Medical Specialties Commons^™

Cost-Effectiveness Of Clipping Vs Coiling Of Intracranial Aneurysms After Subarachnoid Hemorrhage In A Developing Country-A Prospective Study, Muhammad Zubair Tahir, Ather Enam, Rushna Pervez Ali, Atta Bhatti, Tanveer Ul Haq

Section of Neurosurgery

Background: Endovascular coil treatment is being used increasingly as an alternative to clipping for some ruptured intracranial aneurysms. The relative benefits of these 2 approaches have yet to be fully established. The aim of this study was to compare the clinical outcome, resource consumption, and cost-effectiveness of endovascular. treatment vs surgical clipping in a developing country.
Methods: The study population consisted of 55 Patients with aneurysmal subarachnoid hemorrhage (SAH) identified prospectively from January 2004 to June 2007. Of the 55 Patients with ruptured intracranial aneurysms, 31 underwent surgical clipping, whereas 24 were treated via interventional coils. Clinical outcome at 6 …

How Early Do Antibiotics Have To Be To Impact Mortality In Severe Sepsis? A Prospective, Observational Study From An Emergency Department., Shahla Siddiqui, Nawal Salahuddin, Adeel Raza, Junaid Abdul Razzak

Department of Emergency Medicine

BACKGROUND:

The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization.

METHODS:

Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values < 0.05 were considered significant.

RESULTS:

One hundred and eleven patients …

Isolated Oligohydramnios Is Not An Indicator For Adverse Perinatal Outcome, Hina Ahmad, Shama Munim

Department of Obstetrics & Gynaecology

Objectives: To assess the impact of isolated oligohydramnios on Perinatal outcomes.

Methods: A prospective Cohort Study was conducted at the department of Obstetrics and Gynaecology, The Aga Khan University Hospital, Karachi, Pakistan. Pregnant women with isolated oligohydramnios were recruited for the study after obtaining informed consent. The mode of delivery and perinatal outcome were compared with women having normal amniotic fluid.

Results: Between 1st May 2005 and 30th December 2005 a total of 421 women were included in this study. Of these 421 women, 71 were exposed and 350 were unexposed. When compared to the unexposed group women with oligohydramnios …

Venoarterial Pco2 Difference: A Marker Of Postoperative Cardiac Output In Children With Congenital Heart Disease, Muhammad Furqan, Fahad Hashmat, Munir Amanullah, Mansoor Khan, Hina K Durani, Anwarul Haque

Department of Paediatrics and Child Health

OBJECTIVE: To determine the relationship between venoarterial carbon dioxide gradient (DeltapCO2) and central venous oxygen saturation (ScvO2) in children after cardiac surgery.

STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: The Paediatric cardiac intensive care unit of the Aga Khan University Hospital, Karachi, from June 2006 to May 2007.

METHODOLOGY: All children admitted in the paediatric cardiac intensive care after complete repair of congenital heart defect using cardiopulmonary bypass were included in the study. Simultaneous arterial and central venous blood gas samples were obtained from a catheter placed in the artery (either radial or femoral) and superior vena …

Ethnic Differences In Do-Not-Resuscitate Orders After Intracerebral Hemorrhage, Darin B Zahuranec, Devin L Brown, Lynda D Lisabeth, Nicole R Gonzales, Paxton J Longwell, Melinda A Smith, Nelda M Garcia, Lewis B Morgenstern

Faculty, Staff and Student Publications

OBJECTIVE: To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.

DESIGN: Population-based surveillance.

SETTING: Corpus Christi, Texas.

PATIENTS: All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for do-not-resuscitate orders. Unadjusted and multivariable logistic regression were used to test for associations between ethnicity and do-not-resuscitate orders, both overall ("any do-not-resuscitate") and within 24 hrs of presentation ("early do-not-resuscitate"), adjusted for age, gender, Glasgow Coma Scale, intracerebral hemorrhage volume, intraventricular hemorrhage, infratentorial hemorrhage, …

Oncolog Volume 54, Number 10, October 2009, John Lebas, Bryan Tutt

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Early Testicular Cancer
• Metastatic Rectal Cancer
• House Call: What Is Pancreatic Cancer?

