Medical Specialties Commons^™

Is It Possible To Reduce Rates Of Placenta Praevia, Sheena Memon, Kaweeta Kumari, Haleema Yasmin, Sheerin Bhutta

Department of Obstetrics & Gynaecology

To determine factors responsible for rising rates of placenta praevia. This comparative study was performed at Jinnah Post Graduate Medical Centre Karachi, (Group-A) from September 2000 to February 2002 and (Group-B) from January 2008 to January 2009. All women with major degree of placenta praevia diagnosed on ultrasound who came in emergency or through out patient department were included in the study. Patients with mild degree of placenta praevia were excluded. Group A had 100 patients and Group B, 58 patients. Chi-Squire test was used for comparison of previous study and current study. The number of unbooked cases in both …

Editorial Comment From Dr Lallas To Robotic-Assisted Laparoscopic Radical Prostatectomy: Learning Curve Of First 100 Cases., Costas Lallas

Department of Urology Faculty Papers

Editorial comment.

Tubercular Pancreatic Abscess Presenting As Fever And Cystic Pancreatic Lesion With Endoscopic Management., Jonathan M. Fenkel, Maya Spodik, Bheema S. Singu, Anthony Infantolino, Sandeep P. Deshmukh, David E. Loren

Division of Gastroenterology and Hepatology Faculty Papers

Isolated pancreatic tuberculosis is a rare presentation of tubercular infection. There are few reported cases of pancreatic tuberculosis diagnosed by endoscopic ultrasound with fine-needle aspiration (EUS FNA), though EUS is often used in the evaluation of pancreatic cystic lesions. We present a case of a tubercular pancreatic abscess presenting as a cystic lesion in a patient with undiagnosed immunodeficiency. The abscess was aspirated by EUS FNA and treated with endoscopic drainage and anti-mycobacterial medications.

Effects Of A Perindopril-Based Blood-Pressure-Lowering Regimen In Patients With Previous Stroke Or Transient Ischaemic Attack (Progress). How Do The Results Affect Practice In Pakistan?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Birth Weight Estimation--A Sonographic Model For Pakistani Population, Waseem Akhtar, Arif Ali, Mubashir Aslam, Farah Saeed, Salman, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To develop a sonographic birth weight estimation model for Pakistani population and to validate the published models in the same population.

METHODS: Data was collected for pregnant women who presented to Radiology Department of Aga Khan University Hospital Karachi from January 2007 to July 2008 and had undergone ultrasound estimation of foetal weight within 4 days prior to a term delivery (37-42 weeks gestation). The neonate's actual birth weight was used to validate the published foetal weight estimation models and modified sonographic birth weight estimation model was derived for our population by using linear regression.

RESULTS: Modified sonographic birth …

Anaesthetic Management Of Two Patients With Beta-Thalassaemia Intermedia, Shahnawaz Ali, Fauzia Khan

Department of Anaesthesia

There is paucity of literature regarding the anaesthetic management of patients with thalassaemia intermedia. In this case study, the anaesthetic management and concerns in two children with thalassaemia intermedia aged eleven and nine years undergoing herniotomy and splenectomy respectively is reported. Both children had unanticipated difficulty in airway management and high intraoperative blood pressure trends. These cases are representative of the range of problems seen in children with thalassaemia intermedia.

Human Papillomavirus And Survival Of Patients With Oropharyngeal Cancer., K Kian Ang, Jonathan Harris, Richard Wheeler, Randal Weber, David I Rosenthal, Phuc Felix Nguyen-Tân, William H Westra, Christine H Chung, Richard C Jordan, Charles Lu, Harold Kim, Rita S. Axelrod, Md, C Craig Silverman, Kevin P Redmond, Maura L Gillison

Jefferson Hospital Staff Papers and Presentations

BACKGROUND: Oropharyngeal squamous-cell carcinomas caused by human papillomavirus (HPV) are associated with favorable survival, but the independent prognostic significance of tumor HPV status remains unknown.

