Internal Medicine Commons^™

Prevalence Of Body-Focused Repetitive Behaviors In Three Large Medical Colleges Of Karachi: A Cross-Sectional Study., Efaza Umar Siddiqui, Syed Saad Naeem, Haider Naqv, Bilal Ahmed

Department of Medicine

Background: Body-focused repetitive behaviors (BFRBs) that include skin picking (dermatillomania), hair pulling (trichotillomania) and nail biting (onychophagia), lead to harmful physical and psychological sequelae. The objective was to determine the prevalence of BFRBs among students attending three large medical colleges of Karachi. It is imperative to come up with frequency to design strategies to decrease the burden and adverse effects associated with BFRBs among medical students.

Methods: A cross-sectional study was conducted among 210 students attending Aga Khan University, Dow Medical College and Sind Medical College, Karachi, in equal proportion. Data were collected using a pre tested tool, “Habit Questionnaire”. …

Good Knowledge About Hypertension Is Linked To Better Control Of Hypertension; A Multicentre Cross Sectional Study In Karachi, Pakistan, Aysha Almas, Saniya Siraj Godil, Saima Lalani, Zahra Aziz Samani, Aamir Hameed

Section of Internal Medicine

Back Ground: According to the National Health survey only 3% of the population has controlled hypertension. This study was designed to elucidate the knowledge about hypertension in hypertensive patients at three tertiary care centers in Karachi. Secondly we sought to compare the knowledge of those with uncontrolled hypertension and controlled hypertension.

Methods: It was a cross-sectional study conducted at The Aga Khan University hospital (AKUH), Ziauddin Hospital (ZH) and Civil hospital, Karachi (CHK. All diagnosed Hypertensive patients (both inpatients and outpatients) coming to a tertiary care hospital in Pakistan aged > 18 years were included. Patients were categorized into 2 groups: …

Fulminant Invasive Aspergillosis Of The Mediastinum In An Immunocompetent Host: A Case Report., Muhammad Tariq Shakoor, Samia Ayub, Zunaira Ayub, Syed Faisal Mahmood

Department of Medicine

Introduction: Invasive aspergillosis is a serious complication in immunocompromised patients. It is an opportunistic disease, which predominantly occurs in the lungs, although dissemination to virtually any organ is possible. Invasive aspergillosis in an immunocompetent patient with extension to the mediastinum has rarely been reported. Here, we present the case of a patient with no apparent immunodeficiency state, who presented with Aspergillus endocarditis and fulminant invasive aspergillosis with extensive involvement of the mediastinal structures, which ultimately was responsible for her death. To the best of our knowledge, this is the first reported case in the literature on fulminant invasive mediastinal aspergillosis …

Primary Billiary Cirrhosis (Antimitochondrial Antibody Negative) Leading To Secondary Amyloidosis, Om Parkash, Aysha Almas

Section of Gastroenterology

A 49 years old lady presented with low-grade fever (99-100degreesF) for 2 years. During this time she was extensively worked-up for pyrexia of unknown origin but no diagnosis could be established. Her Initial blood work-up was all negative except high alkaline phosphatase and gamma GT (374 IU and 195 IU respectively). She later presented to our tertiary care centre with facial swelling, flushing and bilateral pedal swelling for 3 months. Along with generalized body swelling she had frothy urine. She was diagnosed as nephrotic syndrome on the basis of nephrotic range proteinuria. Her Renal biopsy done for workup of nephrotic …

Primary Billiary Cirrhosis (Antimitochondrial Antibody Negative) Leading To Secondary Amyloidosis, Om Parkash, Aysha Almas

Department of Medicine

A 49 years old lady presented with low-grade fever (99-100°F) for 2 years. During this time she was extensively worked-up for pyrexia of unknown origin but no diagnosis could be established. Her Initial blood work-up was all negative except high alkaline phosphatase and gamma GT (374 IU and 195 IU respectively). She later presented to our tertiary care centre with facial swelling, flushing and bilateral pedal swelling for 3 months. Along with generalized body swelling she had frothy urine. She was diagnosed as nephrotic syndrome on the basis of nephrotic range proteinuria. Her Renal biopsy done for workup of nephrotic …