Spontaneous Left Main Coronary Artery Dissection, Possibly Due To Cystic Medial Necrosis Found In The Internal Mammary Arteries., Hitoshi Hirose, Iwao Matsunaga, Waqas Anjun, Michael D Strong

Department of Surgery Faculty Papers

A 55-year-old male without previous medical history developed chest pain. Coronary catheterization showed left main coronary dissection. Coronary artery bypass grafting was performed using bilateral internal mammary arteries, which were very fragile. The specimens of the internal mammary arteries sent for pathology showed cystic medial necrosis.

Relationship Of Paroxysmal Atrial Tachyarrhythmias To Volume Overload, Rajat Jhanjee Md, Grant A. Templeton Md, Srinivasan Sattiraju Md, John Nguyen Md, Simon Milstein Md, Laura Van Heel, Keith G. Lurie Md, David Benditt Md

Articles

BACKGROUND:

Clinical experience suggests that atrial tachyarrhythmias (ATs) are a frequent comorbidity in heart failure patients with left ventricular systolic dysfunction and that volume overload may increase AT susceptibility. However, substantiating this apparent relationship in free-living patients is difficult. Recently, certain implantable cardioverter-defibrillators provide, by measuring transpulmonary electric bioimpedance, an index of intrathoracic fluid status (OptiVol index [OI]). The goal of this study was to determine whether periods of greater intrathoracic fluid congestion (as detected by OI) correspond with increased AT event frequency.

METHODS AND RESULTS:

This analysis retrospectively assessed the relation between AT events and OI estimate of volume …

Somnoforme: A Century After The Introduction Of The "Ideal" Anesthetic Gas, James W. Heitz, Md

Department of Anesthesiology Faculty Papers

Since the introduction of ether as a general anesthetic, there has been a continuous quest to develop the ideal anesthetic gas. The attributes of the ideal anesthetic gas have evolved over time. At the beginning of the 20th century, the search for the ideal anesthetic was focused upon finding an anesthetic gas with rapid inhalation induction and rapid emergence that could be delivered without cumbersome apparatus and would have limited potential for toxicity. Somnoforme was a mixture of ethyl chloride, methyl chloride, and ethyl bromide designed to provide powerful efficacy with low potential for side effects by blending of several …

Sour Ageusia In Two Individuals Implicates Ion Channels Of The Asic And Pkd Families In Human Sour Taste Perception At The Anterior Tongue., Taufiqul Huque, Beverly J Cowart, Luba Dankulich-Nagrudny, Edmund A Pribitkin, Douglas L Bayley, Andrew I Spielman, Roy S Feldman, Scott A Mackler, Joseph G Brand

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: The perception of sour taste in humans is incompletely understood at the receptor cell level. We report here on two patients with an acquired sour ageusia. Each patient was unresponsive to sour stimuli, but both showed normal responses to bitter, sweet, and salty stimuli.

METHODS AND FINDINGS: Lingual fungiform papillae, containing taste cells, were obtained by biopsy from the two patients, and from three sour-normal individuals, and analyzed by RT-PCR. The following transcripts were undetectable in the patients, even after 50 cycles of amplification, but readily detectable in the sour-normal subjects: acid sensing ion channels (ASICs) 1a, 1beta, 2a, …

Is Furazolidone Therapy For Helicobacter Pylori Effective And Safe? Reply, Z Abbas, Javed Yakoob, Shahab Abid, Wasim Jafri, Muhammad Islam, Zahid Azam, Imran Hilal

Section of Gastroenterology

No abstract provided.

Sirenomelia, The Mermaid Syndrome: Case Report And A Brief Review Of Literature, Rozina Sikandar, Shama Munim

Department of Obstetrics & Gynaecology

Sirenomelia, the Mermaid Syndrome is a rare and lethal congenital anomaly with an incidence of one in 60,000 to 70,000 pregnancies. Sirenomelia is characterized by complete fusion of the lower limbs, commonly associated with renal agenesis, absent external genitalia and other gastrointestinal defects. Another pathognomonic finding is the presence of single umbilical, persistent vitelline artery which is the chief distinguishing anatomic finding from Caudal Regression Syndrome. We report a case of termination of pregnancy done on the basis of ultrasound diagnosis of bilateral renal agenesis with no liquor volume. The foetus was identified to have characteristic features of Sirenomelia at …