METHODS: We performed a retrospective analysis of the association between tumor HPV status and survival among patients with stage III or IV oropharyngeal squamous-cell carcinoma who were enrolled in a randomized trial comparing accelerated-fractionation radiotherapy (with acceleration by means of concomitant boost radiotherapy) with standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients with squamous-cell carcinoma of the head and neck. Proportional-hazards models were used to compare the risk of death among patients with HPV-positive …

Oncolog Volume 55, Number 07, July 2010, Joe Munch, Sunni Hoseman

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

• Refining Approaches to Thyroid Cancer: Time-proven treatments and newer biologic agents offer hope, particularly for patirnts with advanced disease.
• Thyroid Cancer in Children.
• Compass Summer 2010: Locoregional Cancer of the Esophagus: Timimg Surgery and Other Therapies for Resectable Disease.
• HOUSE CALL: Understanding Clinical Trials

Circadian Rhythms In Patients With St-Elevation Myocardial Infarction, Richard Aplin Md, Dr Holmes Md, Fv Acquirre

Articles

BACKGROUND:

Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle.

METHODS AND RESULTS:

The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was …

Health Related Quality Of Life Changes Among Users Of Depot Medroxyprogesterone Acetate (Dmpa) For Contraception, Sikolia Wanyonyi

Master of Medicine in Obstetrics and Gynecology

Background: Contraceptive use is often a lifestyle choice that could impact on the quality of life. Depot medroxyprogesterone acetate (DMPA), like any other contraceptive method has other effects besides fertility control. Understanding how these impacts on the quality of life could assist in client counseling, eventually leading to informed choices. Objective: To determine health related quality of life changes associated with the use of DMPA for contraception. Methods: A longitudinal observational study was carried out between December 2008 and September 2009 at family planning clinics at the Aga Khan University Hospital and Family Health Options, Kenya (FHOK) after institutional and …

Is There An Association Of Giardiasis With Beta-Thalassemia Minor?, Javed Yakoob, Wasim Jafri, Hizbullah Shaikh

Section of Gastroenterology

Beta–thalassemia minor is a symptomless carrier state of a hemoglobinopathy which predisposes to bacterial infections. We report three cases presenting with giardiasis, a parasitic infection of gastrointestinal tract caused by Giardia lamblia. Patients presented with recurrent diarrhea and abdominal pain for over a year. An esophagogastroduodenoscopy finding varied from normal to acute duodenitis. Duodenal biopsy demonstrated changes consistent with mild chronic non-specific inflammation with G. lamblia trophozoites. All three patients were diagnosed as β -thalassemia minor hemoglobin electrophoresis. They were treated with Diloxanide furoate 500 mg and Metronidazole 400mg three times daily for five days. Their symptoms resolved and a …

The Effectiveness Of Training Nurses In Breast Cancer Awareness At A Tertiary Hospital: An Experimental Study, Miriam Mutebi

Master of Medicine in General Surgery

Background: Breast cancer is characterized by late presentation and significant morbidity and mortality in developing countries. Breast screening aids in early detection of breast cancer. The nursing health worker is uniquely placed to provide advocacy and screening in a resource limited environment. Objectives: To assess the effectiveness of an abbreviated training program in breast cancer awareness on nurses at a tertiary hospital, the Aga Khan University Hospital, Nairobi. Methods: Using a statistical tool, the Solomon Model, 79 nurses were identified and divided into experimental and control groups. An abbreviated training intervention in breast cancer awareness was administered to the experimental …

A Randomized Controlled Trial Of The Effect Of Additional Ultrasound Therapy To Analgesia Treatment Protocol For Acute Low Back Pain At Akuh (N), Shamshudin Mohammedali

Master of Medicine in General Surgery

Background: Acute low back pain is a common condition that is encountered by many physicians. Varied treatments are instituted in its management with no defined standard protocol in our institution. Additional physiotherapy has had minimal impact in terms of pain control and the time to return to work in the available literature. Controversy remains regarding effectiveness of ultrasound physiotherapy and its role in management of acute low back pain. Objective: To investigate the effectiveness of the addition of ultrasound physiotherapy to analgesia in patients with acute low back pain at the Aga Khan University Hospital, Nairobi. Methods: A randomized controlled …

A Randomised Comparative Trial Of Seven Versus Fourteen Day Triple Therapy For Helicobacter Pylori Eradication At The Aga Khan University Hospital, Nairobi, Ahmed Sokwala