An Incidentally Discovered Asymptomatic Para-Aortic Paraganglioma With Peutz-Jeghers Syndrome, Nazish Butt, Mohammad Salih, Mohammad Rizwan Khan, Rashida Ahmed, Zishan Haider, Syed Hasnain Ali Shah

Section of Internal Medicine

Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal (GI) tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extraGI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers.We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was …

Proliferating Tricholemmal Tumour: Clinicopathological Aspects Of A Case., Adeel Khoja, Yan B, Lee Sj, Cheong E. C, Tan K B

Department of Medicine

We report the case of a 49-year-old man who presented with an enlarging mass over his occipital scalp. The clinical impression was either a squamous cell carcinoma or an unusual adnexal tumour. A wide excision was performed with skin grafting. Gross examination revealed a large exophytic tumour mass measuring 10 cm. Histopathological examination showed a circumscribed, well-differentiated squamoproliferative lesion with a lobulated architecture. Clear cell features, pilar-type keratinisation, microcalcifications and the presence of mucinous degeneration were noted. A diagnosis of proliferating tricholemmal tumour was made. This entity incorporates a spectrum of lesions, ranging from the mostly benign proliferating tricholemmal cyst …

White Coat Hypertension Is Not A Benign Entity: A Cross-Sectional Study At A Tertiary Care Hospital In Pakistan, Saniya Siraj Godil, Halima Tabani, Aamir Hameed Khan, Aysha Almas

Department of Medicine

Objectives: To determine the frequency of White Coat Hypertension in patients undergoing ambulatory blood pressure monitoring at a tertiary care center and to compare ambulatory blood pressure profiles of normotensives, white coat hypertensives and hypertensives.
Methods: A descriptive cross-sectional study was conducted which included all adult patients undergoing ambulatory blood pressure monitoring over a 3-year period. Those patients with incomplete data, less than 85% successful BP readings and inadequate number of daytime and nighttime readings were excluded from the study. The data on ambulatory blood pressure monitoring comprised of demographics, blood pressure, pulse pressure and mean arterial pressure readings at …

Preventable Lifestyle Risk Factors For Non-Communicable Diseases In The Pakistan Adolescents Schools Study 1 (Pass-1)., Ali Khan Khuwaja, Saleem Khawaja, Komal Motwani, Adeel Khoja, Iqbal Azam Syed, Zafar Fatmi, Badar Sabir Ali, Muhammad Masood Kadir

Department of Medicine

Objectives: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents.

Methods: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis.

Results: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% …

Hepatitis B Vaccination Rate And Determining Factors Amongst Health Care Workers At Aga Khan University Hospital, Nairobi, Herman Ekea

Master of Medicine in Internal Medicine

Aim: To determine Hepatitis B vaccination rate and determining factors for health care workers (HCWs) at AKUHN. Design: Cross sectional analytical study Study subjects and setting: Aga Khan University Hospital-Nairobi, is a 254 bed tertiary hospital, with 815 HCWs with occupational risk of infection with hepatitis B virus (HBV). The hospital has a HCW vaccination policy and vaccine available to HCWs as part of medical scheme Methodology: Two hundred and sixty six (266) eligible HCWs of all cadres were stratified then randomly recruited after giving informed consent. A questionnaire was then administered to assess knowledge, attitude and practice towards HBV …

The Influence Of Depression On Adherence To Antiretroviral Therapy Among Hiv Infected Patients At Aga Khan University Hospital (Nairobi), Evelyn W. Karanja-Mbugua

