Radiology Commons^™

Identifying Differences: A Key Step In Precision Cardiovascular Disease Prevention, Mahmoud Al Rifai, Salim S. Virani, Vijay Nambi

Office of the Provost

No abstract provided.

The Impact Of Delayed Surgical Care On Patient Outcomes With Alimentary Tract Perforation: Insight From A Low-Middle Income Country, Hasnain Zafar, Taha Ahmad Zaka-Ur-Rehman, Muhammad Sohaib Khan, Shayan Ahmed, Amir Hafeez Shariff

Section of General Surgery

Introduction: In-patient delay is associated with increased mortality in patients with alimentary tract perforations. Access to surgical care is a glaring health issue in low-middle income countries (LMICs), where patient presentation is also delayed for a myriad of reasons, which can be broadly categorized as social/cultural, financial, and structural in their nature. The impact these delays have on surgical outcomes in low-middle income countries is not known.
Methods: A retrospective cohort study of patients who underwent emergency laparotomy for alimentary tract perforation from July 2015 to June 2018 was conducted at a tertiary care hospital in Karachi, Pakistan. Time was …

Association Between Social Vulnerability Index And Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study, Vardhmaan Jain, Mahmoud Al Rifai, Safi U. Khan, Safi U. Khan, Ankur Kalra, Fatima Rodriguez, Zainab Samad, Yashashwi Pokharel, Arunima Misra, Laurence S. Sperling

Section of Cardiology

Background Social and environmental factors play an important role in the rising health care burden of cardiovascular disease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemployment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and …

Cardiac Magnetic Resonance Features And Outcomes Of Patients With Non-Compaction Cardiomyopathy - A Retrospective Follow-Up From Pakistan, Pirbhat Shams, Fateh Ali Tipoo Sultan

Section of Cardiology

Background: The exact prevalence of left ventricle non-compaction cardiomyopathy (LVNC) in south Asians is not known and phenotypic CMR characteristics, clinical features, and outcomes of LVNC remain unknown for the SA population.
Objective: To evaluate clinical characteristics, cardiac magnetic resonance imaging features, and outcomes of patients with left ventricle non-compaction.
Methods: This was a retrospective study of 294 patients undergoing cardiac MRI (CMR) for evaluation of cardiomyopathy from 2011 to 2020. Patients were stratified based on the presence or absence of left ventricle non-compaction (LVNC). Clinical characteristics, CMR features, and outcomes were evaluated.
Results: Out of 294 patients, 18 patients …

Barriers To Care For Poststroke Visual Deficits In Alberta, Canada, Kiran Pohar Manhas, Karim F. Damji, Katelyn Brehon, Jennis Jiang, Peter Faris, Fiona Costello

Department of Ophthalmology & Visual Sciences

Poststroke visual impairment (VI) negatively affects rehabilitation potential and quality of life for stroke survivors. In this cross-sectional observational study, stroke survivors and providers were surveyed to quantify perspectives regarding care for poststroke VI in Alberta, Canada (n = 46 survivors; n = 87 providers). Few patients (35%) felt prepared to cope with VI at the time of discharge from acute stroke and inpatient rehabilitation settings. Less than 25% of stroke survivors, and <16% of providers, felt referral processes were adequate. 95.2% of providers and 82% of stroke survivors advocated for a provincial clinical pathway to improve care quality for poststroke VI.

Longitudinal Reduction In Diversity Of Maternal Gut Microbiota During Pregnancy Is Observed In Multiple Low-Resource Settings: Results From The Women First Trial, Minghua Tang, Nicholas E. Weaver, Daniel N. Frank, Diana Ir, Charles E. Robertson, Jennifer F. Kemp, Jamie Westcott, Kartik Shankar, Sumera Aziz Ali, Sarah Saleem