Master of Medicine in Internal Medicine

Background: Helicobacter is associated with a number of important upper gastrointestinal conditions including chronic gastritis, peptic ulcer disease, and gastric malignancy. Proton pump inhibitor -based triple therapies are considered the standard regimens for Helicobacter pylori eradication, but the optimal duration of these regimens is still controversial. Local studies are required to evaluate the H. pylori eradication rates in a country for adequate eradication to prevent H. pylori infection and complications Objectives: The main objective of this study was to compare 7 day and 14 day regimens and determine the optimum duration of triple therapy for H. pylori eradication. Methods: A …

Postoperative Complications Of Powered Intracapsular Tonsillectomy And Monopolar Electrocautery Tonsillectomy In Teens Versus Adults., Douglas R Johnston, Michael Gaslin, Maurits Boon, Edmund Pribitkin, David Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES: This study was performed to determine whether teens have different rates of posttonsillectomy hemorrhage, admission for dehydration, or recurrent tonsillitis compared to adults. Specifically, these parameters were compared within two groups: patients who underwent powered intracapsular tonsillectomy (PIT) and those who underwent monopolar electrocautery tonsillectomy (MET).

METHODS: In a retrospective review of 579 patients at least 12 years of age from January 2000 to July 2006 in a tertiary referral center, outcome measures of reoperation for hemorrhage, readmission or emergency room visit for dehydration, and postoperative tonsillitis were compared for 200 patients 12 to 19 years of age and …

Is There An Optimal Management For Localized Prostate Cancer?, Jaspreet Singh, Edouard J. Trabulsi, Leonard G. Gomella

Department of Urology Faculty Papers

Widespread screening with prostate-specific antigen (PSA) has led to a significant increase in the detection of early stage, clinically localized prostate cancer (CaP). Various ­treatment options for localized CaP are discussed in this review article including active ­surveillance, radical prostatectomy, radiation therapy, and cyrotherapy. The paucity of high-level evidence adds a considerable amount of controversy when choosing the “optimal” ­intervention, for both the treating physician and the patient. The long time course of CaP intervention outcomes, combined with continuing modifications in treatments, further complicate the ­matter. Lacking randomized trials that compare treatment options, this review article attempts to summarize the …

Late Onset Postpneumonectomy Empyema Presenting 24 Years After Pneumonectomy, Saulat Hasnain Fatimi, Umair Khalid, Sanna Fatima, Taimur Saleem

Section of Cardiothoracic Surgery

Empyema is a devastating complication that is rarely seen in the postpneumonectomy setting. A 56-year-old man presented to us 24 years after pneumonectomy with a 15 days history of chest pain and shortness of breath. Physical examination revealed a fluctuant swelling at the thoracotomy site. Computed tomography scan showed a large fluid density mass in the left pneumonectomy space. Needle aspiration and video assisted thoracoscopic surgery was carried out and culture of the aspirated fluid grew Pseudomonas aeruginosa. The patient was discharged with the chest tubes in place. At 2 months follow-up, the patient presented with fever and continuous copious …

Giant Unresectable Lymphangioma Of The Trunk Managed Via Intra-Tumour Injections Of Bleomycin, Umair Khalid, Saulat Hasnain Fatimi, Taimur Saleem

Section of Cardiothoracic Surgery

Surgical excision was once considered the mainstay of treatment for lymphangiomas. However, that paradigm is now changing with sclerotherapy emerging as a viable alternative. A 22-year-old girl presented with a mucopurulent and painful discharge from an extensive wound in the trunk. Chest roentogram showed a large soft tissue abnormality with multiple calcifications in the right upper abdomen and lower thorax. Magnetic resonance imaging revealed an extensive lobulated mass measuring 27 x 19 cm. Due to the extensive involvement of tissues, surgical excision did not appear to be a favourable option in this case. Local injections of bleomycin were successfully administered; …

White Matter Diffusion Alterations In Normal Women At Risk Of Alzheimer's Disease, Charles D. Smith, Himachandra Chebrolu, Anders H. Andersen, David A. Powell, Mark A. Lovell, Shuling Xiong, Brian T. Gold