Euroscore Predicts Postoperative Mortality, Certain Morbidities, And Recovery Time., Hitoshi Hirose, Hirotaka Inaba, Chiaki Noguchi, Keiichi Tambara, Taira Yamamoto, Motoshige Yamasaki, Keita Kikuchi, Atsushi Amano

Department of Surgery Faculty Papers

EuroSCORE (European System for Cardiac Operative Risk Evaluation) used for calculating the risk of the postoperative mortality rate for patients undergoing open-heart surgery may be able to predict postoperative complications as well. Consecutive cases of isolated on-pump coronary artery bypass grafting (CABG) (n=1552) performed between 1991 and 2006 at our hospital group were placed into a systematic database. Patients were stratified using additive EuroSCORE. Incidence of postoperative mortality, morbidity (bleeding, heart failure, mediastinitis, pneumonia, myocardial infarction, renal failure, and stroke), and recovery time (intubation time, ICU stay, and postoperative length of stay) was assessed in each EuroSCORE group. EuroSCORE was …

National Health Accounts: Lessons For Pakistan, Muhammad Ashar Malik

Community Health Sciences

No abstract provided.

Oculocardiac Reflex Elicited During Debridement Of An Empty Orbit, James C. Tsai, Md, James W. Heitz, Md, Edward H. Bedrossian Jr, Md Facs

Wills Eye Hospital Papers

87 yo male with history of hypertension and right periorbital basal cell carcinoma s/p previous right total ethmoidectomy, right maxillary antrostomy, and complete right orbital exenteration for basal cell carcinoma invading the right ethmoid sinus. Functional endoscopic sinus surgery and orbital exploration was scheduled for excision of recurrent basal cell carcinoma. Rapid sequence induction and intubation was uneventful. During right orbital base curettage, the patient experienced several precipitious episodes of profound bradycardia or brief asystole. After surgery, the patient denied cardiac symptoms, and cardiac enzymes were all normal. Oculocardiac-mediated bradyarrhythmias are rarely elicited from empty orbits.

Educational Opportunities In Integrative Medicine: The A-To-Z Healing Arts Guide And Professional Resource Directory, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Brachyspira Species Blood Stream Infection, Mohammad Zeeshan, Seema Irfan, Ishfaq Ahmed

Department of Pathology and Laboratory Medicine

The spirochetes inhabiting the large intestines of humans and animals consist of a diverse group of related organisms. Intestinal spirochetosis caused by Brachyspira pilosicoli is a newly recognized enteric disease of human being and animals manifest as mild colitis and diarrhoea. Few cases have been reported of spirochetaemia especially in critically ill and immunocomprised patients. This is another case of spirochetaemia in a patient diagnosed as a case of chronic liver disease secondary to hepatitis C virus, presented in emergency room with history of fever, abdominal pain and slightly altered mental state. Brachyspira pilosicoli was isolated in anaerobic blood culture …

Breast Carcinoma Grading, Estimation Of Tumor Size, Axillary Lymph Node Status, Staging, And Nottingham Prognostic Index Scoring On Mastectomy Specimens., Zubair Ahmad, Amna Khurshid, Asim Qureshi, Romana Idress, Nasira Asghar, Naila Kayani Naila Kayani

Department of Pathology and Laboratory Medicine

Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise.
Objective:The aim of this study was to acquire information about the extent and spread of breast carcinoma in our Patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors …

Calcifying Fibrous Pseudotumor In Association With Hyaline Vascular Type Castleman's Disease., Muhammad Azam, Yousuf A Husen, Shahid Pervez

Department of Pathology and Laboratory Medicine

Calcifying fibrous pseudotumor is a recently described rare entity. It is considered as sclerosing end stage of inflammatory myofibroblastic tumor. An association with hyaline vascular type Castleman's disease has also been described. We report a case of a 13-year-old boy who presented with pain in epigastrium. Computed tomography scan of abdomen revealed a circumscribed mass arising from the gastric wall along the greater curvature. Histology revealed a tumor composed of spindle cells present within the dense hyalinized collagenous tissue. Lymphoplasmacytic infiltrate was seen along with lymphoid follicles, dystrophic and ossifying calcification. Tumor cells were focally positive for alpha smooth muscle …

How Early Do Antibiotics Have To Be To Impact Mortality In Severe Sepsis? A Prospective, Observational Study From An Emergency Department, Shahla Siddiqui, Nawal Salahuddin, Adeel Raza, Junaid Razzak

Department of Anaesthesia

BACKGROUND: The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization.