Community Health Sciences

Objective: To characterize the changes in gut microbiota during pregnancy and determine the effects of nutritional intervention on gut microbiota in women from sub-Saharan Africa (the Democratic Republic of the Congo, DRC), South Asia (India and Pakistan), and Central America (Guatemala).
Methods: Pregnant women in the Women First (WF) Preconception Maternal Nutrition Trial were included in this analysis. Participants were randomized to receive a lipid-based micronutrient supplement either ≥3 months before pregnancy (Arm 1); started the same intervention late in the first trimester (Arm 2); or received no nutrition supplements besides those self-administered or prescribed through local health services (Arm …

Endovascular Management Of A Congenital Hepatic Arterioportal Malformation In A Low Resource Setting, Poonamjeet Loyal, Ravjit Sagoo

Imaging & Diagnostic Radiology, East Africa

Background: Arterioportal malformations, a rare type of vascular malformation, have significant associated morbid- ity and mortality. Management requires a carefully thought out approach by a multidisciplinary team. Low resource settings have an added challenge of limited treatment options and consumables.

Case presentation: We report a case of a 14-month-old male with failure to thrive due to a congenital hepatic arte- rioportal fistula. He was successfully treated via an endovascular approach with metallic coil embolization.

Conclusion: Hepatoportal fistula, a rare hepatic vascular malformation, has limited treatment options which can further be restricted by overall patient wellness. Minimally invasive …

Statins: Masked Anti-Epileptic Warriors, Govinda Khatri, Priya Kotak, Ayush Kumar, Mohammad Mehedi Hasan

Medical College Documents

No abstract provided.

Case Report: Axilla Fibroadenoma - An Atypical Presentation, Safna Naozer Virji, Lubna Mushtaque Vohra, Syeda Sakina Abidi, Romana Idress

Department of Surgery Docs

No abstract provided.

Association Of U.S. Birth, Duration Of Residence In The U.S., And Atherosclerotic Cardiovascular Disease Risk Factors Among Asian Adults, Mahmoud Al Rifai, Sina Kianoush, Vardhmaan Jain, Parag H. Joshi, Miguel Cainzos-Achirica, Khurram Nasir, Anwar T. Merchant, Sunita Dodani, Zainab Samad, Salim S. Virani

Section of Cardiology

Introduction: Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans.
Methods: We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S.
Results: The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean …

Estimating The Pre- And Post-Diagnosis Costs Of Tuberculosis For Adults In Pakistan: Household Economic Impact And Costs Mitigating Strategies, Shama Razzaq, Aysha Zahidie, Zafar Fatmi

Community Health Sciences

Background: Despite free tuberculosis (TB) care in Pakistan, patients still have to bear high costs, which push them into poverty. This study estimated the pre- and post-diagnosis costs households bear for TB care, and investigated coping mechanisms among adults ≥ 18 years in Karachi, Pakistan.
Methods: We conducted a cross-sectional study comprising of 516 TB patients identified with completion of at least one month intensive treatment from four public sector health facilities from two institutes in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. The study outcomes were direct medical and non-medical costs, and indirect costs. The …

Community-Based Asthma Assessment In Young Children: Adaptations For A Multicentre Longitudinal Study In South Asia, Mohammad Shahidul Islam, Samin Huq, Steven Cunningham, Jurgen Schwarze, Asmd Ashraful Islam, Mashal Amin, Farrukh Raza, Benazir Baloch, Muhammad Imran Nisar, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Systematic assessment of childhood asthma is challenging in low- and middle-income country (LMIC) settings due to the lack of standardised and validated methodologies. We describe the contextual challenges and adaptation strategies in the implementation of a community-based asthma assessment in four resource-constrained settings in Bangladesh, India, and Pakistan.
Method: We followed a group of children of age 6-8 years for 12 months to record their respiratory health outcomes. The study participants were enrolled at four study sites of the 'Aetiology of Neonatal Infection in South Asia (ANISA)' study. We standardised the research methods for the sites, trained field staff …

Case Report On Peri-Operative Surgical And Anaesthetic Management Of Ruptured Humongous Lung Abscess, Khalid Maudood Siddiqui, Akbar Azizullah, Muhammad Saad Yousuf