Master of Medicine in Internal Medicine

Aim: To determine the influence of depression on adherence to antiretroviral (ARV) therapy among HIV-infected patients. Design: Cross-sectional survey Patients: One hundred and forty HIV-positive patients on treatment with Combination Antiretroviral Therapy selected from the out-patient department of Aga Khan University Hospital took part in the survey. Methodology: Every third patient who was eligible was assessed for adherence to antiretroviral therapy using The Adult AIDS Clinical Trial Group follow up adherence questionnaire followed by screening for depression using the Patient Health Questionnaire 9. Pharmacy data was then retrieved for the same patients and used to assess adherence by the medication …

An Analysis Of The Clinical Practice Of Emergency Medicine In Public Emergency Centres In Kenya, Benjamin W. Wachira

Master of Medicine in Internal Medicine

Objectives: To describe the case mix, interventions, procedures and management of patients in public accident and emergency departments (A&Es) in Kenya. Methods: This was an observational study of patients who presented to 15 A&Es from 1 October to 31 December 2010. The study was conducted across Kenya in two national referral hospitals, five secondary level hospitals, and eight primary level hospitals. All patients presenting alive to the A&E during the 24 hour study period that were seen by a doctor or clinical officer were included in the study. A data collection form was completed by the primary investigator at the …

Peripheral Arterial Disease In Hiv Positive And Negative Subjects At The Aga Khan University Hospital, Nairobi, Farida Kaittany

Master of Medicine in Internal Medicine

Aim: To determine the prevalence of peripheral arterial disease (PAD) amongst HIV positive patients and HIV negative subjects and associated risk factors at Aga Khan Hospital Nairobi Design: Cross-sectional descriptive study Patients and Setting: A group of 125 HIV positive and 120 HIV negative subjects aged between 40 – 70 years were included in the study. HIV negative subjects were sampled from HIV positive patients attending the HIV outpatient clinic while HIV negative subjects were sampled from blood donor unit at theAga KhanUniversityHospital. Methodology: Two separate convenient samples were selected for the study. The first sample was a group of …

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 …

Severity Of Acute Hepatitis And Its Outcome In Patients With Dengue Fever In A Tertiary Care Hospital Karachi, Pakistan (South Asia), Om Parkash, Aysha Almas, Wasim Jafri, Saeed Hamid, J. Akhter, Syed H Shah

Department of Medicine

Background: Liver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC) and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications) between patients of Dengue who have mild/moderate (ALT 23-300 IU/L) v/s severe acute hepatitis (ALT > 300 IU/L).

Methods: A Cohort study of inpatients with dengue viral infection done at Aga Khan University Hospital Karachi. All patients (≥ 14 yrs age) admitted with diagnosis of Dengue …

Emergency Evaluation Of Acute Chest Pain., Aysha Almas, Om Parkash, Aamir Hameed, Muhammad Islam

Department of Medicine

Objective: To determine the sensitivity and specificity of initial clinical assessment about the diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain by a cardiology resident in the emergency room and assess the 30-day outcome of patients with ACS and non ACS.

Study Design: Cohort study.

Place and Duration of Study: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.

Methodology: A total of 202 patients, who presented to the emergency room with chest pain, were given an initial ECG and troponin check. Patients were assigned …

Future Prospects For The Utility Of Interferon Assays In Tuberculosis Diagnosis, Taimur Saleem, Madiha Syed, Bushra Jamil

Department of Medicine

No abstract provided.

H1n1 2009 In Karachi: A Situational Analysis, Bushra Jamil, Syed Faisal Mahmood

Department of Medicine

No abstract provided.

Molecular Confirmation Of The Causes Of Inherited Visual Impairment In Northern Pakistan, Mehreen Adhi, Yasmin Rashid, Syed Hussain Jafri, Chris F. Inglehearn, Martin Mc Kibbin

Department of Medicine

Families with inherited visual impairment were identified and examined from January 2000 to December 2005 and given a clinical diagnosis. Known genes and loci were screened for mutations or linkage at Institute of Ophthalmology and Neurosciences, University of Leeds, in order to provide molecular confirmation. Inherited retinal disease was the most common cause of inherited visual impairment in 38 of 57 families (66.6%) with Leber’s congenital amaurosis, rod-cone dystrophy and cone-rod dystrophy being the most common diagnoses in 22, 8 and 3 families respectively. Anterior segment dysgenesis was diagnosed in 8 families (14%). Mutations in known genes or linkage to …