Neurology Faculty Publications

Increased white matter mean diffusivity and decreased fractional anisotropy (FA) has been observed in subjects diagnosed with mild cognitive impairment (MCI) and Alzheimer's disease (AD). We sought to determine whether similar alterations of white matter occur in normal individuals at risk of AD. Diffusion tensor images were acquired in 42 cognitively normal right-handed women with both a family history of dementia and at least one apolipoprotein E4 allele. These were compared with images from 23 normal women without either AD risk factor. Group analyses were performed using tract-based spatial statistics. Reduced FA was observed in the fronto-occipital and inferior temporal …

Modification And Implementation Of Nccn Guidelines On Prostate Cancer In The Middle East And North Africa Region., Waleed A. Hassen, Farrok A. Karsan, Farhat Abbas

Department of Surgery Docs

Abstract

A prostate cancer committee was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Prostate Cancer for adaptation and implementation in the Middle East and North Africa (MENA) region. The objective was to enhance the multidisciplinary approach to the treatment of prostate cancer. The committee, comprising regional experts in the fields of urologic, medical, and radiation oncology, reviewed the 2009 version of the NCCN Guidelines on Prostate Cancer and suggested modifications based on the unique needs of the regions determined through published evidence and local expertise. The committee identified several areas in the NCCN Guidelines …

Hypertension In Children And Adolescents: Epidemiology And Natural History., Bonita Falkner

Department of Medicine Faculty Papers

Primary hypertension is detectable in children and adolescents and, as in adults, is associated with a positive family history of hypertension, obesity, and life-style factors. Owing to the well-established childhood obesity epidemic, the population prevalence of high blood pressure (BP) in the young is increasing. Hypertension in childhood is commonly associated with other cardiovascular risk factors as well as obesity. Although death and cardiovascular disability do not occur in hypertensive children, intermediate markers of target organ damage, such as left ventricular hypertrophy, thickening of the carotid vessel wall, retinal vascular changes, and even subtle cognitive changes, are detectable in children …

Nipple Adenoma Of Breast: A Masquerader Of Malignancy, Kanwal Aftab, Romana Idress

Department of Pathology and Laboratory Medicine

Nipple adenoma is a benign condition simulating malignancy such as breast carcinoma and/or Paget’s disease clinically. In this study 19 cases diagnosed as nipple adenoma over a period of 14 years are described. The diagnosis was confirmed by histology alone. All patients were females with age ranging from 23 to 63 years. Most of the cases presented clinically with in duration and ulceration accompanied by pain and itching. The diagnosis was clinically suspected in only 3 cases. This highlights the importance of histological diagnosis in all suspicious breast lesions. In one case, the clinical and histological diagnosis was incorrect leading …

Gsk-3alpha Directly Regulates Beta-Adrenergic Signaling And The Response Of The Heart To Hemodynamic Stress In Mice., Jibin Zhou, Hind Lal, Xiongwen Chen, Xiying Shang, Jianliang Song, Yingxin Li, Risto Kerkela, Bradley W Doble, Katrina Macaulay, Morgan Decaul, Walter J Koch, John Farber, James Woodgett, Erhe Gao, Thomas Force

Center for Translational Medicine Faculty Papers

The glycogen synthase kinase-3 (GSK-3) family of serine/threonine kinases consists of 2 highly related isoforms, alpha and beta. Although GSK-3beta has an important role in cardiac development, much remains unknown about the function of either GSK-3 isoform in the postnatal heart. Herein, we present what we believe to be the first studies defining the role of GSK-3alpha in the mouse heart using gene targeting. Gsk3a(-/-) mice over 2 months of age developed progressive cardiomyocyte and cardiac hypertrophy and contractile dysfunction. Following thoracic aortic constriction in young mice, we observed enhanced hypertrophy that rapidly transitioned to ventricular dilatation and contractile dysfunction. …

