Love for the people of Pakistan

When the father of the nation Quaid-e-Azam Muhammad Ali Jinnah was requested to grace
this hospital (formely Pakistan Central Hospital for government servents) by given his name, to
which he agreed on one condition. He asked that “this hospital should also provide health care
faculties to the common people along with central government servants”. This shows his love for
the people of Pakistan.
 Messages

Academic Council & Organizing

Committees

Obituary

Departmental Annual Activities

Symposium
Inauguration and plenary session

Scientific Program

Abstracts
Messages
 Honorable Mr. Asif Ali Zardari
President
Islamic Republic of Pakistan

I am pleased to learn that Jinnah Postgraduate Medical Centre Karachi, is holding

its 47th Annual Medical Symposium.

JPMC shall always remain to hold the honour of being the pioneer in initiating
medical symposia. It has been holding symposia for the last 46 years while all other
national symposia and conferences took decades to develop academic gala of such high
standards.

JPMC has a remarkable history and has contributed substantially towards the
advancement of medical education, research & health care services. It has the honor of
producing the largest number of specialists in basic and clinical sciences, nursing and
paramedics as well as physical therapists who are serving both nationally as well as
internationally.

The government has focused its attention on providing adequate facilities to this
institution in the field of research and education as JPMC has a major role to play towards
the promotion of health care in the country.

I wish the organizers a successful symposium for the noble cause of contributing
to medical education & research.

May Allah the Almighty be with us in our endeavors.

Honorable Mr. Syed Yusuf Raza Gilani
Prime Minister
Islamic Republic of Pakistan

It is a pleasure to write this message on the occasion of the 47th Annual Medical
Symposium of Jinnah Postgraduate Medical Centre Karachi.

I congratulate the team for organizing such an auspicious occasion and am sure
that the participants will share their experience, expertise, wisdom and knowledge in the
hopes of benefiting and serving humanity.

With massive advancement in the field of information and communication

technology, there has been a mammoth explosion in scientific knowledge and harnessing
this knowledge has become a major issue on an individual level. Symposia, conferences
and clinical meetings offer the most reliable source for sharing knowledge, experience
and research and unless this knowledge is understood or utilized for the benefit of
humanity, it has little meaning.

I wish the organizers and delegates of the 47th Annual Medical Symposium the
success they deserve now and in future.
 Honorable Mr. Makhdoom Shahabuddin
Federal Minister for Health
Islamabad

It is indeed an honor to write this message for the 47th Annual Medical Symposium
of Jinnah Postgraduate Medical Centre Karachi.

JPMC is Pakistan’s premier health institution where teaching, training, research

and care go hand in hand. It is also a breeding ground for healthy ideas and skills. The
Annual Symposia held at JPMC have always reflected the high ends of this great institution.

I am proud of JPMC and pray that this symposium will also maintain its high
standards and provide great opportunities for Pakistani physicians and surgeons to
exchange the results of their research among themselves, as well as with international
physicians and surgeons.
 Honorable Dr. Mahreen Razzaque Bhutto
Parliamentary Secretary for Health
Islamabad

It is an honour for me to write this message for an institute that’s named after the
father of this nation, Quaid-e-Azam Mohammad Ali Jinnah. The event is a prestigious
gathering of luminaries in the field of medical science, providing an excellent opportunity
to share knowledge and new ideas. No society can progress without giving priority to
research and the quest for new knowledge.

JPMC stands tall as the premier medical institute of Pakistan and a seat of advanced
learning in medical sciences.

It is my firm belief that symposia highlight problems and seek solutions for them.
I congratulate the organizers, Executive Director and her team for holding the symposium.
Mr. Khushnood Akhtar Lashari
Federal Secretary for Health
Islamabad

It is a pleasure to note that the 47th Annual medical symposium of JPMC Karachi
is being held in the month of February 2010.

Regular symposia at JPMC have always remained the focus of academic events
ever since it was declared the first postgraduate institution of Pakistan in 1957.

Symposia and conferences highlight the achievements in the field of medicine

and surgery and provide an opportunity to update ourselves as to the latest frontiers of
knowledge, and to present one’s own experience and research in various fields of medicine
and surgery. This especially provides an opportunity to the junior consultants and
postgraduates to interact with their seniors to improve themselves.

I congratulate the organizers and encourage them to promote the services of

nursing, paramedics and medical technologists, and to improve these services with
knowledge sharing and by presenting research in their fields.

I wish the organizers a successful and fruitful symposium.

 Prof. Rashid Jooma
Director General Health
Islamabad

It is a matter of immense pleasure to see the 47th Annual Medical Symposium

of Jinnah Postgraduate Medical Centre being held as a hallmark of academic achievements
of this Centre.

JPMC took a lead in history of symposia in Pakistan. Leading health professionals

have been invited to speak in the symposium to share their experience, present clinical
analysis, propose solutions and suggest ways and means in the best interest of suffering
humanity.

My relation with JPMC has been for over sixty years and I am the witness that JPMC
Symposia used to be the sole forum for doctors from all over Pakistan to feel privileged
presenting their genuine work. Doctors from all over the world come to attend these
symposia on a regular basis. Since then I have seen many symposia held in JPMC.
Nothing stays at a plateau; it oscillates either going up or losing standards. I hope that
this symposium will not only be a revival of its initial legacy but even take it further to
achieve higher level of competency.

I am sure that getting together and sharing knowledge will bring about very useful
updating of scientific knowledge along with social interaction. This will definitely help
all of us to improve our performance in patient care.

I sincerely thank the organizers for making this event reproductive.

 Prof. Tasnim Ahsan
Executive Director
Jinnah Postgraduate Medical Centre Karachi

It’s a matter of great joy and pride for me to be writing this message on the
auspicious occasion of the 47th consecutive symposium of Jinnah Postgraduate Medical
Centre. This institution enjoys the distinctive position of initiating all postgraduate medical
education in this country, and is a pioneer in holding scientific meetings at the postgraduate
medical level. The JPMC Symposium marks the culmination of a year of academics and
research. It is a time to take stock of all that matters - not only pertaining to education -
but also all aspects of patient care activities. This is also an opportunity for the JPMC
staff to showcase their work for other institutions in the public as well as private sector,
and also provides an opportunity to summarize our work output for the Federal Ministry
of Health. We look forward to listening to the work of our colleagues from other
institutions, and learning mutually from this interaction.

There are some distinctive innovations in the forthcoming symposium which will
set it apart from previous symposia, and hopefully, this wind of change will prove more
successful. I wish the symposium organizers a very successful week of scientific exchange,
and look forward to participating in it.
Prof. Ghulam Mehboob
Chairman
Symposium Organizing Committee

It is a matter of pleasure for me to welcome participants of 47th Annual Medical

Symposium.

The JPMC has privilege to be the pioneer of holding clinical symposia/ conferences
in Pakistan and this symposium is held regularly for last 47 years. I hope that this
symposium is going to be a great success.

Prof. Tariq Mahmood has come with innovative idea for change in the format of
the symposium. The theme of Symposium this year is “Role of Symposia in Education
and Research”. The purpose of this theme is to analyze scientifically the contribution of
these activities in education and research and to have a critical review of the importance
of symposium. I hope this will go a long way to suggest change to improve the standard
of symposia.

This year, we have decided to deviate from usual manner of holding the symposium
and decided to entrust each discipline to hold their sessions independently. The activity
is going to last for 8 days.

I am grateful to Prof. Tariq Mahmood for taking deep interest and all the hard
work he has put in making the event success. I am also thankful to Executive Director,
Members of the Academic Council, and every one who has helped to make this symposium,
a success.
 Prof Tariq Mahmood
Secretary
Symposium Organizing Committee

This modern era brings far better understanding of medical diseases and the rate of
advancements in medical technology and revolutions in investigative and treatment modalities
demands that the health care providers keep pace with these ever changing new trends through
Continued Medical Education (CME). An ongoing phenomenon of research is essential to find
new answers and solutions. Medical Symposia provide forum to health care professionals to
present their work and findings, share their experiences and make recommendations.

Improvements in the healthcare system, where requires measures to be taken by the

government towards increasing health budget, making new hospitals, enhancing facilities to the
existing setups with the aim of providing “Health for all”, it also demands empowering the
health providers with the knowledge and skill to deliver this health to all, with excellence.

Jinnah Postgraduate Medical Centre has been providing a forum for education and
research for many years and it gives me immense pleasure to hold the 47th Annual Medical
Symposium at Jinnah Postgraduate Medical Centre, Karachi from 15th February 2010 to 21st
February 2010. This time, our theme of the symposium is "Role of Symposia in Education and
Research”.

JPMC being the pioneer in holding medical symposia in the country honors this challenge.
It is our resolve in this 47th symposium to aim “Free Education for All”. We have taken a stand
to promote education and not entertainment in this symposium. We have proudly made
arrangements to accommodate and register 5825 participants free of cost and would acknowledge
all the participation with mementos. We are happy to announce the inauguration of the new
Najmuddin Auditorium Complex for all the upcoming activities. This year we have brought
reform to the organization of this symposium by giving autonomy to every specialty so that they
may conduct with liberty and responsibility their own activity according to their needs. We have
given each discipline ample time and logistics dedicated to their specialty so that a maximum
number of participants have the chance and space to acquire and enjoy this learning bonanza.
Best free paper and poster would be awarded Gold Medals. There are 35 scientific sessions
containing 84 invited talks, 218 free papers and 151 posters. We have also arranged 16 workshops
in various specialties. CME hour accreditation would also be awarded. We have also published
a souvenir for all our participants and the details will also be available on the JPMC web site
under the name of 47th Annual Medical symposium.

We wish this humble effort is an enlightening and an enjoyable experience for our
participants.

Thank you.
Academic Council &
Organizing Committees
 Academic Council of J.P.M.C – Karachi
Sitting First Row: Left to right. Prof, Anis Subhan, Prof. Azam J. Samdani, Prof. S.M. Tariq Rafi, Prof. Shereen Z. Bhutta, Prof. Tariq Mahmood,
Prof. Tasnim Ahsan, Prof. Ghulam Mehboob, Prof. Kehmomal Karerra, Dr. Manohar Lal, Prof. Ahmed Usman Chaudhary, Prof. Nasir Khan Jakhrani,

Sitting Second Row: Left to right. Dr. Sayed Waqar Ahmed, Prof. Mohammad Iqbal Afridi, Dr. Nasir Zaman Khan, Prof, Anisuddin Bhatti,
Dr. Mohammed Azhar Chaudhry, Prof. Nagina Fatima, Prof. Nadeem Rizvi, Prof. Javed Hasan Niazi, Prof. Shaukat Ali, Prof. Abdul Sattar M.
Hashim, Prof. Saleem Ahmed Kharal. Members not in the photograph: Prof. Jamal Ara, Prof. S. M. Munir, Prof. G. Asghar Channa, Dr. Qazi Fasihuddin

Administration of J.P.M.C
Sitting First Row: Left to right: Mrs. Zebunnisa, Mrs. Rehana Afghani, Dr. Seemin Jamali, Prof. Tasnim Ahsan, Prof, Ghulam Mehboob,
Dr. Mohammed Zakaria, Dr. Mohammed Malook Bugti, Dr. Mohammed Azhar Khan.

Sitting Second Row: Left to Right: Mr. Mohammed Akhter Anwar, Dr. Srichund V. Talib, Mr. Sharifullah Khan,
Mr. Chaudhary Mohammed Akram, Mr. Mohammed Riaz Bhatti, Mr. Badaruddin Sheikh, Mr. Akber Ali Khan & Dr. Badar Jehan.
 Academic Council of NICVD & Organizing Committee
Sitting 1st row, 3rd from the left: Prof. Arif u Rehman, Prof. Khan Shah Zaman (Executive Director),
Prof. Akhtar Hussain and organizing committee member Dr Zahid Jamal (4th from the left in 3rd row)

Members of Patients Aid Foundation, J.P.M.C.

Left to right: Mrs. Maheen Bashir (Member), Mr. Zahid Bashir (Chairman BOG),
Mrs. Shaheen Sulaiman (Gen. Secretary) Mr. Mushtaq Chapra (Chairman EC), Mr. Masood Shaikh (Member)
 Session Wise Photographs

Organizing Committee of Ophthalmology

Sitting First Row: 2nd from left Dr. Azad A. Sheikh, Dr. Alyscia M. Cheema, Prof. Javaid H. Rizvi,
Dr. Vasdev Harani and other members

Organizing Committee of General Medicine

Standing First Row: 2nd from left Dr. Muhammad Azhar Chaudhry, Dr. Liaquat Ali,
Prof. Tasnim Ahsan, Prof. Jamal Ara, Dr. Rukhsana A. Sattar
 Organizing Committee of Endocrine Session
Standing First Row: 3rd from left Dr. Zeenat Banu, Dr. Umar Farooq, Dr. Shahbaz Haider and other members

Organizing Committee and Faculty of Chest Medicine

Standing First Row: 4th from left Dr. Saifullah Baig, Prof. Nadeem Rizvi and other members
 Organizing Committee & Faculty of Nephrology
Standing Row: 3rd from left: Dr. Abdul Manan Junejo, Dr. Manohar Lal and other members

Organizing Committee of Paediatric Session

Left to Right: Prof. S. Jamal Raza (Executive Director NICH), Dr. Jamshed Akhter (HOD Paeds Surgery)
 Organizing Committee of General Surgery
Standing Row: 2nd Left to right: Prof. Nasir Zaman Khan, Prof. Anis Subhan, Dr. Nisar Mangi,
Dr. Shahid Rasool and Dr. Sagheer Hussain.

Organizing Committee of General Surgery

Standing Row: 3RD Left to right: Prof. Nasir Zaman Khan, Dr. Nisar Mangi,
Dr. Sagheer Hussain, Dr. Zia-u-Islam, Dr. Sughra Perveen and others.
 Organizing Committee of Urology
Sitting First Row: Left to right: Dr. Mansoor, Dr. Khalid Rasheed, Prof. Umar Baloch, Dr. Shahzad Ali and other members

Organizing Committee of Nephrology & Urology

Sitting First Row: 2nd from left Dr. Abdul Manan Junejo, Dr. Manohar Lal,
Prof. Mohammad Umer Baloch, Dr. Shahzad Ali and other members
 Organizing Committee of Dermatology
Standing First Row: 3rd from left Dr. Sobia Liaquat, Dr. Behram K. Khoso, Prof. Azam J. Samdani and other members

Organizing Committee & Faculty of B.M.S.I.

Sitting First Row: Left to Right:. Dr. Naila Tariq, Dr. Shehnaz Kehar, Mrs. Nudrat Anwar Zuberi,
Dr. Anjum Naqvi, Prof. Khemomal Karrera, Dr. A. Shakoor Memon
2nd Row Left to right: Dr. M. Azhar Khan, Dr. M. Asif Durrani, Prof. M. Umer Baloch,
Prof. Saleem A. Kharal, Dr. Moosa Khan, Dr. M. Anwar, Dr. Suresh Kumar
 Nursing Organizing Committee
Standing First Row: 3rd from left Mrs. Zebunnisa, Mrs. Rehana Afghani and other members

Organizing Committee of Gynaecology and Obstetrics

Standing Row: 2nd from left Dr. Halima Yasmeen, Dr. Razia Korejo, Prof. Shereen Z. Bhutta,
Dr. Deedar A. Junejo, Prof. Nagina Fatima and other members
 Organizing Committee of E.N.T
Sitting First Row: 2nd from left Dr. Muhammad Usman, Prof. Tariq Rafi, Dr. Sameer Qureshi

Organizing Committee & Faculty of Neurosciences

Standing First Row: Left to right Dr. Lal Rehman, Prof. M. Iqbal Afridi,
Prof. A. Sattar M. Hashim, Prof. Shaukat Ali and other members
 Organizing Committee & Faculty of Dentistry
Standing First Row: 5th from left Dr. Abid Mehmood and his team

Organizing Committee of Orthopaedic

Standing First Row: 3rd from left Dr. Irfanullah Ansari, Prof. Ghulam Mehboob, Prof. Anisuddin Bhatti and other members
 A. R. Jamali Members of Organizing Committee of Orthopedic
Left to right: Dr. Khalid, Dr. Nasir, Dr. Salman and others

Organizing Committee & Faculty of Physical Medicine and Rehabilitation

Standing First Row: 2nd from left Mr. Shahwar Mustafa, Dr. Irfanullah Ansari and other members
 Organizing Committee & Faculty of Medical Oncology
Standing First Row: 2nd from left Dr. Tehseen Khursheed, Dr. Heeranand, Prof. Ahmed Usman Chaudhry,
Dr. Ghulam Haider and other members

Organizing Committee of Anesthesiology

Sitting First Row: Left to right Dr. Nadeem Munir, Dr. Fauzia Ali, Dr. Capt. Amanullah Khan,
Prof. Nasir Khan Jakhrani, Dr. Roohina Baloch and other members
 Organizing Committee: & Faculty of Radiology
Sitting First Row: Left to right Dr. Amber Paras, Dr. Najam ul Hasan, Dr. Nadira Abid, Dr. Saima Imran,
Dr. Tasneem Butt, Prof. Tariq Mahmood, Prof. Zaffar Sajjad, Dr. Mohammed Salman & Other Members.

Organizing Committee of Department of Ultrasound/Color Doppler

Sitting First Row: 3rd from left Dr. Saima Imran, Dr. Tasneem Butt, Dr. Mohammad Salman,
Prof. Tariq Mahmood and other members
 Faculty and Organizing Committee of Neuro Sciences
From left to right: Dr. Tanoli, Prof. A Sattar Hashim, Prof. Shaukat Ali, Prof. Iqbal Afridi and Dr. Najam

Dedicated Workers
Mr. Iqrar Ali Mr. Zaigum Ali
 Organizing Committee of F.G. Officer Ward
Dr. Arifa Akram (right)

Organizing Committee of A.D.M Office

Sitting First Row: 2nd from left Mr. Iftikharuddin, Dr. Badar Jehan and other office workers
 Organizing Committee of Security Guard
Standing First Row: 2nd from left Mr. Akram Janjua, Mr. Badaruddin Sheikh and other security staff

Organizing Committee of Housekeeping Department

Standing Row: 2nd from left Mr. Izhar Siddiqui, Mr. Badaruddin Sheikh and other staff members
 Acknowledgment
Jinnah Postgraduate Medical Centre
acknowledges the untiring efforts of the following in the
preparation of the Souvenir for the
47th Annual Medical Symposium of JPMC 2010

Dr Raza Younus

Dr Samreen Iqbal
EMERITUS PROF. HASAN AZIZ
AN EPITOME OF DEDICATION & HUMANITARIAN SERVICE

By
Prof. Shaukat Ali
Head of Neurology Department, JPMC
Prof. Hasan Aziz, a pioneer of neurology in Pakistan and needs no introduction. It is extremely difficult to summarize his forty
long years of achievements and dedicated service towards neurology in Pakistan in general and especially in Jinnah Postgraduate
Medical Centre.

A meritorious graduate of the Nishtar Medical College, Prof. Hasan Aziz proceeded to United Kingdom to be formally trained
in Neurology. Turning down lucrative offers, he returned back to his homeland with a vision and spirit of developing the field
of neurology in Pakistan. On his return in 1969 he joined the Jinnah Postgraduate Medical Centre, Karachi as Honorary Associate
Physician and after about two decades of his singular pursuance he succeeded in the establishment of an independent Department
of Neurology at JPMC. In his ongoing innings at JPMC, he has held varied posts including that of the Professor and Head of
the Department of Neurology, Director JPMC, Chairman Academic Council, Chairman Continued Medical Education and
presently Emeritus Professor of Neurology.

Prof. Hasan Aziz has been a part of major neurology-based research projects of international standards conducted in Pakistan.
To his credit are many published research papers, articles, monographs, book chapters, state of the art lectures both locally and
internationally, His population-based study in epilepsy has been acknowledged internationally placing Pakistan on the international
map of epilepsy.

Under the helm of Prof. Hasan Aziz, the Department of Neurology, JPMC (DNJPMC) evolved from its initial days of one senior
consultant and 3-5 junior doctors to a Department with full strength of consultants, residents and postgraduates. It was his
farsightedness to introduce the Diploma in Clinical Neurology course along with MD & FCPS (Neurology) training at DNJPMC
thus producing a somewhat respectable number of senior and middle grade neurologists in the country. To upgrade the fledgling
department, he with the help of concerned doctors of DNJPMC initiated a CBR-exempted NGO, the which also supported
research activities at the department. The present day neurology department is all due to the endeavors of Prof. Hasan Aziz.
Neurology Research and Patient Welfare Fund (NRPWF)

Prof. Hasan Aziz has a special passion towards epilepsy and the affected. It has become his lifetime challenge to bring a difference
in the lives of people with epilepsy in Pakistan. His infectious spirit to help the underprivileged has caught on most of his
associates resulting in formulation of a volunteer team running the all Pakistan-based Comprehensive Epilepsy Control
Programme of Pakistan since 2001; a project conceived implemented and evolved under his supervision. His dream of
establishing an iconic centre for people with epilepsy and providing grace in their management has been fulfilled in the form
of the National Epilepsy Centre, at JPMC. His work in epilepsy has been acknowledged by the international community. In
the past he has served as member of several sub-commissions of the International League Against Epilepsy and presently is a
member of its Commission for Asian and Oceanian Affairs; a distinction unique to any Pakistani neurologist.

It is a rare distinction to come across a person of Prof. Hasan Aziz’s caliber who has felt for the underprivileged people of our
society and has dedicated his skills and influence to help provide better health facilities for them. His belief in the need of public-
private partnerships and its success exemplified at DNJPMC has resulted in the initiation, execution and evolvement of several
such projects at JPMC. Some projects at JPMC that he has been closely involved include construction of Najmuddin Auditorium
Complex, construction of Labor Rooms / Gynae-Operation Theatre Project, construction of Medical Department (Ward
No; 6) under the Medicine and Endocrine Foundation and the Accident and Emergency Foundation’s Emergency Operation
Theatres Project. Other than these, he is a Trustee of The Jinnah Foundation and Hope Trust both working for the welfare
of the underprivileged.

The faculty and staff of Jinnah Postgraduate Medical Centre applaud the services of respectable Prof. Hasan Aziz; a skillful
medical practitioner, a fatherly teacher, an internationally acknowledged researcher, a highly respected colleague, a social
worker, and above all a compassionate human being.
Obituary
DR. SYED ABDUL MUJEEB
Associate Professor
Blood Bank JPMC Karachi

(Feb.12, 1957-Sep.6, 2009)

Syed Abdul Mujeeb acquired his medical degree from LMC Sindh University Jamshoro in 1983 and passed
FPSC and joined JPMC as a Medical officer in the year 1984. Very soon he posted in the department of
Blood Bank, which was the time when blood bank was totally depended on commercial blood donation
then he made the aim for complete elimination of those bad practices not only from the blood bank JPMC
but the whole country. His struggle became true with government support and non-governmental organization
participation (PAF) to established country’s largest hospital based blood bank providing all basic facilities
and services. In 1994 complete elimination of commercial blood donation in the blood bank JPMC by his
weary efforts, gave him some sort of satisfaction. He did not stop here then he struggled for blood transfusion
act in the country and successfully passed the safe blood transfusion act 1997 in Sindh Assembly. He
always in searched for safe and quality blood supply to the patients for this he got external quality assurance
program from NRL Australia since 1997 which is running uptil now.
Dr. Mujeeb was the pioneer of establishing country’s first AIDS Surveillance Centre and HIV/AIDS
Screening centre in the blood bank JPMC as early as 1986 and got the platform for diagnosis of first AIDS
case in the country.
He did M.Phil (Microbiology) in 1992(BMSI) and MSc (Epidemiology) from University of London in
2006.
He had produced more than 60 scientific research papers which published in the International and National
prestigious scientific journals. He also wrote more than 70 articles, pamphlets for specific and general
public awareness. Dr. Mujeeb was the author of three books namely: Blood Transfusion: A technical and
clinical care, AIDS Pandemic in Pakistan, HIV/AIDS in Pakistan. He continuously provided consultancies
to W.H.O., UNAIDS, UNICEF, Government of Pakistan, Government of Sindh, Aga khan University
Hospital, Population Council, Biological Committee MOH, govt. of Pakistan. Safe blood for safe motherhood
(W.H.O) etc. For this he visited throughout the country and all over the world.
President of Pakistan awarded him Presidential Award for “Pride of Performance” in 2007. Government
of Pakistan, Government of Sindh, other National and International Public and community organization
awarded him many appreciation awards for his giant work in the field of Blood transfusion, hepatitis
infection and HIV/AIDS.
It was his dream that our country become free from HIV/AIDS, Hepatitis and 100 percent voluntary blood
donation in the country so that every recipient must get blood without providing exchange blood donor.
Dr. Mujeeb was no doubt a towering personality. He died on 6th September 2009 and left behind a tall
legacy of scientific work for others to further consolidate. He will always be remembered as a firm,
assertive, ethical quietly efficient, kind hearted and yet a very compassionate person.
LATE MR. ABDUL HAQ
(Aug.31, 1951-May.20, 2009)
As per record held in this office Mr. Abdul Haq, Ex-Foreman born on 31.08.1951. He joined Government
Service in JPMC as Shop Assitant on 26.09.1972. He was appointed as Metal Worker on 01.12.1976 and
was promoted as Foreman (BS-14) on 08.10.1996.

Unfortunately, he suffered a biatetic ailment and died during service on 20.05.2009. He rendered 36 years,
5 months and 24 days satisfactorily service in this Centre.

He performed his services throughout in General Workshop where the following work is carried out:-

i. Maintenance of Furniture (coordination)

ii. Patient wheel chairs
iii. Plumbering
iv. Carpentry
v. Tin smithing/Black smithing
vi. Writing and painting of sign boards and banners
vii. Welding

During his entire service he was found punctual, honest and hard worker. Through the passage of his career
in this centre, he acquainted himself with the variety of various machines, appliances and equipments. He
was smart and energetic. In bereaved, he left behind his widow and 3 children.

May God rest his soul ever in the eternal abode.

MR. HUKUM SHAH

Medical Technologist
Mr. Hukum Shah joined Jinnah Postgraduate Medical Centre in 1978. He was initially posted in the
Department of Nephrology. He then was posted in National Institute of Child Health and Main Laboratory.
He was transferred and posted again in department of Nephrology 6 years back, where he worked till his
retirement on 4th June 2008.

He was an efficient worker and dedicated person. He knew his subject well. He was cordial with colleagues
and patients.

May Almighty Allah rest his soul in peace.

Departmental Annual
Activities
 DEPARTMENT OF ACCIDENT & EMERGENCY
Faculty: Patient warming system- Snuggle warmers
Airway devices- Laryngoscopes, tube changers, Percutaneous
Dr. Seemin Jamali Joint Executive Director & Incharge tracheostomy sets.
The Accident and Emergency Department is also the nodal point of
Accident and Emergency care is a specialty that involves the
disaster management . It is fully equipped to handle any type of
management of patients with life-threatening conditions , accidents,
emergency and disaster and has resuscitation facilities round the clock.
trauma and frequently complex medical and surgical illnesses. These
Consultants of other Medical and surgical departments take periodic
patients may have dysfunction or failure of one or more organ systems,
rounds in the emergency.
including the cardiac, pulmonary, neurologic, renal and hepatobiliary
A malaria screening section caters to the diagnostic needs of patients
or gastrointestinal systems. Procedures used to help, support, stabilize
suspected to have malaria in the A& E department , OPD and indoor
and address the critical condition may include endotracheal intubation,
patients of the hospital.
central venous catheterization, arterial cannulation, pulmonary artery
The Emergency Department of the JPMC is amongst the pioneer units
catheterization, bronchoscopy, lumbar puncture, thoracentesis,
for Rabies Immunization and has established a Dog Bite Clinic meeting
paracentesis, and chest tube thoracostomy.
the WHO criteria , which has been worked successfully fot the last
A modern Accident and Emergency care outfit represents the pinnacle
18 years. This clinic provides free of cost treatment to at least 12000-
of any hospital's approach to highly technological & sophisticated in-
15000 patients annually in terms of vaccine and immunoglobulin.
patient care.
Besides the above, the department trains interns as well as post
In Karachi , which has been declared the largest city of the world
graduate doctors in the Emergency management of both medical and
with a population in excess of 18 million, the JPMC Department of
surgical conditions. The exposure is wide and training is supervised
Accident and Emergency is one of the largest emergency medical
closely. This gives the trainees the much needed self confidence in
service provider in Pakistan. This department is unique in its nature
dealing with emergent medical and surgical diseases and conditions.
and quantum of work by virtue of its location in the heart of the
enormous number of people benefit from these facilities on a daily
populous city of Karachi and being a part of a multi disciplinary
basis and precious lives are saved. However the load work on this
tertiary care hospital it has the capability of handling poly trauma and
department is tremendous and the resources are scanty.
a multitude of other medical emergencies. Over the past two decades
A statistical study of the last five years shows a meteoric rise in the
it has evolved from a conventional experience based Casualty Ward
load work whereas the man and material resources have not been
to an increasingly precise and scientifically based Accident and
augmented in the same proportion.
Emergency medical service provider. The department's mission is to
provide an exceptionally high level of critical care & emergency
Year No. of Patients attended by A & E
services, and to maintain, and train a highly qualified staff of health
Department
care professionals devoted to the care of the critically ill.
Built over an area of 18000sq. feet, the Accident and Emergency 2009 277,184
Department bears a very pleasant and aesthetic look. The Accident 2008 206,920
and Emergency Department is situated on the ground floor. It has 2007 193,400
triage area, consultation and examination area, observation ward, state
of the art emergency operation theatre, closed reduction and plaster 2006 202,901
and dressing bay and doctors and staff rooms and patient waiting 2005 189,833
areas. All patient beds have piped gases, Central suction, Multichannel
cardiac monitors, mobile ECG machines and resuscitation facilities. The above figures indicate that on an average the A & E Department
The patient area is divided into 15 critical care pods. The design sees an average of 650 patients every day of the year.
was created keeping in mind the space utilization, patient comfort,
infection control, and ease of providing critical care, nursing care and Similarly the statistics of dog bite cases shows a sharp increase over
the functional requirements . This Unit has 100 beds for initial the last five years.
management and observation . The capacity can be expanded to 150
beds in modular form. All patient beds are equipped with Multichannel Year No. of Dog Bite cases
physiological monitoring systems, which allow close monitoring of 2009 15,870
patients both from the bedside and the central nursing station and the
2008 14,207
use of a variety of invasive and noninvasive modalities.
To provide organ assessment and support, the Accident and Emergency 2007 13,010
Department has a variety of equipment like: 2006 10,094
Defibrillators 2005 10,180
Patient Monitors
Central monitoring stations
Pulse oxymeters
Radiology equipment- X-ray machine- ultrasound- CT Scan MR
ECG
Infusion pumps
 DEPARTMENT OF ANAESTHESIOLOGY & SURGICAL ICU
FACULTY: Pain Clinic:
✧ Services are provided for the management of patients suffering
✧ Professor: Prof. Nasir Khan Jakhrani from chronic pain; examples include but not limited to
✧ Assistant. Professors. Dr. Roohina Baloch Cancer Pain
Dr. Fauzia Ali Sympathetic neuralgias.
Dr. Nadeem Muneer Phantum limb pain, etc.
Dr. Shoaib Malik
Other services:
Dr. A. Rahim Memon
✧ Services are provided for
✧ Senior Registrar Dr. Tahir Amin Choudhary Placement of Endotracheal tubes in wards as well as in Accident
✧ RMOs Eleven and Emergency Department.
Placement of central venous pressure lines.
Cardiopulmonary resuscitation of patients.
FACILITIES: Placement of nasogastric tubes.
Operation theatres Ventilator support guidance to various departments.
Elective surgeries
✧ Eighteen operating rooms are functioning during working hours Anaesthetic Participation in Surgical Workshops:
six days a week, where all sorts of scheduled operations are ✧ Surgical Workshop on Colorectal disease was organized in Accident
performed including. & Emergency Department from 16 -11-09 to 19-11-09.The
ü General surgery anaesthetic team provided general anaesthesia & acute pain control
Ward-03 Nine lists per week to the patients undergoing surgical demonstration.
Ward-02 Seven lists per week
Ward-26 Six lists per week LIBRARY:-
ü Orthopedic surgery Eight lists per week ✧ Departmental library was established in 2002. Recent journals of
ü Neuro & spinal Surgery Nine lists per week Anaesthesiology and latest editions of reference books are available
ü Thoracic surgery Two lists per week in the library.
ü Plastic surgery Three lists per week
ü ENT surgery Seven lists per week TEACHING AND TRAINING ACTIVITES:-
ü Urology Two Lists per week ✧ Daily teaching rounds in SICU
ü Gynecology & Obstetrics Twelve lists per week ✧ Daily teaching and hands on training of undergraduates and
ü Eye surgery Five lists per week postgraduates in operating rooms
✧ Twice weekly presentations / lectures in class rooms
Emergency surgeries: ✧ Morbidity & Mortality meeting twice monthly.
✧ Case presentation / discussion , once weekly
✧ Emergency Anaesthesia care services are provided round the
clock seven days a week for all surgical specialties.
CONTINUOUS MEDICAL EDUCATION:
Statistics: ✧ Workshop on” pain less delivery” was organized on 3rd Feb 2009.
✧ The workshop consisted of lectures concerning anatomy,
✧ Total number of surgeries performed during the year 2009 from
physiology, procedure and technique of epidural anaesthesia,
1st January to 31st December are as follows:
followed by hands on training of epidural anaesthesia on a
ü Main operation theatre (Elective & EOT ) 5958 manrequin.
ü (COT) 2456 ✧ An Update on Anaesthesia was organized by the department of
ü Gynae & Obs (Elective &Emergency ) 4584 Anaesthesiology & SICU on 7th April, 2009 as part of 46th
ü Ophthalmology 1000 Annual Medical Symposium, JPMC. The theme for this update
ü ENT 1190 was “Current Challenges in Anaesthesia,Intensive Care and Pain
ü Urology 712 management”.
✧ Workshop on “Ventilatory modes in ICU” was organized by the
Surgical Intensive Care Unit: department of Anaesthesiology on 8th April 2009.
✧ A well equipped 07 bedded surgical intensive care unit works Workshop on” infection control in intensive care unit” was
under the supervision of anaesthesia department. A variety of organized on 9th December 2009. The workshop consists of
patients admitted who require intensive care, invasive monitoring, lectures regarding sterilization, disinfection and control of infection
ventilatory support and multiple organ support e.g. cardiac, renal. in ICU followed by hands on training on hand washing method,
nutritional support is also provided in SICU. agents and equipment used for disinfection and sterilization .This
✧ During the year 2009, a total of 540 patients were admitted in workshop was very well attended by junior and senior doctors
SICU. from surgical and medical faculty as well as paramedical staff of
the hospital.
 DEPARTMENT OF ANATOMY, BMSI
FACULTIES:
Associate Professor/Incharge Dr. Anjum Naqvi
Assistant Professor Nil
FACILITIES:
Anatomy Department is recognized for M.Phil and PhD by PM&DC
and University of Karachi. Department is actively providing
postgraduate education, training and research facilities leading to
M.Phil& PhD degree. It also provides a forum for presentation of
research papers.
The Department is well equipped with modern research oriented
equipments.
ACTIVITIES: (EDUCATIONAL & RESEARCH)
✧ Presently there are thirteen (13) candidates in the Department of
Anatomy.
✧ All courses in the subject of Anatomy (Histology, Embryology
Neuroanatomy, Micro technique, and Gross Anatomy) &
examinations of all courses for internal assessment are conducted.
✧ Weekly journal club for M. Phil candidates to plan carry out the
research independently.
✧ Weekly slide seminars are conducted for all post graduate trainees.
✧ Subject (Anatomy course) topic presentation for learning &
gaining teaching experience are also conducted.
✧ Research for completion of M. Phil thesis is conducted &
candidates are prepared for M. Phil final examination of University
of Karachi.
✧ Preliminary and final seminars are also conducted for submission
of synopsis and thesis before appearing in University of Karachi
examination.
✧ Seven original papers from Anatomy Department have been
presented at the 45th Annual Medical Symposium JPMC Karachi.
4. The Radio protective Role of Methycobal on Cerebellar Cortex
of young Albino Rats. March 2009, Vol 20, No.3, 18-23 (Dr.
Bashir Ahmed Shaikh & Dr. Anjum Naqvi).
5. To observe and compare the histological features of fat induced
adrenal cortex in Albino Rats. April 2009, Vol 20, No.4,10-
13. (Dr. Iram Quddus & Dr. Anjum Naqvi).
6. Protective role of zinc in piroxicam induced hepatic lobule
damage in mice. April 2009, Vol 20, No.4, 18-21. (Dr.
Muhammad Nadeem Siddiqi & Dr. Anjum Naqvi).
✧ Four Candidates, synopses for the degree of M. Phil Anatomy
were submitted & accepted in 2008, they would appear in the
coming forth examination of University of Karachi July, 2010.
1. Dr. Bashir Ahmed Shaikh: The Radio protective Role of
Methycobal on Cerebellar Cortex of young Albino Rats.
2. Dr. Iram Quddus: Effect of Fat- induced stress on adrenal
gland with Protective role of l-arginine in Albino Rats.
3. Dr. Hemant Kumar: Morphometeric Study of Heat-Induced
Testicular damage with Protective role of Cyancobalamine in
Albino Rats.
4. Dr. Abdul Hafeez: Immunological and Cytoprotective response
of Cyancobalamine on Heat-induced Splenic Tissue in Albino
Rats.
✧ A batch of three candidates is in 2nd year M. Phil they are going
to complete their course work.
✧ A fresh batch of five candidates has started its course from 1st
Sept 2009.

