Medical Specialties Commons^™

Clinical Predictors Of Mortality In Hospitalized Patients With Infective Endocarditis At A Tertiary Care Center In Pakistan, Sadia Arshad, Safia Awan, Syedah Saira Bokhari, M. Tariq

Department of Medicine

Objective: To evaluate the clinical characteristics and predictors of in-hospital mortality in patients with infective endocarditis at a tertiary care centre in Pakistan.
Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from January 1, 2002, to December 31, 2006, and comprised 84 consecutive patients hospitalised with infective endocarditis,. All patients underwent verification of the diagnosis according to the Modified Duke criterion. Data was collected through a questionnaire and analysed using Student's t test, Chi square and Fisher's exact test. Univariate and multivariate logistic regression analysis was performed to assess predictors of mortality.
Results: Of the …

Malignant Ectopic Thyroid Tissue With Distant Metastasis: A Case Report, Shehla Tabassum, Najmul Islam, Saulat H. Fatimi, Mubasher Ikram, Arsalan Ahmed, Maseehuz Zaman

Department of Medicine

Introduction: Ectopic thyroid tissue is the most common form of thyroid dysgenesis. But primary malignant transformation in ectopic thyroid tissue is quite a rare entity, with follicular malignancy being the dominant form at ectopic sites. Very infrequently, malignant ectopic thyroid tissue can present with metastasis to lymph nodes. But we report a case of malignant ectopic thyroid tissue over manubrium sterni with distant metastasis.
Case presentation: A 42-year-old Pakistani female presented with gradually increasing swelling on anterior aspect of manubrium sterni for last 6 months. She had no goitre and was clinically and biochemically euthyroid. Rest of systemic exam …

Frequency And Mortality Associated With Hyperglycemia In Critically Ill Children, Sabeen Abid Khan, Mohsina Noor Ibrahim, Anwarul Haque

Department of Paediatrics and Child Health

Objective: To determine the frequency of hyperglycemia in critically ill children admitted in PICU of a tertiary care hospital of Karachi and to compare the mortality of critically ill children with and without hyperglycemia.

Study Design: Cross-sectional study.

Place and Duration of Study: Paediatrics Intensive Care Unit (PICU) of National Institute of Child Health (NICH), Karachi, from November 2011 to April 2012.

Methodology: One hundred fifty critically ill children admitted to PICU were included. Patients who had fasting blood sugar levels more than 126 mg/dl within 48 hours of admission were included in the hyperglycemic group. The normoglycemic and hyperglycemic …

Diagnostic Accuracy Of Who Verbal Autopsy Tool For Ascertaining Causes Of Neonatal Deaths In The Urban Setting Of Pakistan: A Hospital-Based Prospective Study, Sajid Bashir Soofi, Shabina Ariff, Ubaidullah Khan, Ali Turab, Gul Nawaz Khan, Atif Habib, Kamran Sadiq, Zamir Suhag, Zaid Bhatti, Imran Ahmed, Rajiv Bhal, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Globally, clinical certification of the cause of neonatal death is not commonly available in developing countries. Under such circumstances it is imperative to use available WHO verbal autopsy tool to ascertain causes of death for strategic health planning in countries where resources are limited and the burden of neonatal death is high. The study explores the diagnostic accuracy of WHO revised verbal autopsy tool for ascertaining the causes of neonatal deaths against reference standard diagnosis obtained from standardized clinical and supportive hospital data.
Methods: All neonatal deaths were recruited between August 2006 –February 2008 from two tertiary teaching …

Diagnosis And Management Of Preeclampsia In Community Settings In Low And Middle-Income Countries, Rehana A. Salam, Jai K. Das, Anum Ali, Soumyadeep Bhaumik, Zohra S. Lassi

Department of Paediatrics and Child Health

Hypertensive disorders of pregnancy contribute significantly to maternal mortality and morbidity. Preeclampsia belongs to the spectrum of hypertensive disorders of pregnancy and if undiagnosed and/or untreated leads to fatal consequences for both the mother and the baby. Early detection and prevention of preeclampsia is limited by uncertainty in the knowledge about its etiopathogenesis. While much work has been done in establishing clinical guidelines for management of preeclampsia in the hospital or tertiary care settings, there is considerable lack of work in the domain of evidence-based guidelines for screening, identification and management of preeclampsia at the community-level. The article reviews these …