Department of Anaesthesia

Introduction: Early thoracic empyema is usually treated through video-assisted thoracoscopic (VATS) decortication. Patient selection is important for decortication if an effective surgical outcome is required. Lung isolation techniques are required to provide anesthesia for these patients to facilitate the surgeon while operating on the affected lung. The ultimate target is to protect the non-diseased contra-lateral lung from contamination.
Presentation of case: We are presenting a unique case of 20-year-old female, resident of Karachi, who was brought to the emergency room (ER) with signs of sepsis, hypotension, and multi-organ failure. She was brought to the operating room to undergo video-assisted thoracoscopy …

Modified Jaw Thrust I-Gel Insertion Technique In Adults: A Case Series, Dileep Kumar

Department of Anaesthesia

Background: The I-gel is a second-generation supraglottic airway device that is built with a noninflatable elliptical gel material cuff and has a wide semirigid stem. The I-gel supralaryngeal seal has shown promising efficacy for both spontaneous and controlled ventilation under general anesthesia. The recommended, standard I-gel insertion technique is relatively challenging due to its shape and cuff size. Usually, the I-gel becomes entrapped at the oral cavity and requires excessive force to negotiate across the oropharynx, resulting in insertion resistance, tongue obstruction, insertion failure, and intraoral trauma. This case series evaluated a modified jaw thrust I-gel insertion technique because it …

Renal Cell Carcinoma Of Pelvic Kidney With Atypical Nodal Metastasis: A Diagnostic Challenge, Roshan-E-Shahid Rana, Muhammad Hammad Ather

Section of Urology

Ectopic pelvic kidney is a known congenital anomaly; however, the presence of renal cell carcinoma (RCC) in an ectopic kidney is rare with the evidence available in the form of a few case reports only. In this case report, we present a case of metastatic RCC in the pelvic kidney which became a diagnostic challenge because of atypical contrast-enhanced computed tomographic (CT) characteristics and unusual pattern of lymph node involvement including cervical lymph node in the absence of visceral metastasis. Because of its unusual location and uncertain vascular anatomy, ectopic kidney poses a surgical challenge. Owing to the rarity of …

The Association Of Age At Menarche And Adult Height With Mammographic Density In The International Consortium Of Mammographic Density, Sarah V. Ward, Anya Burton, Rulla M. Tamimi, Ana Pereira, Maria Luisa Garmendia, Marina Pollan, Norman Boyd, Isabel Dos-Santos-Silva, Sudhir Vinayak, Rose Ndumia

Imaging & Diagnostic Radiology, East Africa

Background: Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk.

Methods: Participants were 10,681 breast‐cancer‐free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemio‐ logic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi‐level linear regression models estimated changes in square‐root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult …

Role Of Lipid-Lowering Therapy In Peripheral Artery Disease, Agastya Deepak Belur, Aangi J. Shah, Salim S. Virani, Mounica Vorla, Dinesh K. Kalra

Office of the Provost

Atherosclerosis is a multifactorial, lipoprotein-driven condition that leads to plaque formation within the arterial tree, leading to subsequent arterial stenosis and thrombosis that accounts for a large burden of cardiovascular morbidity and mortality globally. Atherosclerosis of the lower extremities is called peripheral artery disease and is a major cause of loss in mobility, amputation, and critical limb ischemia. Peripheral artery disease is a common condition with a gamut of clinical manifestations that affects an estimated 10 million people in the United States of America and 200 million people worldwide. The role of apolipoprotein B-containing lipoproteins, such as LDL and remnant …

Shortness Of Breath In A Young Lady, Rare Case Report Of Thoracic Endometriosis, Willbroad Kyejo, Ally Zain Ismail, Davis Rubagumya, Rahma Bakari, Munawar Kaguta, Nancy Matillya

Family Medicine, East Africa

Introduction and importance: Endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The clinical presentation is depends on site of implantation. Complications include pneumothorax, pneumohemothorax or hemothorax.

Case presentation: A 31 year old woman with history of infertility presented with shortness of breath and was found to have a significant right sided pneumohemothorax. Drainage was done followed by chemical pleurodesis using bleomycin with resolution of symptoms on her follow up.

