Internal Medicine Commons^™

Ischemic Strokes: Observations From A Hospital Based Stroke Registry In Bangladesh., Nirmalenduk Bikash Bhowmik, Aamir Abbas, Mohammad Saifuddin, Md. Rashedul Islam, Rumana Habib, Aminur Rahman, Md. Amirul Haque,, Zahid Hassan, Mohammad Wasay

Department of Medicine

Background. Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh. Methods. Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded. Results. Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected …

Translating Knowledge For Action Against Stroke--Using 5-Minute Videos For Stroke Survivors And Caregivers To Improve Post-Stroke Outcomes: Study Protocol For A Randomized Controlled Trial (Movies4stroke)., Ayeesha Kamran Kamal, Adeel Khoja, Bushra Usmani, Nargis Asad, Asma Ahmed, Iqbal Azam, Sarah Saleem, Saleem Sayani

Department of Medicine

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.

Methods: Movies4Stroke will be a randomized control, outcome assessor …

A Rare Cause Of Recurrent Wheeze And Seizures., Maryam Hassan,, Saher Quraeshi, Ali Bin Sarwar Zubairi

Department of Medicine

A 34-year-old woman presented with recurrent attacks of breathlessness and seizures. The patient's condition worsened during the course of her hospital stay, as a result of which she had to be intubated twice. Radiological studies showed a mass in the trachea and the subsequent biopsy of the mass revealed an infiltrating carcinoma with morphological features of adenoid cystic carcinoma.

Effect Of Nutritional Deficiency On The Efficacy Of The Polio Vaccines In Pakistan., Aamir Abbas, Romaina Iqbal

Department of Medicine

No abstract provided.

Severity Of Depression, Anxious Distress And The Risk Of Cardiovascular Disease In A Swedish Population-Based Cohort., Aysha Almas, Yvonne Forsell,, Romaina Iqbal, Imre Janszky,, Jette Moller

Department of Medicine

Background: Depression is known to be associated with cardiovascular diseases (CVD). This population-based cohort study aimed to determine the association between depression of varying severity and risk for CVD and to study the effect of concomitant anxious distress on this association.

Methods: We utilized data from a longitudinal cohort study of mental health, work and relations among adults (20–64 years), with a total of 10,443 individuals. Depression and anxious distress were assessed using psychiatric rating scales and defined according to DSM-5. Outcomes were register-based and self-reported cardiovascular diseases.

Findings: Overall increased odds ratios of 1.5 to 2.6 were seen …

Abuse Among School Going Adolescents In Three Major Cities Of Pakistan: Is It Associated With School Performances And Mood Disorders?, Saleem Khawaja, Adeel Khoja, Komal Motwani

Department of Medicine

Objective: To assess the proportion of various types of abuses and their association with school performances and psychological stress among adolescents from three major cities of Pakistan.

Methods: The cross-sectional school survey was conducted from March to September 2009, comprising adolescent students at six schools in Karachi, Lahore and Quetta. Data was collected using a self-administered and pre-tested questionnaire by trained medical students. SPSS 16 was used for statistical analysis..

Results: Of the 414 subjects in the study, there were 223(54%) boys and 191(46%) girls with an overall mean age of 14.36 ±1.08 years. In all, 140(33.7%) participants were physically …

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 …

New Onset Refractory Status Epilepticus As An Unusual Presentation Of A Suspected Organophosphate Poisoning, Shahan Waheed, Amber Sabeen, Nadeem Ullah Khan

Department of Medicine

New onset refractory status epilepticus (NORSE) is a new entity in medical literature. It has different infectious and noninfectious etiologies showing a devastating impact onto the clinical outcome of patients. Therapy with anaesthetic and antiepileptic agents often fails to improve the condition, unless the primary cause is rectified. Here is presented the case of a young female with a history of depression who after a recent bereavement came to the Emergency Department of Aga Khan University Hospital with complaints of drowsiness that lasted for few hours. Though she had no history of organophosphate poisoning, her physical examination and further investigations …

Effects Of Polypharmacy On Adverse Drug Reactions Among Geriatric Outpatients At A Tertiary Care Hospital In Karachi: A Prospective Cohort Study., Bilal Ahmed, Kashmira Nanji, Rakshinda Mujeeb, Muhammad Junaid Patel

Department of Medicine

Background: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication’’. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center.

Methods: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University …

Diuretic Induced Hyponatremia In Hypertensive Patients., Aysha Almas, Nayla Ahmed, Fareed Khawaja, Aamir Hameed

Department of Medicine

Diuretics are the recommended antihypertensive by several international guidelines. This study was designed to determine the association of hyponatremia in hypertensive patients on diuretic therapy. This was a case control study conducted at the Aga KhanUniversity Hospital, Karachi in adult inpatients (> 18 years) who were known hypertensive. Cases were defined as hypertensives with hyponatremia and controls were defined as hypertensives without hyponatremia. Outcome was hyponatremia. Exposed were those using diuretics. Out of 1800 hypertensive patients sampled by the ICD-9-Coding; 1191 (66%) fulfilled the inclusion criteria. Cases n (%) were 553 (46.4) and controls were 638 (53.5). Among 553 cases …

Hypertensive Crisis, Burden, Management, And Outcome At A Tertiary Care Center In Karachi, Aysha Almas, Ayaz Ghouse, Ahmed Raza Iftikhar, Munawar Khursheed

Department of Medicine

Objectives:. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi.
Methods: This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included.
Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) …

Clinical, Lifestyle, Socioeconomic Determinants And Rate Of Asymptomatic Intracranial Atherosclerosis In Stroke Free Pakistanis., Ayeesha Kamran Kamal, Farzin Majeed, Omrana Pasha, Hasan Rehman, Muhammad Islam, Iqbal Azam Syed, Muhammad Saleem Ilyas, Munawar Hussain, Kamran Masood, Bilal Ahmed, Sumaira Nazir, Zafar Sajjad, Scott E. Kasner

Department of Medicine

Background: Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region.