ACHIEVEMENTS:
✧ Three candidates were declared successful in the Final M.Phil
examination of the University of Karachi held in July 2009.
1. Dr. Muhammad Nadeem Siddiqi: The Morphometeric study
of piroxicam induced Hepatic damage with protective role
of Zinc in Mice.
2. Dr. Abdul Latif Panhwar: A Histological study of irradiated
bones with Radio protective effects of somatotrophin and
Ascorbic Acid in young Albino Rats.
3. Dr. Aisha Qamar: A Histological study of High Fat- treated
Live with Fresh Garlic prevention in Albino Rats.
✧ The Anatomy Department has published six original research
papers in 2009.
1. Effect of radiation on growing long bones of young albino
rats. Medical forum, Februrary2009, Vol 20, No.2, 3-7
(Dr.Abdul Latif Panhwar & Dr. Anjum Naqvi).
2. Effect of heat on testicular tissue with protective role of
Cyancobalamine (Vitamin B12) in Albino Rats. Februrary
2009, Vol 20, No.2, 19-22. (Dr. Hemant Kumar & Dr. Anjum
Naqvi).
3. Ameliorating role of fresh garlic on high–fat diet induced
liver in Albino Rats. March 2009, Vol 20, No.3, 3-8. (Dr.
Aisha Qamar & Dr. Anjum Naqvi).
 DEPARTMENT OF BIOCHEMISTRY, BMSI
FACULTY:
✧ Professor & Head :: Prof. Khemomal A. Karira
✧ Associate Professor :: Mrs. Nudrat Anwar Zuberi
✧ Assistant Professor :: Dr Suresh Kumar
✧ Medical Technologist :: Mr Muhammad Altaf
FACILITIES
The Department of Biochemistry involvement in academic activities
continues throughout the year and it provides training, teaching and
research facilities to the students of M.Phil/Ph.D in addition to
understand the research skills and preparation of synopsis, thesis and
articles for publications. Provides teaching to students of Clinical
Pathology Department. Also provides services of special tests to JPMC
Hospital through the postgraduate students related to their research.
TEACHING ACTIVITIES
At present twenty ( Major 13 & 7 minor) postgraduate students are
under going regular course in M.Phil Biochemistry, Basic Medical
Sciences Institute, JPMC. Five candidates appeared in final university
examination and declared pass in 2009, while research of 2 major
students have been completed and likely to appear in July 2010 and
research of four are underway on topics of clinical Biochemistry. Four
have appeared in preliminary seminar and are preparing synopsis for
submission to the university.
ACADEMIC ACTIVITIES
At present twenty ( Major 13 & 7 minor) postgraduate students are
under going regular course in M.Phil Biochemistry, Basic Medical
Sciences Institute, JPMC. Five candidates appeared in final university
examination and declared pass in 2009, while research of 2 major
students have been completed and likely to appear in July 2010 and
research of four are underway on topics of clinical Biochemistry. Four
have appeared in preliminary seminar and are preparing synopsis for
submission to the university.
1. Orientation course includes instrumentation and organic chemistry
to the newly admitted
2. Teaching regular course of Biochemistry to M.Phil students (major
& minor).
3. Topic presentation to gain practical experience of teaching in
Biochemistry.
4. Journal Club once a week to activate the students to plan carry
out the research independently
5. Morning meeting of staff and students to discuss the daily progress
6. Weekly discussion on research progress and solve the problems
of M.Phil students in connection to their research progress
7. Discussion on recent advancements in research related to
Biochemistry quarterly
8. Course of informative Technology through computer in connection
of locating articles and Biostatistics particularly for senior students.
ACHIEVEMENTS
Following achievements were carried out by Prof. K. A. Karira, faculty
members and students
1. Five candidates declared passed M.Phil in 2009 under the
supervision of Prof K. A. Karira
2. Being a member of APTAC, Ministry of Food, Agriculture &
Livestock Islamabad, attending the meetings when invited
3. Two research papers were presented at 46th Annual Medical
Symposium JPMC 2009.
4. Attended seminar “ Men’s Sexual Issues” organized by National
Institute of Diabetes and Endocrinology, DUHS in collaboration
with Professional Development Centre Karachi, held on 26th
September, 2009 By Prof K. A. Karira.
5. Four publications of original research papers in 2009
6. Appointed as member of the Board of study for Biochemistry by
LUMHS, Jamshoro
7. Reviewer of Medical Journal Recognized by PMDC
8. Conduct examination of postgraduate M.Phil candidates (total
86) and of undergraduate MBBS at various Medical
Colleges/Universities
9. Prof. K. A. Karira received the “ Life Time Achievement Award”
in 2009 from JPMC
10. Mrs Nudrat Anwar Zuberi provides services of Coordinator BMSI
PUBLICATIONS
(A) Four publications of original research papers in 2009 and 11 in
2008.
(B) One paper is under publication
DETAILS
1. Antioxidant vitamin E concentration and risk factors hypertension,
diabetes mellitus and smoking in patients with coronary heart
disease. Medical Channel 2008;14(2-II): 215-217.
2. Role of Diet in Type -2 Diabetes Mellitus. Medical Channel 2008;
14(2-II): 218-221.
3. Serum antioxidant vitamin E concentration and lipid profile in
coronary heart disease (CHD) Patients. Medical Channel 2008;
14(2-II): 222-225.
4. Evaluation of testosterone levels of women with pre-eclampsia.
Medical Channel 2008; 14(2-II): 226-229.
5. Thyroid function in relation to liver functions in apparently healthy
subjects and in cirrhotic. Medical Channel 2008; 14(2-II): 230-
232.
6. Assessment of pulmonary functions in apparently healthy subjects
and diabetics. Medical Channel 2008; 14(2-II): 233-35.
7. Elevated vascular endothelial growth factor in malignant ascites.
Medical Channel 2008; 14(2): 6-9.
8. Serum magnesium status in patients with chronic heart failure.
Medical Channel 2008; 14(3): 67-70.
9. Dyslipidemia in type 2 diabetes mellitus explaining more
atherogenic in women. Medical Channel 2008; 14(3): 71-74.
10. Assessment of nutritional status in school going children in
different socioeconomic groups. Medical Channel 2008; 14(3):
75-78.
11. Evaluation of serum Leptin levels during normal pregnancy and
in pre-eclampsia. J Ayub Med Coll Abbottabad 2008 (Oct-Dec);
20(4): 137-140.
12. Serum antioxidant vitamin C concentration and lipid profile in
coronary heart disease (CHD) patients. Medical Channel 2009;
15(2): 61-64.
13. Serum level of insulin, IGF-1 and PSA in prostate cancer patients
in local population. Medical Channel 2009; 15(2): 68-71.
14. Heart failure patients are prone to develop magnesium deficiency
as a result of diuretic/digoxin therapy. JDUHS 2009 (January-
April); 3(1): 4-9.
15. Association of bone mineral density with urinary hydroxyproline
and serum estrogen in postmenopausal women. Medical Channel
2009 (July September); 15(3): 112-114.
 DEPARTMENT OF BLOOD TRANSFUSION SERVICES
Introduction Data for January 2009 to December 2009
Blood Transfusion Service, JPMC, is a hospital-based blood bank, Total donor bled: = 39859
Average donor a day = 109/day
which is working with collaboration of Patients’ Aid Foundation, Total whole blood and packed cell arranged: =61471
JPMC based non-governmental organization. Blood Bank, JPMC is Total F.F.P. arranged: =7290
registered under Sindh Blood Transfusion Act by Sindh Blood Total Platelets arranged: =1993
Total Cryoprecipitate arranged: =304
Transfusion Authority. Total =71058
AIDS Surveillance Centre is a national voluntary counseling and
Average arrangement of blood and product a day:=195/day
testing centre for HIV infection. Annual prevalence of HCV infection =1503 (3.8%)
Annual prevalence of HBV infection =1324 (3.3%)
Goals Annual prevalence of HIV infection =07 (0.02%)
Annual prevalence of VDRL infection =213 (0.53%)
To promote voluntary blood donations.
To promote rational use of blood by providing blood products.
Achievements
To ensure safety of blood and blood products.
Successful participation in Quality Assessment Program of National
To provide voluntary counseling and testing facilities for HIV Reference Laboratory, Australia.
infection. Publication of scientific papers in the well reputed international and
To offer teaching and training facilities at undergraduate, national scientific journals.
postgraduate and paramedical Levels. Active participation in local, provincial, national and international
To create awareness of blood transmitted infection in the efforts for safe blood transfusion.
community.
To promote research in the field of blood transfusion.

Organization and Personnel

Administration
Jinnah Postgraduate Medical Centre, Ministry of Health, Government
of Pakistan

Collaboration
National AIDS Control Program, National Institute of Health,
Islamabad.
Patients’ Aid Foundation: a non-governmental organization.
Sindh Blood Transfusion Authority.

Quality Assurance
Affiliation with National Reference Laboratory, Australia

Personnel
Assistant Professor/Blood Bank Officer
Asstt. Blood Bank Officer
Supervisor
Technician
Nursing Attendants
Sanitation staff

Routine Services
Camping for voluntary blood donations
Facility based collection of blood for walk in donors.
Preparation of blood products.
Screening of blood for blood transmitted infections.
Provision of safe blood and blood products to the needful patients.
Counseling, diagnosis for HIV, AIDS, infections.
Teaching, training and research.
Antenatal screening for hemolytic disease of newborn.
 DEPARTMENT OF CLINICAL ONCOLOGY
FACULTY Follow-up cases 34169
The organization flow chart of Department of Clinical Oncology is Male 15858
as follows: - Female 18311

Designation Status Patients received Radiation Therapy 568

Professor of Radiotherapy Dr. Prof. Ahmed Usman
Associate Professor/In-charge Vacant Patients admitted 1806
Assistant Professor Dr. Heeranand Keswani
Administrative RMO Dr. Tehseen Khurshid One original study on efficacy of Folfox 4 adjuvant treatment in Ca
Sr. Registrar Dr. Ghulam Haider Colon in our local population is in process of completion
Another original study on Neo-Adjuvant chemotherapy in Ca. Breast
is also in process of publication.
FACILITIES
Another study on Cancer Registry one the last 10 years has been
The Department of Clinical Oncology is the first oncology centre
completed.
established in Pakistan. The centre is rendering services to the patients
all over the country. It is one of the 25 clinical disciplines of JPMC
consist of 48 bedded indoor facility along with day care center and
teletherapy services. By the Grace of God a new oncology ward
complex has been constructed in the vicinity of Radiotherapy
department with an estimated cost of Rs. 50 million which is functioning
very effectively. We are providing all oncology services under one
roof for the sake of convenience to the patients.
Indoor and Outdoor treatment facilities and day care chemotherapy
Palliative Care to Cancer Patients
Radiation Treatment

ACTIVITIES
The department has established CME programs through which
lectures and group discussions in the field are being conducted on
monthly basis. The invited speakers also deliver lectures in the said
program.
Conduction of regular clinical meetings
Regular classes for DMRT-I & II trainees
Weekly self assessment tests are conducted for DMRT students
Weekly case presentations
Weekly death meeting to discuss different aspects of management
and cause of death in cancer patients

TRAINING
We are running a two years postgraduate training program leading to
DMRT, which is affiliated, with Liaquat University of Medical and
Health Sciences and recognized by PMDC. At present 09 postgraduate
students are enrolled in this program and are completing their training
for part-I and part-II.

ACHIEVEMENTS DURING THE YEAR 2008

Registered Case 2169
Male 1144
Female 1025
 DEPARTMENT OF CLINICAL PATHOLOGY
FACULTY LABORATORY TESTS ARE AS FOLLOWS:
Dr. Syed Owais Ahmed Clinical Chemistry 742811
Assistant Professor of Clinical Pathology Hematology 108083
Dr. Zahid Ali Abidi Microbiology 10758
Medical Officer Serology 11826
Main Laboratory operates in one of the most dynamic tertiary hospital Emergency Lab 447707
JPMC in Karachi Main. Lab is the only unified service provider in Urine / Stool D/R 34359
JPMC round the clock throughout the year, able to serve all the patients Anti HCV 16804
who come in OPDs and Emergency and admitted in different wards HBs Ag 16804
with comprehensive laboratory tests. Hb AIC 170
Grand Total 1389322
FACILITY
We are emphasizing laboratory worker training on par. In addition,
we are focusing on improving our patients and clinician satisfaction
level to bring us in line with the best.
Significant effort is also being made in infrastructures improvement,
introduction of new operational support system including computer
reports and patient care and laboratory test process improvement with
the introduction of strict internal & external quality control system.
The number of patients coming to JPMC is increasing due to increased
growth of population in Pakistan and proportionately the pressure of
laboratory tests continues which is now exceeding. 1.3 million
test/annum so we are trying to enhance our capabilities from our
existing instrumental base. We are having some modern automatic
chemistry and hematology analyzer like SELECTRA-XL, Abacus,
Medonic, Nihon Koden, Sysmex, Easilyte, Evolis, Unosys/ Automatic
(ELISA), etc etc.

ACADEMIC ACTIVITIES, TRAINING & RESEARCH &

ACHIEVEMENT
Moreover the department involvement in academic activities continues
throughout the year and it provides training, teaching, and research
facilities to M.Phil, FCPS students. The department also offers
education facilities to the students of College of Medical Technology
and teaching/training facilities to paramedics like laboratory technician
and medical Technologists & particularly provides teaching & training
facilities to 45 students of laboratory training course of Benazir youth
program in this current year 2009.
 DEPARTMENT OF DERMATOLOGY
FACULTY Chromoblastomycosis: In a 10 year old Pakistani boy. 6th SARCD
Professor & Head: Prof. Azam J Samdani & 7th SODVELONCON (National Conference of Society of
Assistant Professor: Dr. Behram Khan Khoso Dermatologist, Venereologists and Leprologists of Nepal), 13-15,
Registrar: Dr.Sameera Rizwan Nov, Kathmandu, Nepal, 2009.
RMO: Dr. Sobia
Dr. Qaisera Awareness of Acne and its relationship with Diet and Stress.6th
Dr. Syed Farooq Shah Liquat National Hospital Symosium, Karachi, Pakistan, 11-13, Dec
2009.
INTRODUCTION/BACKGROUND
The Department of Dermatology is a fully established unit with highly Cutaneous Leishmaniasis. “Breakthrough in Cutaneous Therapy”.
qualified faculty members. We are attempting to make it a center of 6th Liquat National Hospital Symosium, Karachi, Pakistan, 11-13,
excellence for clinical, academic and research activities in the field Dec 2009.
of dermatology. It is a 20 bedded tertiary care unit with both outdoor
and indoor facilities. PUBLICATIONS:
Laboratory studies and clinical trials on new formulations against
FACILITIES cutaneous Leishmaniasis: Dermatologic Therapy, USA. 2008.
Total number of beds-20(male 12 and female 8) (Accepted for publication).
Twice a week OPD-Tuesday and Friday “A rare Albino village of Bhatti tribe in Upper Sindh.” An
Dermato-surgical procedures such as cautery, cryotherapy, Epidemiological study: Iranian Journal of Dermatology. .(Accepted
electrofulgation once a week for publication.).
Referral management of indoor units of JPMC, NICVD and NICH.
MEETINGS REPRESENTED
ACADEMICS Programme Manager’s Meeting on Leishmania Control,
C.M.E for post/under-graduates and paramedical staff. WHO/EMRO , Sharm Al Sheikh ,Egypt, Oct 2009.
Academic sessions such as journal club and clinical pathological 6th SARCD (South Asia Regional Conference of Dermatology,
meetings are arranged fortnightly. Venerology and Leprology) & 7th SODVELONCON (National
Lectures & Clinical teaching of final year students of SMC. Conference of Society of Dermatologist, Venereologists and
Teaching and training for Post Graduates Residents in General & Leprologists of Nepal), 13-15, Nov, Kathmandu, Nepal, 2009.
Family Medicine from AKU in OPD.
OTHERS ACHIEVEMENTS:
RESEARCH Many FCPS-II residents from medicine and ophthalmology have
Following projects are in progress restarted their clinical rotations in dermatology. The department is in
A comparison study of two brands of Adapalene gel for the treatment the process of being recognized for MD in Dermatology from University
of Acne. of Karachi. Prof. Azam Samdani is co-supervising students doing MS
A comparison study of Adaplene alone and combination of Adapelene in psychology/sociology and M.Phil in pharmacology from BMSI,
and clindamycin for the treatment of mild to moderate Acne. JPMC respectively. Reverse teaching has been started by Prof. Azam
The association of Pemphigus Vulgaris and Hepatitis B and C virus. Samdani on telemedicine to train doctors working in rural areas of
The association of Pemphigus Vulgaris with different Blood Groups. Sindh for treating basic dermatology problems.Dermatology is the
most active department involved in telemedicine services being
TRAINING provided by JPMC centre.
Post-graduate training for FCPS II candidates (Medicine &
Ophthalmology).
Diploma course is about to start.
Academic activities for house officers are carried on weekly basis.

PRESENTATIONS
Leishmaniasis in Pakistan “Epidemiology & Challenges in the
management of Cutaneous Leishmaniasis in Pakistan” Programme
Manager’s Meeting on Leishmania Control, WHO/EMRO , Sharm
Al Sheikh ,Egypt, Oct 2009.

Molecular studies of children with Ichthyosis Vulgaris for the

detection of filaggrin gene mutation (R501X) in Pakistani Famalies.6th
SARCD & 7th SODVELONCON (National Conference of Society
of Dermatologist, Venereologists and Leprologists of Nepal), 13-15,
Nov, Kathmandu, Nepal, 2009.
 DEPARTMENT OF DENTISTRY & ORAL DISEASES
Faculty:

Dr. Abid Mehmood Incharge

A single dental institute existed in the country for about twelve years
after the independence. In 1960, the government decided to install
dental surgeons in three main medical institutes. It was also decided
to set a Dental Pain Relieving Clinic in JPMC. Dr. Syed Naseem
Haider Rizvi (a premier and prominent dental surgeon) was assigned
the task, who started the job from a scratch. His tremendous work
was soon recognized and from one room clinic, the premises were
shifted to the present building where full fledged dental department
was established in 1980.

At present this department is divided into five sub-sections, namely

Diagnosis and Dental Radiology, Exodontia, Operative Dentistry,
Periodontology, Oral Surgery and Endodontics. It helps to manage
the treatment delivery in a better way.

The department is equipped with 20 dental units, 2 intra-oral x-rays

machines, 2 OPG machines, 1 digital intra-oral X-rays machine, 1
laser dental unit and 1 photo-dynamic laser machine for the treatment
of advanced oral cancer lesions. Including 1500 patients with pre-
cancerous and oral cancer lesions, about 30,000 dental patients are
treated yearly.

Approximately, 40-50 house officers and clinical attaches are being

trained yearly in this department. Postgraduate students also attach
themselves for internship. The Oral Surgery section possesses special
attractions for postgraduates in this field, throughout the country.

There are three faculty members, who work tirelessly to provide all
types of dental treatment to the needy and ailing humanity. In spite
of heavy workload, some time is spared for research purposes also.

Dental surgery assistant course is another feature in which 10-20

students are trained every year.

It is planned that this department should stand out with colours like
JPMC itself, and wished that it should emerge as centre of excellence
one day, Insha-Allah.
 DEPARTMENT OF ENT (WARD-15)
INDOOR & OUTDOOR STATISTICS

WARD NAME: E.N.T. WARD-15

Sanctioned Bed Strength 40
Activated Bed Strength 37

Admission 1355
Discharges 1357
Deaths 10

Outdoor Patients 54423

No. of OPDs. 247

Operations 2165

Admissions/Day 3.71
Discharges/Day 3.72
Mortality Rate (%) 0.73
Bed Occupancy Rate (%) 89.55

Average Patients/OPD 220.34

 DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS- UNIT I
FACULTIES: trainees and Resident Medical Officers, House Officers present
details of events of the last 24 hours and all admissions are
Professor : Prof. Sheeren Z. Bhutta discussed in detail.
Associate Professor : Dr. Razia Korejo ✧ Teaching/Training classes for House officers, Postgraduate trainees,
Assistant Professor : Dr. Ayesha Nasir undergraduate and student Nurses.
Assistant Professor : Dr. Haleema Yasmin ✧ Periodic assessment of House officers by written and clinical tests.
Senior Registrar : Dr. Iffat Javed ✧ Training course for postgraduate trainees twice a year.
: Dr. Shazia Naseeb ✧ Monthly maternal and perinatal mortality meeting.
FACILITIES IN THE DEPARTMENT: RESEARCH:
The department of Obstetrics and Gynaecology consist of Ward-8 The following research projects are being conducted presently in
(Unit-I) and Ward-9 (Unit-II), the units are on call on every alternate the unit:
day, each unit has to conduct three operation lists, two gynaecological ✧ Ongoing Trial of Active Management 3rd stage of labour in
OPDs and one Antenatal clinic every week. collaboration with Prevention of Postpartum Haemorrhage Initiative.
Special gynaecological clinic i.e. infertility clinic, HRT clinic are also ✧ The role of partogram to reduce complications in labour
conducted twice a week, Hypertension and cardiac clinics are organized ✧ Research project “Prevalence & treatment of Methicillin Resistant
on antenatal day in collaboration with NICVD. Staphylococcus aurous in obstetrics and gynaecological sepsis at
This department has 135 beds, a separate Casualty department and tertiary care hospital” approved by funding by PMRC.
separate Labour suite. ✧ Perinatal mortality rate in relation to fetal gender
Operation Theatre: INTERNATIONAL RESEARCH PROJECTS:
There are five operation theatres, two for emergency and three for ✧ Community based interventions to reduce maternal and perinatal
elective surgery. Apart from conventional gynaecological surgery mortality and morbidity in ruler sindh Pakistan awarded by
Endoscopic surgery, operative hysteroscopy, laparoscopic and International Federation of Obstetrics and Gynaecology.(FIGO)
colposcopic surgical facilities are also available. ✧ Project on Obstetric fistula, an obstetric problem, awarded by
World Health Organization.
Labour Room: ACHIEVEMENTS:
One labour suite with 10 beds in 1st stage room, 3 fully equipped
labour rooms with facilities of Cardiotocography (CTG) ultrasound, Postgraduate trainees from the unit passed the following
Entonox administration, and central oxygen supply function round postgraduate Examinations.
the clock. The labour and delivery suite also has 5 beds in the immediate ✧ FCPS 2
postoperative and recovery room which in addition to other facilities ✧ DGO 3
has a ventilator as well. Four additional beds are reserved for academic ✧ Intermediate Module 8
patients requiring intensive care. INTERNATIONAL ACHIEVEMENTS:
Prof. Shereen Bhutta received a FIGO award in” women recognition
STATISTICS (Ward-8, Unit-I): in Obstetrics and Gynaecology.
✧ Total No. patients seen in Casualty 17,710 Dr Haleema Yasmin was selected in FIGO 2009. International fellow
✧ Total No. of admission 9, 580 ship program started from 25th Sep 9th Oct 2009 held in Cape Town
✧ Gynae admissions 786 South Africa.
✧ Obstetrics Admission 8,476
✧ Abortions 318 NATIONAL AND INTERNATIONAL CONFERENCES:
✧ OPDs 31,007 ✧ Prof: Shereen Bhutta, Dr Razia Korejo and Dr Haleema Yasmin
Antenatal 19,866 attended a FIGO XIX World Congress of Gynecology and
Gynaecology 11,141 Obstetrics held at Cape Town South Africa from 5th to 9th Oct
2009.
✧ Total No. of deliveries 7,821 ✧ Dr Razia Korejo attended 8th International Scientific Meeting of
Lower segment Caesarean section 1,450 Royal College of Obstetricians and Gynecologists from 7th to 9th
1. Emergency 1,082 Dec 2009 in Abu Dhabi.
2. Elective 368 ✧ Dr Razia Korejo attended a workshop on “Experts in Cancer
Forceps 351 Education and Leadership Initiative” on 6th Dec, 2009 held in
Vacuum 119 Abu Dhabi.
✧ Dr. Ayesha Nasir attended the XX1st AOCOG congress meting
✧ Total No. of operations 2,726 from 25th to 30th March 2009 in Auckland New zeland.
Major 1,886 ✧ Dr Ayesha Nasir Attended workshop on reproductive health in
Minor 840 Egypt.
✧ Total No. of maternal deaths 57 ✧ Dr. Haleema Yasmin attended a workshop of values clarification
and attitude transformation from 3rd to 5th Aug, 2009 at Carlton
Hospital deaths 40 hotel Karachi arranged by Ipas international.
Brought dead 17 ✧ Dr Ayesha Nasir conducted a workshop on hysteroscopy held in
✧ Total No. of perinatal deaths 461 LUMHS Hyderabad on Oct 25th 2009.
Fresh stillbirths 199 ✧ Two Workshops on EmOC for medical officers from all over
Macerated stillbirths 222 country with the collaboration of PAIMAN were conducted in the
Neonatal deaths 40 Department Obs and Gyn in April and Oct 2009.
✧ Two workshops on skills development of EmOC and Ultrasound
POSTGRADUATE TRAINING: for health care providers with the collaboration of MOH and
Department is recognized for FCPS, MRCOG, M.S, DGO. UNFPA held at the Department of Obstetrics and Gynaecology,
✧ FCPS trainees 22 Jinnah Postgraduate Medical Center Oct 13th to 25th Oct 2009.
✧ DGO 10 PUBLICATION
WARD ACTIVITIES: Sami S, Korejo R, Bhutta S. Prevalence of hepatitis B and C, JPMC
✧ Daily morning meetings in which all faculty members Postgraduate experience. J obest Gynaecol Res (AOFOG) 2009; 35(3):533-38.
 DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS - UNIT II
FACULTY: Total No. of Operations 4611
Professor Prof. Nagina Fatima Obstetrical Hystectomy 33
Assistant Professor Dr. Samia Shuja Major Gynaecological Operation 1791
Dr. Khadija Bano Minor Operation 1641
Senior Registrar Dr. Afia Ansar Tubal ligation 1362
Dr. Saba Khan Vasectomy 60
Registrar Dr. Nasreen Kishwar Total No. of Maternal deaths 60
Dr. Mirab Emanuel Total No. of Perinatal deaths 928
Fresh stillbirth 494
INTRODUCTION: Macerated Stillbirth 243
The department of Obstetrics and Gynaecology consists of two wards Neonatal deaths 191
(8 & 9),a separate emergency room, and a labour suite. The total bed
strength of wards is 140 of which ward-9 (Unit-II) has 73. Ward-9 WARD ACTIVITIES:
conducts combined antenatal and gynaecological clinics three days Daily morning meeting in which all faculty members, postgraduate
a week and side by side care is provided to the seriously ill and trainees, resident medical officers and house officers meet and go
laboring patients reporting to the emergency room. In a week, three through details of the last 24 hours, admissions are discussed in
operation lists for planned surgical procedures are conducted. Regular detail and appropriate plans made for their management.
ward rounds by faculty members are carried out daily. Tutorials/classes for house officers, postgraduate trainees,
undergraduate students on Tuesdays and Thursdays.
Facilities in the department:- Periodic assessment of House officers and Postgraduates is done
Special Clinics:- by written and clinical tests.
Special gynaecological clinics i.e. infertility clinic and menopause Death conference is conducted every week.
clinic are conducted twice a week. Hypertension and cardiac clinics Teaching rounds for postgraduate House officers & undergraduates
are organized in collaboration with NICVD. Diabetic clinic is arranged thrice weekly by Professor and Assistant Professors.
in collaboration with Diabetologist. Weekly ward round to look for area of improvement in patient care.
Regular meeting in ward with donors to encourage them for donation
for needy and poor patients.
Operation theatre:
There are five operation theatres, two for emergency and three for
elective surgery. POSTGRADUATE TRAINING:-
Apart from conventional gynaecological surgery, Laparoscopy, Postgraduate Doctors working in the department
hysteroscopy and colposcopy is also done. FCPS 19
Manual Vacuum aspiration is done in specially allocated post abortion DGO 04
care room.
Trainees passed in the year 2009
Intermediate Module (Passed) 10
Labour room: DGO 04
One labour suite with 10 beds in 1st stage room, 3 fully equipped
delivery room with facilities of Cardiotocography and ultrasound.
Entonox administration and central oxygen supply function round the RESEARCH WORK COMPLETED IN GYNAE UNIT-II
clock. The labour and delivery suite also has 5 beds in the immediate
postoperative and recovery room which in addition to others facilities a. Research Papers Published
has a ventilator as well. Four additional beds are reserved for eclamptic 1. Spinal vs General Anesthesia in emergency Cesarean sections
patients requiring intensive care. to see maternal and neonatal effects.
2. Comparison of Oral versus vaginal Misoprostol for induction
of labour at term.
STATISTICS: 3. Is single oral dose of Misoprostol a safe alternative to manual
Total No. of Patients seen in Casualty
vacuum aspirations for post abortion care?
20034
4. Case report published in JCPSP- November, 2009-rupture
Total No. of Admission 8459
of primigravid Uterus.
Obstetric Admission 7300
Gynaecological Admission 693
b. Paper under the Process of Publication
Abortion 496
1. Laparoscopic findings in chronic pelvic pain.
Total No. of patients seen in OPD 44841
2. Outcome of teenage pregnancy.
Out door Obstetric Patients 27736
3. Transvaginal repair of VVF (Vesico vaginal fistula)
Out door Gynae patients 17105
a prospective study.
Total No. of Deliveries 6654
Vaginal Deliveries 5361
C-Section 1293
c. Research Completed
1. Active versus conventional management of 3rd stage of
labour.
2. Role of CTG in detecting foetal distress during labour.
3. To compare the safety and efficacy of manual vacuum
aspiration for first trimester abortions.
4. Maternal outcome in mild to moderate mitral stenosis.
5. Effect of age on vaginal birth after C/S.
6. Comparison between maternal and fetal outcome in vaginal
and C/S breech deliveries in primigravidas.
7. Incident of endometrosis in cases undergoing laproscopy in
primary infertility.
8. Complications of twin pregnancies.