Clinical discussion: Thoracic endometriosis tend to present with chronic or sub-acute symptoms which are nonspecific symptoms leading to late diagnosis. Video Assisted Thoracoscopic surgery offer both …

Labrad : Vol 47, Issue 1 - June 2022, Aga Khan University, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• From the Editor’s Desk
• LABRAD Star Contributors for the Year 2021
• Clinical Relevance of Measuring Thyroid Stimulating Hormone Receptor Antibodies in Pregnancy and Newborns
• Aromatic l-amino Acid Decarboxylase (AADC) Deficiency- An Ultra-rare and Underdiagnosed Neurometabolic Disorder
• Role of Flowcytometry & Kleihauer - Betke Test in Detection and Quantification of Fetomaternal Hemorrhage
• Gestational Trophoblastic Diseases: An Overview
• Acrania-Exencephaly-Anencephaly Sequence/ Spectrum: Radiological Features on Antenatal Screening
• Minimally Invasive Tissue Sampling (MITS) A New Way to Investigate Cause of Death In Resource-constrained Countries
• Laboratory Guideline for Detection, Interpretation and Reporting of Maternal Cell Contamination (MCC) in Prenatal Analysis
• Molecular Analysis of Alpha Thalassemia …

Financial Toxicity Tumor Board: A Multi-Disciplinary Team Activity Required In Low And Middle-Income Countries (Lmic), Ahmed Nadeem Abbasi, Sohail Rasool, Laraib Khan

Department of Radiation Oncology

No abstract provided.

Sex Differences In The Association Between Cardiovascular Diseases And Dementia Subtypes: A Prospective Analysis Of 464,616 Uk Biobank Participants, Caiyun Dong, Chunmiao Zhou, Chunying Fu, Wenting Hao, Akihiko Ozaki, Nipun Shrestha, Salim S. Virani, Shiva Raj Mishra, Dongshan Zhu

Office of the Provost

Background: Whether the association of cardiovascular diseases (CVDs) with dementia differs by sex remains unclear, and the role of socioeconomic, lifestyle, genetic, and medical factors in their association is unknown.
Methods: We used data from the UK Biobank, a population-based cohort study of 502,649 individuals. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between CVD (coronary heart diseases (CHD), stroke, and heart failure) and incident dementia (all-cause dementia, Alzheimer's Disease (AD), and vascular dementia (VD)). The moderator roles of socioeconomic (education, income), …

Association Between Ct Severity Score And Clinical Severity Score Of Covid-19 Pneumonia At Aga Khan University Hospital, Nairobi, Paul Kareithi Nduati

Master of Medicine in Imaging and Diagnostic Radiology

Background: Imaging with chest computed tomography (CT) has demonstrated a role in stratifying COVID-19 patients into different clinical severity groups thus facilitating appropriate care decisions. In a limited number of settings, the wider applicability and reproducibility of these findings is unclear. Objectives: To determine the association between chest CT severity score and clinical severity of illness in RT-PCR confirmed SARS-CoV2 patients. To evaluate the relationship of CT chest severity score with short term clinical outcome of patients. Methods: CT chest of 172 SARS-CoV2 patients who accessed care at Aga Khan University Hospital Nairobi between 14th March and 31st December 2020 …

Diagnostic Accuracy Of Axillary Ultrasound In Predicting Nodal Metastasis Among Patients With Early Breast Cancer At Aga Khan University Hospital, Nairobi, David Mwaniki

Master of Medicine in Imaging and Diagnostic Radiology

With emerging evidence showing that the incidence of breast cancer in Kenya is increasing, there is renewed emphasis on screening, early detection, and management of breast cancer. Early breast cancer (EBC) has a better prognosis and is potentially curable. Axillary nodal metastasis is an important prognostic indicator in breast cancer. Axillary ultrasound is the best modality for assessing, and managing, the affected nodes. It is a readily available and versatile tool with several sonographic nodal characteristics suggestive of metastatic involvement having been described in previous studies. Axillary ultrasound (AUS) performance in predicting nodal metastasis has yielded variable results which are …

