Pulmonology Commons^™

Cardiac Tamponade After Removal Of Temporary Pace Maker In Multidiscipinary Intensive Care Unit, Muhammad Faisal Khan, Ali Bin Sarwar Zubairi

Department of Medicine

Cardiac tamponade is a medical and surgical emergency, which needs early recognition and treatment. Myocardial perforation leading to cardiac tamponade is a rare complication after pace maker insertion. We are reporting a case of cardiac tamponade after removal of temporary pace maker in a multidisciplinary intensive care unit.

Longitudinal Association Of Sleep-Disordered Breathing And Nondipping Of Nocturnal Blood Pressure In The Wisconsin Sleep Cohort Study, Khin Mae Hla, Terry Young, Laurel Finn, Paul E. Peppard, Mariana Szklo-Coxe, Maryan Stubbs

Community & Environmental Health Faculty Publications

Study objectives: The association of sleep-disordered breathing (SDB) and blunting of normal nocturnal lowering of blood pressure (BP) (nondipping) has only been examined cross-sectionally. The purpose of this study is to investigate whether SDB is prospectively associated with nondipping.

Methods: The longitudinal association between SDB and incident nondipping was examined in a subsample of 328 adults enrolled in the Wisconsin Sleep Cohort Study who completed 2 or more 24-hour ambulatory BP studies over an average of 7.2 years of follow-up. SDB identified by baseline in-laboratory polysomnography was defined by apnea-hypopnea index (AHI) categories. Systolic and diastolic nondipping was defined by …

Lung-Derived Macrophage Migration Inhibitory Factor In Adult Patients With Septic Shock, And Its Role In Cardiocirculatory Depression, Hans Lee, Kaie Ojamaa, Greg Ruskin, Erfan Hussain, Maowen Hu, Xinchun Lin, Christine Metz, Yousef Al-Abed, Edmund Mille

Department of Medicine

Migration inhibitory factor (MIF), a critical proinflammatory mediator in sepsis, has a profound affect on cardiovascular function. Our animal studies show that the lungs release MIF into the systemic circulation during late sepsis. MIF released in this way has direct and immediate access to cardiac cells. The purpose of our study was to assess the lung as a source of MIF in human septic shock patients and to further study the MIF-associated pathways involved in cardiovascular depression.

Bleomycin Induced Pneumonitis: A Case Successfully Managed With High-Dose Steroids, Shahid Javed Husain, Ali Bin Sarwar Zubairi, Muhammad Irfan

Department of Medicine

No abstract provided.

Reducing Lung Disease In Cystic Fibrosis: Model Systems And Anti-Inflammatory Treatment, Scotty Mcglothlin Buff

MUSC Theses and Dissertations

Cystic fibrosis (CF), the most common lethal autosomal recessive disease in Caucasians resulting in a median life span of approximately 35 years, is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). The primary cause of morbidity and mortality is respiratory failure caused by progressive obstructive lung disease. CF airway disease is characterized by the abundance of pro inflammatory cells, chemokines and cytokines with a deficiency of regulatory/anti-inflammatory cytokine interleukin 10 (lL10). We hypothesized that CF airway obstruction originates from excessive inflammation and gene transfer of IL-I0 would decrease inflammation in the airways of mice infected with Pseudomonas …

Chest Radiographs In Acute Pulmonary Embolism, Ali Bin Sarwar Zubairi, Shahid Javed Husain, Muhammad Irfan, Kulsoom Fatima, Muhammad Atif Zubairi, Muhammad Islam

Department of Medicine

Background: Pulmonary embolism (PE) is a serious clinical entity carrying significant morbidity and mortality. Clinically, it is a difficult condition to diagnose and remains under treated condition in Pakistan due to non-availability of objective tests and lack of awareness among physicians. This study was conducted to determine the chest radiographic presentation in known cases of acute PE presenting to a tertiary care hospital.
Methods: Hospital records of patients with a diagnosis of acute PE were reviewed from June 2000 until June 2004. Fifty diagnosed cases of acute PE on Spiral Computed tomography (CT) of the chest demonstrating an intraluminal-filling defect …