RESEARCH WORK ONGOING IN GYNAE UNIT-II

1. Role of MgSO4 for seizure prophylaxis in pre-eclamptics.
2. Role of B-Lynch suture in PPH.
3. Role of Internal iliac artery ligation in PPH.
4. Advantages of interval hysterectomy in cases of morbidly adherent
placenta.

ACHIEVEMENT AND ACADEMIC ACTIVITIES:

Nine doctors completed FCPS Postgraduation
Ten doctors passed Intermediate Module
Four doctors completed DGO
Prof. Nagina Fatima is an examiner of CPSP for FCPS/MCPS &
intermediate module exams.
Dr. Khadija Bano is a master trainer for MVA in post abortion care
in JPMC, working in collaboration with National Committee for
maternal and neonatal health in province of Sindh.
Dr. Afia Ansar has been facilitator for CPSP preparatory courses
for FCPS/MCPS students.
 DEPARTMENT OF MEDICINE (WARD-5)
& National Poison Control Centre Federal Ministry of Health and WHO
FACULTY: Diagnosis, Evaluation and management of all types of poisoning 24 hours on
call.
Prof. Jamal Ara : Professor Provide Online services to public and private sector regarding poison control and
Dr. Liaquat Ali : Professor its first aid management
Dr. Rukhsana A. Sattar : Associate Professor Library having Internet facility and largest collection of books on chemical
poisoning provided by Ministry of Health & WHO
Dr. Rasheed Durrani : Senior Registrar Training programs for doctors and nurses
Dr. Tahir Ansari : Senior Registrar Public Awareness programs.
Dr. Tariq Aziz : Senior Registrar Teaching Clinical Toxicology, at National Poison Control Center, Medical
Dr. Shaam Kumar : Registrar Unit I, Jinnah Post Graduate Medical Centre, Karachi.
Teaching Pharmacology, School of Physiotherapy, Jinnah Post Graduate
Medical Centre, Karachi from 1999 till date
INTRODUCTION/BACKGROUND Teaching Toxicology, 3rd Year MBBS, Ziauddin Medical University, Karachi
Medical Unit-I (Ward-5) has a 55 bedded medical unit, with National Poison Control as visiting Professor
Center of Federal Ministry of Health and WHO with 10 ICU beds and 4 step down Teaching Clinical Toxicology, Final Year MBBS, Sindh Medical College,
beds. The ward is a recognized unit for postgraduate training by College of Physicians Karachi.
and Surgeons of Pakistan, Royal College of Medicine of United Kingdom and Lectures & Facilitation of Seminars for D. Pharmacy and M. Pharmacy
University of Karachi. This unit has elective students from all the leading tertiary students, University of Karachi.
medical schools (both the private and pubic) and from International Medical Universities Supervises Weekly Clinical Case Presentation, at National Poison Control
like China and UK. It is providing special care to the admitted patients as well as Center, Karachi.
running general OPD and specialist OPDs. Clinical round of NPCC along with bedside teaching to medical students,
This unit is one of the most sorted with maximum admission per year and maximum post-graduates, and residents on daily basis.
numbers of out patient attendance. Teaching FCPS Part II postgraduates in Clinical Toxicology at NPCC, JPMC,
This unit is one of the most organized and busiest at Jinnah Postgraduate Medical Karachi
Center, Karachi. Trained 100 doctors of Basic Health Units, Government of Sindh on “Pesticide
Vision And Mission. poisoning management” at Hyderabad on 11th May 2003 sponsored by Crop
To provide better evidence based medical care to the patients. Life Pakistan
Structured training and research facilities to the undergraduate and postgraduate Regular Serial Workshops on Evaluation, Diagnosis, & Management of
medical students. Poisoning, National Poison Control Center, Jinnah Post Graduate Medical
Management, research and prevention of poisoning cases. Centre, Karachi.
Workshops on Poison Control & Chemical Safety in different cities, under
Facilities: January To December 2009 Incharge the auspices of Ministry of Health & WHO.
General Medical OPD (i) male (ii) female Twice a week Holds local and country wide workshops on Poison control and management
Prof. Jamal Ara round the year.
OPD attendance 49433 It provides complete registry of patients, information given to the medical personel
Admission in the Ward 4450 and public about the poison control and chemical safety, gives treatment to the poisoned
Average Patients/OPD 49932 patients, and above all this center also involved in research and academic activities
for the betterment of patients.
National Poison Control Center
Incharge and National Coordinator Prof Jamal Ara RESEARCH/PRESENTATION:
This unit is providing the toxicological emergency cover for all types of poisoning 1) Vitamin B12 deficiency still the common cause of megaloblastic anemia.
including snakebite. The patients from all over Pakistan are referred to this department 2) Iron deficiency anemia in women of child bearing age.
as no other hospital in public sector, in the province has poison control unit to deal 3) Cost of diabetic care in community.
with poisoning emergencies. To deal these types of emergencies, the NPCC has 4) Malarial Hepatopathy.
modern equipment and enough trained staff including doctors and nurses. 5) Hyperglycemic emergencies and their precipitating in Department of Medicine.
The cases admitted have unsually been poison by chemicals and drugs, animal bite, 6) Dietary services available for diabetic patients and patients satisfaction at JPMC,
plants, heavy metals etc. The center is providing evaluation (record data), diagnosis, Karachi.
investigation and management of poisoning cases. The service provided is round the 7) Electrocardiographic changes in patients with Acute Stroke.
clock and 365 day a year. 8) Association of NAFLD with dyslipidemia and obesity.
Actual Bed Strength = 10 9) Effect of statin on lipid profile of hypothyroid patients.
Occupancy Strength = >10 10) Prevalence and fatality related to methanol poisoning.

Number of Patients admitted in NPCC per year ACTIVITIES (2009):

✧ Daily ward rounds by Incharge of Ward and Associate Professors.
2005 2006 2007 2008 2009 Daily 1 hour teaching class for House officer Postgraduate after rounds
1075 1424 1158 1257 1217 1. Clinical Class of postgraduate.
a) Case presentation b) Problem case discussion.
Poisoning cases admitted in NPCC c) Clinical methods.
Alcohol intoxication 2. Death conference fortnightly.
Corrosives 3. General Club fortnightly.
Dhatura Poisoning 4. Clinical Class of undergraduate of SMC daily by RMO, Senior Registrar,
Drug Overdose and abuse Associate Professor.
Heroin Capsule as body packers 5. Morning presentation every week in Department of Medicine (Ward – 7) by
Insect bite postgraduate students.
Kerosene Oil ingestion 6. Morning presentation in ward every Friday morning of new admitted patient.
Opium poisoning 7. Final year lectures in Sindh Medical College by consultants of wards.
Pesticide ✧ Ward activities include OPD two times per week.
Rat Killer ingestion ✧ Ward activities also include emergency duties 10 times per month. (24 hour duties
Snakebite in Accident & Emergency Department)
Unknown Poisoning ✧ 30 Postgraduate Students are undergoing training leading to F. C. P. S–II.
✧ We got undergraduate students of III, IV and Final Year M. B. B. S. from Sindh
Functions of NPCC: Medical College for clinical teaching and training. Their classes a taken regularly
Deals with all kinds of poisoning emergencies coming through A & E department, and the progress of each group is assessed at the end of their posting and duly
JPMC. recorded in their progress books
Workshops
Workshop on Electrocardiography.
Workshop of Clinical Toxicology

TRAINING:
Department is actively involved in training of future consultants.
-FCPS -MCPS -Clinical Toxicology

ACHIEVEMENTS:
Passed Intermediate Module.
1. Dr. Sarwar Malik
2. Dr. Iqbal
3. Dr. Dania
4. Dr. Maseer
5. Dr. S. Hisallah Rehman
6. Dr. Nasrullah
7. Dr. Dleep Kumar
8. Dr. Erum
Passed fellowship examination from College of Physicians and Surgeon Pakistan.
1. Dr. Shobha
2. Dr. Asif Usmani
Dr. Tariq Aziz and Dr. Tahir Ansari got training in Endoscopy.

FUTURE PLAN:
Up gradation of National Poison Control Centre
Up gradation of existing Medical Unit.
Establishment of Gastro and Colonic endoscope research cell
Up gradation of Research cell.
Establishment of Poison Information Services
Establishment of Provincial poison Control Centres all over Pakistan.
 DEPARTMENT OF MEDICINE (WARD-6)
FACULTY : ULTRASOUND FACILITIES:
Prof. Tasnim Ahsan Head of the Department For all indoor patients ultrasound facility is available within the
Dr. Tariq Mahmood Associate Professor department.
Dr. Niaz Ahmed Assistant Professor
Dr. Ali Shaheer Senior Registrar
ANNUAL BUDGET:
Dr. Muhammad Umar Farooq Senior Registrar
Allocated budget for the year 2008 was Rs.14,80,000/-( Fourteen
Dr. Zeenat Bano Senior Registrar
lacs Eighty Thousand Only) for indoor patients. Specialty clinics
Dr. Subheen Kanwal Senior Registrar
expenditures were met by Medicine & Endocrine Foundation.
Dr. Rakhshanda Jabeen Senior Registrar
Dr. Fayyaz Mujtaba Deputed to NICVD
ACADEMIC ACTIVITIES:
CONSTRUCTION: Teaching ward rounds are conducted twice weekly each by Professor,
We have a plan of developing “ Skills Laboratory” on the first floor Associate Professor , Assistant Professor and Senior Registrars.
of existing ward. The project details have already been sent to the
Ministry of Health , Islamabad. As a part of the regular teaching programme multimedia presentations
are done weekly on recent articles published in various journals .
MEDICAL FACILITIES: Topic oriented lectures are delivered both by PGs and interns weekly.
Patients with diverse medical problems are admitted and provided Case presentations on admitted patients with interesting findings are
comprehensive medical care. During the past year 2530 patients were also done twice weekly.
admitted and treated. Mortality was (27.08%).
POSTGRADUATE STUDENTS:
ICU FACILITIES: At present 14 postgraduate students are undergoing training for
3 bedded ICU started functioning in June 2004. Total of 256 patients FCPS/MRCP. Two postgraduate students, i.e. Dr. Rakhshanda Jabeen
were admitted in need of critical care during 2009. 10 patients and Dr. Nisar Ahmed have passed FCPS II exam in 2009.
received ventilatory care.
House officers average 20-30 doctors in each 6 month tenure of
MEDICAL OPD: house job. They are graduates of different medical colleges of the
General Medical OPD is conducted twice weekly on Tuesdays and country apart from the regular lot of SMC graduates.
Fridays. Around 20-25 cases are admitted on each
emergency/admission day from OPD and emergency department.
OTHER ACADEMIC ACTIVITIES:
Patient attendance in every medical OPD is around 369 patients /
Monthly Endocrine meetings are held in rotation with AKUH, LNH,
OPD. Total 36168 patients visited the medical OPD last year. Besides
Baqai Hospital & NICH. Leading Endocrinologists of the city
medical OPD 3 specialized clinics are also run by the department.
participate and interesting cases are presented and discussed in these
meetings alongwith an exhaustive review of one endocrine topic.
ENDOCRINE CLINIC:
Patients with endocrine problems are seen twice weekly. This clinic
was established in 1993 and is supervised by Professor Tasnim Ahsan. RESEARCH:
7654 patients with various endocrine diseases have been registered The unit is currently engaged in research on various aspects of
so far. 2533 patients were seen in 2009. Out of which 1097 were new Metabolic Syndrome. A study on “Liver disease in Metabolic
cases. Syndrome” has been started as the first recipient of “ Sarwar Zuberi
Research grant of PMRC ”. The rest of our projects of drug interventions
RHEUMATOLOGY CLINIC: are awaiting funds from the Ministry of Health, Islamabad.
Dr. Tariq Mahmood, Associate Professor of this unit supervises the
Rheumatology Clinic that is conducted once weekly. 552 new cases PUBLICATIONS:
were seen this year. Total registered patients in this clinic are 1387. A case report on “ Chronic Arsenic Poisoning” was published in
JPMA in February, 2009.
DIABETIC CLINIC:
Diabetic clinic started functioning in September, 2004, supervised by
all faculty members in rotation. This clinic is held twice weekly. A
total of 1815 patients have been registered uptil now. 939 patients
visited OPD this year.
 DEPARTMENT OF MEDICINE (WARD-7)
FACULTY: ESR 2350 - R.A.. Test 13
Dr. Syed Muhammad Munir Professor of Medicine Widal test 19 - VDRL 02
Dr. Syed Masroor Ahmad Senior Registrar ASOT 03 - HBA1C 07
Dr. Kirpal Das Senior Registrar CRP (C-Reactive Protein) 05 - MP 845
Dr. Amanullah Senior Registrar RETIC -- - PT 3794
Dr. Zeeshan Ali Senior Registrar APTT 3644 - AFB 662
Dr. Shabnam Senior Registrar HCV 4032 - T3 340
Dr. Tharpal Das Medical Officer T4 343 - TSH 380
Dr. Shafique Rehman Medical Officer LH 360 - FSH 365
Dr. Rabia Ghafar Medical Officer PRO 370 - URINE PT 12
Dr. Munir Afzal Medical Officer
Dr. Ghafrana Memon Medical Officer We have high-tech. Elisa Machine and plate reader on which we
can performed all sorts of markers, profiles and specialized tests
INTRODUCTION/BACKGROUND including hormone assays.
Medical Unit-III (Ward-7) is a 51 beds unit, which is a recognized
unit for postgraduate training by College of Physicians and Surgeons 4. Hepatology Clinic (Prime Minister Program)
of Pakistan and University of Karachi. It is providing in care facility This Unit is the Sentinel Site Prime Minister program for Prevention
to the admitted patients as well as running general OPD and specialist and control of Hepatitis since 2005 and has been recognized as a
OPD for Diabetics and Gastroenterology patients. esteemed and reputed centre for treatment of patients of Ch. Hepatitis-
C and Ch. Hepatitis-B. 1033 patients have been registered and treated
This unit is equipped with modern research oriented Laboratory, successfully. This is an going program and new patients are being
Diabetic Clinic and G.I. Clinic for indoor as well as outdoor patients registered.
the in the premises. Under able guidance of Prof. S.M. Munir this
unit is one of the most organized units in Medical Department of 5. Pakistan Bait-ul-Mal.
J.P.M.C. Pakistan Bait-ul-Mal provides treatment of Ch. Hepatitis B- & Ch.
Hepatitis C patient and 208 patients have been registered for treatment
OBJECTIVES: of above disease.
To provide the best medical care to indoor and outdoor patients.
Training of undergraduate and postgraduate students. ACTIVITIES:
Research and publication. Teaching of undergraduate medical students of Sindh Medical
College, Karachi.
FACILITIES: Teaching/training of postgraduate medical students for MCPS, FCPS
1. In-door Patients and M.D.
Total Admission 2223 Daily morning meeting for clinical presentation by medical and
Discharge 1824 allied units.
Death 399 Topic oriented symposia.
General OPD Twice a week CME programs are organized in Medical Unit-III, JPMC.
(Wednesday & Saturday) Three examinations of MBBS final year held from January 2009
Diabetic Clinic (5 days a week) 15621 to September 2009.
G.I. Clinic (Once a week) 7424
Gastroscopies 1166 TRAINING:
Colonoscopies 123 Department is actively involved in training of future consultants.
Following postgraduates are attached with the unit:
2. Endoscopy -FCPS-II 24 Candidates
We are doing both diagnostic and therapeutic endoscopies e.g. Band
ligations, Sclerotherapies, Stricture dilatations, Oesophageal stent Research
placements, Hemostatic clips, P.E.G. Tube insertions, Polypectomies. Five papers are published in International Journal.
Stone extraction etc.
1. Frequency Of Anti Hcv Antibody In Type 2 Diabetic Patients In
3. Laboratory Pakistani Population. Jama Pakistan Vol.20 No.1-2 March – April
The laboratory of Ward-7, J.P.M.C. is doing all routine tests besides 2009.
it has made any new additions. The statistics of routine tests are as 2. Clinical Feature Diagnostic Technique For Combined Infection
follows: Of Malaria & Dengue Jcpsp 2009.
Routine Biochemistry tests 134400 - HbsAg 4032 3. Hypokalemic Paralysis And Megaloblastic Anaemia In Laurence
Electrolytes 9433 - Urine D.R 644 moon-bardet-biedl Syndrome – 2009.
Sputum D.R 662 - CP. 10530
4. Association Of Hepatitis C-virus With Diabetes Mellitus – 2009.
5. Thrombocytopenia In Malaria In Cpsp Journal 2009.

ACHIEVEMENTS:
The laboratory of Ward-7 is now accredited by International Quality
Assessment Scheme from Central Laboratory, London.
2 candidates have passed their fellowship examination from College
of Physicians and Surgeons of Pakistan: (Dr.. Susheel, Dr. Aziz
Saitho in 2009 )
2 Candidates have passed MRCP in 2009. Dr. Shabnam - Dr. Mohan

FUTURE PLAN:
We are planning to upgrade our diabetic clinic by setting an Institute
of Diabetology and Metabolic Disorders. In addition to dealing
with diabetic emergency and providing routine care of diabetic
patients, it will act as a focal point of research in diabetes, not only
imparting training to future consultants of JPMC but also establishing
a 24 hours hot line, so that any doctor or patient in the country can
contact.

Upgradation of G.I. Clinic and establishment of ERCP facilities.

 DEPARTMENT OF MEDICAL ICU
FACULTY: RESEARCH
Dr. M. Azhar Chaudhry Associate Professor/Incharge Research study ‘Single dose of octreotide reduces the portal pressure
Dr. Aly Haider Associate Professor as assessed by Doppler ultrasound. ’ (Under print in JCPSP)
Dr. Qurban Hussain Shaikh Senior Registrar Research study ‘Carvedilol reduces the portal pressure assessed by
Dr. Shahbaz Haider Senior Registrar damping index waveform in portal vein’. (Under print in JCPSP)
Dr. Noor Muhammad Solangi Senior Medical Officer
Dr. Nanak Ram RMO ACHIEVEMENTS
Dr. M. Kaleem Part-II trainee of this ward passed intermediate
INTRODUCTION: module of FCPS.
The goal of intensive care is to save lives of patients with acute life
threatening but reversible medical conditions through aggressive Future Plan
therapy, interventions, close monitoring and use of Electromechanical Ground breaking ceremony of new building of Medical ICU was held
devices. in July 2009 at place of old Radiotherapy OPD. It is our desire and
ambition to create a state-of-art training facility for the future
In order to achieve this goal, the Medical ICU at JPMC comprises 18 ‘Intensivists’ with the help of Patients Aid Foundation (PAF).
Beds. Out of this 5 beds are in Critically Ill Patient Area (CIPA) and
13 beds in the step down care.

Over period of time the unit has acquired an experience in dealing

with complications of end stage liver disease. Other than that patients
of septicemia, respiratory failure, encephalitis, cerebral malaria and
dengue fever were admitted and managed. Many of the ill affording
patients were given free medicines through zakat funds and
philanthropic donations.

The unit also runs a once weekly follow up clinic for the patients who
were treated in the ward and discharged. To cater to the increasing
number of follow up patients the follow up clinic has been shifted to
OPD No 6 in the main Surgical Building.

FACILITIES:
The Medical ICU is equipped with facilities for bedside monitoring,
infusion pumps for accuracy of drug delivery, defibrillators, piped
oxygen delivery, ventilator, and portal x-ray machine.

STATISTICS:
(Jan – Dec 2009)
Admissions 1204
Deaths 320
Follow up OPD Patients 2554

ACADEMIC ACTIVITIES:-
Weekly Morning meeting of clinical presentation for Medical and
allied units.
Daily Morning and afternoon academic meetings.
Daily teaching rounds and bedside clinical methods class.
 DEPARTMENT OF MICROBIOLOGY, BMSI
FACULTY
Professor of Microbiology Dr. Saleem Ahmed. Kharal
Assistant Professor Dr. Mohammad Asif Durrani
Department of Microbiology like the previous years continues to
provide education, training and research facilities to M.Phil and Ph.D.
students in Microbiology and moreover to those students who opt to
take Microbiology as a minor subject. It also provides a forum for
presentation of research papers and thesis.
In the Department, ELISA equipments, Fluorescence microscope,
High Performance Liquid Chromatography (HPLC), Teaching
Microscope, different types of incubators including CO2 incubator,
Cool incubator, which can be adjusted at different temperatures,
refrigerators, centrifuge machines (Ordinary and Refrigerated), water
baths (shaking and ordinary), pH meter, water distillation plants,
deionizer, compound microscopes, sterilizers, Safety Cabinet Class
II, staining and culture facilities for bacteria, fungi, parasites and
Mycobacteria are available.
The Department is working as reference laboratory. Moreover, culture
sensitivity tests of different specimens (580), AFB (155), mycological
specimens (56) and parasitological specimens sent to the Department
from different wards and OPDs have been routinely carried out and
reported in time. A new method Nitrate Reductase Assay (NRA) has
been introduced for drug susceptibility testing of Mycobacterium
tuberculosis. Moreover this department is engaged in nosocomial
surveillance to make the Hospital pathogen free.
Department is also providing facility for water testing. In this regard
water samples (200) from different areas Karachi and JPMC have
been tested and reported. The results however turned out to be eye
openers to ponder over.

Dr. Ahmed Ali Khan has appeared in final M.Phil Examination in

December 2008. His research topic was:-

Identification of mycobacterium species by non-conventional method

and its comparison with conventional methods along with the sensitivity
pattern in clinical practice (Dr. Ahmed Ali Khan)

Dr. Shafqat Qamar, Dr. Hadi Imam, Dr. Sambreen Rafique and Dr.
Samia Khanam have completed their major and minor subjects
successfully. Their synopsises have been approved from University
of Karachi and they are carrying out their research. Their topics of
research were:

1. Resistance pattern of extended spectrum beta lactamase producing

enterobacteriaceae isolates from surgical wards (Dr. Shafqat Qamar)

2. Bacterial gastroenteritis impact in drinking water of Karachi and

drug resistance of the isolated organisms (Dr. Hadi Imam)

3. Efficacy of salmonella typhi vaccine prepared from local strain

at BMSI, JPMC, Karachi (Dr. Sambrin Rafique).

4. Identification of (XDR) extremely drug resistant pattern in multi-

drug resistant TB isolates (Dr. Samia Khanam).

One more student has completed his course work and is preparing his
synopsis for onward transmission to University of Karachi.

A batch of 3 more students has completed their major as well as their

first minor subject.

A new batch of four students has started their course from September,
2008.
 NEONATOLOGY UNIT/OBST/GYNAE JPMC
Neonatology Unit plays a key role, works round-the clock, rendering
services to Unit – I and Unit-II of Obstetrics and Gynaecology. There
are about more then 16,000 deliveries per annum. This unit is looking
after all the babies, in collaboration with NICH and is firmly committed
to train paramedics, house officers and postgraduates to cognize the
common and basic problems of newborn, in ward, labour room and
operation theatre. The department also conducts combined morning
meeting, indoor postnatal round in each shift and also holds workshop
on neonatal resuscitation every three months and teaches the lactation
management skills.

FACILITY:
Incubator
Heated cot
Central oxygen supply
Stand by generator
Apnae monitor
Pulse oximeter
Resuscitation trolley

STATISTICS YEAR OF 2009

Total admissions 2172
Reference to NICH 340
Neonatal deaths including transfer to NICH 202

Indication for admission in Nursery:

Meconium aspiration and birth asphyxia 812
Low birth weight plus IRDS 718
Sepsis 168
Neonatal jaundice 93
Infant of diabetic mother 108
Birth injuries 30
Metabolic disorders 20
Haemorrhage diseases of newborn 35

Congenital anomalies:
Meningomyelocele 51
Hydrocephalus 28
In born error of metabolism 15
Duodenal atresia + Tracheo-esophageal fistula 12
Congenital heart disease 52
Anencephaly 17
Imperforate anus 07
Ompholocele 06
 DEPARTMENT OF NEPHROLOGY (WARD-22)
FACULTIES: Daily evening round with one senior consultant, Postgraduates &
Associate Professor Dr. Manohar Lal Dawani house physicians on duty.
(Incharge Unit) Every Wednesday lectures by Postgraduate on various topics.
Every Friday Journal Club with Postgraduates on latest articles.
Assistant Professor Dr. Abdul Manan Junejo Every Saturday topic combined Nephro-Urology presentations
conducted by Postgraduate trainees.
Registrar/Medical Officers Dr. Darshan Lal
Dr. Dileep Kumar Dr. Manohar Lal.
Dr. Nausheen Iqbal Arranged course for Postgraduates.
Dr. Maseer Ahmad One paper was published in JCPSP.
Attended 7th Biennial Nephrology Conference at Faisalabad one
FACILITIES: papers & One poster presentation.
Annual Symposium JPMC, one paper.
We provide in patient facility of 38 beds (20 beds in ward & 18 beds Screening of normal renal functions in population of Gazdarabad
in Dialysis) with emergency cover 24 hours/day & seven days a week. (Ranchhor line-karachi), District Mirpur Khas & Umerkot in
association with The Kidney Foundation, Karachi.
OPDs are conducted thrice weekly on Monday, Tuesday & Thursday. Medical Camps at Tando Muhammad Khan & Mir-pur Khas, in
addition workshop on Kidney diseases at Mir Pur Khas, for
Patients seen in OPD 4836 doctors.
Patients Registered in OPD 1210 Medical Camp & Lecture on “Vascular Access” at Kidney Centre,
Admission (Jan 2009 to Dec 2009) 3657 Quetta.
Almost all types of Hematological, biochemical, immunological Arranged the “World Kidney Day” with Kidney Foundation &
tests are carried out of outdoor & indoor patients free of cost. also participated in screening of women prisoners at central jail
Chest & KUB/Bone x – rays of patients are carried out. Karachi.
Facility of tissue typing for renal transplant is also available. Participated in radio & TV talks on awareness of kidney diseases.

Dr. Abdul Manan Junejo.

Dialysis Facilities. Attended “World Congress of Nephrology” 2009 at Milan, Italy.
The Department has got facility for dialysis i.e. haemodialysis and
Organizes Postgraduate course for students of Nephrology and
peritoneal dialysis.
other specialties.
Well established dialysis unit that comprises of 17 dialysis machines
Arrange and actively participate in World Kidney Day at JPMC,
including dedicated machine for Hepatitis B. The dialysis Unit runs
Karachi.
round the clock for emergency dialysis and maintenance
Lecture on Prevention of CKD in Symposium of Pakistan Society
haemodialysis.
of Nephrology at JPMC, Karachi.
42 patients are registered for twice a week maintenance dialysis.
Delivered lecture on HTN CKD at PIA Karachi.
Participated in Radio talk on epidemic of CKD on event of World
No of Dialysis done:
Kidney Day.
New Patients inducted 310
Attended 7th Biennial Nephrology Conference at Faisalabad.
Haemodialysis 4358
Peritoneal dialysis 010
Double lumen catheter 0372 RESEARCH PROJECTS.
Undergraduate (Sindh Medical College) & Postgraduate teaching.
House physician training. A) COMPLETED
Etiology & outcome of ARF in Pregnancy(published in JCPSP)
Pattern of dyslipedemia in CRF.
ACHIEVEMENTS: Frequency of Hepatorenal Syndrome in Hepatitis - C Patients
During last year following equipment & consumables were added:
Pattern of ARF in JPMC
Dialysis machines 01(received through donation)
Frequency of malnutrition inflammation complex syndrome in
Computerization of the patient’s record (in progress).
patients on maintenance H.D.
Establishment a library containing books, journals & CDs on
Pattern of Renal Osteodystrophy in patients on maintenance H.D.
Kidney Diseases, New Books & Journals added.
Echocardiographic findings in Haemodialysis patients.
Skin Manifestation of CKD patients.
ACTIVITIES Frequency of UTI in pregnant females.
Daily ward round for indoor patients at 9am. Screening of relatives of patients with CKD.
Every Wednesday and Saturday grand round with all seniors and
house physicians, RMO and Postgraduates. B) On Going:
Prof. S. A. Jaffer Naqvi joins us in the round & presentation
every Saturday & Wednesday. Thyroid problem in CKD.
Daily round in haemodialysis unit. Estimation of GFR in Healthy population.
COURSE/WORKSHOP.
Arranged 2 days symposium on 5th & 6th December, 2009 on
“Early Detection & Prevention Of CKD” for postgraduates. In this
symposium, Director of USRDS Prof. Allan J.Collins & various
Nephrologists from Karachi delivered lectures on common renal
problems and shared their experience with Postgraduates.

TRAINEES:
Six Postgraduate trainees have completed their training in FCPS
Nephrology.
Eight are being trained for FCPS in Nephrology
Postgraduates for FCPS – II in medicine on rotation from various
medical units for the completion of their requirement.