The Clinical Utility Of Multidisciplinary Rehabilitation In Individuals With Huntington’S Disease, Travis Miles Cruickshank

Theses: Doctorates and Masters

Background

Huntington’s disease (HD) is a chronic neurodegenerative disorder characterised by a progressive loss of cognitive function, motor control and psychiatric features. Individuals also display a variety of systemic features. Progressive neuronal dysfunction and neuronal cell death are thought to underlie the onset and progression of many clinical features of HD.

Despite scientific progress, there is still no cure or disease modifying therapy for HD, and available pharmaceutical agents only provide partial relief of motor and psychiatric features. An emerging body of evidence indicates that lifestyle enrichment may delay the onset and progression of clinical features, and exert favourable effects …

Accurate Modelling And Positioning Of A Magnetically-Controlled Catheter Tip, Vi T. H. Le

Theses: Doctorates and Masters

This thesis represents the initial phase of a proposed operator and patient friendly method designed to semi-automate the positioning and directing of an intravascular catheter in the human heart using a variable electromagnetically induced field to control a catheter tip equipped with three tiny fixed magnets oriented in XYZ planes. Here we demonstrate a comprehensive mathematical model which accurately calculates the magnetic field generated by the electromagnet system, and the magnetic torques and forces exerted on a three-magnet tip catheter. From this we have developed an iterative predictive computer algorithm to show the displacement and deflection of the catheter tip. …

Saying ‘No’: A Biographical Analysis Of The Experiences Of Women With A Genetic Predisposition To Developing Breast/Ovarian Cancer Who Reject Risk Reducing Surgery, Doreen Molloy

Theses: Doctorates and Masters

Background: Genetic technologies have identified some of the genes implicated in cancer susceptibility. Women with mutations in breast/ovarian cancer-susceptibility genes (BRCA1 and 2) have a lifetime combined risk of breast/ovarian cancer of more than 80%. Risk reducing surgery (RRS) reduces cancer risk by as much as 90% in high risk populations. Despite this, some BRCA1/2 mutation-positive women say no to RRS.

Purpose: To illuminate an understanding of why women at high risk of developing breast/ovarian cancer say no to risk reducing surgery (RRS).

Design: Denzin’s (1989) interpretive biography was combined with Dolby-Stahl’s (1985) literary folkloristic methodology to provide a contextualised …

Heat Stress: A Risk Factor For Skin Carcinogenesis, Leslie Calapre

Theses: Doctorates and Masters

BACKGROUND: The incidence of skin cancer in Australia has increased rapidly in the last few decades. Ultraviolet radiation (UV) is a major risk factor for skin carcinogenesis. UV, particularly the UVB spectrum, causes formation of cyclobutane pyrimidine dimers (CPD) in cellular DNA. Persistent and incorrectly repaired CPDs lead to DNA mutations and consequently, formation of cutaneous lesions. Interestingly, recent epidemiological studies have shown a significant increase in skin cancer incidence in geographical locations with high environmental temperatures. Thus, heat stress may potentiate the effects of UV exposure and act as an additional risk factor for skin cancer. Previous studies …

Dengue Hemorrhagic Fever Complicated By Intercostal Artery Hemorrhage., Syed Ahsan Ali, Sara Ahmed, Mehmood Riaz

Department of Medicine

Hemorrhagic manifestations are fairly common in Dengue hemorrhagic fever and are associated with increased mortality. During last few decades there have been increasing reports of Dengue infection with unusual manifestations. Here we present a case of dengue hemorrhagic fever complicated by spontaneous rupture of an intercostal artery leading to a large hematoma which was treated successfully with angio-embolization. To the authors' knowledge this is a first case of dengue hemorrhagic fever complicated by spontaneous intercostal artery hemorrhage.