Soft Tissue Profile Response In Extraction Versus Non-Extraction Orthodontic Treatment, Munizeh Khan, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare changes occurring in the soft tissue profile with orthodontic treatment in extraction versus nonextraction cases, and to determine the hard and soft tissue parameters that show significant correlations to understand the factors influencing the response to tooth movement. Study Design: Quasi-experimental. Place and Duration of Study: Dental Section, The Aga Khan University Hospital, Karachi, from 2005 to 2008. Methodology: Pre- and post-treatment lateral cephalographs of 34 subjects were assessed. For half of the patients (n=17), treatment included the extraction of 4 premolars, whereas the other half were treated by the non-extraction approach. Incisal and soft tissue effects …

Updating The Dermatologic Nomenclature: Names That Are Good Or Bad., Lawrence Charles Parish, Joseph A. Witkowski

Department of Dermatology and Cutaneous Biology Faculty Papers

Dermatology probably has the largest vocabulary of any of the medical specialties,¹ a statement to which we can attest when we reviewed aspects of the Dermatology Lexicon project. Some terms are derived from the Latin or Greek and present spelling problems to all but a select few. Examples include acrokeratosis verruciformis and pterigium. Other diseases carry names that are such a mouthful that few can call them out without the interruption of breathing. These might include erosio interdigitalis blastomycetica and dermatitis exudative discoid and lichenoid of Sulzberger and Garbe. No wonder the former is now referred to simply as …

Development Of A P.O.I. And A Blended Learning Ecology For Use In Combat Lifesaver Skills Training For The Army, Bea Babbitt

Telemedicine & Advanced Technology Research Center

The primary purpose of the project, as originally conceived, was to design and implement a series of applied research studies to validate the effectiveness of a blended learning ecology in the teaching of life saving medical skills to US Army combat military personnel. The project has undergone several changes to include changing the focus to the development of a Program of Instruction (POI) for Combat Lifesaver Skills (CLS). The new scope of work which has been followed for the past year includes the completion of the POI as well as the integration of the Personal Response System (PRS) into the …

Clopidogrel Hypersensitivity: Clinical Challenges And Options For Management., Kimberly L Campbell, John R Cohn, Michael P Savage

Division of Cardiology Faculty Papers

Over 90 million patients have been prescribed clopidogrel since its US FDA approval in 1997. Clopidogrel hypersensitivity affects up to 6% of patients, most commonly in the form of a pruritic rash. Symptoms are severe enough to result in drug discontinuation in 1.5% of patients. Premature discontinuation of clopidogrel is problematic following percutaneous coronary intervention because of the risk of stent thrombosis leading to myocardial infarction and death. Accordingly, the management of patients with clopidogrel hypersensitivity is of significant clinical importance. Conventional clopidogrel desensitization protocols, while successful in most patients, employ a washout period off medication to enable accurate detection …

Histamine Reduces Flash Sensitivity Of On Ganglion Cells In The Primate Retina, Nikolay P Akimov, David W Marshak, Laura J Frishman, Randolph D Glickman, Rafail G Yusupov

Faculty, Staff and Student Publications

PURPOSE. In Old World primates, the retina receives input from histaminergic neurons in the posterior hypothalamus. They are a subset of the neurons that project throughout the central nervous system and fire maximally during the day. The contribution of these neurons to vision, was examined by applying histamine to a dark-adapted, superfused baboon eye cup preparation while making extracellular recordings from peripheral retinal ganglion cells. METHODS. The stimuli were 5-ms, 560-nm, weak, full-field flashes in the low scotopic range. Ganglion cells with sustained and transient ON responses and two cell types with OFF responses were distinguished; their responses were recorded …

Outcomes After Implantation Of The Taxus Paclitaxel-Eluting Stent In Saphenous Vein Graft Lesions: Results From The Arrive (Taxus Peri-Approval Registry: A Multicenter Safety Surveillance) Program, Emmanouil S. Brilakis Md, Phd, John M. Lasala Md, Phd, David A. Cox Md, Peter B. Berger Md, Thomas S. Bowman Md, Mph, Ruth M. Starzyk Phd, Keith D. Dawkins Md

Department of Medicine

No abstract provided.

Effects Of A Perindopril-Based Blood-Pressure-Lowering Regimen In Patients With Previous Stroke Or Transient Ischaemic Attack (Progress). How Do The Results Affect Practice In Pakistan, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.