Secondary Surfactant Dysfunction And Deficiency, Robin Louise Bissinger

MUSC Theses and Dissertations

Based on literature in Adult Respiratory Distress Syndrome in humans and evidence of surfactant activation in vitro and vivo, and our clinical observations of secondary respiratory decompensation in premature infancies recovering from RDS, a study was designed to look at the possibility of benefit from secondary surfactant administration in premature infancies with secondary decompensation after recovery from respiratory distress syndrome (RDS). A prospective pilot study was performed to study the effects of secondary surfactant administration on oxygenation, ventilation and pulmonary function of neonates who had respiratory decompensation after recovery from RDS. A secondary data analysis was performed looking at pulmonary …

Clinical Characteristics Of Pulmonary Tuberculosis In Adult Pakistani Patients With Co-Existing Diabetes Mellitus, A Jabbar, S F. Hussain, A A. Khan

Section of Pulmonary & Critical Care

A review was made of the records of all patients with pulmonary tuberculosis and diabetes mellitus admitted over a 5-year period to a teaching hospital in Karachi, Pakistan. Among 42358 patients, the total number with both tuberculosis and diabetes was 173. The prevalence of tuberculosis in diabetic patients was 10-times higher than in non-diabetic patients and prevalence increased with duration of diabetes. The lower lung field was most frequently involved, followed by the upper and middle. Bilateral involvement was seen in half and an associated pleural effusion in one-third of the patients. Cavitating lesions were seen in 32% of men …

Foreign Body Aspiration In Adults., Ali Bin Sarwar Zubairi, Haque A. S, Husain S. J, Javaid Khan

Department of Medicine

Foreign body aspiration is not an uncommon problem, particularly in children, the elderly, and those with predisposing factors like neurological impairment. In adults, regional differences exist in the type of foreign body aspirated. We report four cases of foreign body aspiration in South Asian adults, three of which were related to the widespread habit of chewing stimulant seeds such as betel nuts (two) and tamarind seed (one). It is important for clinicians to maintain a high index of suspicion for the diagnosis of foreign body inhalation in the appropriate clinical setting. Bronchoscopy is necessary not only for the diagnosis but …

Trends In Hospital-Based Management Of Acute Asthma From A Teaching Hospital In South Asia., S F. Hussain, M D. Omar, H. Ari, S .R. Sameeruddin, Ali Bin Sarwar Zubairi, Javaid Khan

Department of Medicine

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved …

A Case Of Non-Resolving Cough And Weight Loss., Omer Ashraf, Ali Bin Sarwar Zubairi, Fawad Aslam, Kashif Ashraf, Suhail Muzaffar

Department of Medicine

Sarcoidosis is a chronic granulomatous multi-system disease with a clinical picture often mimicking tuberculosis. We present a case of a patient who presented with a clinical picture akin to both of these granulomatous disorders and was started on anti-tuberculous regimen despite the lack of any solid evidence pointing towards tuberculosis. As a result her clinical condition continued to deteriorate for months until finally a bronchoscopic biopsy established her disease process as sarcoidosis. She was then started on systemic corticosteroid therapy for sarcoidosis and during the ensuing period has shown marked improvement in her clinical picture with near normalization of the …

Systemic Lupus Erythematosus Presenting As Hemolytic Uremic Syndrome: A Case Report, Malik Anas Rabbani, Bushra Ahmad, Sabeen Fatima Mekan, Suhail Muzaffar, Syed Sohail Ali

Section of Pulmonary & Critical Care

Associating systemic lupus erythematosus (SLE), with an initial presentation of hemolytic uremic syndrome (HUS) is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general …

Smoking Prevalence, Knowledge And Attitudes Among Medical Students In Karachi, Pakistan, F M. Khan, S J. Husain, A Laeeq, A Awais, S F. Hussain, J A. Khan

Section of Pulmonary & Critical Care

A survey of smoking prevalence and attitudes was made among medical students randomly selected from classes at the Aga Khan University, Karachi, Pakistan. Of 271 respondents, 14.4% were current smokers (22.0% male and 3.8% females) and 3.3% ex-smokers. A majority of students recognized the dangers associated with active as well as passive smoking although only 55% of current smokers planned to quit in the near future. Most smokers (96%) believed that they as well as other health professionals needed training on smoking cessation and 95% of all students believed that doctors should play a role model in smoking cessation by …

On The Utility Of Stochastic Models Of Chronic Obstructive Pulmonary Disease, Rebecca Boehm

MUSC Theses and Dissertations

Chronic obstructive pulmonary disease (COPD) is a progressive and irreversible lung disease characterized by reduced lung function, abnormal inflammatory response, dyspnea, increased sputum production, and costly and debilitating exacerbations. Common treatments for COPD include smoking cessation therapy, short- and long-acting bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, and home oxygen therapy. However, a recent meta-analysis demonstrated that inhaled corticosteroids fail to slow the decline in FEV1, the primary clinical marker of COPD progression. In addition, some evidence exists to suggest that long-term inhaled corticosteroid use may increase bone density loss, leading to osteoporosis. Given that the bone health effects of inhaled corticosteroid …

Cardiogenic Shock After Dipyridamole Administration For Myocardial Perfusion Imaging, Fahim H. Jafary, Nageeb Basir, Adnan Amin, Nasiruddin Ahmed

Section of Cardiology

No abstract provided.