FUTURE PROJECTS:
Establishment of ICU.
Acquiring of Original books & Journals for Library

REQUIREMENT:
Appointment of 32 posts according to PC-I (1996) Construction of
Offices
 DEPARTMENT OF NEUROLOGY
Faculties INTRODUCTION / BACKROUND
Professor One Neurology unit at JPMC is the oldest and one of the only four such
Assistant Professor One units in the country. It provides neurology services to approx 40
Senior Registrar’s Two millions population (provinces of Sindh and Balochistan)

Facilities Objective / Targets

Out Patients Department 26,360 patients attended OPD held on every
Monday Thursday
Besides Monday and Thursday Daily OPD including Special OPDs,
for Parkinson’s disease Dementia Epilepsy, Multiple Sclerosis. Daily
Consultant OPD where difficult and referred patients are discussed
with consultants for case & comfort of patients that have been referred
from an out of Karachi emergency.
Emergency
24 hours daily services are provided to patients referred to neurology
department.
Indoor
1522 patients are admitted in neurology department from January
2009 to December 2009.
Diagnostic Facilities
Diagnostic facilities including EEG, EMG, NCV are provided to
patients.
Activities
Teaching of undergraduate medical students of Sindh Medical College
Karachi
Teaching/Training of Post Graduate students of Diploma in Clinical
Neurology (DCN) FCPS (Neurology), MD (Neurology).
Teaching/Training of Post Graduate Students of General Medicine
for their clinical rotation in Neurology from JPMC, other hospitals
of Karachi and also out of Karachi where Facility of training in
Neurology is not available. The Para medical training Include these
for school of Physiotherapy, School College of Nursing & EEG
Technologist. Awareness program was held for patients of Parkinson’s
disease and Multiple Sclerosis last year.
Research
The department has vast experience in Neurology research including
Migraines Movement of Disorder (Parkinson’s disease, Wilson disease)
Myasthenia Gravies and Dementia. The research paper have been
presented and published in natural and international.
As a part of public sector and an important institute the primary
objective is to provide quality and dedicated health care services to
the community. And to train professionals belonging to faculty of
neurology who can server the nation with pride.
Organization / Personnel
The faculty of the department includes an Emeritus Professor, an
Associate Professor and Incharge of the department, an Assistant
Professor and senior Registrars. The medical staff also includes a
trainee registrar, Postgraduate for FCPS Neurology, Postgraduate
student for MD Neurology and Postgraduate Students for Diploma
in Clinical neurology (DCN). Paramedical staff includes nurses,
nursing attendant, EEG technologists, a peon, a gardener and a sanitary
worker.
Routine Services provided
The department has an OPD wing, an investigation wing a 31-bedded
ward and an academic floor. It conducts 3 times weekly OPD (300
patients per OPD), daily emergency and referral cover and inpatient
services. It is equipped with modern medical equipments including
X-ray, EEG, EMG. The academic floor has a library and three computers
with Internet facility.
The clinical services have an OPD load of 200 new patients per year
and 25,000 old patients per year. The special clinical include those
of epilepsy, migraine, movement disorder including Parkinson’s
disease, Wilson’s disease, myasthenia and dementia.
This department is actively involved in academic activities including
training for diploma in Clinical neurology (10 students), FCPS
Neurology (1student), MD Neurology (6 students) and allied fields.
The undergraduate training imparted to the students of Sindh medical
College. The paramedical training includes those for School of
Physiotherapy, School/College of Nursing and EEG technologist.
This department has a vast experience in neurology research including
epilepsy, migraine, movement disorders (including Parkinson’s disease,
Wilson’s disease), Myasthenia and dementia. The research papers
have been presented and published at national and international forums.

Training CONSTRAINTS
The department is actively involved in academic Activities Including Only meager resources
for Post Graduates in FCPS (Neurology) 10 candidates DCN 10 Financial Resources both for inpatients and outpatients
Students, MD (Neurology) candidates. FCPS (General Medicine) on Technical Resources
their clinical rotation of neurology (10), The Para medical training
includes these for school of Physiotherapy, School College of Nursing INDOOR & OUTDOOR STATISTICS
& EEG Technologist. January 2009 to December 2009
ACHIEVEMENTS Bed Strength 31
Research work done under following: Admissions 1522
Epilepsy Discharges 1441
Multiple Sclerosis Deaths 93
Parkinsonism Outdoor patients 26,360
Alzheimer’s disease & other dementias No. Of OPDs 101
Neurological Infectious diseases
Young Stroke
 DEPARTMENT OF NEUROSURGERY (WARD-16 & 18)
FACULTY
Dr. A. Sattar M. Hashim Professor & Head
Dr. Lal Rehman Assistant Professor
Dr. Arshad Ali Assistant Professor
(Sharing with Neuro-radiology Department)

FACILITIES
All diagnostic facilities of neuron-imaging including CT, MRI,
C-arm, EEG, Angiography, Microscopic.
Operative – General neurosurgery – Stereotactic neurosurgery, spinal
reconstruction and trauma surgery
O. V. Jooma Memorial Course of Neurosurgery at International
level date
Participated in National & International Conference / courses
Participate in inter departmental monthly meetings

TRAINING
Postgraduates leading to FCPS six
Postgraduates leading to M. Sc ( UK ) six

PAPERS
1. Professor A. Sattar M. Hashim
Papers on congenital anomalies published in Journal of Surgery
(Sarc)
2. Dr. Lal Rehman
Papers under publication

INDOOR & OUTDOOR STATISTICS

JANUARY 2009 TO DECEMBER 2009

Ward-16 Ward-18
Brain Cases Spinal Cases
Admissions 2360 508
Discharges 1811 494
Deaths 350 29
Lama 52 Nil
Outdoor Patients 9053 9203
No. of OPDs 100 47
Operation 1461 210
Sanctioned Bed Strength 75 0
Activated Bed Strength 64 25
Admissions/Day 6.47 1.39
Discharges/Day 4.96 1.35
Mortality Rate (%) 14.30 5.54
Bed Occupancy Rate (%) 110.82 105.50
Average Patients/OPD 170.53 195.81
 DEPARTMENT OF ORTHOPAEDIC SURGERY (WARD-14 & 17)
PROFESSOR: SENIOR REGISTRARS / MEDICAL OFFICER:
Prof: Ghulam Mehboob (Ward – 14) Dr. Azad Ali Sheikh
Prof. Anisuddin Bhatti (Ward – 17)
REGISTRARS
ASSOCIATE PROFESSOR: Dr. Nasir Baig
Dr. A.R. Jamali Dr. Saeed Ahmed
Dr. M. Qasim
Dr. Kashif Mehmood
ASSISTANT PROFESSOR:
Dr. Barkatullah
Dr. M. Saeed Minhas
Dr. Muhammad Suleman
Dr. Irfanullah Ansari
Incharge Physical Medicine & Rehabilitation.
ADMISSION:
W-14 W-17 Total
I. INTRODUCTION / BACK GROUND: Total admitted cases were 1137 + 879 = 2016
Department of Orthopaedic Surgery was established in 1955. It Total Discharge 1099 + 869 = 1968
comprises two wards each with capacity of 40 beds. The unit is headed Total Death 16 + 11 = 27
by a Professor. There are 05 out patient clinic weekly and 08 operation Operations Performed 1168 + 1096 = 2264
suites under anesthesia and 02 suites weekly under local anesthesia Out Patient Department 35113 + 25457 = 60570
along with round the clock emergency service. No. of OPD’s 150 + 100 = 250
The Orthopaedic Surgery department deals with patient coming from
1/3rd of the Karachi and upcountry including far flung areas of IMPORTANT PROJECTS:
N.W.F.P. Punjab, Balochistan and Sindh. 1. Total Knee Replacement.
The department has produced 48 FCPS and M.S. consultants, working 2. Total Hip Replacement.
all over the country. Department has published, 52 research publications 3. Spine Surgery (Scoliosis).
printed in PMDC recognized national and international journals. 4. Congenital Dislocation of Hip.
5. Congenital Knee Dislocation and AMC.
II. OBJECTIVE / TARGETS: 6. Ponseti Technique to TEV Management.
To under take patients care, teaching undergraduates (M.B.B.S., 7. Fibular Grafting for Femoral Neck Fracture.
Physiotherapy, Nursing, Paramedics, Medical Technologists) and 8. Limb Sparing Tumor Surgery.
Postgraduate FCPS, M.S Orthopaedic, FRCS and other disciplines 9. Ilizrove Surgery.
of surgery, conducting research and publication, CME activities like 10. tsp superposed DHS
lectures, courses and workshops.

III. ANNUAL BUDGET: VI-B ACHIEVEMENTS AND ACADEMIC ACTIVITIES:

Annual Budget of Orthopaedic ward is Rs. 02 million, which come
to about Rs: 70/= per patient per day.
However the implants are being purchased by patients themselves or
provided by Zakat Department and some by Philanthropists.
IV.A) ORGANIZATION:
The department of Orthopaedic Surgery is an 80 (eighty) bedded unit
with round the clock emergency and daily Orthopaedic and fracture
OPD.
A) J.P.M.C. Orthopaedic department arranges an intensive clinical
course for FCPS candidates, of one week duration. This is attended
by more than 30 candidates from all over the country. The salient
features of the course are mock examination including short, long
cases, viva and OSCE, along with interactive vibrant discussions
among the examiners and the candidates; we do not charge any course
fee.
B) Pakistan Orthopaedic Association South chapter meeting held
twice in our department, attended by large number of Orthopaedic
Surgeons and postgraduates, where difficult and challenging cases
were discussed.
C) Weekly Orthopaedic conference was regularly convened on every Post fellowship training scholarships are non existent and this is need
Friday for two hours, supervised by Prof: Emeritus Z.K. Kazi, Prof: of time to keep one self aware of latest developments and technology
Suleman A. Khan, Prof: Idrees and attended by all the faculty of advancements.
Orthopaedics of JPMC and postgraduate residents.

D) 16 Postgraduate are under training for FCPS and 04 for M.S.

Successfully Passed Candidates

1. Dr. Khurram Rasheed MRCS

2. Dr. Nasir Baig FCPS II
3. Dr. Adeel FCPS II
4. Dr. Toufeeq FCPS II
5. Dr. Salman Adil MS (Orthopaedic Surgery)

E) Publication in year 2009:

Outcome of Single versus two incision operative approach used for
one stage correction of neglected congenital dislocation of the hip
joints. By Dr. Anisuddin Bhatti. JPOA Vol. 21 No. 2 August 2009
Broken Bones and Bone Setters. By Dr. Anisuddin Bhatti. Medical
Channel January 2010 medical channel: No.16CD/ 7–9
Pakistan: The New Target of Terrorism. The Karachi’s Emergency
medical response adequately prepared. JPMA vol. 59, No. 7 July 2009
441-445

VII) INVITED TALK:

Workshop on Reconstruction Surgery for Cerebral Palsy &
Rehabilitation (Dr. Anisuddin Bhatti)

Workshop on “Bomb Blast Injuries Pattern and Disaster management

at LMR Peshawar (Dr. Saeed Minhas).

Two day Primary Trauma Care Course at JPMC for 25 participants.

Orthopaedic Review Course for FCPS Orthopaedic Part – II

VIII CONSTRAINT:
The work load on the department has tremendously increased due to
blowing population of Karachi and increasing No. of accidents.
However the teaching posts in this 80 bedded remain the same since
inception of Orthopaedic Surgery ward in 1959 - 76 i.e. one Professor,
two Associate Professors and two Assistant Professor, which results
in too much constraint to deal significantly increasing patient load.

There is need to increase number of operating suits, especially we are

in dire need of separate, properly equipped and staffed operation
theater.

The budget of department is not in accordance with work load.

The instruments need to be replaced or procured new one to keep

pace with new developments in the department.
 DEPARTMENT OF PATHOLOGY, BMSI
FACULTY:- ACHIEVEMENTS:-
Incharge/ Associate Professor Dr. Shahnaz Imdad Kehar. 1. Total number of histopathological specimens were 5620 and number
Assistant Professor. 1. Dr. Naushaba Rahat. of Cytology specimens were 3960 received and diagnosed with the
2. Dr. Naila Tariq. credibility for satisfaction of clinicians.
3. Dr. Muhammad Anwar. 2. Efforts are being made for availability of antibodies for
Lecturer: 1. Dr. Humera Shahzad. immunohistochemistry and immunoflurosence microscopy.
2. Dr. Ayesha. 3. 13 Postgraduate students are presently enrolled for M.Phil training
programme in the department.
FACILITIES:-
The pathology department is providing free of cost facilities
Histopathology and Cytopathology for the admitted patients of JPMC.
FNAC of out door patients as well as admitted patients and
histopathology of samples received from other Hospitals done with
proposed charges.

ACTIVITIES:
a) Actively providing diagnostic facilities like histopathology and
cytopathology on regular basis.
b) FNAC clinic thrice a week.
c) Immuno chemistry of selected cases with available antibodies.
d) Training of M.Phil post graduate students in Pathology.
e) Weekly journal club and slide seminars participated training and
education by students and pathologists.

TRAINING:
Training and education of M.Phil students as well as FCPS postgraduate
students for rotation posting according to standard teaching programme.

RESEARCH:-
The following two research projects completed during academic year.
1. Morphological study, P53, BCL2 expression in breast carcinoma.
(Dr. Fouzia Shaikh).
2. Frequancy of carcinoma cervix, cyclin A2 and P53 in dysplasia
and carcinoma in cervix.(Dr. Rubab Naqvi).

ON GOING RESEARCH PROJECTS:

Research work is in process for three proposed studies tittled as:-
1. Use of Immunoflourrence technique to confirm the diagnosis of
lupus dermatitis and lichen planus with emphasis on over lap
syndrome and its origin.
2. Diagnosis of hydatiform mole using p57 immuno histochemistry.
3. Diagnostic assessment of problematic prostates specimen using
cyto keratin 5 – 6
 DEPARTMENT OF PHARMACOLOGY & THERAPEUTIC, BMSI
A. FACULTY: 1) Dr.Ayesha Siddiqui
Professor & Head Department of Dr. Muhammad Umer Balouch Topic: To evaluate the effectiveness of Metformin in diagnosed
Pharmacology and Therapeutics Polycystic ovary syndrome
2) Dr. Ali Gul
Assistant Professor Dr. Moosa Khan Topic: Study to compare efficacy and adverse effect of Trazodone
and Paroxetine in the treatment of major depressive disorder.
B. ACTIVITIES: 3) Dr. Syed Muhammad Masood Ali
Topic: Study to evaluate The effectiveness of clindamycin gel
versus fusidic acid cream topical therapy in diagnosed venereal
Main Activities: vulgaris in local population.
a. Enrolled students of every new batch, have to go through 4) Dr. Dial Das
orientation classes initially, then are assessed, after about every Topic: Study to Compare the efficacy of topical lodoxamide with
6-weekstime, through periodicals. sodium cromoglycate for the treatment of diagnosed verenal
b. The new batch of five students, have completed their first two keratoconjuctivitis.
periodicals.
c. The four students of new IInd year are engaged in their research
D. TRAINING:
work, their project proposals have been approved by BASR,
Trainings Post-Graduate Teaching in Basic and Clinical work at
University of Karachi in September 2009.
the level of M.Phil degrees/courses are conducted on regular basis.
d. Four students of senior most batches will appear in final
examination in February 2010.
e. The Course, Practical Work, is assessed (as periodicals) and E. ACHIEVEMENTS:
routine Research Works in the Department are in progress. All M.Phil research projects/ studies, duly approved by the BASR,
f. The few articles that have been published in the recent Journals University of Karachi for Batches 2006-07and 2007-08have been
of International repute were first presented in the Seminars. completed successfully.
g. The freshly published articles are presented in the Journal Club
weekly, by one student in turn.
h. The old protocols/practical have been changed on new trends (on
line) For this purpose the old instrument/equipments have been
changed to new ones.
i. The various collaborative Research Works which are regularly
conducted with different Departments/ Wards/ Clinics/ OPDs are
effectively in progress.
j. Problem solving discussions are also organized on weekly basis.

New Batch2009-2010:
The following 5-students have completed their two periodicals, and
are ready to appear in the IIIrd periodical, named:
1. Dr. Irfan Zafar
2. Dr. Fara Asad
3. Dr Fatima Rizvi
4. Dr. Syeda Zain
5. Dr.Rana Mehmood

C. RESEARCH:
Senior Most Batch:
The four students of the senior most batch cleared their final seminar
and appeared in final examination to be held in the month of February,
2010.

Intermediate Batch:
All the students of new 2nd year have completed their major subject
and one minor subject as well. After the search of articles they started
writing their protocols/synopsis which have been completed approved
by the BASR University of Karachi and the research is in progress
under the supervision of Dr. Moosa KhanThe Research topic of the
individuals are:
 DEPARTMENT OF PLASTIC & RECONSTRUCTIVE SURGERY
FACULTY
DR.NASIR ZAMAN KHAN ASSOCIATE PROFESSOR

DR.NISAR AHMED MANGI ASSISTANT PROFESSOR

DR.MOHIBULLAH KHAN SENIOR REGISTRAR

FACILITIES:-
ONE G.A. THEATRE.
ONE L.A.THEATRE
TWO WOUND DRESSING ROOM
ONE LIBRARY CUM-SEMINAR ROOM

ACTIVITIES:-
Monday – OPD from 9.00 am to 1:00pm
Tuesday Ward Round with Postgraduate Teaching +
Local Theatre (LA)
Wednesday G.A.Theatre and Local Theatre.
Thursday G.A.Theatre and Local Theatre.
Friday Ward Round and Journal Club
(Postgraduate Training)
Saturday G.A.Theatre and L.A Theatre.

TRAINING
Four M.S. Student training in Plastic Surgery and 2 FCPS(General
Surgery) trainees on rotation.

RESEARCH:-
Synchronous repair of Bilateral Cleft Lip & Nasal deformity by
Mulliken’s Technique.
Bilateral Cleft Lip nasal deformity by Salyer’s technique.

ACHIEVEMENT:-
Two postgraduate are appearing in exam in March, 2010.

WARD NAME PLASTIC SURGERY WARD-24.

Sanctioned Bed Strength 40
Activated Bed Strength 34
Admissions 281
Discharges 283
Discharges/Day 0.78
Deaths 02
Bed Occupancy Rate (%) 96.85
Out-Door Patients 2443
Average Patients/OPD 12.21
No. of OPD”s 48
Operations 885
 DEPARTMENT OF PHYSICAL MEDICINE & REHABILITATION
FACULTY TEACHING AND TRAINING:
Dr. Irfanullah Ansari Head Of The Department/Principal, F.C.P.S. in Physical Medicine & Rehabilitation.
Dr. Zamir Hussain Baloch Medical Officer Postgraduate Training to the F.C.P.S. Part-II candidates, posted in
Ot. Humaira Masood Incharge Physical Medicine & Rehabilitation from Orthopedic Surgery.
Pt. Shahwar Mustafa Incharge, Physiotherapy O.P.D. B.Sc. in Occupational Therapy.
Pt. Bashir Ahmed Qureshi Clinical Incharge, Students & Clinical Training of B.Sc. Occupational Therapy students in
House Officers. department of Occupational Therapy.
Mr. M.A. Hafeez Supervisor, Orthopaedic Workshop Clinical Orientation visits from various Organization / Hospitals /
Nursing Institutes.
FACILITIES:
Management of rehabilitation to patients having impairments and FUTURE PLAN
disabilities To extend 03 years B.Sc. Occupational Therapy to 04 years B.S.
College of Occupational Therapy for 03-Years B.Sc. Occupational Occupational Therapy Program.
Therapy Degree Program. To enhance the Research program at Department of Physical Medicine
Physiotherapy O.P.D. & Rehab.
Occupational Therapy O.P.D. To improve treatment facilities at Physical Medicine O.P.D.,
✧ C.P Physiotherapy O.P.D., Occupational Therapy O.P.D. and Orthopeadic
✧ M.R. Workshop.
✧ Delayed Milestone
✧ C.V.A. NUMBER OF PATIENTS ATTENDED O.P.D. IN 2009
✧ R.A, O.A. Physical Medicine & Rehabilitation 2545
✧ Speech Patients Physiotherapy O.P.D. 25019
✧ Erb’s Palsy Occupational Therapy O.P.D. 7711
✧ Spina Bifida
✧ Psychiatric Patients (Child & Adult) STRENGTH OF STUDENTS:
✧ etc. College of Occupational Therapy 46
Rheumatoid Arthritis O.P.D.
EMG and Nerve Conduction Testing.
Polio Conference ORTHOSES AND PROSTHESIS DELIVERED TO THE
Orthotics and Prosthetic Workshop PATIENTS DURING THE PERIOD:
S.NO NAME OF OBJECTS QUANTITY
ACTIVITIES:
Lectures of Postgraduates, Occupational Therapy 01. A.K Prostheses 18
Patient Management Evaluation, Lectures of Students of 02. P.T.B. Prostheses 38
B.Sc. Occupational Therapy. 03. Upper Limbs 08
Rehabilitation of Physically and Mentally disabled patients. 04. Long Leg Brace 75
05. Short Leg Brace 04
RESEARCH: 06. Spinal/Tailor Brace 10
Role of Physical Therapy in patients who present with Backache.
Role of Rehabilitation in Neuromuscular Diseases. 07. Surgical Shoes 60
Functional outcome of Rehabilitation Management in Stroke patients. 08. Hand/Other Splint 40
Role of Occupational Therapy in management of Cerebral Palsy. 09. Arch Support 125
Polio Myelitis. 10. Heel Pad 35
Role of Occupational Therapy in speech patients. 11. A.F.O. 417
12. Lumbo Corset 04
ACHIEVEMENTS: 13. Leather Jacket 16
Yearly basis admission in College of Occupational Therapy has
been started on merit basis. 14. KAFO 05
The College of Occupational Therapy successfully completed 15. Repair Orthosis 36
affiliation process for B.Sc. Occupational Therapy with the University TOTAL 891
of Karachi.
The classes were conducted very regularly and examination system
was regularized and now January to December Session is in progress.
The course curriculum was successfully completed in time by all
the respective teachers by the end of academic session.

FACULTY:
Assistant Professor/Incharge:
Medical Technologist
Physiological Technician
Laboratory Assistant
DEPARTMENT OF PHYSIOLOGY, BMSI
Dr. Abdul Shakoor Memon
Mr. Ghulam Mustafa Abro
Mr. Mehboob ur Rehman
Mr. Abdul Saeed

FACILITIES:
The department provides regular course Physiology leading to
M.Phil/PhD in addition to understanding the research skills and
preparation of synopsis and thesis. The department is equipped
adequately with 21st century, state of the art equipment to cater to
the needs of postgraduate students.

ACTIVITIES:
1. Lectures
2. Physiology experiment (Practical work)
3. Seminars and journal clubs
4. Research work

RESEAERCH:
Four M.Phil students will appear in July 2010 final M.Phil examination.
Their topics of research are as follows:
1. Thyroid Hormone levels in apparently healthy individuals and
type II diabetes mellitus individuals in local population.
(DR. ABDUL WAHAB SHAIKH)
2. QT, RR, QTc intervals in apparently healthy individuals of normal
Body Mass Index and in obese subjects. (DR. SALEEM ABBAS)
3. Status of appetite hormone Ghrelin in apparently healthy
individuals and in lean, obese and type II diabetics.
(DR. MONA RANI)
4. The comparative study of pulse pressure, echocardiography and
lipid profile in apparently healthy early age menopause and
Normal age menopause women in local population.
(DR.UZMA TASNEEM)

TRAINEES:
Fourteen M.Phil students have physiology as their major subject, out
of which four will appear in June/July 2010 examination. Four more
will appear after one year and remaining six will appear in the
subsequent year.

PHYSIOLOGY AS MINOR SUBJECT:

Eight M.Phil students from various departments (Biochemistry and
Pharmacology) of BMSI have selected physiology as minor subject.

ACHIEVEMENTS:
Four M.Phil students have been declared successfull by the University
of Karachi on 5th December 2009.
 DEPARTMENT OF PSYCHIATRY
FACULTY & STAFF
Dr. Muhammad Iqbal Afridi Professor & Head
Dr. S. Zafar Haider Assistant Professor
Ms. Salma Lari Social Welfare Officer
Dr. Chuni Lal RMO
Dr. Zar Wali RMO
FACILITIES:
Outpatient Department
About 29249 patients were seen in twice weekly (Tuesday, Friday)
major OPD days. 16478 patients were male and 12771were female.
Special Clinics
Consultation Liaison Psychiatry (Psychosomatic Disorders) including
patient with chronic gastro intestinal symptoms. In all 288 reported
at this clinic during last year.
1. Weekly special Clinics for chronic psychotic patients with
provision of normal and long acting anti psychotic drugs
2. Weekly Clinic for Government Servants and their dependants
every Wednesday
3. Weekly Clinic for drug dependents about 505 patients attended
the clinic.
4. Follow up clinic for previously hospitalized Psychiatric patients
held on Thursday.
5. Liaison services for medical, surgical & allied disciplines of
JPMC,
6. 24 hours emergency coverage at Accident & Emergency
Department
Others
Disposal of forensic/ML cases and administrative referrals from
Civil Surgeon for assessment
Medicines from Zakat fund provided to needy patients.
In-door services
About 686 patients were admitted in psychiatry department during
the year 2009. 465 patients were male and 221 patients were female.
ACTIVITIES
Regular case conference in Psychiatry ward on all admissions
Weekly administrative meeting every Wednesday, regular in its
fifth year
Conducted Examinations of FCPS at CPSP and B.Sc occupational
therapy and Physiotherapy of University of Karachi
9 PGS (FCPS) working under supervision of Prof. M. Iqbal Afridi
to fulfill part - II training.
Lectures of behavioral sciences given by consultants to students of
Sindh Medical College.
Lectures given to students of occupational therapy.
Special Classes and lectures for students of clinical Psychology
from various institutes.
Classes, weekly journal club, case presentations and topic
presentations conducted under supervision of consultants as a part
of CME.
TRAINING
Undergraduate training of students of SMC, Karachi
Postgraduate training leading to MCPS, FCPS and PhD in psychiatry
and FCPS-Medicine on rotation
B.Sc physiotherapy and occupational therapy
Undergraduate and postgraduate nursing
Teaching and training to students of Islamic Mission Hospital, Holy
Family Hospital, Karachi Adventist Hospital, St. John Homeopathic
Medical College, Karachi and Sir Syed Medical College Karachi.
RESEARCH ACTIVITIES
Research/Publications: ‘Psychiatric morbidity among married male
and female children & adolescents.’ Presented in 46th Annual Medical
Symposium, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
“Physical co-morbidity according to ICD-10 among patients with
depressive disorder” Psychiatric Conference, on Spectrum of Mood
Disorder to be held from 15th August 2009 at Islamabad.
“Body Mass Index of Outpatients with Diagnostic Entity According
to ICD-10” Presented in 18th National Psychiatric Conference held
in Bhuban, 11-13 December, 2009, published in Abstract Book
page 03.
Gastrointestinal Somatization in males and females with depressive
disorder has been published in internationally recognized indexed
Journal (J Pak Med Assoc 2009ÊOct; 59(10):675-9).
Dr. Zafar Haider presented paper on social determinants in case of
schizophrenic patients at JPMC Annual symposium.
Conducted a work shop on positive and negative syndrome scale
on schizophrenics at Sir Cowasjee institute of behavioral sciences
at Hyderabad.
One paper published in Journal of Pakistan Psychiatric Society on
role of "John Worts" in Depression.
Following research topics are under process in supervision of Prof.
M. Iqbal Afridi
Assessment of sexual dysfunction in female psychiatric patients
using anti depressants reporting at JPMC.
Deliberate self harm and the socio demographic factors contributing
to it.
Insomnia in medical students of public sector medical college
Karachi.
Suicidal intents and determinants to act on, in depressed patients
presenting at JPMC- OPD
Motivational factors to quit drug addiction.
Frequency of substance use in bipolar affective disorder.
A research on “Depression in patients with chronic renal failure on
maintenance haemodialysis was conducted and showed that 73%
of haemodialysis patients were suffering from depressive disorder
ACHIEVEMENT
Prof Dr. M Iqbal Afridi continued as Coordinator Medical Faculty
JPMC and Secretary, Faculty of Psychiatry, CPSP (College of
Physicians & Surgeons, Pakistan)
Conducted examination of undergraduates & postgraduates students
JPMC, CPSP, University of Karachi, Agha Khan and Hamdard
University.
Participated as Assessor & Editor of research papers PJMS, JCPSP
& JLUMS as Member Editor, of Editorial Board, JPMA, & JPMRC.
As a member of Panel of Experts in PMRC and Higher Education
Commission Islamabad, assessed various research projects to justify
funding.
Reviewed a Textbook on “Integrating Behavioral Sciences in Health
Care” a project of Higher Education Commission.
Participated in National and International forum. To promote mental
health participated on local Radio Pakistan, FM, Voice of America
& TV, BBC.
Courses attended
Facilitated/Resource person “First FCPS training course in psychiatry”
at College of Physicians and Surgeons Pakistan Regional Centre
“Depression and Anxiety in Primary Care” by American Psychiatric
Association, Middle East, North America, Dubai
Recovering the whole person in Schizophrenia & bipolar Disorder,
Beirut, Lebanon
 DEPARTMENT OF RADIOLOGY
FACULTY:
✧ Professor & Head : Dr. Tariq Mahmood
✧ Assistant Professors : Dr. Saima Imran
Dr. Arshad Ali
✧ Consultant Radiologists : Dr. Muhammad Salman
Dr. Nadira Abid
Dr. Amber Paras
Dr. Rajnee Bai
Dr. Sohail Ahmed Khaan
Dr. Najamul Hasan
✧ Medical Officers : Dr. Tahera Fatima Zaidi
Dr. Fayyaz Ahmad
Dr. Razia Tabassum
Dr. Rana Yasmin
Dr. Syeda Sadaf Rizvi
Dr. Tehmina Shah
Dr. Kausar Abbas
Dr. Shaista Nizam
Dr. Rubina Ishtiaq
✧ Postgraduate FCPS-II : Dr. Mahreen Rasool
Dr. Kavita Sattivan
Dr. Aneeta G. Muhammad
Dr. Rani Bai
Dr. Rani Benish
Dr. Kausar Ilahi Bux
Dr. Asha Kumari
Dr. Arifuzaman
Dr. Zafar Nasir
INTRODUCTION:
✧ Radiology is one of the busiest departments of JPMC, established
on 15th August 1947. Entertain around 700 to 1100 patients every
day. Our Ultrasound/Color Doppler section is the largest in Asia
and entertain approximately 500 patients every day.
The Department is equipped with:
18 Conventional x-ray machines
02 Fluoroscopy machines
02 C-arms
18 Ultrasound units
04 Power Color Doppler’s.
02 16-Slices Spiral C.T. Scanners
02 Echocardiography Machines.
Digital Data Storage and Internal facilities.
08 Auto-processors of 20 to 60l.
08 Dry Laser Imager
1.5 Tesla Phillips MRI, system.
Toshiba Flat Panel Whole Body Angiography.
Five Computed Radiography systems.
DIFFERENT SECTIONS / FACILITIES:
Accident and emergency section: open 24 hours 365 days a
year.
Main radiology section: (8.00am to 2.30pm) daily except
holidays.
C.T Scan section: Daily 24 hours 365 days a year.
M.R.I section: (8.00am to 2.30pm) daily except holidays.
Ultrasound and Color Doppler: (8.00 to 2.30pm) daily except
holidays.
Filter Clinic x-ray and ultrasound: (8.00 to 2.30pm) daily
except holidays.
Echocardiography: (9.00am to 5.00pm) daily except holidays.
Invasive Procedures: (9.0am to 2.30pm) daily except holidays.
F.N.A.C clinic with Pathology Department: (Saturday 9.0am
to12.00pm).
Ultrasound facility at Gynae OPD: 9.0am to 1.00pm daily
except holidays.
TRAINING:
The department is recognized for F.C.P.S. Diagnostic Radiology
Training there are two supervisor and 24 trainees. There is a daily
morning session of reporting and discussion followed by hands on
procedures. Clinico-radiological meetings are also arranged with
different specialties at JPMC.
F.C.P.S-II residents of different specialties are also given attachment
for elective training for 15 days to six months throughout the year.
We also conduct six months basic ultrasound training course twice
a year, which include preparation for ARDMS.
We have a well-established Library containing a good collection of
Radiological Books and Journals. We also have our own Video & CD
Library, which helps our doctors under training with new procedures
and latest interventions going on around the world. We also have
digital data storage and transfer facilities.
Radiology Aid Foundation [RAF} is an NGO registered with DSW
and FBR it has been working for the benefit of patients since 2000.
RAF has been providing a number of equipments, stationary,
consumables and staff to operate and report. Out of three lac thirty
thousand patient seen during the last fiscal year, one hundred and
eighty thousand patients were entertained with the help of Radiology
Aid Foundation.
 DEPARTMENT OF GENERAL SURGERY (WARD-2)
FACULTY: Four postgraduates have passed FCPS-II
✧ Professor Ghulam Asghar Channa Professor Six postgraduates have passed IMM examination
Three postgraduates have passed MRCS 1&2
✧ Dr. Muhammad Shamim Qureshi Assistant Professor
✧ Dr. Salim Ahmed Soomro Assistant Professor
✧ Dr. Muhammad Naseem Baloch Senior Registrar
RESEARCH CONDUCTED:-
Role of NG tube in patient undergoing Ileostomy reversal
✧ Dr. Dileep Kumar Senior Registrar Audit of Splenectomy done in 05 years-elective and emergency
✧ Dr. Zaka-ur-Rab Siddiqui Senior Registrar cases
Audit of surgery for complex fistula in ano in last 5 years
Therapeutic role of gastrograffin in the patients with sub acute
INTRODUCTION/BACKGROUND:- intestinal obstruction
Surgical Unit-I (Ward-2) is a 40 bedded unit, which is a recognised Rationale of near-total Thyroidectomy in MNG patients
unit for postgraduate training by College of Physicians & Surgeons, Contribution of FNAC in the Diagnosis of Malignant Thyroid
Pakistan, Royal College of Surgeons of United Kingdom and University Nodule
of Karachi. Surgical management of Hyper parathyroidism
Timing of completion Thyroidectomy and its complications
The unit has its own Endoscopic suite in which upper and lower G.I. Changing faces of Breast Cancer Treatment
Endoscopy are done routinely. The ward is planning to start ERCP Outcome of haemorrhoidal band ligation at JPMC
in the coming year. The unit is well equipped with all the modern Re-Laparotomy on demand in peritonitis published in Journal of
equipments and regularly doing advance open and laparoscopic Pakistan Society of Surgeon
procedures including single incision laparoscopic surgery (SILS), Laparoscopic assisted colectomy our early experience
Case report of duplication cyst in Journal of Pakistan Society of
Laparoscopic Hernia repair, rt. Hemicolectomy, Splenectomy and Surgeons
anterior resection. GTN ointment healing or headache ?? JPMA
Short term out come of stapled Haemorrhoidectomy in
AIMS AND OBJECTIVES:- Haemorrhoids published in JPMA
Our aim is to deliver quality surgical care to less privileged patients Outcome of Ileostomy closure at JPMC
and provide structured surgical training and research facilities to
postgraduates and undergraduate students. Our target is to emerge as
a centre of excellence.