Can Trained Field Community Workers Identify Stroke Using A Stroke Symptom Questionnaire As Well As Neurologists? Adaptation And Validation Of A Community Worker Administered Stroke Symptom Questionnaire In A Peri-Urban Pakistani Community., Maria Khan,, Ayeesha Kamran Kamal, Muhammad S. Ilyas, Muhammad Islam, Iqbal Azam Syed, Azam Virk,, Alia Nasir, Hasan Rehman,, Anita Arif,, Muhammad Jan,, Anjum Akhtar,, Minaz Mawani, Junaid Abdul Razzak,, Omrana Pasha

Department of Medicine

Background: Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by Community Health Workers (CHWs) are required to identify stroke in the community in a resource strapped region such as this.

Methods: The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire for Verifying Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community dwelling subjects using purposive sampling. Each CHW collected data independently which was validated by a vascular neurologist who …

Abdominal Lymphonodular Cryptococcosis In An Immunocompetent Child, Mehjabeen Zaidi, Sonia Qureshi, Sadia Shakoor, Saira Fatima, Fatima Mir

Department of Paediatrics and Child Health

We describe our experience with an apparently immunocompetent child presenting with pyrexia of unknown origin without focal signs. Investigations revealed lymphadenopathy at lung hila, mesentery, and porta hepatis. The child had received at least two months of empiric antituberculous therapy (ATT) before she came to us. A CT-guided biopsy revealed granulomatous inflammation. PAS stain showed yeasts which stained blue with Alcian blue, suggesting C. neoformans.

Impact Of Withholding Breastfeeding At The Time Of Vaccination On The Immunogenicity Of Oral Rotavirus Vaccine--A Randomized Trial, Asad Ali, Abdul Momin Kazi, Margaret M. Cortese, Jessica A. Fleming, Sungsil Moon, Umesh D. Parashar, Baoming Jiang, Monica M. Mcneal, Duncan Steele, Zulfiqar Bhutta

Department of Paediatrics and Child Health

Background: Breast milk contains anti-rotavirus IgA antibodies and other innate immune factors that inhibit rotavirus replication in vitro. These factors could diminish the immunogenicity of oral rotavirus vaccines, particularly if breastfeeding occurs close to the time of vaccine administration.
Methods: Between April 2011 and November 2012, we conducted an open label, randomized trial to compare the immunogenicity of Rotarix (RV1) in infants whose breastfeeding was withheld one hour before through one hour after vaccination with that in infants breastfed at the time of vaccination. The trial was conducted in the peri-urban area of Ibrahim Hyderi in Karachi, Pakistan. Both groups …

Just A “Click” Away From Evidence-Based Online Breast Cancer Information, Advice And Support Provided By A Specialist Nurse: An Ethnonetnographic Study, Cynthia Ann Witney

Theses: Doctorates and Masters

Breast cancer has had, and will continue to have, a devastating impact on the lives of many Australian women, their families, friends and the wider community. The concomitant treatment of this disease places a considerable burden on the health care system and the supporters of the person diagnosed with this disease. While there are many government and non-government organisations that provide treatment and support services for the person with breast cancer, these services are usually provided in person either in the home or at the organisation’s offices. This study extended the information advice and support aspects of these services to …

Outcome Of Pediatric Procedural Sedation & Analgesia In A Tertiary Care Hospital In Pakistan, Humaira Jurair, Amyna Bhimani, Anwar-Ul-Haque

Department of Paediatrics and Child Health

Background and Objective: Procedural sedation and analgesia (PSA) is pharmacologically induced state which allows patients to tolerate painful procedures while maintaining protective reflexes. It is the standard of care but there is limited data from Pakistan. Our objective was to assess the safety of the procedural sedation and analgesia in pediatric population at a tertiary care setting.
Methods: A retrospective notes and record review was conducted at the Aga Khan University Hospital, Karachi over 4 years from April 2010 to August 2014. Patients were between ages 6 months to 16 years and were in low risk category. The combination of …

Predictors And Outcome Of Tetanus In Newborns In Slum Areas Of Karachi City: A Case Control Study, Arjumand Sohaila, Yasir Shafiq, Shazia Azim, Benazir Baloch, Ali Syed Muhammad Akhtar, Shiyam Sunder Tikmani, Nick Brown