Patterns Of Tuberculosis In The Central Nervous System, Soobia Raza, Aliyah Sadaf, Faisal Fecto, Rushna Pervez Ali, Muhammad Ehsan Bari, Ather Enam

Medical College Documents

Tuberculous involvement of central nervous system (CNS), although not very frequent, results in severe morbidity. Tuberculosis (TB) is endemic in developing countries but even in developed countries, after an initial decline up until 1980’s, incidence of TB is on the rise. The AIDS epidemic, emergence of multi-drug resistant strains and immigration of people from endemic areas are some of the factors significantly contributing to this increase. Consequently, the burden of central nervous system tuberculosis has increased significantly worldwide.

Bronchiolitis Obliterans Organizing Pneumonia Associated With Cytomegalovirus Infection In A Patient With Systemic Lupus Erythematosus., Muhammad Irfan, Ali Bin Sarwar Zubairi, S.J. Husain

Department of Medicine

No abstract provided.

Severe Hypercalcemia In Tuberculosis, A Soofi, A Malik, J Khan, S Muzaffar

Section of Pulmonary & Critical Care

No abstract provided.

Treatment Failure Of Tuberculosis Due To Concomitant Pathology, Z A. Qasim, A R. Sarwari, S M. Jilani

Section of Pulmonary & Critical Care

No abstract provided.

Tuberculosis Diagnosis And Treatment Practices Of Private Physicians In Karachi, Pakistan, J Khan, A Malik, H Hussain, N K. Ali, F Akbani, S J. Hussain, G N. Kazi, S F. Hussain

Section of Pulmonary & Critical Care

In a densely populated urban area of Karachi, Pakistan, a questionnaire survey was made of the knowledge and practices of 120 private general practitioners about the diagnosis and treatment of tuberculosis (TB). The majority knew that cough, fever and weight loss were the main symptoms of TB, but less than half knew that blood in sputum, poor appetite and chest pain were associated with the disease. Only 58.3% of physicians used sputum microscopy for diagnosing TB and 35.0% used it as a follow-up test. Only 41.7% treated TB patients themselves, the remaining referring their patients to specialists. Around 73.3% of …

General Physicians' Perspective Of Sleep Apnea From A Developing Country, Syed Fayyaz Hussain, Sumaiya Zahid, Raana Haqqee, Javaid Ahmed Khan

Section of Pulmonary & Critical Care

To assess the knowledge of general physicians about the diagnosis and management of obstructive sleep apnea (OSA), a self-administered questionnaire, containing 15 questions, was distributed to 160 doctors attending a pulmonary CME program in March 2002. After 15 minutes of response time, the questionnaires were collected. The data were entered and analyzed using SPSS (Version 10.0) software. One hundred and twenty (75%) questionnaires were returned. Only 41% of responders had ever read an article about OSA and 36% had suspected it at least once in their practice. The majority (61-77%) of responders were aware of the common symptoms of OSA, …

A Hospital Based Preliminary Report On Sleep Disordered Breathing In Pakistani Population, R Haqqee, S F. Hussain, M Mujib, H R. Ahmad

Section of Pulmonary & Critical Care

Background: Sleep Disordered Breathing is an important medical condition leading to significant morbidity and mortality. Western studies have shown its prevalence in middle age to be 9% in women and 24% in men. The aim of this study was to have a preliminary assessment on the frequency of Sleep Disordered Breathing in Pakistani subjects.

METHOD: Patients attending a medical clinic were surveyed. A sleep questionnaire elicited information about snoring, witnessed apnea, nocturnal choking and excessive daytime sleepiness. Data were recorded for age, height, collar size and weight. Epworth Sleepiness Scale was used to assess excessive daytime sleepiness. Statistical analysis …

Disseminated Bipolaris Infection In An Immunocompetent Host: An Atypical Presentation, J A. Khan, S T. Hussain, S Hasan, P Mcevoy, A Sarwari

Section of Pulmonary & Critical Care

No abstract provided.