STATISTICS OF ACTIVITIES DURING YEAR 2009:-

Total Admission 2059
Discharges 2026
Deaths 48

Outdoor patients 15040

Number of OPDs 97
Operations 1012

Bed Strength 46
Admission/day 5.64
Discharges/day 2.56
Mortality rate 2.31%
Bed Occupancy rate 69.1%
Average patients/OPD 155.05

ACTIVITIES AND ACHIEVEMENTS:-

Four Sub-speciality Clinics are run by Specialists

BREAST CLINIC By Dr. Salim Ahmed Soomro

THYROID CLINIC By Dr. M. Naseem Baloch
COLORECTAL CLINIC By Dr. M. Shamim Qureshi
HEPATOBILIARY CLINIC By Dr. Dileep Kumar
GENERAL OPD By Dr. Zaka-ur-Rab

Ca breast and Oncological advancement an update held in June,

2009
Conducted colorectal week in November, 2009 with Professor
Neil Mortenson as a Master Trainer.
Conducting Annual examinations of MBBS every year
Conducted TDACS for candidates appearing in FCPS/MRCS
examination.
 DEPARTMENT OF GENERAL SURGERY (WARD-3)
FACULTY: Research: 1)Performed Sentinel Lymph Node Biopsy
Prof. Anis subhan MBBS, FCPS (10 cases).
Professor 2) An article on Unusual Cases Presented
Dr. Shahid Rasul MBBS, FICS, FCPS, FRCS (Glasg) Breast Clinic (submitted to JCPSP).
Assistant Professor 3) Pattern of Breast Diseases presented to
Dr. Mazhar Iqbal MBBS, FCPS Breast Clinic (submitted for publication).
Senior Registrar 4) Accessory breast tissues in axilla
Dr. Iram Bokhari MBBS, FCPS Management (submitted for publication).
Senior Registrar 5) Comparison of incision and drainage vs.
Dr. Zahid Mehmood MBBS, MACS, MCPS, MRCS (ED), FCPS aspiration in breast abscess (submitted for
Senior Registrar publication)
Dr. Nasir Ali MBBS, MCPS, FCPS 6) Early complication of mastectomy with
Senior Registrar axillary clearance (under process)

REGISTRARS: Hepatobiliary Clinic:

Dr. Tanveer Ahmed MBBS Date of Establishment: January 2003
Dr. S. Shafqatullah MBBS Registered patients: 675
Dr. Mahvish Nazir MBBS Operations: 345
Dr. Asadullah Aslam MBBS Research: 1) Role of preemptive analgesia in
Dr. Mansoor Iqbal MBBS laparoscopic cholecystectomy (published
in JSP).
INTRODUCTION/BACKGROUND 2) Outcome of surgical management of
Surgical Unit-I (Ward-3) is a 40 beds unit, which is a recognized unit Obstructive Jaundice (submitted for
for postgraduate training by College of Physicians and Surgeons of publication).
Pakistan, Royal College of Surgeons of United Kingdom and University 3) Role of C-reactive protein in acute
of Karachi. It is providing in care facility to the admitted patients as pancreatitis (under process).
well as running general OPD and specialist OPDs. 4) Application of Ranson criteria in acute
This unit is equipped with modern research oriented Upper and Lower pancreatitis (under process).
G.I. Endoscopes, Laparoscope, Harmonic Scalpel and Sonotom for 5) Application of APACHE criteria in acute
indoor as well as outdoor patients in the premises. This unit is one of pancreatitis (under process).
the most organized unit in J.P.M.C.
Colorectal Clinic:
Date of Establishment: January 2003
OBJECTIVES: Registered patients: 892
To provide better evidence based surgical care to the patients and
Operations: 282
structured training and research facilities to the undergraduate and
Research: 1) Early complications of fistulectomy vs.
postgraduate medical students.
fistulotomy (submitted for publication).
2) C-reactive protein in Acute Appendicitis
FACILITIES: (Accepted for publication).
January to December 2009

General Surgical OPD Twice a week

ACHIEVEMENTS:
Dr. Shahid Rasul, Assistant Professor;
OPD attendance 16341
Attended workshop on gastrointestinal laparoscopic surgery
Admission in the Ward 1468
Vietduc Hanoi Vietnam in march 2009.
Operation 753
Attended meeting of BSS (British Society of Surgeons) Glasgow
(UK) in May 2009.
Hernia Clinic: Attended IASGO (International Association of Surgeons
Date of Establishment: January 2003 Gastroenterologists & Oncologists) meeting in china in Oct 2009.
Registered patients: 1422 Attended meeting on surgical site infections Singapore in
Operations: 262 December 2009.
Dr. Zahid Mehmood, Senior Registrar;
Endocrine Clinic: Wrote a book on Exam oriented surgical BCQs.
Date of Establishment: January 2003 Wrote a book on “Exam oriented surgical skill” (2nd edition).
Registered patients: 1183 Dr. Iram Bokhari, Senior Registrar;
Operations: 144 She wrote a book a book on selfassesment of surgical skills for
Research: 1) 10 years Study of Carcinoma students in surgery.
thyroid (submitted for publication) Added to the list of reviewer of JCPSP.
Conducted Workshop on medical ethics and research methodology
Breast Clinic: in CPSP.
Date of Establishment: January 1999 Dr. Nasir Ali, Senior Registrar, passed FCPS (general surgery)
Registered patients: 944 in June 2009.
Operations: 076 Dr. Sadiqa, Posrgraduate, passed FCPS (general surgery) in June
2009.
 Will start first time in Pakistan Bariatric Surgery soon for this 13) Role of C-reactive protein in acute pancreatitis (under process).
purpose Dr. Shahid Rasul, Assistant Professor got training in the 14) Application of Ranson criteria in acute pancreatitis (under process).
field of Bariatric Surgery. 15) Application of APACHE criteria in acute pancreatitis (under
Department is actively involved in training of future consultants, process).
at present 19 postgraduate students are under training and 8 16) Causes of acute pancreatitis (under process).
postgraduates are appearing in FCPS-II examination. 17) Tubercular Fistula in Ano (published in JSP).
Dr. Imran Adeeb passed MRCS (viva). 18) Early complications of fistulectomy vs. fistulotomy (submitted
for publication).
The following postgraduate students have passed their MRCS 19) C-reactive protein in Acute Appendicitis (submitted for publication).
II (Theory) examination:
1) Dr. Maham Yousuf ACTIVITIES (2009):
2) Dr. Quratul Ain Dr. Anis Subhan, Dr. shahid rasul, Dr. Zahid, & Dr. Nasir started
3) Dr. Adeel Hussain SILS in Ward 03 JPMC.
4) Dr. Mehmooda Teaching of undergraduate medical students of Sindh Medical
5) Dr. Surrendar College, Karachi.
6) Dr. Asadullah Aslam Teaching/training of postgraduate medical students for MCPS, FCPS
7) Dr. Mehwish and MRCS.
8) Dr. Zahid Ali Daily morning meeting for clinical case presentation by surgical
9) Dr. Ali and allied units.
Topic oriented symposia on weekly basis.
The following postgraduate students have passed MRCS-I CME programs.
examination in 2009. Monthly joint meeting with Liaquat National Hospital and Aga
1) Dr. M. Sikandar Baig Khan University Hospital.
2) Dr. M. Ali Raffat Monthly morbidity / mortality meeting.
3) Dr. Mehvish Nazir One examination of MBBS final year held from January to December
4) Dr. Surrender 2009.
5) Dr. Uzair 12 Research papers presented in 46th annual symposium Jinnah
6) Dr. Navaid post graduate medical centre, Karachi, Pakistan.
7) Dr. Bashir Two days workshop on Hands-on Laparoscopic surgery.
One day Surgical Skills workshops.
The following House Officers have passed FCPS-I examination: Communication skills workshop.
1) Dr.Rabiya Workshop on Communication Skills.
2) Dr. Javeria Workshop on Total Nutritional Therapy.
3) Dr. Batool Workshop Hands on Gastrointestinal Stapling devices.
4) Dr. Ashar Workshop Hands on Laparoscopic Surgical skills.
5) Dr. Sanjay Workshop on Micro-education technique.
6) Dr. Ameen Workshop Hands on Basic and Advance Laparoscopic Surgical
7) Dr. Arsala skills.

RESEARCH PAPERS: TRAINING:

1) Role of Sentinel Lymph Node Biopsy in Breast Cancer (published Department is actively involved in training of future consultants.
in JSP). -FCPS -MCPS -MRCS -FRCS
2) Role of preemptive analgesia in laparoscopic
cholecystectomy(published in JSP). FUTURE PLAN:
3) Millighan morgan v/s stapled haemorhoidectomy (published in Upgradation of endo-surgery clinic.
JSP) Laparoscopic advanced surgery.
4) Role of antibiotics in clean surgery (submitted for publication). Establishment of ;
5) Comparison between oral vs. injectable antibiotics in clean surgery Hands on Surgical skills workshop centre.
(under process). Hands on Laparoscopic surgical skills workshop.
6) Prevalence of Malignancy in Solitary Thyroid Nodule (submitted Bariatric Surgery Centre.
for publication). Establishment of surgical sub-specialty units at JPMC.
7) 10 years study of Carcinoma thyroid (submitted for publication). Upgradation of Research cell.
8) An article on Unusual Cases Presented Breast Clinic (submitted
to publication).
9) Pattern of Breast Diseases – presented to Breast Clinic (submitted
for publication).
10) Accessory breast tissues in axilla – Management (submitted for
publication).
11) Comparison of incision and drainage vs. aspiration in breast
abscess (submitted for publication)
12) Early complication of mastectomy with axillary clearance (under
process)
13) Outcome of surgical management of Obstructive Jaundice
(submitted for publication).
 DEPARTMENT OF GENERAL SURGERY (WARD-26)
Introduction / Back Ground Following postgraduate students passed in intermediate module
Surgical Unit-III (Ward-26) was established in 1991 in order to share / FCPS examination in 2009.
surgical training teaching and sharing surgical work load within the Dr. Muhammad Akhtar Rao
department of surgery. Dr. Barkatullah Burki
Dr. Taimur Asif
Objective / Targets Dr. Rekha Kumari.
Our aim is to provide best possible surgical care to patient and establish
academic set up for under and postgraduate students in such a way Constraints
that it may become a surgical unit par excellence. Limited no. of postgraduate, house officers.
Limited budgetary allocation as compare to other surgical units.
Facilities Radiological and scanning facilities.
Following is the working schedule for the ward. Laboratory facilities are limited.
There is no secretarial back up cover for the logistics of the ward
Emergency on Wednesday, Saturday and every third Sunday. & record keeping.
Out patient department of Wednesday and Saturday. Limited research facilities available.
Grand ward rounds on Tuesday and Friday.
Round the clock we have senior surgical cover. Future Plans
Laparoscopic and open surgical operation are done twice weekly Our future plans are to up-date the ward in a way which designates
on Monday and Thursday. it as a unit of surgical excellence.
Daily morning meeting except O.T days.
Ward rounds by incharge of ward and senior registrar daily. Indoor & Outdoor Statistics
Grand teaching round by incharge of the ward on ward days, Tuesday January 2009 to December 2009.
and Friday.
Night round by registrar daily. Ward Name Surgical Unit-III Ward-26
We have dry lab for laparoscopic techniques in ward. Bed Strength 40
Admission 1205
Following doctors are under training program in ward.
Discharge 1140
Postgraduate students for FCPS-II (09) Deaths 32
Post fellow training attachment FCPS-II (Nil) Admission / Day 3.12
House Officers (05) Discharge / Day 3.12
Mortality Rate (%) 2.73
Activities Bed Occupancy Rate (%) 75.04
We have a well planned teaching program both for under graduate Average Patients 144.69
and postgraduate students.
No. of OPDs 102
Postgraduate Program Outdoor Patients 14758
Bed side clinical teachings and case discussions. No. of Operation Major (539)
Morning meeting daily. No. Operation Minor (1390)
Emergency case discussions. Total Operations (1929)
Journal Club.
Clinico -Pathological conference once a month.
Radiological conference once a month.
Surgical conference once a month.
Surgical audit & morality meetings once a month.

For Undergraduates.
Morning and evening classes.
Final Evaluations ward test and grading (clinical assessments)
V year lecture programmes.
Coordinating undergraduate teaching of Sindh Medical College
& JPMC.

Achievements during the year.

We have done workshop on
Basic Laparoscopic skills.
PTC workshop.
 DEPARTMENT OF THORACIC MEDICINE
ANNUAL ACTIVITIES Undergraduate Teaching Program
The Department of Chest Medicine was housed in old prepartition Department of Chest Medicine providing the teaching facilities to
barrack, now with support of philanthropists and government resources undergraduate students for IIIrd year, IV year and V year.
Department of Chest Medicine is providing the clinical Pharmacy
the new building of Chest ward has been constructed having 60 general training under a senior consultant for one week duration on rotation
beds and six bedded Intensive Care, with facility of invasive and non- basis for each batch from University of Karachi.
invasive ventilation. This unit also has a bronchoscopy suite, lung Department of Chest Medicine is also providing the teaching services
function laboratory and special asthma clinic with a centre for diagnosis to Medical Technologist trainee students from Dow Medical University,
and treatment of Tuberculosis under the National T.B control program. Karachi.
The Department is also computerizing the in-door patients data for
which a special soft-ware developed, meeting the requirements. The ACADEMIC ACHIEVEMENTS
Candidates awardedDTCD-2008 – 2009
Department has established an Internet Café for postgraduate doctors 1. Dr. Asad Ali
attached to this unit. Recently service of pleuroscopy has been started 2. Dr. Rizwan-Ul-Huda
for diagnosis of pleural diseases. 3. Dr. M. Jawad Nazimi
The Department of Chest Medicine is providing training in field of 4. Dr. Nazir Ali
Respiratory Medicine leading to M.D MCPS, D.T.C.D, F.C.P.S,. A 5. Dr. Imtiaz Ali Shah
6. Dr. Ghulam Murtuza
total 24299 patients were seen during current fiscal year in the 7. Dr. Ghulam Abbas.
outpatients and 1310 patients were treated as in-patients in ward-12
& 13. As per tradition in the year 2005-2006 this department organized Services for in and out Patients
a number of activities, which included seminars, symposia, and For the year 2009.
actively participated in conferences and published papers in local and
international journals. - Chest Intubation 310
- Pleural Biopsy 120
- Lung Biopsy 39
SYMPOSIA,SEMINARS AND CME ACTIVITIES - Pleural Fluid Aspiration 312
1. Attended a MDR TB workshop in Turkey from 26th January, - Gastric Lavage AFB Smear 233
2009 to 30th January, 2009. - Dressing Chest Tube Washing 1807
2. Arranged International Conference on Tuberculosis COPD/HIV - Bronchoscopy 164
collaboration with Pakistan Chest Society in Hotel Pearl - Pleuroscopy 17
Continental on 21st and 22nd Feb, 2009.
3. Seminar held on World T.B Day in lecture hall of ward-7 on 24th
March, 2009.
4. Visit to Pulmonology at Services Hospital / SIMS & Fatima
Memorial Medical & Dental College Lahore on 15th April, 2009
by CPSP.
5. Attend the meeting of National Commission for Non
Communicable disease in Pakistan at PMRC, Islamabad on 16th
April, 2009.
6. Attended Chronic Respiratory Disease Commission meeting at
Islamabad on 1st and 2nd May, 2009 by ministry of Health,
Islamabad.
7. Article Published in daily Muqadma on 31st May, 2009 ( Evil of
Tobacco).
8. World no Tobacco day on 14th June , 2009 at PMA house
collaboration with Pakistan Chest Society.
9. Prevention of COPD. PMA , Jacobabad collaboration with Chest
Department of Chandka Medical College on Oct, 2009.
10. Deliver a lecture on “”Community Acquired Pneumonia”” at
Dow University of Health Science on 2nd Nov, 2009
11. Attended PMA meeting and deliver a lecture on “”Prevention of
COPD”” at Jaccababad on 7th Nov, 2009.
12. Seminar on World COPD Day and two workshops held in Chest
Department on (1). Spirometory (2) Non invasive Ventilator
collaboration with Pakistan Chest Society on 18th Nov, 2009,
JPMC, Auditorium.
13. A lecture on “ Acute Exacerbation of COPD”” by Dr. Nadeem
Rizvi on 12th December, 2009 at Symposium of Liaquat National
Hospital.

Papers Presented:
“ Implementation of DOTS for tuberculous patients in tertiary care
hospital: does it matter”? 19th European Respiratory Annual Congress
Vienna, Austria, September 12-16, 2009.
 DEPARTMENT OF THORACIC SURGERY
FACULTY Dr. S. Waqar Ahmed, Incharge Department Thoracic Surgery has
Dr. S. Waqar Ahmed Associate Professor & been awarded honorary Fellowship (FRCS-Glasg) by Royal College
Incharge Dept. of Thoracic Surgery of Physicians and Surgeons, Glasgow in 2009.
Dr. Tanveer Ahmed Asst. Prof. (current charge basis)
Dr. Niaz Hussain Senior Registrar Following two papers from the Department were published in the
Dr. Khalil Ahmed Postgraduate Journal of CPSP:

Department of Thoracic surgery JPMC is the only department of
Thoracic Surgery in the public sector, not only in Karachi, but in the
entire province of Sindh. We get referrals from Interior Sindh and
Baluchistan. We are on call 7 days a week & look after the various
Thoracic Trauma cases coming to JPMC.
1. “Role Of Urgent Thoracotomy in improving the survival of
patients with severe Chest Trauma”
2. “Role of video assisted thoracoscopy in the management of clotted
hemothorax”

FACILITIES 3. The third paper entitled “Clinical Profile and postoperative

Our department is routinely performing thoracotomies for various outcome in patients with simple and complex Aspergilloma of
diseases like Hydatid Diseases, Bronchiectasis, aspergillomas, Various lung” has been accepted by JCPSP for publication.
benign and, malignant tumors and decortications. Apart from this we
have a good outcome in the management of Oesophageal Cancers.
We also have a facility of thoracoscope, enabling us in evacuation of
retained clots without thoracotomy. We also perform rigid
Bronchoscopy and Oesophagoscopy. Patients with tight strictures of
oesophagus are also referred to us for dilatation.
We are also doing Thymectomies for patients of Myasthenia Gravis
reffered to us from the Neurology Department with good results. As
these procedures are a team effort they are only possible with joint
efforts and cooperation of Anesthesia Department and Neurology
Department.

POST GRADUATE TRAINING

The department also has the responsibility of training Postgraduates
for fellowship in Thoracic Surgery. Presently, there are three
Postgraduates registered for fellowship training in Thoracic Surgery.
In addition we also train Postgraduates coming to our department on
rotations of 2-3 months from JPMC surgical department and also
other hospitals like Abbassi Shaheed Hospital, PNS Shifa Hospital
and Civil Hospital. We have a regular programmme of bedside teaching,
case presentations and Journal Clubs, and hands on experience of
trauma management and operative skills.

ACHIEVEMENTS
Dr. Tanveer Ahmed has recently passed his fellowship examination
in Thoracic Surgery in first attempt while Dr. Niaz is appearing for
his final fellowship examination in March 2010.
 DEPARTMENT OF UROLOGY
FACULTIES Vesico-vaginal Fistula Paus Meeting 2009
Prof.Muhammad Umar Baloch Professor
Dr. Qazi Fasih-ud-Din Associate Professor Experience Of Radical Cystectomy at JPMC Paus Meeting 2009
Dr. Shahzad Ali Assistant Professor
Dr. Khalid Rasheed Senior Registrar
Dr. Mubashir H. Turi Senior Registrar POSTERS:
Dr. Mohammad Mansoor Senior Registrar Cystoscopic Evaluation Of Genito-urinary Fistula—AKUH
Dr. Iqbal Shahzad Senior Registrar Symposium
Dr. Naresh Kumar Registrar

TRAINING
FACILITIES There is hands on training of different endoscopic and open surgical
It is a 26-bedded department with all facilities for Urological surgery procedures. Endovision camera also being used for training.
including emergencies, endoscopic and open surgery. Total 902
patients were admitted and 1880 major and minor surgical procedures
POSTGRADUATES
carried out in the 3-suite urology operation theatre.
FCPS-II: Five
MS: One
ACTIVITIES
1. Routine activities include out-patient clinics thrice a week attending
UNDERGRADUATES
12861 patients per year. Operative days are thrice weekly. Daily
There is a structured teaching program for undergraduates actively
teaching round with grand round on Saturday are being held followed
carried out by Unit Incharge and Senior Registrars.
by discussions, case presentations and morbidity/mortality meeting.

2. Good clinical practice workshop held from 22nd to 23rd January

2010.

3. Meeting of PAUS held in the month of September, 2009.

4. Combined Nephrourology clinico pathologic conference is being

held every week.

RESEARCH
Following research projects were carried out during the year 2009:

PAPERS READ AT SCIENTIFIC MEETING.

Scrotal abscess:is testicular preservation beneficial?
JPMC SYMPOSIUM 2009

Complications of URS JPMC SYMPOSIUM 2009

Penile gangrene JPMC SYMPOSIUM 2009

Improvising our technique of posterior urethroplasty

JPMC SYMPOSIUM 2009

State of art lecture on flap urethroplasty in Symposium at

Kidney Centre 2009

Genito-Urinary Tuberculosis –PAUS MEETING 2009

 FEDERAL GOVERNMENT OFFICERS’ WARD, JPMC
The Federal Government Officer’s Ward, JPMC, is a 35 bedded Ward
which has about 60% bed occupancy. It is committed to providing
comprehensive medical facilities to high government officials from
grade 16 above and also private paying patients from all over the
country particularly Karachi and Interior Sindh Government official
are admitted in different categories of rooms according to their grades
and they have to pay only diet charges. Private paying patients are
admitted by the consultants and they have to pay room charges,
operation and investigation charges, they get the best possible attention
and medical care and at the same time this ward generates revenue
for the government as well.
The patients are admitted through Out-Patients department ( OPD’s)
or transferred from General Ward, Accidental & Emergency ward or
Intensive Care Unit. A brief account of admissions during the years
is as follows:-
Total No. of Admission. 561
Total No. of Non Govt. Servants. 456
Total No. of Federal Govt. Servants. 105
Total No. of Discharge. 529
Total No. of Death. 022
( Death are mainly due to terminally ill patients of cancer)
4. Catering & Kitchen Facilities:-
There is a separate Kitchen to cater to the patients where whole some
meals, both English and Pakistani diet is served at nominal rates
charges.
5. Equipment:-
X- Ray Facilities, Blood Sugar, E.C.G. Machine, BP Monitor Nebulizer,
Suctions Machine, etc are available.
6. Academic Activity:-
Medical Officers who want to do post graduation gain rich experience
& knowledge due to variety of patients being managed here.
7. Renovation Work:-
During the year under report better facilities have been provided by
repair and renovation of furniture, room to room distemper painting
and polishing work of this Officers ward.
It is strongly appreciated that, Executive Director JPMC is taking
keen interest in renovation and maintenance of FGO Ward. In her
kind guidance and auspicious control F.G.O. Ward has performed out
standing and towards better facilities.

1. Ward Administration:-
This ward is Directly under Professor Dr. Tasneem Ahsan who is the
Executive Director, JPMC.
1. DR. ARIFA AKRAM. (Senior Medical Officer
& Incharge of Federal Government Officer Ward)
2. Dr. Nosheen Rauf. (Medical Officer and
Administrative R.M.O. F.G.O. Ward)
3. Dr. Uzma Batool Kiyani, (Medical Officer)
4. Dr. Nasreen Fatima. (Medical Officer)
5. Dr. Salma Haj. (Medical Officer)
6. Dr. M. Arshad. (Medical Officer)
7. Dr. Saleem Shahzad. (Medical Officer)

All R.M.O.s and Medical Officers offer services to the patients round
the clock.

2. Nursing Care:-
There is one Head Nurse and eight Staff Nurses who work in shifts
to provide nursing care to the patients.

3. In- Door Facilities:-

There are 35 Rooms including eight VIP rooms each room has One
Refrigerator, One T.V with hot water line facilities, three single Air-
conditioned rooms and 24 ordinary rooms are also available. These
rooms are allotted to the Professor of different units and patients are
admitted either by the Professors or their Associates and Senior
Registrar.
 JPMC LIBRARY
FACULTY
Ms Nudrat Ara Alvi Incharge Library
Library was established in 1958.Mrs Eileen R Cunningham and Mr.
J G Robert Asthon were the pioneers of the library and working on
Indiana University Contract. During the first five year the Library
was situated in Basic Medical Science Institute building.In1964 the
library was moved to a central location in the Jinnah Central Hospital
compound. Library collection in the clinical departments of the Jinnah
Central Hospital was combined with the original Basic Medical
Sciences Library collection. Indiana University support of the library
under the contract was withdrawn and Mr.Jakiuddin Ahmed become
acting Librarian and receive training in Indiana University under the
Indiana University contract, earning the M.A.degree in Library Science.
Thereafter with the passage of time more new buildings were
constructed to cater to the growing need of various specialties of this
hospital. It can now proudly claim to be biggest and best equipped
hospital of Pakistan employing highly qualified staff in various
specialties to render humanitarian services to the ailing. JPMC meets
the highest international standards and produce graduates who assume
leadership role in the private and public sectors of Medicine as teachers,
clinicians and researchers in health care.
ACHIEVEMENTS AND ACTIVITIES
Latest books and international journals have been purchased.
Gazettes of Pakistan have been purchased.
Theses of MPhil were received from BMSI.
Purchases two newspapers.
Backset is prepared for reference purpose
Subject-wise theses in chronological order are prepared for reference
purpose.
National journal list has been compiled.
Subject wise WHO collection was arranged in a separate portion.
Different delegates have visited the library.
Inter library loan facility is provided with the cooperation of medical
libraries.
Annual symposium of JPMC was held in the library.

COLLECTION
The library collection is based on a current and backset of periodicals,
textbooks and monographs on all phases of medicine, including the
basic and clinical medicine and other related subjects. Bound
periodicals, loose journals, theses MPhil,FCPS, WHO publications,
Government Publications, Proceedings, Pamphlets and Reports.

MEMBERSHIP
All the faculty members, medical officers selected by FCPS (permanent
basis) and all the registered postgraduate students of the centre
MS,FCPS, MPhil, Ph.D.

SERVICES
For research scholars, library is providing photocopy services, CD-
ROM Medline services, five full text journals, reference articles for
dissertation and thesis writing. All the postgraduate students of the
centre alongwith the students of BMSI are availing facilities in the
library. Library was essential to the development of an effective
postgraduate education in BMSI.

TRAINING
The library orientation programme is organized regularly for newly
admitted students of MPIL and Ph.D.The course comprises of the
basic guideline, for the use of research library, references,
bibliographical work.
 COLLEGE OF NURSING
FACULTY MEMBERS: EXTRA CURRICULAR ACTIVITIES:
1. Ms.Rehana Afghani Principal Welcome party for new inductees
2. Ms.Salina Chand Vice Principal Annual Picnic
3. Ms.Munira A.Ali Nursing Instructor Sports
4. Ms.Ruth.K.Alam Nursing Instructor Biannual Social Evening+
5. Ms.Fouzia Mariam Nursing Instructor.
6. Ms.Shahnawaz Nursing Instructor STATISTIC DATA:
7. Ms.Naheed Jamal Nursing Instructor
SR # MSc.N BSc.N
8. Ms.Durre Shahwar Nursing Instructor
Induction of Student 1st year (14) 1st year (56)
9. Ms.Mustaqeema Nursing Instructor
02ND Year (15) 02ND Year (64)
10. Ms.Musarrat Sadiq Nursing Instructor
FOLLOWING STUDENTS GRADUATED IN 2009
BSc.N 26
INTRODUCTION:
DIPLOMA IN TEACHING ADMINISTRATION 21
1956 The College of Nursing (CON ) , Jinnah Postgraduate Medical
DIPLOMA WARD ADMINISTRATION 16
Center(JPMC )was established as a joint project of the Government
DIPLOMA IN COMMUNITY HEALTH NURSING 10
of Pakistan, Ministry of Health and the Government of the United
DIPLOMA IN PSYCHIATRIC HEALTH NURSING 10
States of America, which offered a combined course for preparation
DIPLOMA IN ADVANCE MIDWIFERY 05
in both Ward Administration.
1957 The first batch of students graduated.
1962 It was decided to offer two separate courses. The first year
program was to prepare head nurses and a second year program to
prepare teachers. The second year program was offered after successful
completion of the first year program.

FACILITIES:
Being a pioneer College of Nursing of the Country the College of
Nursing is offering Post base diploma of five discipline in various
field i.e DIPLOMA WARD ADMINISTRATION, DIPLOMA IN
TEACHING ADMINISTRATION, DIPLOMA IN COMMUNITY
HEALTH NURSING, DIPLOMA IN PSYCHIATRIC HEALTH
NURSING and DIPLOMA IN ADVANCE MIDWIFERY as well as
BSc. Nursing degree and MSc.Nursing degree program Candidates
are inducted from all one the Country in all provinus depending on
quota.