Department of Paediatrics and Child Health

Background: Tetanus in newborns, is an under-reported public health problem and a major cause of mortality in developing countries. This study aimed to determine the predictors and outcome of tetanus in newborn infants in the slums of Bin-Qasim town, Karachi, Pakistan.
Methods: We conducted a case-control study at primary health care centers of slums of Bin-Qasim town, area located adjacent to Bin Qasim seaport in Karachi, from January 2003 to December 2013. Cases were infants aged ≤30 days with tetanus, as defined by the World Health Organization. Controls were newborn infants aged ≤30 days without Tetanus, who were referred for …

The Effect Of Strength And Plyometric Training On Functional Dance Performance In Elite Ballet And Modern Dancers, Joe Girard, Kristina Koenig, David Village

Faculty Publications

Background:

Ballet and modern dance are both art forms that require technique, artistry, grace and precision. Both dance forms require a degree of strength and muscular endurance for optimal performance. It is not known what value strength or plyometric training may have on functional dance performance.

Objective:

To systematically review the effects of strength and/or plyometric training on functional dance performance in elite ballet and modern dancers.

Methods:

A systematic review of literature indexed in the following databases: Medline, CINAHL, SportsDiscus, Physiotherapy Evidence Database (PEDro) and PubMed was conducted. The quality of the studies was graded using the PEDro Scale. …

Intraosseous Vascular Access In The Emergency Department, Nicole M. Helsper Devoe

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Current guidelines and recommendations from the American College of Surgeons Advanced Trauma Life Support and the American Heart Association (AHA) include intraosseous (IO) access as a second-line alternative when delayed or failed peripheral vascular access occurs in emergent or trauma situations. IO access is underutilized in the emergency department (ED) due to registered nurses’ knowledge deficit, lack of training and education, and lack of supplies (Cheung, Rosenberg, & Vaillancourt, 2014). The National Association of EMS Physicians (NAEMSP) supports the use of IO access and describes IOs as a significant time saving intervention in achieving vascular access and decreasing the time …

Brca1 185delag Mutation Enhances Interleukin-1Β Expression In Ovarian Surface Epithelial Cells, Kamisha T. Woolery, Mai Mohamed, Rebecca J. Linger, Kimberly P. Dobrinski, Jesse Roman, Patricia A. Kruk

Pathology and Cell Biology Faculty Publications

Familial history remains the strongest risk factor for developing ovarian cancer (OC) and is associated with germline BRCA1 mutations, such as the 185delAG founder mutation. We sought to determine whether normal human ovarian surface epithelial (OSE) cells expressing the BRCA1 185delAG mutant, BRAT, could promote an inflammatory phenotype by investigating its impact on expression of the proinflammatory cytokine, Interleukin-1β (IL-1β). Cultured OSE cells with and without BRAT were analyzed for differential target gene expression by real-time PCR, western blot, ELISA, luciferase reporter, and siRNA assays. We found that BRAT cells expressed increased cellular and secreted levels of …

Tp53 And Mdm2 Single Nucleotide Polymorphisms Influence Survival In Non-Del(5q) Myelodysplastic Syndromes, Kathy L. Mcgraw, Thomas Cluzeau, David A. Sallman, Ashley A. Basiorka, Brittany A. Irvine, Ling Zhang, P.K. Epling-Burnette, Dana E. Rollison, Mar Mallo, Lubomir Sokol, Francesc Solé, Jaroslaw Maciejewski, Alan F. List

Pathology and Cell Biology Faculty Publications

P53 is a key regulator of many cellular processes and is negatively regulated by the human homolog of murine double minute-2 (MDM2) E3 ubiquitin ligase. Single nucleotide polymorphisms (SNPs) of either gene alone, and in combination, are linked to cancer susceptibility, disease progression, and therapy response. We analyzed the interaction of TP53 R72P and MDM2 SNP309 SNPs in relationship to outcome in patients with myelodysplastic syndromes (MDS). Sanger sequencing was performed on DNA isolated from 208 MDS cases. Utilizing a novel functional SNP scoring system ranging from +2 to −2 based on predicted p53 activity, we found statistically significant differences …