Methods: The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used …

Mechanical Thrombectomy Versus Intrasinus Thrombolysis For Cerebral Venous Sinus Thrombosis: A Non-Randomized Comparison., Fazeel M. Siddiqui, Chirantan Banerje, Susanna M. Zuurbier, Qing Hao, Chul Ahn, Glenn L. Prid, Mohammad Wasay, Charles B.L.M. . Majoie, David Liebeskind, ,Mark Johnson, Jan Stam

Department of Medicine

Small retrospective studies have shown the benefit of endovascular treatment with intrasinus thrombolysis (IST) or mechanical thrombectomy (MT) with/without IST (MT ± IST) in cases of multifocal cerebral venous thrombosis (CVT). Our study compares the mortality, functional outcome and periprocedural complications among patients treated with MT ± IST versus IST alone. We reviewed clinical and angiographic findings of 63 patients with CVT who received endovascular treatment at three tertiary care centers. Primary outcome variables were discharge mortality and neurological dysfunction, and intermediate (three months) and long-term (>six months) morbidity. The modified Rankin scale (mRS) was used to assess morbidity. …

Nanotechnology And Its Implication In Medical Science, Syed Ahsan Ali, M. Tariq

Department of Medicine

No abstract provided.

Clinical Reasoning And Dual Mental Processing In Diagnostic Competence., M. Tariq, Syed Ahsan Ali

Department of Medicine

No abstract provided.

Illuminating The Dark Side--Vitamin D Status In Different Localities Of Karachi, Romaina Iqbal, Lena Jafri, Ali Haroon, Aysha Habib Khan

Department of Medicine

This study was conducted to determine the association between place of residence (grouped into neighbourhoods), and 25-hydroxy D (25[OH]D) levels of individuals of Karachi. Addresses of 4788 individuals tested for 25[OH]D at the clinical laboratory of the Aga Khan University (AKU), Karachi, from January 2007 to June 2008 were reviewed. The neighbourhoods were categorized into ten, based on locality attributes. A high overall prevalence (74%) of vitamin D deficiency (VDD) was observed. There was a significant difference (p-value < 0.01) between mean log 25[OH]D levels amongst neighbourhoods grouped according to distinct housing structure attributes and localities. A high frequency of VDD in all the studied localities of an urban city warrant dietary vitamin D supplementation and food fortification.

Self-Perceived Health Among School Going Adolescents In Pakistan: Influence Of Individual, Parental And Life Style Factors?, Asad Ali Khan Afridi, Komal Motwani, Saleem Khawaja, Adeel Khoja, Zafar Fatmi, Iqbal Azam Syed, Muhammad Masood Kadir

Department of Medicine

BACKGROUND: Adolescents are at substantial risk of acquiring behaviors which might influence their health status. This study was aimed to assess the proportion of school going adolescents (both males and females) with poor self-perceived health and its associated factors.

METHODOLOGY: A cross-sectional study was conducted in three major cities of Pakistan i.e. Karachi, Lahore and Quetta. From each city, six (6) secondary schools were randomly selected (3 public and 3 private). Pre-tested, self-administered questionnaire was distributed to students. Binary logistic regression analysis was conducted to determine independent factors associated with poor self-perceived health.

RESULTS: Approximately 29% adolescents (119/414) reported poor …

Unintentional Childhood Poisoning, Epidemiology And Strategies For The Prevention And Policy Change In Pakistan, Omer Ul Hassan, Hasana Qadri, Umer Mir, Bilal Ahmed

Department of Medicine

Poisoning is the fifth leading cause of unintentional injuries among young children. Agents most commonly ingested by young children include medicines, cleaning substances, hydrocarbons, pesticides and cosmetics. Children with less educated fathers, living in more crowded conditions and from lower income families are more predisposed to unintentional poisoning. Unsafe storage of medicines, chemicals and other hazardous substances is one of the leading reasons for childhood poisoning. Knowledge of parents and caregivers about prevention of poisoning may be the basis to prevent subsequent injuries. This paper is a review of the epidemiology of unintentional poisonings among young children (less than five …

Patients' Insight Of Interpreting Prescriptions And Drug Labels--A Cross Sectional Study., Muhammad Junaid Patel, Muhammad Shoaib Khan, Farheen Ali, Zehra Kazmi, Safia Awan, Ayesha Sorathia

Department of Medicine

Background: Errors in consuming drugs are associated with significant morbidity and mortality, besides an impact on the already overburdened health-care system. Misunderstanding drug labels and prescriptions plays an important role in contributing to adverse drug events.

Objective: To evaluate abilities to understand prescriptions and drug labels among patients attending tertiary care hospital in Karachi.

Methods: A cross sectional study was conducted at the Aga Khan University Hospital (AKUH), from January to March 2009. After informed consent, 181 adult patients and their healthy attendants were interviewed at AKUH using a standardized questionnaire, which ascertained patient demographics, factors that might increase exposure …

Mers-Cov - Are We On The Verge Of A Pandemic?, Bushra Jamil, Kiren Habib

Department of Medicine

No abstract provided.

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”. …

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

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 …

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% …

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.