Radiological Comparison Of Tumour Burden Of Lymphoma In Hiv Positive And Hiv Negative Patients, Poonamjeet Kaur Loyal

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Patients with Human Immunodeficiency Virus (HIV) are known to exhibit atypical pattern of lymphoma on imaging. There is paucity of literature on differences in tumour volume or burden of disease amongst HIV positive patients compared with HIV negative patients and how this correlates with clinicopathological parameters of aggressiveness and effects on prognosis. Objective: The purpose of this study was to evaluate the tumour burden of non-Hodgkin’s lymphoma in HIV positive patients compared with HIV negative and how this correlates with the clinicopathological parameters of aggressiveness and the overall clinical outcome. Methods: This was a retrospective analytical cross-sectional study. All …

Optimal Fasting Duration To Effectively Suppress Physiological 18f- Fluorodeoxyglucose (Fdg) Myocardial Uptake On A Positron Emission Tomography Scan., Fatima Abdullahi Ali

Master of Medicine in Imaging and Diagnostic Radiology

Background: Positron emission tomography (PET) with 18F fluorodeoxyglucose (FDG) is used in evaluation of inflammatory disorders, including the heart such as cardiac sarcoidosis and myocarditis. However, the normal uptake of the myocardium is a challenge as it can obscure pathological uptake in these conditions. The primary objective of this study is to determine the optimal fasting duration to suppress physiological myocardial uptake and thereafter establish an imaging protocol. Methods: Patients who had whole body FDG PET CT examination for oncological evaluation at the Aga Khan University Hospital between January 2019 and December 2020 were retrospectively reviewed. Patients were divided into …

Mcph1: A Novel Case Report And A Review Of The Literature, Stefano Giuseppe Caraffi, Marzia Pollazzon, Muhammad Farooq, Ambrin Fatima, Lars Allan Larsen, Roberta Zuntini, Manuela Napoli, Livia Garavelli

Department of Biological & Biomedical Sciences

Microcephaly primary hereditary (MCPH) is a congenital disease characterized by nonsyndromic reduction in brain size due to impaired neurogenesis, often associated with a variable degree of intellectual disability (ID). The genetic etiology of MCPH is heterogeneous and comprises more than 20 loci, nearly all following a recessive inheritance pattern. The first causative gene identified, MCPH1 or Microcephalin, encodes a centrosomal protein that modulates chromosome condensation and cell cycle progression. It is also involved in DNA damage response and telomere maintenance in the nucleus. Despite numerous studies on MCPH1 function, MCPH1-affected individuals are rare and the available clinical reports are …

18 Fdg Pet/Ct Imaging In Carcinoma Cesophagus, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Virtual Meetings During Covid-19 Pandemic: Is It Time To Say Goodbye To Physical Meetings?, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

Abstract are not provided by the author/publisher

Identifying The 'Vulnerable Plaque' In Asymptomatic Carotid Artery Disease Patients, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.

Development And Validation Of Standard And Real Patient Gallstone Library Using Fourier Transform Infra-Red Spectroscopy, Lena Jafri, Muhammad Abbas Abid, Humera Asif, Syed Bilal Hashmi, Hafsa Majid, Farooq Ghani, Sibtain Ahmed, Imran Siddiqui, Aysha Habib

Department of Pathology and Laboratory Medicine

Background: Analysis of the constituents of gallstones using various spectroscopic techniques assists in identification of the pathogenesis of gallstones. In the current study, using Fourier Transform Infra-Red (FTIR) Spectroscopy, a Gallstone Standard Library (GSL) and a Gallstone Real Patients' Library (GRPL) were developed and validated for gallstone composition analysis.
Methods: The study was conducted at the Department of Pathology & Laboratory Medicine, Aga Khan University, Pakistan. Pure standards (cholesterol, calcium carbonate, bilirubin and bile salts) and gallstone specimens were analyzed using FTIR Nicolet iS-5 Spectrometer from Thermo Fisher Scientific, USA. Thermo Scientific™ QCheck™ algorithm, embedded within the OMNIC™ software, was …