Itraq-Based Proteomic Analysis Of Visual Cycle-Associated Proteins In Rpe Of Rd12 Mice Before And After Rpe65 Gene Delivery, Qinxiang Zheng, Yueping Ren, Radouil Tzekov, Shanshan Hua, Minghan Li, Jijing Pang, Jia Qu, Wensheng Li

Ophthalmology Faculty Publications

Purpose. To investigate the iTRAQ-based proteomic changes of visual cycle-associated proteins in RPE of rd12 mice before and after RPE65 gene delivery. Mehtods. The right eyes of rd12 mice underwent RPE65 gene delivery by subretinal injection at P14, leaving the left eyes as control. C57BL/6J mice were served as a wide-type control group. ERGs were recorded at P42, and RPE-choroid-sclera complex was collected to evaluate the proteomic changes in visual cycle-associated proteins by iTRAQ-based analysis. Western blot was used to confirm the changes in the differentially expressed proteins of interest. Results. ERG parameters improved dramatically at P42 after …

Visual Electrodiagnostic Testing In Birdshot Chorioretinopathy, Radouil Tzekov, Brian Madow

Ophthalmology Faculty Publications

Birdshot chorioretinopathy (BSCR) is a rare form of autoimmune posterior uveitis that can affect the visual function and, if left untreated, can lead to sight-threatening complications and loss of central vision. We performed a systematic search of the literature focused on visual electrophysiology studies, including electroretinography (ERG), electrooculography (EOG), and visual evoked potentials (VEP), used to monitor the progression of BSCR and estimate treatment efficacy. Many reports were identified, including using a variety of methodologies and patient populations, which makes a direct comparison of the results difficult, especially with some of the earlier studies using nonstandardized methodology. Several different electrophysiological …

Craniopharyngioma Causing Bilateral Vision Loss 4 Months After Unremarkable Magnetic Resonance Imaging Of The Brain, Rainy Betts, Curtis E. Margo, Mitchell Drucker

Ophthalmology Faculty Publications

A 65-year-old man developed bilateral vision loss 4 months after magnetic resonance imaging demonstrated no lesion in the vicinity of the optic chiasm, hypothalamus, and suprasellar tissues. Repeat computed tomography 3 months later showed a predominantly cystic mass of the suprasellar cistern with extension into the anterior third ventricle, which histologically was a craniopharyngioma. The clinical course of this case fuels the controversy whether craniopharyngiomas arise from embryonic rests or can be acquired. From a clinical perspective, it raises questions about when to obtain imaging studies dedicated to the chiasm and the appropriate interval in which a scan should be …

Frataxin Levels In Peripheral Tissue In Friedreich Ataxia, Michael Lazaropoulos, Yina Dong, Elisia Clark, Nathaniel R. Greeley, Lauren A. Seyer, Karlla W. Brigatti, Carlton Christie, Susan L. Perlman, George R. Wilmot, Christoper M. Gomez, Katherine D. Mathews, Grace Yoon, Theresa Zesiewicz, Chad Hoyle, Sub H. Subramony, Alicia F. Brocht, Jennifer M. Farmer, Robert B. Wilson, Eric C. Deutsch, David R. Lynch

Neurology Faculty Publications

No abstract provided.

Addition Of Interleukin-21 For Expansion Of T-Cells For Adoptive Immunotherapy Of Murine Melanoma, Christine Kathryn Zoon, Wen Wan, Laura Graham, Harry D. Bear

Surgery Publications

We previously demonstrated that interleukin (IL)-7/15 was superior to IL-2 for expansion of T cells in vitrofor adoptive immunotherapy. We sought to ascertain whether IL-21 would further improve yield and therapeutic efficacy of T cells in culture. Naïve T cell receptor (TcR) transgenic splenocytes or antigen-sensitized lymph node cells were harvested from PMEL-1 mice and exposed to bryostatin-1 and ionomycin (B/I) for 18 h. Cells were then cultured in IL-2, IL-21, IL-7/15 or IL-7/15/21 for six days. Harvested cells were analyzed by flow cytometry and used to treat C57Bl/6 mice injected intravenously with B16 melanoma. Lungs were harvested and …

Bilateral Choroidal Neovascularization After Pegylated Interferon Therapy, Pir Salim Mahar, Abdul Sami Memon