METHODS: Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values < 0.05 were considered significant.

RESULTS: One hundred and eleven patients …

Determination Of Complication Rate Of Picc Lines In Oncological Patients, Ghulam Haider, Shiyam Kumar, Basit Salam, Nehal Masood, Asim Jamal, Yasmeen Abdul Rasheed

Department of Radiation Oncology

OBJECTIVE: To determine the complication rate of (PICCs) peripherally inserted central catheters in cancer patients with a 1 year prospective cohort study.

METHODS: All PICCs inserted in adult cancer patients in Radiology Department of The Aga Khan University Hospital were followed prospectively till removed or patient expired and pattern of complications noted.

RESULTS: One hundred and fourty six PICCs were inserted over a period of 1 year and followed for a total of 3329 catheter-days; median placement, 14 days: range 3-218 days. Of these 67 (32.8%) PICCs were complicated and removed earlier, for a rate of 14.4/1000 PICC-days. Patients with …

Foxp3-Expressing T Regulatory Cells (T-Regs) Increase With The Severity Of Active Disease In Chronic Hepatitis C, Adam D. Toll, Md, John L. Farber, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The hepatitis C virus (HCV) leads to chronic disease in 80% of those infected and is associated with a chronic inflammatory response that is mediated by both cytokine producing (CD4+) and cytotoxic T cells (CD8+). FoxP3-expressing, CD4+, CD25+T cells (T-regs) are a subset of T lymphocytes that inhibit immune responsiveness and thereby control immunological reactions. Whether FoxP3+ T regulatory cell-mediated suppression is a factor in HCV persistence and/or the course of chronic liver injury has not been defined. In order to assess the association between these T regulatory cells and the severity of chronic hepatitis C, we evaluated liver biopsies …

Labrad : Vol 34, Issue 3 - October 2009, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Detection of Amoebic Meningitis by Wet Film of Cerebrospinal Fluid (CSF)
• Biochemical Tests in the Diagnosis of Anaemia
• Pathophysiology and Laboratory Investigation in Anaemia of Chronic Disease
• Haematogones: A pitfall in the Diagnosis of Leukemias/Lymphoma in Children
• Porphyria: The Mysterious Disease
• Imaging Features of Thalassaemia and Sickle Cell Anaemia
• N-Terminal Pro-BNP for Rapid Diagnosis of Heart Failure
• Frozen Section: A Rapid Diagnostic Tool
• Prenatal Diagnosis of ß-Thalassaemia
• Farewell to Administrative Director, Mr Sajid Khan

Methods And Animal Model For Analyzing Age-Related Macular Degeneration, Jayakrishna Ambati

Ophthalmology and Visual Science Faculty Patents

Methods for testing candidate drugs for treatment of age-related macular degeneration are provided. Ccl2-deficient, and Ccr2-deficient mice are used to determine the effect of candidate drugs and treatments on development of age-related macular degeneration. Also provided is a Ccl2-deficient, Ccr2-deficient dual knockout mouse, which is a useful animal model for age-related macular degeneration.

Long-Term Immunity To Lethal Acute Or Chronic Type Ii Toxoplasma Gondii Infection Is Effectively Induced In Genetically Susceptible C57bl/6 Mice By Immunization With An Attenuated Type I Vaccine Strain, Jason P. Gigley, Barbara A. Fox, David J. Bzik

Dartmouth Scholarship

C57BL/6 (B6) mice are genetically highly susceptible to chronic type II Toxoplasma gondii infections that invariably cause lethal toxoplasmic encephalitis. We examined the ability of an attenuated type I vaccine strain to elicit long-term immunity to lethal acute or chronic type II infections in susceptible B6 mice. Mice immunized with the type I cps1-1 vaccine strain were not susceptible to a lethal (100-cyst) challenge with the type II strain ME49. Immunized mice challenged with 10 ME49 cysts exhibited significant reductions in brain cyst and parasite burdens compared to naive mice, regardless of the route of challenge infection. Remarkably, cps1-1 strain-immunized …

Orbital Aspergillus Infection Mimicking A Tumour: A Case Report, Muhammad Ahsan Zafar, Syeda Sidra Waheed, Ather Enam

