Of The Knee On Magnetic Resonance Imaging: Correlation With Arthroscopy, Gul-E Khanda, Waseem Akhtar, Humera Ahsan, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To evaluate the validity of MRI, in the assessment of the meniscal and cruciate ligamenteous injuries of the knee joint and comparison with arthroscopic findings.

METHODS: A one year prospective cross-sectional study from January 2006 to January 2007, was performed on 50 patients (32 males & 18 females) with knee injury presenting at the orthopedic unit of AKUH. The patients were referred to radiology department for MRI evaluation and arthroscopy.

RESULTS: The sensitivity, specificity and accuracy for MRI of the menisci and ligaments were as follows: medial meniscus resulted in 100% sensitivity, 69.27% specificity, 90% PPV, 100% NPV and …

Minimally Invasive Papillary Carcinoma Of The Extrahepatic Bile Ducts, Samia Fatima, Zubair Ahmad, Asim Qureshi, Khurram Minhas, Inam Pal

Department of Pathology and Laboratory Medicine

Invasive papillary carcinomas of the Extrahepatic Bile Ducts (EBD) are uncommon (4-5%). The course is less aggressive than conventional adenocarcinomas of the extrahepatic bile ducts. Non-invasive and minimally invasive papillary carcinomas are even rarer, behave as in-situ carcinomas and are associated with excellent long-term prognosis. A variety of lesions of the EBD that show papillary architecture should be distinguished from papillary carcinoma. Here, we report a case of papillary carcinoma of the common bile duct showing minimal invasion. Separation of invasive from non-invasive or minimally invasive papillary carcinoma is critical in estimating the patient outcome.

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 …