Paroxysmal Atrial Fibrillation Presenting As Anterior Wall Stemi In An Elderly Woman, Muhammad Asim Shabbir, Muhammad Hamza Saad Shaukat, Lance Sullenberge, Mikhail Torosof

Section of Internal Medicine

A 77-year-old woman without traditional risk factors for coronary artery disease (CAD) underwent coronary CT-angiography for evaluation of palpitations after negative Holter monitoring and non-diagnostic ECG exercise stress test. Coronary artery calcium score was reported zero; 1 day later, she was admitted with anterior-wall ST elevation myocardial infarction. Acute left anterior descending artery thrombus was treated with mechanical thrombectomy and Percutaneous Coronary Intervention (PCI). Interestingly, the coronary arteries were angiographically normal. During hospitalisation, paroxysmal atrial fibrillation was noted followed by initiation of anticoagulation. Echocardiogram did not show thrombus or atrial shunt. Cardioversion with Sotalol was successful. Myocardial infraction was most …

Risk Of Contrast Induced Nephropathy In Hiv Patients Receiving Radiographic Contrast At Three Aga Khan Hospitals, Sitna A. Mwanzi

Master of Medicine in Internal Medicine

Aim: To study the influence of HIV infection on the development of contrast induced nephropathy in patients receiving radio contrast material Design: Prospective cohort study Patients and setting:One hundred and twenty five (125) HIV positive patients and one hundred and fifty five (155) HIV negative patients selected from in and out patient departments of the Aga Khan University Hospital, Nairobi and Aga Khan Hospitals in Mombasa and Kisumu, were evaluated for the study between August 2008 and August 2009. Methodology: Eligible patients undergoing radiological evaluation requiring the use of radio contrast material were consecutively recruited for the study after which …

Clinical Profile And Outcome Of Infective Endocarditis At The Aga Khan University Hospital, M. Tariq, Bilal Karim Siddiqui, Atif Jadoon, Mahboob Alam, Sohail Abrar Khan, Mehnaz Atiq, Raymond A Smego

Section of Internal Medicine

Background: The spectrum of infective endocarditis (IE) is significantly different in developed and developing countries. The present study was conducted to study the clinical profile and outcome of infective endocarditis in Pakistan.
Methods: A descriptive cross-sectional study with review of medical records for 188 patients admitted to our teaching hospital with a diagnosis of IE from January 1988 to December 2001. One hundred fifty-nine subjects fulfilled the modified Duke diagnostic criteria.
Results: Definite IE was found in 59.7% (95/159) patients, while the rest had possible IE. One-third of subjects had acute IE 55/159 (34.5%). Subacute IE was found in …

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 …

A Randomised Comparative Clinical Trial Of Prokinetic Agents And Proton Pump Inhibitors In H. Pylori Negative Non-Ulcer Dyspepsia, Mzee Ngunga

Master of Medicine in Internal Medicine

Aim: To compare the efficacy of prokinetic agents and proton pump inhibitors in symptom relief of patients with non-ulcer dyspepsia. Design: Comparative prospective single blind clinical trial. Patients and setting: Fifty four cases of non-ulcer dyspepsia in whom H. pylori has been eradicated were seen in the specialist gastroenterology clinic of a tertiary care hospital. Methodology: Patients with dyspepsia and negative endoscopy for peptic ulcer disease, gastro-oesophageal reflux disease, hiatus hernia and upper gastrointestinal malignancy in whom H pylori has been eradicated but still had dyspepsia were assessed and scored using the modified Glasgow dyspepsia severity score (GDSS) at baseline. …

Prevalence, Risk Factors And Outcome Of Acute Kidney Injury At The Aga Khan University Hospital Nairobi, Peter W. Munyu