Section of Neurosurgery

A 14-year-old male presented to the neurosurgical clinic with swelling just above the right eye which had been growing slowly for the last eight years. The swelling first appeared following a non-penetrating trauma eight years ago. On examination it was a non-tender, non-erythematous, firm, round swelling causing marked proptosis and diplopia on downward gaze only. The visual acuity was intact. MRI showed an intraorbital, extraconal mass isointense on T1 and hypointense on T2 imaging. A diagnosis of orbital tumor was made. A white, friable mass consistent with meningioma was resected. However histopathology report later showed it to be an Aspergilloma. …

The Otto Aufranc Award Identification Of A 4 Mb Region On Chromosome 17q21 Linked To Developmental Dysplasia Of The Hip In One 18-Member, Multigeneration Family, George Feldman, Chelsea Dalsey, Kasia Fertala, David Azimi, Paolo Fortina, Marcella Devoto, Maurizio Pacifici, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Developmental dysplasia of the hip (DDH) is a disabling condition of the hip that, depending on geography, can afflict between 20-80% of patients with end-stage arthritis of the hip. Despite its prevalence, the etiology of this disease remains unknown. DDH is a complex disorder with both environmental and genetic causes.. Based on the literature, the candidate genes for the disease are HOXB9, collagen type I α1, and DLX 3. The purpose of our study was to map and characterize the gene or genes responsible for this disorder by family linkage analysis. We recruited one 18-member, multigeneration affected family to provide …

Giant Adrenal Endothelial Cyst Associated With Acute And Chronic Morbidity In A Young Female: A Case Report., Muhammad Rizwan Khan, Saad Ajmal, Taimur Saleem

Department of Surgery Docs

Adrenal cysts are rare clinical entities that can present as acute abdomen through rupture and internal hemorrhage as well as chronic symptoms such as gastrointestinal disturbances. A 20-year-old girl presented to our hospital with a 4-years history of abdominal pain and diarrhea. Ultrasound of the abdomen revealed a cystic area measuring 10 x 10 cm between the spleen and left kidney. Computed tomography scan showed a large cystic, homogeneous mass measuring 12.8 x 9.5 x 9.4 cm in the left hypochondrium with most likely origin from the left adrenal gland. Limited work up for hormone hypersecretion was negative. The Patient …

Impairments In Attention In Occasionally Snoring Children: An Event-Related Potential Study., Maria E. Barnes, Elizabeth A. Huss, Krista N. Garrod, Eric Van Ray, Ehab Dayyat, David Gozal, Dennis L. Molfese

Faculty and Staff Scholarship

Objective: To determine whether minimal snoring is benign in children. Procedure: 22 rarely snoring children (mean age = 6.9 years, 11 females) and age- and sex-matched controls participated in an auditory oddball task wearing 128-electrode nets. Parents completed the Conners Parent Rating Scales–Revised Long (CPRS–R:L). Results: Snorers scored significantly higher on four CPRS-R:L subscales. Stepwise regression indicated that two ERP variables from a region of the ERP that peaked at 844 msec post-stimulus onset predicted CPRS-R:L Attention Deficit Hyperactivity Disorder (ADHD) Index scores. Conclusions: Occasional snorers, according to parental report, do exhibit ADHD-like behaviors. Basic sensory processing is longer than …

Geographic Variation And Environmental Conditions As Cofactors In Chlamydia Psittaci Association With Ocular Adnexal Lymphomas: A Comparison Between Italian And African Samples, Alessandro Carugi, Anna Onnis, Giuseppina Antonicelli, Benedetta Rossi, Susanna Mannucci, Anna Luzzi, Stefano Lazzi, Cristiana Cristiana Bellan, Gian Marco Tosi, Shahin Sayed, Giulia De Falco, Lorenzo Leoncini

Pathology, East Africa

A particular extra-nodal lymphoma type arises from B cells of the marginal zone (MZ) of mucosa-associated lymphoid tissue (MALT). The aetiology ofMZ lymphomas suggests that they are associated with chronic antigenic stimulation by microbial pathogens, among which Helicobacter pylori-associated gastricMALT lymphoma is the best studied. Recently, MALT lymphomas have been described in the context of chronic conjunctivitis, which can be associated with Chlamydia spp. infection. Studies from Italy showed the presence of Chlamydia psittaci in 87% of ocular adnexal lymphomas (OAL), and C. psittaci has been described in a large part of samples from Austria and Korea as well. However, …