Section of Ophthalmology

A 30-year-old male presented with gradual decrease in vision in his both eyes after the use of interferon alpha for his hepatitis-C. Ocular examination of patient included, Best Corrected Visual Acuity (BCVA), fundus photographs, Fundus Fluorescein Angiography (FFA) and Optical Coherence Tomography (OCT). His BCVA was recorded as 6/18 in the right eye and 6/12 in the left eye. The anterior segments were unremarkable, with normal intraocular Pressure (IOP) in his both eyes. Both fundi revealed the presence of bilateral Choroidal Neovascularization (CNV), confirmed on FFA and OCT. To the best of authors' knowledge, simultaneous presence of CNV in both …

Ceftriaxone-Resistant Salmonella Enterica Serotype Typhimurium Sequence Type 313 From Kenyan Patients Is Associated With The Blactx-M-15 Gene On A Novel Inchi2 Plasmid, Samuel Kariuki, Chinyere Okoro, John Kiiru, Samuel Njoroge, Geoffrey Omuse, Gemma Langridge, Robert A. Kingsley, Gordon Dougan, Gunturu Revathi

Pathology, East Africa

Multidrug-resistant bacteria pose a major challenge to the clinical management of infections in resource-poor settings. Although nontyphoidal Salmonella (NTS) bacteria cause predominantly enteric self-limiting illness in developed countries, NTS is responsible for a huge burden of life-threatening bloodstream infections in sub-Saharan Africa. Here, we characterized nine S. Typhimurium isolates from an outbreak involving patients who initially failed to respond to ceftriaxone treatment at a referral hospital in Kenya. These Salmonella enterica serotype Typhimurium isolates were resistant to ampicillin, chloramphenicol, cefuroxime, ceftriaxone, aztreonam, cefepime, sulfamethoxazole-trimethoprim, and cefpodoxime. Resistance to β-lactams, including to ceftriaxone, was associated with carriage of a combination …

Proceedings Of The African Pathologists Summit; March 22-23, 2013; Dakar, Senegal: A Summary, Shahin Sayed

Pathology, East Africa

Context: This report presents the proceedings of the African Pathologists Summit, held under the auspices of the African Organization for Research and Training in Cancer.

Objectives: To deliberate on the challenges and constraints of the practice of pathology in Sub-Saharan Africa and the avenues for addressing them.

Participants: Collaborating organizations included the American Society for Clinical Pathology; Association of Pathologists of Nigeria; British Division of the International Academy of Pathology; College of Pathologists of East, Central and Southern Africa; East African Division of the International Academy of Pathology; Friends of Africa-United States and Canadian Academy of Pathology Initiative; International Academy …

Impact Of Service Provision Platforms On Maternal And Newborn Health In Conflict Areas And Their Acceptability In Pakistan: A Systematic Review, Zohra S. Lassi, Wafa Aftab, Shabina Ariff, Rohail Kumar, Imtiaz Hussain, Nabiha Musavi, Zahid Memon, Sajid B. Soofi, Zulfiqar A. Bhutta

Woman and Child Health

Various models and strategies have been implemented over the years in different parts of the world to improve maternal and newborn health (MNH) in conflict affected areas. These strategies are based on specific needs and acceptability of local communities. This paper has undertaken a systematic review of global and local (Pakistan) information from conflict areas on platforms of health service provision in the last 10 years and information on acceptability from local stakeholders on effective models of service delivery; and drafted key recommendations for improving coverage of health services in conflict affected areas.

The literature search revealed ten studies that …

Metastatic Pancreatic Carcinoma And Experience With Folfirinox - A Cross Sectional Analysis From A Developing Country, Muhammad Nauman Zahir, Adnan Abdul Jabbar

Department of Radiation Oncology

Background: Pancreatic cancer is the fourth leading cause of cancer related death with median survival ranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatment in advanced stage and has evolved over time. Data pertaining to the disease are scarce from our part of the world where treatment poses a significant challenge due to lack of resources.MATERIALS AND Methods: A retrospective chart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary care hospital in Karachi, Pakistan between January 2008 and December 2012. Data were collected using a …