Master of Medicine in Internal Medicine

Introduction: Acute kidney failure (acute kidney injury, AKI) is a group of syndromes that result in a decline in the glomerular filtration rate. In 2002, the Acute Dialysis Quality Initiative (ADQI) group proposed the RIFLE criteria to standardize the definitions of AKI severity and outcome. This criterion has been validated in several studies. AKI is frequently encountered in hospitalized patients; it has a negative impact on mortality and morbidity. A lot of work has been done to describe the epidemiology of AKI in developed countries. The same does not apply for developing countries. This study was designed to evaluate AKI …

Infective Endocarditis In Patients With Congenitally Malformed Hearts: Characterization Of The Syndrome In A Developing Country, Bilal K. Siddiqu, M. Tariq, Atif Jadoon, Ghulam Murtaza, Asim Syed, M. Bilal Abid, Maria Qamaruddin, Mehnaz Atiq, Raymond A. Smego

Section of Internal Medicine

Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world’s population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi.

We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004.

We identified 48 patients with endocarditis according to the modified Duke Criterions, with just …

Poor Glycaemic Control Is The Major Factor Associated With Increased Frequency Of Gastrointestinal Symptoms In Patients With Diabetes Mellitus, Shahab Abid, Wasim Jafri, Firdous Jahan, Fauziah Rabbani, Najmul Islam, Masood H. Khan, Rana Masood

Department of Medicine

Objective:To compare the GI symptoms in diabetic patients with controls and its relationship with the complications, duration of diabetes and glycaemic control. Methods:Consecutive patients were prospectively enrolled in to two groups. Group I (diabetic patients) and Group II (non-diabetic, Controls). Patient's characteristics, demographic profiles and GI symptoms were evaluated on a questionnaire. Groups were compared for differences in various GI symptoms. Group I was further analyzed for the relationship between GI symptoms with complications, duration of diabetes andglycaemic control.
Results:Atotal of 514 patients were enrolled 250 were diabetics (group I) and 264 were non-diabetics (groupII). Mean age …

Spectrum Of Neurological Involvement In Adult Patients With Bacterial Endocarditis, Faisal Wasim Ismail, Muhammad Tariq, Mahboob Alam, Raymond A Smego

Section of Internal Medicine

Objective: To describe the spectrum of neurological involvement, and document in-hospital mortality in adult patients with bacterial endocarditis.
Design: Descriptive, non-interventional.
Place and duration of study: Department of Gastroenterology, The Aga Khan University Hospital, Karachi from November 1999 to October 2002.
Patients and methods: Patients were enrolled from the emergency and outpatient departments, using purposive, non-probability sampling, provided they fulfilled pre-defined inclusion and exclusion criteria. Case records of patients admitted to hospital with a diagnosis of bacterial endocarditis were prospectively analyzed. Data was entered and analyzed on SPSS 11. Frequency, Mean, Mode and Percentage were calculated.
Results: Neurological complications were …

Spectrum And Outcome Of Infections In Systemic Lupus Erythematosus Patients, Bushra Jamil, Sobia Rafi, Hammad Hussain, Khizar Hameed

Department of Medicine

No abstract provided.

Characteristics Of Patients With Guillain Barre Syndrome At A Tertiary Care Centre In Pakistan, 1995-2003, Mohammad Yawar Yakoob, Aisha Rahman, Bushra Jamil, Nadir Ali Syed

Department of Medicine

Objective: To study the clinical presentation, hospital course and outcome of patients admitted with Guillain Barre Syndrome (GBS) to a tertiary care hospital in Karachi, Pakistan.
Methods: The charts of patients conforming to International Classification of Diseases (ICD) code 9.0, for GBS, from September 1995 to January 2003 were reviewed. Clinical data was recorded on a standardized questionnaire, which included patients' age, sex, antecedent events, neurological signs and symptoms and ventilation requirement. The hospital course was analyzed, including nosocomial infections, therapy given and the functional status of patients, using the Rankin scale (0-6). Standard SPSS 11.5 software (Windows) …