Postprandial Glucose Response To Mango, Banana And Sapota, Z Contractor, F Hussain, A Jabbar

Section of Pulmonary & Critical Care

Objective: Mango and Sapota are two fruits indigenous to Indian subcontinent. The objective of this study was to evaluate postprandial blood glucose response to mango and sapota in comparison to banana in patients with diabetes mellitus Type 2.METHOD: The plasma glucose response to mango, sapota and banana were determined in ten diabetic patients. Blood was tested at 0, 30, 60, 120 and 180 minutes following the ingestion of test meal.Results: The results showed that the blood glucose response to these three fruits was not different in terms of area under the curve and postprandial change in blood glucose from baseline.CONCLUSION: …

Why Physicians And Lay People Smoke And How Can It Be Reduced?, S B. Memon, A M. Memon

Section of Pulmonary & Critical Care

Objective: The objective of this study was to find out the level of knowledge the physicians and lay people have pertaining to the effect of cigarettes, why certain physicians smoke and what measures could be applied to reduce the rate of smoking.

Methods: A questionnaire was administered to the one hundred physicians who smoke, one hundred non-smoking physicians and one hundred lay people who smoke to determine their attitude towards this addition. Subjects were chosen using convenience sampling. The physicians were picked from six hospitals of Karachi.

Results: When the smoking physicians were asked what could motivate them …

Role Of Fibreoptic Bronchoscopy In The Management Of Immunocompromised Patients With Pulmonary Infiltrates, S F. Hussain, I Malik, J A. Khan

Section of Pulmonary & Critical Care

Immunocompromised patients are prone to develop various pulmonary complications. The range of diagnostic possibilities is wide, infection being the commonest cause. Non-invasive diagnostic tests are often unrewarding. In this study, we have evaluated the diagnostic efficacy and safety of fibreoptic bronchoscopy in immunocompromised patients with pulmonary infiltrates. Patients tolerated the procedure well. This technique identified the etiology in up tp 75% of cases. After treatment based on the result of bronchoscopy, 63% patients improved and were discharged.

Tuberculosis Presenting As Polyarthritis, J A. Khan, M Y. Ahmadani

Section of Pulmonary & Critical Care

No abstract provided.

Immunopathogenesis Of A Spectrum Of Inflammatory Lung Diseases Induced By Experimental Reovirus Infection, Stephen Clifford Bellum

MUSC Theses and Dissertations

Inflammatory lung diseases cause a significant amount of morbidity and mortality. However, the mechanisms that control the initiation and resolution of pulmonary inflammatory responses have not been well-elucidated. Histopathological data suggests that the lung responds with a similar pattern of inflammation to diverse range of injurious stimuli. In order to investigate the immunopathogenesis of lung inflammation, a series of in vivo models of lung inflammation were generated in CBA/J and CD-I mice by respiratory reovirus 1/L infection. Using this approach, it was observed in CBA/J mice that a relatively low titer of reovirus 1/L induced a pattern of intraluminal fibrosis …

Dyslipidemia And Its Relation With Body Mass Index Versus Waist Hip Ratio, A Jabbar, A Irfanullah, J Akhter, Y K. Mirza

Section of Pulmonary & Critical Care

To study the magnitude of dyslipidemia in asymptomatic subjects and its relation to body mass index (BMI) and waist-hip-ratio (WHR), 88 subjects attending the health analysis programme were examined and their age, sex, BMI, WHR, fasting blood glucose and lipids were measured. The distribution of the lipid levels and the frequency of dyslipidemia were noted. Forty-eight percent had a total cholesterol of > 200 mg/dl and 50% had an HDL-cholesterol of < 40 mg/dl. On comparing the means of total cholesterol to BMI and WHR, it was found that total cholesterol level was statistically significant for WHR above and below 0.9 for males and 0.8 for females, whereas not so for BMI above and below 27 kg/m2. The prevalence of dyslipidemia in asymptomatic people in this group emphasizes the need for routine health screening for early institution of preventive measures. The correlation with WHR rather than BMI points towards importance of measuring parameters of central obesity rather than body weight and height only.

Renal Tubular Acidosis With Muscle Paralysis, A M. Nagaria, A Jabbar, J A. Khan

Section of Pulmonary & Critical Care

No abstract provided.