ACTIVITIES:
Presentations by the students to build confidence among students.
Three publications of the MSc.Nursing students in Nursing magazine
Salient Voice.
Scientific paper presentations in 45TH Symposium (Nursing Session).
Poster presentation by the MSc.N student in 47th Symposium.
Monthly religious activity i.e. recitation of Quran (monthly)& Eid
Melad-un-Nabi, Iftar Parties (annually).
Educational visits of the students of Diploma in Community Health
Nursing and Psychiatric Health Nursing.
Teaching Practice of the students of Diploma in Teaching
Administration in different institutions.
Annual graduation ceremony of all diploma courses.
 MEDICAL RECORD AND STATISTICS DEPARTMENT
The medical records have been recognized today as a major unit of The adhoc activities are:
management in determining the quality of medical care rendered to 1. Statistical lectures on Bio-Statistics to M.Phil/Ph-D students of
the patients by the hospital. An analysis of medical records allows Basic Medical Sciences Institute of JPMC, Postgraduate students
a Physician to study successes and failures of himself and his colleagues of FCPS and to the students of Medical Diploma Courses.
and eliminate the mistakes and go forward rather than duplicating 2. The conduct of Entrance Test Examination for Postgraduate
them over and over again. A properly maintained medical record can Medical Students, School of Physiotherapy Students, School of
meet the demand of medical staff, research work and back references. Nursing students and for Recruitment.
The effective handling of medical record is, therefore, basic to sound 3. Research analysis and guidance to postgraduate medical students
hospital organization in as much as it provides the required accurate in writing their research papers, synopsis and dissertations.
and adequate medical statistics for all purposes.
According to mutual agreement between Ministry of Health, Labour
& Social Welfare (Health Division), Government of Pakistan and
W.H.O., it was decided to assign Dr. M. Ishida W.H.O. Statistician
to “Hospital and Health Centre Statistics Project (PAK – 0057)” in
1967.
The purpose of the project was to provide statistical information
regarding the activities of Hospitals and Health Centres in curative
and preventive medicine and their utilization by various Socio-
economic population groups to develop model procedure for recording
activities, number of visits, diagnostic information, treatment and to
make special studies relating to the registration of vital events. On
the basis of the above project a Plan to create a new Department of
Medical Records and Statistics in JPMC was formulated and submitted
to Health Division, Government of Pakistan in May, 1969.
Jinnah Postgraduate Medical Centre is one of the prime medical
complexes in Pakistan. The hospital renders the services to more than
52 thousand indoor patients, 1 million outdoor patients, 24 thousand
emergency patients and 26 thousand operations annually. With the
time quantum of maintaining medical records and statistics is increasing
significantly.

Function of the Medical Record and Statistics

Department:
Medical Record and Statistics Department of Jinnah Postgraduate
Medical Centre functions under the supervision of a “Medical
Statistician who is an M.Sc. (Statistics). This Department maintains
the Morbidity, Mortality and Fertility Statistics of J.P.M.C. that includes
the indoor and out door patients. There exists a medical record Library
in the department for the preservation of the Medical records. Such
data is then classified, summarized and analyzed in the department.
The regular activities of the department are as follows:-

1. Preparation of Index Summary sheets.

2. Sorting of Medical records.
3. To make available the records on demand to the Physician for
back references and research purposes.
4. To make available the records for issuance of birth, death and
medical certificate.
5. To keep the complete returns and accuracy of the census report.
Daily monthly and annual summary reports.
6. Correspondence related to statistical data.
7. To deal with the patients referred to JPMC for medical treatment.
8. Supervision of the out door registration counter.
9. Preparation of Monthly, Quarterly and Annual reports of indoor,
outdoor, communicable diseases and mentally ill patients. These
reports are sent to Bio-Statistics Department of Ministry of Health
on a regular basis.
 PAKISTAN MEDICAL RESEARCH COUNCIL
FACULTY:
Research Director : Dr. Waquaruddin Ahmed
Medical Officer : Dr. Ambreen Arif
: Dr. Fareeha Sajjad
: Dr. Javeria Waquar
Research officer : Miss Safia Bibi (Microbiologist)
: Miss Tranum Ruba Siddiqui (Microbiologist)
: Mr. Ejaz Haider (Biochemist)
Statistical Officer : Mr. Syed Ejaz Alam
The PMRC Research Centre at Jinnah Postgraduate Medical Centre,
Karachi was established in 1968. The Director Jinnah Postgraduate
Medical Centre is the Honorary Director of the centre. The centre has
its own building where the land was donated by the host institution
while the building was constructed by a philanthropist who supports
the janitorial services to maintain the hygiene. This centre is designated
as the specialized centre for gastroenterology and hepatology. The
centre has an out patients department where patients with
gastrointestinal and hepatic disorders are referred from all over the
country. A comprehensive clinical and research data on all cases is
maintained at this centre.
FACILITIES:
Outpatient clinic for G. I., Liver disease and diagnostic
procedures/facilities is available at the centre for the following
specialties:
GASTROENTEROLOGY:
Peptic ulcer disease, inflammatory bowel disease i.e. ulcerative colitis,
Crohn’s disease, tuberculosis of the GI tract, malabsorptive disorders,
cancer of the GI tract and colonic polyps. Upper and lower GI
endoscopy and its related therapeutic procedures like dilatation of the
strictures, placement of prosthesis, endoscopic gastrostomy, pyloric
dilatation, small bowel biopsy, polypectomies.
HEPATOLOGY:
Diagnosis and management of acute and chronic hepatitis, cirrhosis,
and portal hypertension. Procedures like liver biopsy, banding of
esophageal varices are done regularly at the centre, specialized
procedures like esophageal manometery, ultrasonography and guided
biopsies are done when required.
LABORATORY:
This center has adequate biochemistry and microbiology laboratories
and trained staff who have worked with several advanced techniques
in the field of clinical biochemistry and molecular biology to facilitate
research for this unit and others interested to collaborate. The various
available techniques are Spectrophotometer, Radial Immunodiffusion,
Viral markers of Hepatitis including rapid testing by strip method and
ELISA, Immunofluroescence, developed the rapid diagnostic test
(CLO) for H pylori (Patent from Govt. of Pakistan)
BIO-STATISTICS
Statistical support is provided in conducting research projects
undertaken by researchers and postgraduate students (M. Phil /Ph.
D/ FCPS / MD / MS)
SUPPORT IS PROVIDED ON:
Study design, determination of Sample size, Sampling Technique,
Questionnaire designing & format designing for data entry according
to computer software, Data collection, management and analysis
ACTIVITIES:
The department is actively involved in conducting research projects
mainly related to gastrointestinal and hepatobiliary diseases, genetic
markers, gastrointestinal flora, cytokine analysis and diarrhoeal
diseases and trained young researchers in project writing. Project
writing is a skill which refines with time and experience. Often lot
of time is spent on making projects but major points like sample size,
sampling technique, feasibility, costing and collaboration with other
department is over looked. To provide the solution young researchers
are trained in how to collect a sample size, use of sampling technique,
data management and analysis. It has been observed that in most
instances projects are made on topics which do not cater to the needs
of the population at large but are more individual oriented therefore
they are not supported by the funding agency.
TRAINING:
Two doctors were trained in Diagnostic and therapeutic procedures
in year 2009
RESEARCH:
Research Projects Completed in 2009:-
- Are cheaper, old time antibiotics still effective in the control of
post operative wound infections?
- Screening of HBV/HCV by Eliza Methods for Referred patients
of the Depts. of JPMC
- Trends of HBV/HCV markers in last 20 years
- Yield of culture positivity of Helicobacter pylori on CLO + ve
Research Project – Ongoing
- Serial antibody titers of H. pylori after specific treatment
- Clearance and rate of transmission of hepatitis C in new born from
infected mothers.
- Biofilm formation of pathogens isolated from post operative wound
infections.
Publications:
1. Ziadi S, Usmani A, Shokh IS and Alam SE. “Ovarian Reserve
and BMI Between Fertile and Subfertile Women”. J. Coll
Physicians Surg Pak. 2009 Jan; 19(1):21-4.
2. Qureshi H, Arif M, Riaz K, Alam SE, Ahmed W and Mujeeb
SA. Determination of risk factors for hepatitis B and C in male
patients suffering from chronic hepatitis. BMC Research Notes
2009, 2:212.
3. Aziz S and Alam SE. Implementation of Directly Observed
Treatment Short Course at a Trust Hospotal in Karachi. PJMR.
Vol 48: 68-70, 2009.
4. Baig S, Siddiqui AA, Ahmed W, Arif A, Qureshi H. Frequency
of Hepatitis C and D Super Infection in Patients with Hepatitis
B Related Complex Liver Disorders. JCPSP 2009,
Vol. 19 (11): 699-703.

5. Qureshi H, Arif M, Ahmed W and Alam SE. YMDD Mutation

in Pakistani Patient. The comparision of Eastern response with
the Western Response. JPMA 2009, Vol 21:50.

ACHIEVEMENTS:
Data analysis of the project “To see if treatment given for hepatitis
B and C is according to the protocol and treatment response set by
Prime Minister’s Programme

Research activities: Work Output (in Year 2009)

Patients
PROCEDURE 1048
- COLONOSCOPY 82
- ENDOSCOPY 683
- SIGMOIDOSCOPY 49
- DILATATION 20
- STENT 2
- POLYPECTOMY 10
- BANDING 141
- LIVER BIOPSY 6
- ULTRASOUND 55
OUTPATIENTS (OPD) 3533
LABORATORY TEST 7377

TOTAL 11958

OPD days Saturday & Wednesday

PROCEDURE days Monday, Thursday & Friday

 PATIENTS AID FOUNDATION
Following are the members of Patients Aid Foundation ONGOING Project of Medical ICU
Medical ICU is one of the most important departments of C.C.U.
Mr. Zahid Bashir Chairman Board of Governors (Critical Care Unit). The ward is in dire need of renovation /
Mr. Mushtaq Chhapra Chairman Executive Committee construction. We hope to bring this ward to the standards that patients
Mr. Yunus Bengali Treasurer and doctors deserve.
Mrs. Shaheen Suleman Hon. General Secretary
Mr. Masood Shaikh Member FUTURE PROJECTS
Mr. Shabbir Dewan Member Request received from different wards:-
Mr. Shabbir Patka Member 1. Renovation and construction of first floor at Ward 5.
Mrs. Anisa Rasheed Khan Member 2. Construction of Resource Training Center at the roof of Gynae
Mrs. Ghazala Ahmed Member OPD
Mr. Sikander A. Ghulam Ali Member 3. Renovation / construction of Chest ward.
Mr. Daruis Kandawala Member 4. Dermatology Department requires a Phototherapy System for the
Mr. Dawood Baswani Member treatment of skin diseases. This therapy machine has different models,
i.e. HOUVA & PUVA of 32 lamps and 48 lamps, respectively.
Patients Aid Foundation (PAF) established in 1990 is a voluntary
welfare organization set up by the concerned citizens to administer Please visit our website at www.patientsaidfoundation.org for further
to the needs of poor patients at the Jinnah Postgraduate Medical information.
Center, Karachi PAF helps the hospital and patients by providing a
wide range of services round the clock. These include a drug bank
functioning on a daily basis, providing the deserving with free MRI,
CT Scan, Lab tests, Endoscopies, Angiography, Orthopedic, and
artificial limbs. PAF also runs free Shuttle Van Services of pick &
drop facilities to approx. 3500 Patients per month from the Main Gate
of JPMC to different wards.
The PAF is engaged with major projects on a yearly basis. These
include renovation and construction of buildings duly equipped with
the latest medical equipment.

The prominent activities carried out by Patients Aid Foundation are:

Renovation / Construction of the following wards:
i. Accident and Emergency Department & operation Theater
ii. Surgical ICU
iii. Chest Ward
iv. Gynae ward
v. Eye Ward
vi. Blood Bank
Provision of 200 pints of fully screened blood free of cost to the
patients on daily basis.
Pathological Lab tests and Diagnostics like C.T. Scan, M.R.I. Lab
Blankets, Bed sheet, Coffin Sheet for various wards.
Medical Equipment provided to Radiology Department.
Catheters for Neuro-Intervention to Ward 16 Neuro-surgery
Symposium
Inauguration &
plenary session
 Zafar Sajjad
Continuous Medical Education
The situation in Pakistan

With the exponential growth in our knowledge and understanding of the human
body and its physiological and disease states it has became imperative for health care
professional to keep them abreast of the current developments. Failure to do so will put
the lives of patients under their care at risk. This fact has led to a worldwide recognition
of the need of continuous medical education. There are now well developed systems to
ensure the quality and quantity of continuous medical education and this is now a statutory
requirement in many countries and regions.

There are several terms that are used to describe the processes such as
recredentialling, revalidation, recertification, relicensure which all seem similar but have
different connotations. This presentation will initially look to address these differences
and define the meaning and scope of the terms used in the context of continuous medical
education. It will also look at the need and application of the various processes.

We will also describe a working model that is being used in Pakistan and will
define how this can be achieved with limited resources. The current state of affairs in
Pakistan with reference to continuous medical education will be reviewed and some
suggestion presented for the way forward will be discussed.

Zafar Sajjad, MRCP(UK), FRCR

Associate Professor,
Interim Chair,
Department Of Radiology,
Aga Khan University Hospital,
Karachi.
 Huma Qureshi
Pakistan Medical Research Council
Islamabad
“How to improve research culture in Pakistan”
There are many reasons for the non development of research culture in Pakistan, of
which
Lack of revision of curricula, scarcity of mentors, lack of time to do research due to over
work on part of health providers, lack of funding, non paying research job and lack of appreciation
of research by users are the main hurdles. Despite constraints, commitment, vigor and persistence
always work especially in researchers.
Establishment of PMRC centre at JPMC in 1968 is an example of this commitment and
vigor. Most of the research on local GI and liver diseases came out of this centre at a time when
gastroenterology as a subject was not known and there was no information on liver diseases in
Pakistan. Over the years this centre has become the referral centre for this specialty and a hub
for information on these diseases. Extensive data from this centre was referred to while making
the PC1 on hepatitis.
The present survey on the prevalence of hepatitis B and C in Pakistan is an example of
commitment and desire of these researchers to develop the baseline values for Pakistan on these
diseases.
This survey was conducted from July 2007 to May 2008, in collaboration with Ministry
of Health, Statistics Division, Federal Bureau of Statistics (FBS) and Pakistan Medical Research
Council (PMRC).
A sample size of 7000 houses in 350 primary sampling units (PSUs) all over Pakistan
was calculated by FBS, thus requiring checking of 47000 persons. Whole blood devices were
used and their sensitivity and specificity was checked against ELISA using serial dilutions. Only
devices having an over 98% sensitivity and specificity were used.
A total of 47043 persons were screened. Overall prevalence of hepatitis B (HBsAg) was
2.5% and hepatitis C (HCV) was 4.9%. HBeAg positivity in HBsAg positive cases was 14.4%.
For HCV the prevalence within provinces showed 5% in Sindh, 6.7% in Punjab, 1.1% in NWFP
and 1.5% in Balochistan. For HBV the figures were 2.5% in Sindh, 2.4% in Punjab, 1.3% in
NWFP and 4.3% in Balochistan.
The sample size was more targeted towards getting the country and provincial prevalence,
therefore although all districts were checked but their figures can not be used as the real prevalence
in each district.
Of the risk factors for disease transmission, therapeutic injection use due to various
ailments was high and showed strong positivity to HCV prevalence and about 30% of the
screened population was taking more than 5 injections per person per year. The positivity of
HCV was twice more in those where a syringe was reused. Operations, hospitalization and blood
transfusions came out as the next important risk factors indicating improper sterilization of
invasive medical devices and improperly screened blood use in our population
To control the disease in Pakistan, one has to increase the hepatitis B vaccination in
newborns and high risk groups. For HCV the use of therapeutic injections has to be curtailed
to a minimum of 3-4 injections per person per year with stronger injection safety measures.
 Shaukat Ali Jawaid
Chief Editor, Pulse International,
Managing Editor,
Pakistan Journal of Medical Sciences
“Symposium, Past, Present and Future”
My professional love affair with medical journalism started in 1966 and if I recall
correctly in those days the JPMC annual symposium used to be the only worthwhile academic
activity in Pakistan. It was considered to be an honour to be invited as one of the guest speakers
at the JPMC symposium and those whose presentations were accepted after scrutiny also
considered it a privilege. Lecture hall at the BMSI was the venue and inauguration itself used
to be a very simple affair. Just Cookies with tea were served during the tea break. The symposium
always attracted eminent members of the medical profession from all over the country. Apart
from this there used to be a session on Medicine in the Pakistan Science Conference while
PMA’s biennial conference also had some scientific programme which with the passage of time
has almost disappeared.
Things have changed a lot since then. In mid 70s some other institutions also started
holding seminars and symposia.. The more conscious among the presenters used to travel with
their own slide projectors. However, the real impetus to academic activities got when the
Association of Pakistani Physicians of North America (APPNA) started holding its meetings
in Pakistan every year encouraged by the government of the day. Advances in information
technology replaced slide projectors and OHP with Multimedia with the result that tremendous
improvements in the quality of slides and presentations was witnessed.
Later on a number of specialty organizations were formed which started holding their
own annual and biennial conferences and one witnessed academic activities all of the country
on regular basis. Thanks to the generous support by the pharmaceutical trade and industry these
academic activities shifted from medical institutions to the five star hotels. Now there are too
many conferences, seminars and symposia being organized by different institutions and specialty
organizations but except a few, most of them can be termed as social get together. Academics
has gone in the back ground while there is too much emphasis on lunches, dinners, entertainment
and musical programmes and a lot goes on under the disguise of these so called music and
variety programmes all sponsored by the pharma industry. Most of the participants are seen
visiting pharmaceutical company stalls collecting gifts and samples or enjoying pharma industry
hospitality in the exhibition area. Attendance in scientific sessions is most often very thin but
it suddenly increases at the time of lunch and dinner.
Often there is no scrutiny of abstracts submitted for presentations. It is the quantity and
not quality which matters. Protocol and security in case some VIP has been invited as chief
guest takes lot of time. Scientific sessions start late and time management is extremely poor.
After the presentations, most often no time is left for discussion. The chair persons fail to monitor
the speakers to restrict to the allotted time.
 More recently some conference, symposium organizers have assumed the role of Medical
Nazims and their main emphasis always is in generating as much funds as possible. Pharma
trade and industry is ordered and at times coerced to cough up huge amounts. Not only that the
industry is also ordered to register delegates which is also meant to generate more funds which
are used for providing expensive conference bags, lunches and dinners at these five star hotels
. Eventually the pharma industry passes on all this to the patients in the form of expensive drugs
and medicines which are beyond the reach of common man. High cost of drugs is also one of
the important reasons for failure of compliance with drug therapy. In many cases, conference
accounts are neither audited nor presented in the GB meeting though there are a few exceptions.
This also gives rise to various disputes among the members leading to court cases.
Symposium by any institution should prove to be a show case of its original research
and other academic accomplishments which should be presented and in case they do not have
anything worthwhile to present, I feel there is no need to have a symposium. The quality and
standard of JPMC symposium has also witnessed many ups and downs depending upon the
chairperson of the organizing committee and his/her team. In some cases the symposium has
just been a formality.
It is high time that the members of the medical profession go back to the auditoriums
and lecture halls of medical institutions from the Banquet Halls of Five Star Hotels. This will
reduce the cost of these academic activities drastically and the funds thus saved can be used for
improvement of services, equipping and expanding facilities, and funding research projects or
to provide stipends to the postgraduates in addition to provision of books, journals and updating
library facilities within the wards and the institutions.
Scientific committee should scrutinize all abstracts and select only those which are worth
presentation. There should be few papers in a session and the speakers should be asked to stick
to the timings. Adequate time should be provided for discussion after every presentation or at
the end of each session. Making a presentation is also an art which one has to learn. Poor quality
of slides and presentation not only reflects badly on the presenters but on his/her seniors, unit
and above all the institutions itself. We can have a central body which can issue CME credit
hours for all these academic activities based on the quality of scientific programmes which can
be used for re-certification of doctors at a later stage. Only accredited professional specialty
organizations, associations should be permitted to organize these meetings and ask for funding
from the pharma industry. The accounts must be audited and available on the website of the
respective specialty organizations. The presentation will highlight some unethical practices
besides offering suggestions to improve the quality and standard of these academic activities.
Scientific Program
 SCIENTIFIC PROGRAMME
Jinnah Post Graduate Medical Centre, Karachi.
47TH Annual Medical Symposium
(J.P.M.C. – N.I.C.V.D. – N.I.C.H.)
From 15th February 2010 to 21st February 2010

Theme: Role of Symposia in Education & Research

Date of Session Specialty

Inauguration & Plenary Session - Najmuddin Auditorium
Mon. 15th Feb.
Ophthalmology - Library Building Hall
Najmuddin Auditorium Auditorium Hall-A Auditorium Hall-B
Main Hall
General Medicine, Endocrine Nephrology
Tue. 16th Feb. Gastroenterology,
Dermatology, Hematology,
Rheumatology Cardiology Chest

Paeds Medicine & Surgery at N.I.C.H. Auditorium

Najmuddin Auditorium Auditorium Hall-A Auditorium Hall-B
Main Hall
General Surgery, Colorectal, Urology Breast
Gastrointestinal,
Wed. 17th Feb. Hepatobiliary, Laparoscopy,
Plastic Surgery, Thoracic Dermatology Thyroid
Anatomy, Physiology, Biochemistry, Pharmacology, Histopathology, Microbiology,
Clinical Pathology at BMSI Hall
Nursing & Paramedics at Library Building Hall
Gynecology & Obstetrics at Najmuddin Auditorium Main Hall
Thur. 18th Feb.
E.N.T Head & Neck at Library Building Hall
Neuromedicine, Mental Health, Neurosurgery at Najmuddin Auditorium Main Hall
Fri. 19th Feb. Dentistry & Maxillo-Facial - Library Building Hall
Orthopedic & Trauma, Plastic, Reconstruction, Hand, Micro-Surgery, Paeds Orthopedic
Sat. 20th Feb. Najmuddin Auditorium Main Hall
Radiotherapy - Oncology - Cancer OPD Hall, JPMC
Anesthesia / Intensive Care / Pain Management - Library Building Hall
Najmuddin Auditorium Auditorium Hall-A Auditorium Hall-B
Main Hall
Sun. 21st Feb.
Ultrasound / Color Doppler CT / MRI Radio-Isotope & Dexa Scan

CONCLUDING SESSION: Najmuddin Auditorium

 SCIENTIFIC SESSION: OPHTHALMOLOGY
MONDAY 15TH FEBRUARY 2010 - TIME 11:30 AM TO 2:00 PM
VENUE: LIBRARY BUILDING HALL
JURY MEMBERS FOR BEST PAPER AND POSTER
DR. NISAR SHEIKH (ASH)
DR. SHARMEEN AKRAM (AKUH)
SESSION (11:30 am - 2:30 pm)
Chairman PROF. ARSHAD SHEIKH
Co-Chairman DR. MISBAH AZIZ
Secretary DR. ALYSCIA CHEEMA
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Mr. Shahzaib Pervez Prevalence of subtypes and severity of red green color vision 11:30 - 11:40
deficiency in medical students of Karachi.
2. Dr. Atiq ur Rehman Outcome of dacrocystorhinostomy for acquired nasolacrimal 11:41 - 11:50
duct obstruction at 4 months follow up
3. Dr. Saima Majid Corneal endothelial cell density in open glaucoma patients 11:51 - 12:00
using specular microscopy
4. Dr. Mohd Ali Memon Beta radiation therapy for appropriate ocular lesions 12:01 - 12:10

INVITED TALK (25-30 minutes each)

1. Prof. Wajid Ali Khan Corneal Stem cell transplant 12:30 - 1:00
2. Prof. Mohd Moeen Lid reconstruction 01:01 - 01:30
Question and Answer session 01:31 - 02:00
CLOSING OF SESSION BY THE CHAIRMAN
REFRESHMENTS (2:00 pm onward)
ORGANIZING COMMITTEE
PROF. JAVED H. NIAZI DR. VASDEV HARANI DR. SHAISTA SHAUKAT
DR. ALYSCIA CHEEMA DR. HUMAIRA MEHBOOB DR. ARIF RABBANI
DR. SABEEN DR. QURATUL AIN DR. ATIQ UR REHMAN
COURTESY:
 SCIENTIFIC SESSION: GENERAL MEDICINE
TUESDAY 16TH FEBRUARY 2010 - TIME: 8:00 AM TO 02:30 PM
VENUE: NAJMUDDIN AUDITORIUM MAIN HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
PROF.KHAWAR A .KAZMI PROF.FASIHA BASHIR PROF. JAMAL AHMED
PROF.M.H.OSMANI PROF. SALEEMULLAH DR.ISHAQUE GHORI
PROF.ABU NOEM FAROOQUI DR. ASHFAQUE
PROF. ASAD SADIQ PROF. MASHOOR ALAM

FIRST SESSION (8:00 am - 11:00 am)

Chairman PROF. MASHOOR ALAM SHAH
Co-Chairman PROF. SHABEER HUSSAIN
Secretary DR. RUKHSANA SATTAR
Moderator DR. TAHIR ANSARI
INVITED TALK (25-30 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Bushra Jamil H1N1 infection 8:30 - 8:50
2. Prof. Mashoor Alam Shah Present past future aspects of diabetes 8:50 - 9:10
3. Prof. S. M. Rab Profession at cross road 9:10 - 9:30
Question and Answer 9:30 - 9:40
Free paper – 9:40 am onwards (10 minutes each)
S# Name of Presenter TOPIC
1. Dr. Rubaba Khan Analysis of acute poisoning during four years period (2005-2008) in national poison
control centre JPMC, Karachi.
2. Dr. Waquaruudin Ahmed Changing trend of viral hepatitis - A 21 year report from JPMC
3. Dr. Aiyesha Humaira Thallasemia prevention programme planning and development Fatimid Foundation
4. Dr. Amanullah Abbasi Clinical characteristics and liver biopsy of chronic hepatitis C non responders and
relapsers to previous conventional interferon plus ribavarin therapy
5. Dr. Shafqat Hussain ECG findings in acute stroke
6. Dr. Ameet Kumar Lohana Occupational exposures to needle stick injury and their associated factors among health
care workers in developing country.
7. Dr. Adeel Akbar Khoja Patterns of physical activity and its differences among school girls and boys in Pakistan.
8. Dr. Muhammad Rizwan Hyperglycemic emergencies & its precipitating factors
9. Dr. Asmat Non invasive predictors of oesophageal varices in patients with hepatitis B and hepatitis
C related cirrhosis
Closing of session by the Chairman
Tea break & poster presentation (11:00 am - 11:30 am)
SECOND SESSION (11:30 am - 2:30 pm)
Chairman PROF. SYED HAMID SHAFQAT
Co-Chairman PROF. TAHIR HUSSAIN
Secretary PROF. JAMAL ARA
Moderator DR. TARIQ AZIZ
INVITED TALK (25-30 minutes each)
S# Name of Presenter TOPIC Time
1. Prof. Afzal Memon Toxicology 11:30 – 11:50
2. Dr. Shakeel Baig Current management in SLE 11:50 – 12:10
3. Mrs. Saima Rasheed Nutritional needs of hospitalized patients 12:10 - 12:30
Question and Answer session 12:30 – 12:40
Free paper – 12:40 onwards (10 minutes each)
S# Name of Presenter TOPIC
1. Dr. Meh Jabeen Relation of brain natriuretic peptide, mean arterial and pulse presssure among
normotensive , prehypertensive and hypotensive male cohort.
2. Dr. Ayesha Waggan Prevalance and fatality related to methanol poisoning - A 2 year survey of patients in
national poison control centre JPMC Karachi.
3. Dr. Firdous Jahan Depression in patients with diabetes mellitus and its relationship with diabetes selfcare,
medication adherence and glycemic control.
4. Prof. Sultan Ayoub Meo Significance of lung function test (spirometry) in diabetic patients
5. Dr. Fareeha Sheikh Depression and diabetes in high risk urban population of Pakistan
6. Dr. Zeenat Banu Clinical spectrum of tetanus and factors influencing its mortality in a tertiary care
hospital.
7. Dr. Zeenat Banu Dengue fever related acalculus cholecystitis
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMMITTEE:
PROF. TASNIM AHSAN DR. RAKHSHANDA JABEEN DR. SHAHBAZ HAIDER
PROF. JAMAL ARA DR. RUKHSANA SATTAR DR. TARIQ AZIZ
PROF. S. M. MUNIR DR. QURBAN SHEIKH DR. FURQAN
DR. M. UMAR FAROOQ DR. RIZWAN DR. MAIROY
DR. SUMERA TABASSUM DR. TAHIR ANSARI MR. ZAFAR
DR. IMRAN HILAL DR. SALMAN DR. KAREEM
DR. SUMAYYA
COURTESY:
 SCIENTIFIC SESSION: ENDOCRINOLOGY
TUESDAY 16TH OF FEBRUARY 2010 - TIME: 8:00 AM TO 11:30 AM
VENUE: NAJMUDDIN AUDITORIUM, HALL-A
JURY MEMBERS FOR BEST PAPER
Prof. Najam ul Islam
Prof. Naeem ul Haq
Prof. Tasnim Ahsan
SCIENTIFIC SESSION (8:00 am - 11:00 am)
Chairman PROF. NAJAM UL ISLAM
Co-Chairman PROF. NAEEM UL HAQ
Secretary PROF. TASNIM AHSAN
Moderator DR. NOUREEN AIJAZ
INVITED TALK (20 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Mussarat B-cell mass and its dysfunction in type-I & II DM 8:30 - 8:50
2. Prof. Najmul Islam Endocrine hypertension 8:50 - 9:10
3. Prof. Syed Jamal Raza Disorders of growth development 9:10 - 9:30

FREE PAPER (10 minutes each)

1. Dr. Rukhshinda Jabeen Clinical spectrum and various forms of thyrotoxicosis in 9:30 - 9:40
Endocrine Clinic
2. Dr. Musarrat Riaz Assessment of insulin resistance in South East Asia Women 9:40 - 9:50
with Polycystic Ovarian Syndrome.
3. Dr. Shazia Kiran Association of FTO & MC4R genes with obesity-related traits 9:50 - 10:00
and type-II DM in Pakistani Population
4. Dr. Tamseela Ahmed An audit of pituitary tumors in patients presenting to Endocrine 10:00 - 10:10
Clinic over a period of 3-1/2 years.
5. Dr. Asma Ahmed Comparison of metabolic syndrome prevalence in type-II 10:10 - 10:20
DM using NCEP ATP-III, IDF & WHO criteria
6. Dr. Saima Ghaus Confusing phenotypes of polycystic ovaries in Endocrine 10:20 - 10:30
Clinic
7. Dr. Shahid Ahsan Is serum adiponectin a precursor of type-II DM? 10:30 - 10:40
8. Dr. Asma Ahmed Diabetes related knowledge among residents & nurses: A 10:40 - 10:50
multi-centre study in Karachi
Question and Answer sessions 10:50 - 11:00

CLOSING OF SESSION BY THE CHAIRMAN

REFRESHMENTS (11:00 am - 11:30 am)
ORGANIZING COMMITTEE
PROF. TASNIM AHSAN DR. SAADAT ALI DR. SAIMA GHAUS
DR. M. UMAR FAROOQ DR. SAMAR ABBAS JAFFERY DR. RAKHSHANDA JABEEN
DR. ZEENAT BANO DR. NOUREEN AIJAZ DR. ZAFAR NASIR
DR. IMRAN HILAL DR. SUBHEEN KANWAL DR. FURQAN KHAN
DR. MAHESH DR. AMEEN ZUBAIR
COURTESY:
 SCIENTIFIC SESSION: NEPHROLOGY
TUESDAY 16TH FEBRUARY 2010 TIME: 8:00 AM TO 11:30 AM
VENUE: NAJMUDDIN AUDITORIUM - HALL B
JURY MEMBERS FOR BEST PAPER AND POSTER
Prof. Fazal Akhtar
Dr. Bilal Jamil
Dr. Manohar Lal
SCIENTIFIC SESSION (8:00 am - 11:00 am)
Chairman PROF. S.A JAFFAR NAQVI
Co-Chairman DR. ABDUL MANAN JUNEJO
Secretary DR. DILEEP KUMAR
Moderator DR. DARSHAN LAL
FREE PAPER (10 minutes each)
1. Dr. Kaneez Zehra Frequency of the malnutrition and inflammation complex 8:30 - 8:40
syndrome(MICS)
2. Dr. Maseer Ahmed Prevalence of urinary tract infection in pregnancy at JPMC 8:41 – 8:50
3. Dr. Asifa Khurram Frequency of pattern and potentially reversible risk factor of 8:51 – 9:00
left ventricular dysfunction in hemodialysis patients
4. Dr. Pooran Mal Frequency of Hepato-Renal syndrome in patients with liver 9:01 – 9:10
cirrhosis associated with Hepatitis C Virus at JPMC
5. Dr. Nausheen Iqbal Frequency of different pattern of renal osteodystrophy in 9:11 – 9:20
end stage renal failure patients on maintenance hemodialysis
6. Dr. Dileep Kumar Two years experience of renal amyloidosis at JPMC 9:21 – 9:30
7. Dr. Bhagwan Das Left ventricular hypertension in end stage renal disease 9:31 – 9:40
patients on maintenance hemodialysis
INVITED TALK (20 minutes each)
1. Prof. S.A Jaffar Naqvi Cardio-Renal Syndrome 10:00 – 10:20
2. Prof. S. Anwar Naqvi/ Nephrolithiasis 10:21 – 10:40
Dr. Manzoor Hussain
3. Dr. Manohar Lal Chronic Kidney Disease 10:40 – 11:00
Question and Answer session
CLOSING OF SESSION BY THE CHAIRMAN
TEA BREAK & POSTER PRESENTATION (11:00 AM – 11:30 AM)
ORGANIZING COMMITTEE
DR. MANOHAR LAL DR. KASHIF GULZAR DR. TAUQEER ANJUM
DR. ABDUL MANAN DR. DARSHAN LAL DR. SANTOSH
DR. DILEEP KUMAR
COURTESY:

Mission
Pharmaceutical
 SCIENTIFIC SESSION: CARDIOLOGY
TUESDAY 16TH FEBRUARY 2010 - TIME:11:30 AM TO 2:30 PM
VENUE: NAJMUDDIN AUDITORIUM, HALL-A
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
Prof.Asadullah Kundi Dr.Tariq Ashraf
Dr.Syed Zahid Jamal Dr.Syed Ishtiaq Rasool
Dr.Zia Yaqoob Dr.Sultana Habib
Dr.Fawad Farooq
SCIENTIFIC SESSION (11:30 am - 2:30 pm)
Chairman PROF. KHAN SHAH ZAMAN
Co-Chairman PROF. ARIF UR REHMAN
Secretary / Moderator DR. TARIQ MASOOD
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Sultana Habib Size of radial and ulnar artery in local population. 11:30 - 11:40
2. Dr. Fareena Khan Coronary arteries occlusion sites and left ventricular 11:40 - 11:50
dysfunction in patients visiting Karachi institute of Heart
Diseases
3. Dr. Abbas Raies Abbas Frequency of coronary artery stenosis among patients of 11:50 - 12:00
stable angina having left bundle branch block: effects of
gender and age
4. Dr. A. Rasheed Khan Qualitative and quantitative assessment of coronary arteries 12:00 - 12:10
in Pakistani population on angiographic study
5. Dr. Nousheen Fatima Predictive value of Pathological q waves for fixed perfusion 12:10 - 12:20
defect and its impact on LV function estimated by gated
SPECT
6. Dr. Maseeh uz Zaman Prevalence of positive gated myocardial SPECT in diabetic 12:20 - 12:30
and non diabetic women and impact on other risk factors
7. Dr. S. Fayyaz Mujtaba To determine prevalence of non compliance in heart failure 12:30 - 12:40
patients and frequency of various reasons of non compliance.
8. Dr. Nadia Naeem 5-azacytidine and zebularine enhance cardiomyogenic 12:40-12:50
potential of rat bone marrow mesenchymal stem cells in vitro
9. Dr. Hasan Raza Prognostic value of normal exercise 99mTc-Sestamibi 12:50-13:00
myocardial perfusion imaging in Pakistani population
10. Dr. Sidra Farooq Comparison of risk factors of coronary heart disease in young 13:00 - 13:10
individuals as compared to older people at Rawalpindi
11. Dr. Farhan ul Haq Prospective coronary catheterization registry database at 13:10-13:20
KIHD; non-availability of huge funding is not an issue
12. Dr. Sultana Habib Frequency and predictors of cognitive decline in patients 13:20-13:30
undergoing CABG surgery in mixed Pakistani population
13. Dr. Fareena Khan Coronary arteries occlusion sites and LV dysfunction in 13:30-13:40
patients visiting KIHD
14. Dr. Rukhsana Tariq Evaluation of congenital heart disease by multi-detector CT 13:40-13:50
Question and Answer session 13:50-14:00

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS

ORGANIZING COMMITTEE:
DR. ZAHID JAMAL DR. FAWAD FAROOQ DR. ASHA KUMARI

COURTESY:
 SCIENTIFIC SESSION: CHEST MEDICINE
TUESDAY 16TH FEBRUARY 2010 / TIME: 11:30 AM TO 2:30 PM
VENUE:NAJMUDDIN AUDITORIUM, HALL-B
JURY MEMBERS FOR BEST PAPER
Dr. Mir Saleem
Dr. Ghazala Ansari

SCIENTIFIC SESSION (11:30 am - 2:30 pm)

Chairman DR. IFTIKHAR AHMED
Co-Chairman DR. ZAFARYAB HUSSAIN
Secretary / Moderator DR. MIRZA SAIFULLAH BAIG
INVITED TALK (25-30 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Sohail Akhter Asthma control can we achieve the goal 11:30 - 12:00
2. Dr. Nawal Salahuddin Assessment and Management of Hospital Acquired 12:00 - 12:30
Pneumonia
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Shahina Qayyum Comparison of Daily Versus partially Intermittent Regimen 12:30 - 12:40
of ATT (Ethambutol, Pyrazinamide, INH, Rifampicin) in non
HIV with new Pulmonary Tuberculosis (TB) in DOTS program
2. Dr. Fakhir Raza To determine the frequency of depression in Chronic 12:40 - 12:50
Obstructive Pulmonary Disease (COPD) patients
3. Dr. Nisar Rao Initial default of Pulmonary Tuberculosis patients in a chest 12:50 - 13:00
clinic in Karachi
4. Dr. Farooq Oighur Tobacco Cessation Treatment: Knowledge, attitude and 13:00 - 13:10
practice of Physician in Karachi
5. Dr. Rabia Aamir Comparison of Pleuroscopy and Abrams biopsy in the 13:10 - 13:20
diagnosis of Exudative Pleural Effusion
6. Dr. Nadia Sharif Atypical Pathogens in adults with Community-Acquired 13:20 - 13:30
Pneumonia in Pakistan
7. Dr. Noureen Hanif To assess effectiveness of BiPAP in COPD patients with 13:30 - 13:40
type II respiratory failure with decreased conscious level
8. Dr. Babar Dildar The Influence of Age and Gender on proper use of Metered 13:40 - 13:50
Dose Inhaler
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
TEA at 2:00 pm
ORGANIZING COMMITTEE:
PROF. NADEEM RIZVI DR RABIA JAVAID DR Z.HABIB BAIG
DR MIRZA SAIFULLAH BAIG DR FAKHIR RAZA DR KAMRAN SOOMRO
DR KAMRAN KHAN DR GHULAM SIDDIQUE BURGRI DR FARHAN IBRAHIM
DR MALIK ABID DR BABRA MUGHAL DR ADNAN AHMED
DR DILLEP KUMAR DR NAYYER ABBAS DR SAIMA TAJ
DR NAUSHEEN AHMED DR MOHAMMED TAUFIQ DR MOHAMMED AIJAZ
DR HUMERA NISAR
COURTESY:
 SCIENTIFIC SESSION: PEDIATRIC MEDICINE & SURGERY
TUESDAY 16TH OF FEBRUARY, 2010 (09:00AM – 01:00PM)
VENUE: N.I.C.H. AUDITORIUM
JURY MEMBERS FOR BEST PAPER
Prof. Abdul Ghaffar Nagi
Prof. Talat Mehmood
Dr. Najma Patel
SCIENTIFIC SESSION (9:00 am - 1:00 pm)
Chairman PROF. SYED JAMAL RAZA
Co-Chairman DR. JAMSHED AKHTAR
INVITED TALK (25-30 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Syed Mahfooz Alam Rationale use of disease modifying anti rheumatic drugs in 9:00 - 9:30
children with juvenile idiopathic arthritis
CME (9:30 am - 10:45 am)
1. Dr. Shamvil Ashraf Diagnosis and management of a child with abdominal mass 9:30 - 10:30
Questions and Answers 10:30 - 10:45
CLOSING OF SESSION BY THE CHAIRMAN
TEA BREAK & POSTER PRESENTATION (10:45 AM - 11:00 AM)
SECOND SESSION (11:00 AM - 1:00 PM)
FREE PAPER (11:30 AM - 1:00 PM)
Chairman PROF. ZEENAT ISANI
Co-Chairman DR. AMMARA JAMAL
Secretary DR. TAYYABA BATOOL
FREE PAPER (11:30 am - 1:00 pm)
1. Dr. Kashif Abbas Anthropometric measurements of newborns in urban Karachi 11:00 - 11:10
population
2. Dr. Anjum Shahid Blood pressure, body mass index and waist circumference 11:10 - 11:20
of school going children of Karachi
3. Dr. Syed Muhammad Raees Penile tourniquet syndrome 11:20 - 11:30
4. Dr. Nasir Saleem Saddal Audit of neonatal surgery 11:30 - 11:40
5. Dr. Najma Patel Scope of percutaneous catheter interventions in children 11:40 - 11:50
with heart diseases
6. Dr. Ali Faisal Saleem Pan-resistant Acinetobacter in neonates in Karachi 11:50 - 12:00
7. Dr. Ali Faisal Saleem Dose prophylactic use of Dexamethasone has a role in 12:00 - 12:10
reducing post-extubation stridor and re-intubation in children?
8. Dr. Nizam ul Hasan Cytogenetic lab at National Institute of Child Health, it’s value 12:10 - 12:20
to patients and physicians
9. Dr. Khair-un-Nisa Clinical presentation of coeliac disease in children 12:20 - 12:30
10. Dr. Veena Tresa Pathogens of dysentery in children under five years of age 12:30 - 12:40
and their sensitivity pattern.
11. Dr. Sadaf Asim Anemia in children with chronic kidney disease at National 12:40 - 12:50
Institue of Child Health, Karachi
Question and Answer session 12:50 - 13:00
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMMITTEE:
PROF. SYED JAMAL RAZA DR. JAMSHED AKHTAR DR. RANI BENISH
COURTESY:
 SCIENTIFIC SESSION: SURGICAL & ALLIED
WEDNESDAY 17TH FEB 2010 TIME: 8:00AM TO 2:30AM
VENUE: NAJMUDDIN AUDITORIUM- MAIN HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
PROF. RIZWAN AZMI PROF. IRSHAD WAHEED
PROF. NUSRAT ANIS PROF. ASADULLAH KHAN
DR. S. WAQAR AHMED DR. SHAHID RASOOL
FIRST SESSION (8:00 am - 11:00 am)
Chairman PROF. ASADULLAH KHAN
Co-Chairman PROF. WAQAR AHMED
Secretary DR. NASEEM BALOCH
Moderator DR. MASOOD RAZA KHAN
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Safia Bibi Surveillance for post operative wound infections in general surgery 8:30 - 8:40
ward of a tertiary care hospital of Karachi
2. Dr. Sijad Ahmed Incidence of chronic post operative pain in patients operated for 8:41 - 8:50
inguinal hernia and its impaction on quality of life
3. Dr. Shireen Ramzanali Early laproscopic cholecystectomy for acute versus chronic 8:51 - 9:00
Damani cholecystitis: A prospective comparative study
4. Dr. Syed Shahabuddin Extending the scope of cardiopulmonary bypass 9:01 - 9:10
5. Dr. Bilal Fazal Shaikh Outcome of reconstructive procedures in Fournier’s gangrene at 9:11 - 9:20
Liaquat university hospital Jamshoro
6. Dr. S. H. Waqar Two port laparoscopic cholicystectomy; an early experience 9:20 - 9:30
INVITED TALK (25-30 minutes each)
1. Prof. Rizwan Azmi Post graduate medical education, problems and role of CPSP 9:30 - 10:00
2. Prof. Muhammad Ayaz Spleno-Renal shunt portal hypertension the current status 10:00 - 10:30
Question and Answers 10:30 - 11:00
Closing of Session by the Chairman
Tea Break & Poster Presentation (11:00 am - 11:30 am)
Second Session (11:30 am - 2:30 pm)
Chairman PROF. IRSHAD WAHEED
Co-Chairman DR. SAGHEER H. SHAH
Secretary DR. ZIA-UL- ISLAM
Moderator DR. ZAHID MEHMOOD
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. K. M Inam Pal AKUH Evolving approach to neoplasia of the esophagus: Over a decade 11:30 - 11:40
of experience
2. Dr. Shireen Ramzanali The effect of ramadan fasting on duodenal ulcer perforation: 11:41 - 11:50
Damani JPMC A Retrospective Study
3. Dr. Mahesh Kumar LUMHS Management of scalp defects 11:51 - 12:00
4. Dr. Tanveer Ahmed JPMC Intracavitary drainage of giant emphysematous bullae in patients 12:01 - 12:10
with poor pulmonary reserve
5. Dr. Syed Kamran Ahmed Paired abdominal flap: A reliable hand sandwich for degloving hand 12:11 - 12:20
Indus Hospital injuries
6. Dr. Shahriyar Ghazanfar To evaluate the effectiveness of endoscopic ballon sphincteroplasty 12:11 - 12:20
as an adjunct to endoscopic sphincterotomy in removing large and
difficult bile duct stones
INVITED TALK (25-30 minutes each)
1. Prof. Mumtaz Maher Obesity Surgery: Current Concepts & Future Perspective 12:30 - 01:00
2. Prof. Ghulam Asghar Channa Spleno-Renal shunt portal hypertension the current status 01:01 - 01:30
Question and Answer session 01:31 - 01:40
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMMITTEE:
PROF. ANIS SUBHAN DR. SHAHID RASOOL DR. ALI AHMED DR. BASHEER
DR. S. WAQAR AHMED DR. FARMAN DR. ALI RIFFAT DR. MIRZA SIKANDER
DR. SAGHEER HUSSAIN DR. ZAHID ALI DR. SURRENDER DAWANI DR. ZEEHAN
DR. ADEEL HASSAN DR. MANSAB DR. UZAIR DR. IMRAN ADEEB
DR. FAHEEM DR. MAHMOODA WASEEM DR. MAHAM YOUSUF DR. M. ARIFUZZAMAN
DR. BATOOL DR. MEHVISH NAZEER DR. RABBIYA DR. MOHD USMAN KHAN
DR. ZAHID MEHMOOD DR. SALEEM DR. S. ALI MEHSAM
COURTESY:

TYCO Ethicon
 SCIENTIFIC SESSION: UROLOGY
WEDNESDAY 17TH FEBRUARY 2010 - TIME: 8:00 AM TO 11:30 PM
VENUE: NAJMUDDIN AUDITORIUM MAIN HALL A
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
DR. HAMMAD ATHER (AKUH) DR. RAZIUDDIN BIYABANI (AKUH)
DR. MANZOOR HUSSAIN (SIUT) DR. MUSTANSIR JHAVERI (FH)
DR. ZAFAR ZAIDI (INDUS) DR. SALMAN-EL-KHALID (KCK)
SCIENTIFIC SESSION (8:00 am - 11:00 am)
Chairman PROF. MASOOD A. SHEIKH (JPMC)
Co-Chairman PROF. AMANULLAH MEMON (AKUH)
Secretary DR. IQBAL SHAHZAD (JPMC)
Moderator DR. SHAHZAD ALI (JPMC)
FREE PAPER 8:30 ONWARDS (10 minutes each)
S# Name of Presenter TOPIC
1. Dr. Mustansir Jhaveri Case report of androgen insensitivity syndrome
2. Dr. Khurram Siddiqui Laprascopic pyeloplasty : stenting technique
3. Dr. M. Mansoor Superficial bladder tumors recurrence & progression
4. Dr. Naresh Kumar PCNL-JPMC experience
5. Dr. Rehamatullah Soomro Pre-operative standard informed consent
6. Dr. Rehamatullah Soomro Urethral stricture disease a review
7. Dr. Syed Johar Raza Grading complication following radical cystectomy and ileal condiut for bladder
cancer
INVITED TALK (25 - 30 minutes each)
1. Prof. Masood A. Sheikh Urinary Tract Infections (UTI) 9:30 - 10:00
2. Prof. Amanullah Memon Induratio Penis Plastica 10:00 - 10:30
Question and Answer session 10:30 - 10:40
CLOSING OF SESSION BY THE CHAIRMAN
TEA BREAK & POSTER PRESENTATION (11:00 AM – 11:30 AM)
ORGANIZING COMMITTEE
DR. UMER BALOCH DR. SHAHNAWAZ DR. TAUQIR ANJUM
DR. SHAHZAD ALI DR. MANSOOR ALI DR. NARESH
DR. M. MANSOOR DR. IQBAL SHAHZAD DR. SANTOSH KUMAR

COURTESY:
 SCIENTIFIC SESSION: BREAST
WEDNESDAY 17TH FEBRUARY 2010 / TIME: 08:00 AM TO 11:30 AM
VENUE: NAJMUDDIN AUDITORIUM MAIN HALL B
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
Prof. Ghulam Asghar Channa Dr. Khawar Jamali
Dr. Sughra Parveen Dr. Noor Soomro

SCIENTIFIC SESSION (8:30 AM - 11:00 AM)

Chairman PROF. S. H. M. ZAIDI
Co-Chairman PROF. NAHEED SULTAN
Secretary DR. SAJIDA QURESHI
Moderator DR. SALIM SOOMRO

FREE PAPER - 9:00 am onwards (10 minutes each)

S# Name of Presenter

1. Dr. Shireen Modified Radical Mastectomy with axillary clearance using

Ramzanali Damani harmonic scalpel

2. Dr. Aliya Ishaq Malignant phyllodes: Is radiotherapy mandatory?

3. Dr. Hina Khan Frequency of triple negative breast cancer

INVITED TALK (20-30 minutes each)

1. Dr. Rufina Soomro Role of surgery in metastatic breast cancer 9:30-10:00

2. Dr. Azmina Vali Triple negative breast cancer 10:00--10:30

Muhammad

3. Question and Answer session 10:30--10:40

CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS

Hi-tea (11:00 am - 11:30 am)

ORGANIZING COMMITTEE:
DR. SALIM SOOMRO DR. REKHA
DR. TABINDA ASLAM DR. SAMREENA
DR. ANUSANDHIYA DR. HINA KHAN

COURTESY:
 SCIENTIFIC SESSION: DERMATOLOGY
WEDNESDAY 17TH FEBRUARY 2010 - TIME:11:30 AM TO 2:30 PM
VENUE: NAJMUDDIN AUDITORIUM HALL A
JURY MEMBERS FOR BEST PAPER
Prof. Peter Baillie
Dr. Ijaz Ahmed

SESSION (11:30am - 2:30pm)

Chairman PROF. AZAM J. SAMDANI
Co-Chairman DR. SIKANDAR AZAM MAHAR
Secretary DR. BEHRAM KHAN KHOSA
Moderator DR. SAMIRA RIZWAN
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Sadia Masood Reticulated multifocal fixed drug eruption due to mefenamic 12:00 - 12:10
acid.
2. Dr. Saadia Tabassum Case of non HIV Kaposi sarcoma of skin and gastric mucosa. 12:11 - 12:20
Dr. Abdul Mannan
3. Dr. Maria Farooqi Frequency of different species of clinically diagnosed Tinea 12:21 - 12:30
Capitis in children reporting on a tertiary care hospital of
Karachi.
4. Dr. Sana Amin Assess efficacy of combination of topical 2%minoxidil lotion 12:31 - 12:40
and isotretinoin 0.05% gel in treatment of Alopecia Areata.
5. Dr. Junaid Rabbani Frequency and pattern of nail changes in patients with 12:41 - 12:50
Psoriasis vulgaris.
6. Dr. Ahson Ghias Age and sex distribution and effect of various factors on the 12:51 - 13:00
course of acne in patients attending OPD at JPMC
7. Dr. Qaisra Masroor Dermatosis with keloid /scars due to DEET <N,N –Diethyl- 13:00 - 13:10
meta – Toluamide.>
8. Dr. Sobia Liaqat Two sisters with an interesting presentation of lipoid 13:10 - 13:20
ptotienosis
9. Dr. Zafar Alam Famciclovir Evaluation programe 13:20 - 13:30
10. Dr. Satti Jewat Frequency of scabies in rural areas is still primary health 13:30 - 13:40
care challenge.
INVITED TALK (25-30 minutes each)
1. Prof. Peter Baillie The polycystic ovary and its manifestation 13:40 - 14:00
2. Dr. Abid Azhar Congenital skin disorders :A brief overview of the Molecular 14:00 - 14:20
Genetic Potential.
Question and Answer session 14:10 - 14:30
CLSOING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
REFRESHMENT 2:30 pm
ORGANIZING COMMITTEE:
DR. SAMIRA RIZWAN DR. ASIF JATOI DR. SHAHNAWAZ KARIM
DR. BEHRAM KHAN DR. SHAHNAWAZ DR. PARAS NAGPAL
DR. SOBIA LIAQAT DR. ABDUL GHAFFAR DR. NAZIA MEMON
DR. AHSAN GHIAS DR. QAISRA MASROOR DR SHAGUFTA HANIF BAIG
DR. MEHWISH RAZA DR. SANAM DAHRI DR. YASIR PARACHA
DR. SONIA RAJPAL DR. SANOBER MUMTAZ DR. NIGHAT BROHI
COURTESY:

Shaigan Derma
 SCIENTIFIC SESSION: BMSI
WEDNESDAY 18TH FEBRUARY 2010 - TIME: 8:00 AM TO 02:30 PM
VENUE: BMSI HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
Prof. Muhammad Saleh Soomro Porf. Asif Bhurgri
Prof. Khemomal A. Karira Prof. Saleem A. Kharal
Dr. Anjum Naqvi Dr. Shehnaz Imdad Kehar
FIRST SESSION (8:00 AM – 11:00 AM)
Chairman PROF. DR. PARWAIZ SANDILA
Co-Chairman PROF. NAZIR A. SOLANGI
Secretary DR. SURESH KUMAR
Moderator DR. UZMA TASNEEM
FREE PAPER (10 minutes each)
S# Name of Presenter Time
1 Prof. Dr jawed (LCMD) Biochemistry 8:20-8:30
2 Ms. Sitwat Zehra (KIBGE) Biochemistry 8:31-8:40
3 Ms. Hira Khan( u Sind) Biochemistry 8:41-8:50
4 Ms.Farhat Batool (KU) Biochemistry 8:51-9:00
5 Dr. S. M. Shahid Biochemistry 9:01-9:10
6 Dr. S.Haider Raza Naqvi Pharmacology 9:11-9:20
7 Dr. Nazir Solangi (LNH) Pharmacology 9:21-9:30
8 Ms.Qurratulain (KU) Pharmacology 9:31-9:40
9 Ms. Huma Ikram (KU) Pharmacology 9:41-9:50
10 Dr. Hamid Zia Shaikh (ISRA) Physiology 9:51-10:00
11 Dr. Mehjabeen (HCMD) Physiology 10:01-10:10
12 Dr. Humaira Nawab (KMDC) Physiology 10:11-10:20
13 Dr. Khalid Saeed (LCMD) Physiology 10:21-10:30
INVITED TALK (25-30 minutes each)
1 Prof. Dr. Muhammad Ishaq (SSMC) Genetic Engineering 10:30-11:00
CLOSING OF SESSION BY THE CHAIRMAN
TEA BREAK AND POSTER PRESENTATION
Chairman PROF. AMEER ALI SHORO
Co-Chairman PROF. ASIF BHURGARI
Secretary DR. S. OWAIS AHMED
Moderator DR. UZMA TASNEEM
FREE PAPER (10 minutes each)
S# Name of Presenter Time
1 Prof. Dr. Waseem Iqbal (BMC) Pathology 11:50 – 12:00
2 Dr. Salman Farooq (AKU) Pathology 12:01 – 12:10
3 Ms. Saima Saleem (KU) Pathology 12:11 – 12:20
4 Dr. Shahreera Shakeel Malik (SIUT) Pathology 12:21 – 12:30
5 Dr. Aftab Ahmed (SOBS) Anatomy 12:31 – 12:40
6 Dr. Abdul Hafiz (BMSI) Anatomy 12:41 – 12:50
7 Dr. M. Saeed Vohra (KS) Anatomy 12:51 – 13:00
8 Dr. Sameera Khursheed (KU) Anatomy 13:31 – 13:40
9 Dr. Wajid Khursheed (BMSI) Microbiology 13:41 – 13:50
10 Dr. Syed Uzair Ali Shah (KU) Microbiology 13:51 – 14:00
11 Dr. Shadab Parveen (KU) Microbiology 14:01 – 14:10
12 Dr. Raziuddin Ahmed (BMSI) Microbiology 14:11 – 14:20
13 Dr. Tarnum Rubab Siddiqui (PMRC) Microbiology 14:21 – 14:30
INVITED TALK (25-30 minutes each)
1 Prof. Dr. Muhammad Anwar Akhund Swine Flu 13:00 - 13:30
(PMC), Nawab Shah
CLSOING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMMITTEE:
PROF. SALEEM AHMED KHARAL MRS. NUDRAT ANWAR ZUBERI
DR. ABDUL SHAKOOR MEMON DR. SHAHNAZ IMDAD KEHAR
 SCIENTIFIC SESSION: NURSING & PARAMEDICS
WEDNESDAY 17TH FEBRUARY 2010 - TIME: 8:00 AM TO 02:30 PM
VENUE: LIBRARY BUILDING HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
MRS. SUSAN MUNAWAR MRS. MYWISH NADIR KHAN
MRS. AMTUL ANEES MRS. ASTER GHULAM
MRS. AZRA NASREEN MS. SHEHLA ZAFAR
FIRST SESSION (8:00 am - 11:00 am)
Chairman MS. REHANA AFGHANI
Co-Chairman MS. ZAIB-UN-NISA
Secretary MS. RUTH K. ALAM
Moderator MS. SALINA CHAND
INVITED TALK (25-30 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Hasnain Quettawala Hazards of needle stick injury 9:00 - 9:20
2. Ms. Afshan Nazli Handling and taking over of nurses in clinical setting 9:20 - 9:40
3. Dr. Rozina Kamalaini Importance of research in nursing education and practice 9:40 - 10:00
4. Dr. Alia Nasir Evidence base practice through nursing education 10:00 - 10:20
Questions and Answers
FREE PAPER (10 minutes each)
1. Ms. Durr-e-shahwar Pasha Perceptions of nurses about the diploma in teaching and 10:20 - 10:30
adminsitration nursing programme Karachi, Pakistan
2. Mr. Hidayatullah Swine flu: information is the best prevention 10:30 - 10:40
3. Ms. Fouzia Naz Development of nursing education in pakistan 10:40 - 10:50
4. Mr. Manzar Hussain Repeat cranial computed tomography in patents with mild head
10:40 - 10:50
Ather Enam injury
5. Mussarat Fatima & Reasons for unscheduled absenteeism of registered nurses
11:00 - 11:10
Rukhsana Parveen
Closing of Session by the Chairman Tea Break & Poster Presentation (11:00 am - 11:30 am)
Second Session (11:30 am - 2:30 pm)
Chairman MS. REHANA AFGHANI
Co-Chairman MS. ZAIB-UN-NISA
Secretary MS. RUTH K. ALAM
Moderator MS. SALINA CHAND
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Raisa B. Gul, Ms. Salima Implications of faculty members becoming students in the same 11:40 - 11:50
Moez & Ms. Rubina Barolia institution
2. Dr. Raisa B. Gul & Practice of patients teaching for discharge after day surgery 11:50 - 12:00
Ms. Nuzhat Sultana
3. Ms. Nasreen Ghani & Woman’s perceptions of nursing support during chaild birth 12:00 - 12:10
Ms. Shaheen Ghani
4. Ms. Husan Bano Channar Importance of continuing nursing education 12:10 - 12:20
5. Mr. Irshad Akhter Medication errors in hospital care setting 12:20 - 12:30
6. Ms. Shabana Wazir Effective clinical teaching is an essential component of nursing 12:30 - 12:40
education program.
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMMITTEE:
MS. REHANA AFGHANI MRS. SAFINA LAWRANCE MRS. SHAHNAWAZ Dr. MONICA
MS. ZAIB-UN-NISA MRS. ASTER GHULAM MR. SAIF ALI MR. IRSHAD ABBASI
MS. RUTH K. ALAM MRS. SHAHEEN KOUSAR MRS. MUNIRA ALI MRS. VIOLET BARKAT
MRS. SALINA CHAND MRS. SHAHNAZ BANO MRS. NAHEED JAMAL MRS. UROOGE RASHEED
MRS. MUSARRAT SADIQ MRS. NARGIS QURESHI MRS. MARIYUM FOUZIA MR. ZULFIQAR
MRS. MUSTAQIMA BEGUM MRS. MUKHTARI SARDAR MR. FAROOQ AHMED MS. SHAMSHAD BEGUM
MRS. DURR-E-SHAHWAR MRS. AZRA NASREEN MR. ZAIDULLAH KHAN MR. TAHIR BHUTTO
MRS. RIAZ AKHTER MR. ASIF ZIA SIDDIQUI MR. IRFAN AHMED MS. TALAT NOUREEN
COURTESY:

B-BRAUN
 SCIENTIFIC SESSION: GYNEACOLOGY/OBSTETRICS
THURSDAY 18TH FEBRUARY 2010 TIME: 8:00 AM TO 2:30 PM
VENUE: NAJMUDDIN AUDITORIUM MAIN HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
PROF. HASAN FATIMA PROF. SUBHANA TAYYAB
DR. NAGINA FATIMA DR. ASIFA GHAZI
DR. RAZIA KOREJO DR. SAMIA SHUJA
FIRST SESSION (11:30 am - 2:30 pm)
Chairman PROF. SADIQUA JAFAREY
Co-Chairman PROF. SUBHANA TAYYAB
Secretary DR. SAMIA SHUJA
Moderator DR. HALEEMA YASMIN
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Hina Hashmi Pattern of cervical cancer in Kiran hospital. 8:30 - 8:40
2. Dr. Saba Khan Role of interval hysterectomy and methotrexate in preventing mortality 8:40 - 8:50
in placenta percreta.
3. Dr. S. Ahmed First trimester threatened miscarriage and related obstetrical 8:50 - 9:00
complications.
4. Dr. Khadija Efficacy and safety of S/C administered erythropoietin along with 9:00 - 9:10
intravenous Iron sucrose in the management of Iron deficiency
anemia in patients awaiting elective gynecology surgery.
5. Dr. Afia Ansar Predisposing factor of uterine rupture and assessment of fetomaternal 9:10 - 9:20
out come.
6. Dr. Nasreen Fatima Anemia during entinatal period: evaluation of different related 9:20 - 9:30
perameter in pragnant women
INVITED TALK (30 minutes each)
1. Dr. Tanveer Zubairi (TUC) Gyneacological ultrasound 9:30 - 10:00
2. Dr. Musarrat Hasan Doppler ultrasound in Obstetrics and Gynecology 10:00 - 10:30
3. Dr. Shahida Zaidi (ZUC) Obstetric ultrasound 10:30 - 10:40
Closing of Session by the Chairman
Tea Break & Poster Presentation (11:00 am - 11:30 am)
Second Session (11:30 am - 2:30 pm)
Chairman PROF. HASSAN FATIMA JAFERY
Co-Chairman DR. ASIFA GHAZI
Secretary DR. KHADIJA BANO
Moderator DR. AFIA ANSAR
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Arifa Jabeen Kakar Prevalence of vaginal hemolytic 12:00 - 12:10
2. Dr. Iffat Javed Butt Insertion of intra uterine contraceptive device 12:11 - 12:20
3. Dr. Farkhunda Nadeem Frequency of cervical and endometrial........ 12:21 - 12:30
4. Dr. Haleema Yasmin & Knowledge and attitude medical students........ 12:31 - 12:40
Tooba Malik
5. Dr. Sadia Nasim Knowledge regarding TH disease 12:41 - 12:50
6. Mr. Shahzaib Pervaiz Relationship of gestational diabetes mellitus........ 12:51 - 13:00
7. Dr. Ramna Davi Five years experience of ovarian tumor at........ 13:01 - 13:10
8. Dr. Nusrat Nisar Severity menopausal symtoms at ........ 13:11 - 13:20
INVITED TALK (25-30 minutes each)
1. Dr. Sadia Ahsan Pal (NCMNH) Doctors and media 13:30 - 14:00
Question and Answer session 14:01 - 14:30
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMMITTEE:
PROF. SHEREEN ZULFIQAR BHUTTA DR.SAMIA SHUJA DR. HALEEMA YASMIN
PROF. NAGINA FATIMA DR. IFFAT ASHER DR. KHADIJA BANO
DR. RAZIA KOREJO DR. SAMREEN IQBAL DR. SHAZIA NASEEB
DR. KAUSAR ILLAHI BUKSH DR. AYESHA NASIR DR. AFIA ANSAR
COURTESY:
 SCIENTIFIC SESSION: ENT
THURSDAY 18TH FEBRUARY 2010 - TIME: 8:00 AM TO 02:30 PM
VENUE: LIBRARY BUILDING HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
Prof. Iqbal Hussain Udaipurwala Dr. Abbas Zafar
Prof. Khalid Ashrafi Prof. Iqbal Udaipurwala
Dr. Shakeel Aqil Dr. Shakeel Aqil
FIRST SESSION (8:00 AM – 11:00 AM)
Chairman PROF. JAVED ALAM
Co-Chairman PROF. KHALID ASHRAFI
Secretary DR. IMTIAZ SIDDIQUI
INVITED TALK - Time (09:00 am – 10:00)
S# Name of Presenter TOPIC Time
1. Prof. Muhammad Saleem Marfani Spectrum of Laryngeal Pathology Tertiary Care Experience 9:00 - 9:20
2. Prof. Abbas Zafar Reconstruction in Head and Neck Surgery 9:20 - 9:40
3. Dr. Mumtiaz Jamshed The option of oropharyngeal resection 9:40 - 10:00
PANEL DISCUSSION ON HEAD AND NECK (TIME 10:00 - 11:00am)
Moderator PROF. MUMTAZ JAMSHED
Panelist PROF. IFTIKHAR SALAHUDDIN
PROF. KAMALUDDIN KHAN
DR. IQBAL HUSSAIN UDAIPURWALA
TEA BREAK & POSTER PRESENTATION (11:00 am - 11:30 am)
SECOND SESSION (11:30 am - 2:30 pm)
Chairman DR. MUMTAZ JAMSHED
Co-Chairman PROF. SALMAN MATIULLAH
Secretary DR. NASEER AHMED
PANEL DISCUSSION ON OTOLOGY (TIME 11:30 - 12:15 am)
Moderator PROF. IFTIKHAR SALAHUDDIN
Panelist PROF. Q.M.H. JALISI
PROF. JAVED ALAM
PROF. AZAM YOUSUFANI
FREE PAPER - Time (12:15 am - 02:00 pm) 10 mins each
S# Name of Presenter TOPIC Time
1. Dr. Iqbal Hussain Efficacy of Fat - Plug mringoplasty in small and dry perforation of 12:15-12:25
Udaipurwala Pars - Tensa
2. Dr. Arsalan Ahmed Allergic fungal rhinosinusitis CT findings compare to operaive findings 12:25-12:35
3. Dr. Zubair Anwar Baloch Experience of Carotid body tumor in ENT department of JPMC 12:35-12:45
4. Dr. Aqil Pre-Operative findings in Atico-Antral type of CSOM 12:45-12:55
5. Dr. Saba Abbasi Screening programme for hearing assessment in newborn and 12:55-1:05
children
6. Dr. Mehboob Afzal Presentation of Nasopharyngeal Carcinoma 1:05-1:15
7. Dr. Imtiaz Siddiqui Frequency of vestibular neuronitis in vertigo presented at JPMC 1:15-1:25
8. Dr. Naseer Ahmed Preevalence of Chronic sinusitis among outdoor psychiatric patients 1:25-1:35
Questions and Answers session 1:35-1:45
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMITTEE:
PROF. TARIQ RAFI DR. JAVED JAMALI
DR. SAMEER QURAISHY DR. NASEER AHMED
DR. MOHAMMAD USMAN DR. ZUBAIR BALOCH
DR. IMTIAZ SIDDIQUI DR. JAN MOHAMMAD

COURTESY:
 SCIENTIFIC SESSION: NEUROSCIENCES SESSION
FRIDAY 19TH FEBRUARY 2010, TIME: 8:00AM-1:30PM
VENUE: NAJMUDDIN AUDITORIUM MAIN HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
PROF. SHAHID AHMED PROF. A.SATTAR M. HASHIM
DR. MUHAMMAD WASAY DR. SARWAR SIDDIQUI
DR. NAILA SHAHBAZ DR. ISHAQ SARHANDI
FIRST SESSION (8:00 am - 11:00 am)
Chairman PROF. HASAN AZIZ
Co-Chairman PROF. A. SATTAR HASHIM
Secretary DR. S. WASIM AHMED
Moderator DR. KHALID SHER
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr.Abdul Basit Outcome of occipital encephalocele 8:30 – 8:40
2. Dr.Lal Rehman Role of cloward technique for cervical disc herniation 8:41 – 8:50
3. Dr.Manzar Hussain Repeated computed tomography in patients with mild head injury 8:51 – 9:00
4. Dr Arshad Ali An early experience of endovascular techniques at first ever public 9:01 – 9:10
sector unit at JPMC
5. Dr Shamsher Ali Outcome of spinal meningiomas and neurofibromas 9:11 – 9:20
6. Dr.Asif A.Qureshi Role of early decompressive craniotomy in the management of head 9:21 - 9:30
injury
7. Dr. Muhammed Abid 500 Consecutive cases of gamma knife stereotactic radiosurgery 9:31-9:40
8. Dr. Kauser Mehmood Paroxysmal dyskinesias, a rare movement disorder with intact 9:41-9:50
consciousness
INVITED TALK (20 minutes each)
1. Prof. Junaid Ashraf Neurosurgical management of epilepsy, movement & functional 9:51 - 10:10
disorders; Current practice
2. Dr. Nadir Ali Syed Update on parkinsons disease 10:10 - 10:30
Questions and Answers session 10:30 - 10:40
CLOSING OF SESSION BY THE CHAIRMAN
TEA BRAKE & POSTER PRESENTATION (11:00 am - 11:30 am)
SECOND SESSION (11:30 am - 2:30 pm)
Chairman PROF. S. HAROON AHMED
Co-Chairman PROF. IRSHAD QAZI AND CDR. FARRUKH HAYAT
Secretary DR. ZAFFAR HAIDER
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Saima Qureshi Assessment of sexual dysfunction in female psychiatric patients 12:00 – 12:10
using antidepressants
2. Dr. Rozeena Dharwarwala Pattern of comorbid substance use among female psychiatric patients 12:11 – 12:20
3. Dr. Aisha Yousuf Depression & its associated risk factors in medical & surgical 12:21 – 12:30
postgraduate trainees
4. Dr. Washdev Sociodemographic profile of substance users attending psychiatry 12:31 – 12:40
department
5. Dr. Niloufer Sultan Ali Effectiveness of councelling for anxiety and depression 12:41 – 12:50
6. Dr. Marriam Shaheen Self medication among males and females in Karachi 12:51-13:00
7. Dr.Shakila Atif Deliberate self harm-Gender based analysis in terms of age, intent 13:01-13:10
and motivation
8. Dr.Daulat Ram Insomnia in medical students of medical college 13:11-13:20
INVITED TALK (20 minutes each)
1. Prof. Musarrat Hussain Psychiatry; yesterday, today and tomorrow 13:20 – 13:40
2. Dr. Muhammad Wasay Burden of neurological diseases 13:41 – 14:00
Questions and Answers session 14:01 – 14:10
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMITTEE:
PROF. SHAUKAT ALI DR ANWAR TANOLI DR SADAF DR KHALID SHER
PROF. SATTAR HASHIM DR ASGHAR DR MOAZAMA DR SAFDAR
PROF. M. IQBAL AFRIDI DR YAHYA DR ZOHRA NIAZI
DR. NAJMUS SAQIB DR ASMA DR SHAKILA
COURTESY:
SCIENTIFIC SESSION: DENTISTRY, ORAL DISEASES & MAXILLO-FACIAL SURGERY
FRIDAY 19TH FEBRUARY 2010 - TIME:9:00 AM TO 4:00 PM
VENUE: LIBRARY BUILDING HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
PROF. MERVYN HUSSAIN PROF. REHANA MAHER
PROF. NAVEED RASHEED DR. MOHAMMAD ALTAMASH
PROF. MOHSIN GIRACH DR. INAYAT PADHIAR
PROF. SAQIB RASHEED DR. SHAKIR MIRZA
FIRST SESSION (9:00 am - 12:00 am)
Chairman PROF. MOHAMMAD ANSAAR KHAN
Co-Chairman PROF. ABDUL QADIR KHERO
Secretary PROF. ABDUL HAKEEM ARAIN
Moderator DR. ABID MEHMOOD

By Dr. Abid Mehmood Beginning with the name of ALLAH

By Dr. Waseem Mushtaq Recitation from Holy Quran and Translation
By Dr. Amna Rehman Prayer and Pledge
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr Rashna Firoze Aga, Dental age table for orthodontic patients at the AKUH Karachi. 9:00 - 9:10
Dr.Mubassar Fida
2. Dr.Talha Bin Aslam Lefort I down osteotomy for chondroma,a cranial base tumor 9:10 - 9:20
3. Dr. Farhana Ghaffar, Effect of extraction of first four premolars on smile aesthetics after 9:20 - 9:30
Mubassar Fida orthodontic treatment.
4. Dr.Jehan Alam Comparison of cryosurgery and peripheral neurectomy in the 9:30 - 9:40
treatment of trigeminal neuralgia.
5. Dr. Sarwat Memon, Applicability of three mixed dentition analysis methods in orthodontic 9:40 - 9:50
Dr.Mubassar Fida patients at AKUH
6. Dr. Muhammad Haseeb, Causes of tooth extraction at a tertiary care centre in Pakistan 9:50 - 10:00
Kamran Ali, Faisal Munir
7. Dr. Zubair Ahmad Abbasi Surgical approach in oral submucous fibrosis 10:00 - 10:10
8. Dr. Maryam Riaz Radiographic interpretation 10:10 - 10:20
9. Dr. Syed Hammad Ahsan Determination of efficacy of anti-plaque agent : A clinical trial 10:20 - 10:30
10. Dr. Ashar Hussain Triditional prosthodontic improves aesthetics and hand function 10:30 - 10:40
CLOSING OF SESSION BY THE CHAIRMAN
TEA & PRAYER BREAK & POSTER PRESENTATION (12:30 PM – 03:00 PM)
SECOND SESSION (03:00 PM – 5:30 PM)
Chairman PROF. MUSHTAQ AHMED MEMON
Co-Chairman PROF. ABDUR RAUF MEMON
Secretary PROF. ZIA ABBAS
Moderator DR. ABID MEHMOOD
INVITED TALKS (20 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Fawad Javed Oral inflammatory condition and diabetes mellitus 3:00-3:20
2. Dr. Mehmood Hussain Prosthodontics rehabilitation of diabetic patients. 3:21-3:40
3. Dr. Mohammad Mujahid Khan Maxillary artery perforating inferior alveolar nerve 3:41-4:00
Questions and Answers session 3:41-4:00
Workshop (Hands on) DENTAL IMPLANTS, A to Z by Mr. Mohammad Shamim
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS / TEA BREAK
BREAK FOR MAGHRIB PRAYERS
Organizing Committee:
DR. ABID MEHMOOD DR. AMNA REHMAN DR. ARIFA AFZAL DR. SANA SALEEM
DR. INDRA RAJWANI DR. REETA SUKHARANI DR. HASSAN FURQAN DR. WAJIHA ZAHID
DR. JAHAN ALAM DR. HARESH KUMAR DR. MUSTAFA KAMAL DR. SHAHRYAR KHAN
DR. RAKHI DR. HIRA MIRZA DR. M. KASHIF RAIZ DR. SANA BATOOL NAQVI
DR. FATIMA DR. AHSAN ALI DR. ASHA DEVI DR. MEHWISH
DR. SAFA DR. AFSHAN HIDAYAT DR. NATASHA SAEED
COURTESY:

Platinum
 Scientific Session: ORTHOPEDIC & TRAUMA (Reconstruction, Hand, Micro-Surgery, Paeds Orthopedics)
SATURDAY 20TH FEBRUARY 2010 / TIME: 8:00 AM TO 2:30 PM
VENUE: JPMC NAJMUDDIN AUDITORIUM - MAIN HALL
JURY MEMBERS FOR BEST PAPER JURY MEMBERS FOR BEST POSTER
Prof. Sulaiman A. Khan Prof. M. Idrees
Prof. I. A. Jokhio Prof. Anis Bhatti
Prof. Ghulam Mehboob Prof. Mujahid Humail
FIRST SESSION (8:00 AM – 11:00 AM)
Chairman Prof. Muhammad Idrees
Co-Chairman Prof. Shahid Ilyas
Secretary Dr. A. R. Jamali
Moderator Dr. Irfanullah Ansari
FREE PAPER (10 minutes each)
S# Name of Presenter Time
1. Suresh Kumar, AR Jamali, Azad Shaikh, Functional outcome of olecranon osteotomy for fixation of 8:30 –8:40
Anisuddin Bhatti, JPMC t-y fractures distal humerus
2. Shahryar Noorddin AKUH Pelvic dissociation in revision total hip arthroplasty: 8:40 –8:50
Diagnosis and treatment.
3. Siraj Ahmed But, A.R. Jamali, Outcome of treatment of not united femoral neck fractures 8:50 –9:00
Azad Shaikh, Anisuddin Bhatti, JPMC in adults with free fibular graft
4. S. Kamran Ahmed, Indus Hospital Paired Abdominal Flap, A reliable hand sandwich for hand injuries 9:00 – 9:10
5. Hasnain Raza, Haroon-ur-Rashid, Outcome of hip reconstruction Osteotomy 9:10 – 9:20
Masood Umer AKUH
6. Kashif Abbas and Ligament reconstruction with tendent interposition for 9:20 – 9:30
Pervaiz Hashmi carpometacarpal joint arthritis
INVITED TALK (20 minutes each)
1. Prof. Zaki Idress (LNH) Orthopedic Training: A National Perspective 9:30 – 9:50
2. Dr. M. Amin Chinoy (Indus Hospital) Metal on metal large ball arthroplasty in Pakistan 9:50 – 10:10
3. Dr. Intikhab Taufiq (LNH) Early Mobilization After Pelvic fracture Fixation 10:10—10:30
4. Dr. Syed Shahid Noor (LNH) THR: Choice of head size bearing Surface & method 10:30—10:50
5. Dr. Masood Umer (AKU) Limb salvage vs amputations in musculoskeletal tumor surgery 10:50—11:00
Q&A Session Participant VS Panel of Experts At Tea time
CLOSING OF SESSION BY THE CHAIRMAN
TEA BREAK & Poster Presentation (11:20 AM – 11:40 AM)
SECOND SESSION: Seminar ; LEVELS OF AMPUTATIONS (11:30 AM – 2:30 PM)
Chairman Prof. I A Jokhio
Co-Chairman Prof. Zaki Idress
Secretary Prof. Ghulam Mehboob
Moderator Dr. Azad Sheikh
INVITED TALK (20 minutes each)
1. Prof. Anisuddin Bhatti (JPMC) Diabetic Foot Ulcers: Patho-physiology 11:40 – 12:00
2. Prof Syed Muhammad Munir Practical guidelines on the management and prevention of diabetic 12:00 – 12:20
(JPMC) foot
3. Prof. Mujahid Humail (DUHS) Diabetic foot amputations: can we prevent that 12:20 – 12:40
4. Prof. Abdul Moeed Kazi (Z.U.H) Level of amputations: an over view 12:40 – 13:00
5. Prof. Ghulam Mehboob (JPMC) Level of amputations: ideal stump formation 13:00 – 13:20
6. Prof. Nabila Soomro (DIPMR) Levels of amputations: pit falls & problems 13:20 – 13:40
Q&A Session Participants vs panel of experts 13:40 – 14:00
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMITTEE:
Prof. Anis Bhatti Dr. Amara Saeed Dr. Suresh Dr. Muhammad Sulaiman
Dr. A. R. Jamali Dr. Mujeeb Ur Rehman Dr. Irfanullah Ansari Dr. Azad. A Shaikh
Dr. M. Saeed Minhas Dr. Kashif Mehmood Dr. Khurram Shahzad Dr. Barkatullah
Dr. Nasir Baig Dr. Qasim Mr. Sajid Dr. Badruddin
Dr. Saeed Mr. Saeed Kashif Dr. Ghulam Mehboob
COURTESY:
 SCIENTIFIC SESSION: RADIOTHERAPY/ONCOLOGY
SATURDAY 20TH FEBRUARY 2010 TIMINGS: 11:00 AM TO 2:00 AM
VENUE: CANCER OPD HALL
JURY MEMBERS FOR BEST PAPER AND POSTER:
Prof. S.H.M Zaidi
Dr. Azmeena Vali Muhammad
Dr. Salman Adil
SESSION :11:00 AM – 2:00 PM
Chairman Prof. S.H.M. Zaidi
Co-Chairman Prof. Ahmed Usman
Secretary Dr. Heeranand
Moderator Dr. Maryam Gul
INVITED TALK (20-25 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Azmeena Vali Muhammad (AKUH) Management of locally advanced breast ca 11: 00 -11:25
2. Dr. Salman Adil (AKUH) Diagnosis & management of acute leukemia 11:26 – 11:50
3. Dr. Nehal Masood (AKUH) An update on treatment of non- small cell lung cancer 11:51 – 12:15
Q&A Session 12:15 – 12:39
FREE PAPER (10 minutes each)
1. Dr. Heeranand (JPMC) Safety and tolerability of folfox,4 in the adjuvant treatment 12:40 – 12:50
of colon cancer in our population
2. Dr. Mutahir A .Tunio (SIUT) Neoadjuant cisplatinum and gemcitabine based 12:51 – 13:00
chemotherapy followed by concurrent chemo-radiation
for muscle invasive bladder cancer
3. Dr.Mansoor Rafi (SIUT) Comparison of three methods for skin markings in 13:01-13:10
conformal radiotherapy, temporary markers and
permanent steritatt civco® tattooing: patients’ comfort
and radiographers’ satisfaction
4. Mr. Asad Zameer (SIUT) Role of medical physicist in radiation oncology 13:11- 13:20
5. Dr. Noor M. Soomro (CHK) Breast cancer history to, today 13:21- 13:30
6. Dr. Rafia Toor (SIUT) Hypofractionated schedule of palliative radiotherapy in 13:31- 13:40
the management of gross haematuria of invasive bladder
cancer patients.
7. Dr. Amir Maqbool (KIRAN) Concurrent cisplatin based chemo-radiation for locally 13:41 – 13:50
advanced head and neck cancers- experience at kiran.
8. Dr. Ahmed Mateen (KIRAN) Risk stratification in breast cancer; retrospective analysis 13:51 – 14:00
at KIRAN
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
ORGANIZING COMMITTEE:
Prof. Ahmed Usman Dr. Tahseen Khursheed Dr. Abdul Sami
Dr.Heeranand Dr. Maryam Gul Mr. Mussarat Abbas
Dr. Ghulam Haider Dr. Khalil Ahmed Mr. Murtaza Haider
Dr. Aneeta G. Mohammad
COURTESY:

Dabur
Oncology
 SCIENTIFIC SESSION: ANAESTHESIA, SURGICAL ICU & PAIN MANAGEMENT
SATURDAY 20TH FEBRUARY 2010 / TIME: 09:00 AM TO 01:00 PM
VENUE: NAJMUDDIN AUDITORIUM HALL-A
JURY MEMBERS FOR BEST POSTER
Prof. S. Tipu Sultan
Prof. Rehana Kamal
Prof. Akhtar Waheed Khan
INVITED TALK (20-25 minutes each)
S# Name of Presenter TOPIC
1. Prof. Nasir Khan Jakhrani Are we ready to manage bomb blast injuries in our city?? —An Overview
(JPMC)

2. Prof. Younis Khatri Optimizing poly trauma patient at the site of bomb blast
(ZMU)

3. Dr. Akhtar Aziz Transfer of patient from the site of bomb blast to the Hospital
(Indus Hospital)
4. Prof.Saeeda Haider (CHK) Managing major haemorrhage in poly trauma

5. Prof.Fazal Hameed Khan Battle Field Anaesthesia

(AKUH)
TEA BREAK : 11:15 - 11:40 am
6. Brigadier Asif Gul Kayani Challenges faced by the anaesthetic team in poly trauma due to
(CMH, Bhawalpur) bomb blast

7. Brigadier M.Saleem Management of pain due to poly trauma in bomb blast

(RH-Rawalpindi)

8. Prof. Qamar-ul-Hoda Anaesthetist’s contribution to the management of burns due to bomb

(AKUH) blast

9. Prof. Najma Amjad Anaesthetic management of cardio thoracic injuries due to bomb blast
(NICVD)

CLSOING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS

ORGANIZING COMMITTEE:
DR. ROOHINA BALOCH DR. SHOAIB MALIK
DR. ERUM ZEB DR. NIGHAT YASMIN
DR. NADEEM MUNIR DR. SHEHNEELA RAZA
DR. A. RAHIM MEMON DR. KASHIF MAHMOOD
DR. AYAZ SARWAR

DR. ZULFIQAR ALI DR. FAUZIA ALI

DR. NAEEM KHAN DR. AMANULLAH MEMON
DR. NAZEER AHMED DR. TAHIR A. CHAUDHRY
DR. UMAR FAROOQ DR. KHALID CHOHAN
COURTESY:
 SCIENTIFIC SESSION: ULTRASOUND COLOR DOPPLER
SUNDAY 21ST FEBRUARY 2010 - TIMING: 8:00 AM TO 02:30 PM
VENUE: NAJMUDDIN AUDITORIUM MAIN HALL
JURY MEMBERS FOR BEST PAPER
PROF. SHABBIR A NAEEM (SIUT)
DR. ANWAR AHMED (ZUH)
DR. MUKHTAR A MEMON (CHK)
FIRST SESSION (8:00 AM – 11:00 AM)
Chairman DR. MOHAMMAD NAFEES (ARC)
Co-Chairperson DR. IMRANA MASROOR (AKUH)
Secretary DR. FAYYAZ AHMED (JPMC)
Moderator DR. SAIRA MANSUR (JPMC)
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. DR. NURUDDIN MOHAMMED Uterine artery Doppler screening in the second trimester for prediction of 8:30 – 8:40
(AKUH) adverse pregnancy outcome in high risk Pakistani women.
2. DR. FARHEEN IMTIAZ Role of grey scale & Doppler u/s in the diagnosis of painless scrotal 8:41 – 8:50
masses in patients.
3. DR. VAQAR BARI (AKUH) Role of abdominal U/S in trauma patients. 8:51 – 9:00
4. DR. SAIRA NAZ (LNH) Diagnosis in staging of ovarian cancer comparative study 9:01 – 9:10
between U/S and CT correlated with surgery.
5. DR. RUBINA ASHRAF (LNH) Comparison of CT and U/S in the diagnosis of acute 9:11 – 9:20
appendicitis.
6. DR. ADNAN HASHMI (KIRAN) Frequency of penile arterial insufficiency and venous leakage in patients 9:21- 9:30
having erectile dysfunctional by color Doppler U/S.
INVITED TALK (25-30 minutes each)
1. DR. NADEEM AHMED (AKUH) Carotid Doppler. 9:31 – 10:00
2. DR. FURQAN AHMED (SCH) Role of endoscopic ultrasound in meditational lymphadenopathy. 10:01– 10:30
Q&A Session 10:31 – 11:00
CLOSING OF SESSION BY THE CHAIRMAN
TEA BREAK & Poster Presentation (11:00 AM – 11:30 AM)
SECOND SESSION (11:30 AM – 2:30 PM)
Chairperson DR. TANVEER ZUBERI (TUC)
Co-Chairman DR. SALEEM KHEMANI (ZMU)
Secretary DR. MUSSART HASAN (DU)
Moderator DR. NAYYER NAWAZ ( JPMC)
INVITED TALK (25-30 minutes each)
S# Name of Presenter TOPIC Time
1. DR. NADEEM ABBASI (AKUH) Radiologist – An important team player in cancer management. 11:40 - 12:00
2. PROF. TAMEEM AKHTAR (ZHU) U/S of fetal anomalies. 12:01 - 12:30
3. DR. AMJAD SATTAR (SIUT) U/S of prostate. 12:31 - 13:00
4. DR. AMBER PARAS (JPMC) Characterization of bowel pathologies on U/S. 13:01 - 13:30
5. DR. NAILA NADEEM (AKUH) Role of musculoskeletal U/S in pediatrics. 13:31 - 14:00
Q&A Session 14:01 - 14:10
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF MEDALS & MOMENTOS
Organizing Committee:
PROF. TARIQ MAHMOOD DR. SAIRA MANSOOR DR. TASNEEM BUTT DR. NAJAMULHASSAN DR. RAZA YOUNUS
DR. KAUSAR SALDERA DR. NOMITA IRFAN DR. IRAM RAZA DR. AKHTAR ABBAS MR. IQRAR ALI
DR. RUBINA ISHTIAQUE DR. AYESHA MUGHAL DR. MANSOOR ALI DR. NISAR AHMAD MR. ZAHEER AHMED
DR. SHAGUFTA NAZ DR. BUSHRA AYUB DR. NAILA KAMRAN DR. WARYAL MEMON MR. MOOSA JAN
DR. NIRMAL DR. NAUMAN IRSHAD DR. NADIA MALIK DR. GHANSHAM MR. JUNAID A. KHAN

COURTESY:
 SCIENTIFIC SESSION: CT & MRI
SUNDAY, 21ST FEBRUARY 2010 - TIME: 8:00 AM TO 2:30 PM
VENUE: J.P.M.C. NAJMUDDIN AUDITORIUM-HALL A
JURY MEMBERS FOR BEST PAPER JURYMEMBERS FOR BEST POSTER
BRIGD. IRFAN UL HAQ DR. SYED MAHMOOD
DR. MAHIRA YUNUS DR. RASHID AHMED
DR. WASIM AKHTAR DR. WASIM MEMON
FIRST SESSION (8:00 AM – 11:00 AM)
Chairman PROF. MUMTAZ MAHER - JPMC
Co-Chairman DR. AYUB MANSOOR - LNH
Secretary DR. JAWAID MAHBOOB - KIRAN
Moderator DR. AMARA SAEED – JPMC
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. DR. MAHIRA YUNUS (SIUT) Ct guided lung abscess drainage 8:30 – 8:40
2. DR. MUNAZZA SALEEN BAIG Megnetic resonance arthrogram: a screening test to diagnose 8:41 – 8:50
(AKUH) shoulder joint instability
3. DR. KAUSAR ILLAHI BUX Mdct assessment of acetabular fracture: a comparison 8:51 – 9:00
(JPMC) between modified reconstruction images and 3d images
4. MS. SHAHEEN DHANANI Awareness of radiation protection in clinical and non-clinical 9:01 – 9:10
(AKUH) staff
INVITED TALK (25-30 minutes each)
1. BRIG. MOHAMMAD ILYAS Role of CT in acute abdomen 09:30 – 10:00
2. DR. TANVEER UL HAQ Role of radiology in management of CLD 10:00 – 10:30
Q&A Session 10:30 – 10:40
CLOSING OF SESSION BY THE CHAIRMAN
TEA BREAK & Poster Presentation (11:00 AM – 11:30 AM)
SECOND SESSION (11:30 AM – 2:30 PM)
Chairman DR. MUHAMMAD AZEEMUDDIN – AKUH
Co-Chairperson DR. SABA SOHAIL – CHK
Secretary DR. AMIR BHATTI – NMC
Moderator DR. AMARA SAEED- JPMC
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. DR. IMRANA MASROOR (AKUH) To determine the sensitivity of dwi in detection of endometrial carcinoma (case control 11:40 - 12:00
study): role of adc values
2. DR. SADAF NASIR (LNH) Flexion / extension cervical spine views in blunt cervical trauma 12:11 – 12:20
3. DR. SHAISTA SHAUKAT (JPMC) Additive value of susceptibility weighting imaging in 12:21 – 12:30
neuroradiology
4. DR. MAHREEN RASOOL (JPMC) Mri imaging in the evaluation of medically intractable epilepsy 12:31 – 12:40
5. MR. ZAFAR JAMIL (AKUH) Heart: what can be seen on non coronary thoracic multi 12:41 – 12:50
detector computed tomography scan?
INVITED TALK (25-30 minutes each)
1. DR. ZIA FARUQUI Principles of staging in lung cancer 13:00 – 13:30
2. DR. ZAFAR SAJJAD Megnetic resonance evaluation of white matter 13:31 – 14:00
Q&A Session 13:31 – 14:00
CLOSING OF SESSION BY THE CHAIRMAN & DISTRIBUTION OF PRIZES & MEMENTOS
Organizing Committee:
Dr. Zafar Sajjad Dr. Amber Paras Dr. Sadaf Rizvi Dr. Rani Benish
Dr. Saima Imran Dr Rajni Dr. Mahreen Rasool Dr. Madiha Asad
Dr. Muhammad Salman Dr. Sohail Ahmad Dr. Kavita Dr. Sadaf Imran
Dr. Nadira Abid Dr. Kashif Mughal Dr. Darshan Lal Dr. Inayatullah
Dr. Champa Rani Dr. M. Farhan Baig
COURTESY:
 SCIENTIFIC SESSION: RADIOISOTOPE AND DEXA SCAN
SUNDAY 21ST FEBRUARY 2010 - TIME: 8:00 AM TO 11:30 AM
VENUE: NAJMUDDIN AUDITORIUM MAIN HALL B
JURY MEMBERS FOR BEST PAPER AND POSTER
Dr. SHAHID KAMAL
Dr. AKHTER AHMED
Dr. HASSAN RAZA
SCIENTIFIC SESSION (8:00 AM – 11:00 AM)
Chairman Prof. S.H.M. Zaidi – BMU
Co-Chairman Dr. Abid Hameed – KIRAN
Secretary Dr. Akhter Ahmed – KIRAN
Moderator Dr. Zafar Nasir – AEMC, JPMC
FREE PAPER (10 minutes each)
S# Name of Presenter TOPIC Time
1. Dr. Bashir Ahmed Attenuation correction in Myocardial perfusion SPECT imaging 8:20 – 8:30
2. Dr. Sajid Sattar LV EF derived by ECG gated SPECT vs angiography 8:31 – 8:40
determination in suspected or known CAD.
3. Dr. Zafar Nasir Utility of combined MIBI & bone scan in solitary 8:41 – 8:50
musculoskeletal pathology
4. Dr. Maseeh uz Zaman Prevalence of positive gated myocardial SPECT in diabetic 8:51 – 9:00
& non-diabetic women & impact of other risk factors; KIHD
5. Dr. Nosheen Fatima Predictive value of pathological Q-waves for fixed perfusion 9:01 – 9:10
defect & its impact on LV function by gated SPECT.
6. Dr. M. Obaid Arif Detection of CAD in hypertensive patients by exercise stress 9:11 – 9:20
MPI using Tc-99m MIBI
7. Dr. Kashif Niyaz Role of split dose bone scanning for the assessment of 9:21 – 9:30
skeletal metastasis in patients with malignancy
8. Dr. Naureen Nizar Role of Tc-99m MAG3 scintigraphy in management of non- 9:31 – 9:40
functioning kidney on IVU
INVITED TALK (20-30 minutes each)
1. Dr. Zia Faruqui PET/CT 09:50 – 10:20
2. Dr. Maseeh uz Zaman Recent development & future prospect of SPECT Myocardial 10:20 - 10:40
Perfusion Imaging
Question and Answer
CLOSING OF SESSION BY THE CHAIRMAN
REFRESHMENTS (11:00 AM – 11:30 AM)
Organizing Committee:
Dr. Akhter Ahmed Dr. Raheela Mehmood
Dr. Zafar Nasir Dr. Minhaj Maqbool
Dr. Muhammad Ejaz
COURTESY:
Abstracts
PREVALENCE OF SUB-TYPES AND SEVERITY OF RED-GREEN The services can be better utilized or improved by
COLOR VISION DEFICIENCY IN MEDICAL STUDENTS OF KARACHI
1. Proper & timely referral of cases
FAIZ-UR-REHMAN FAROOQUI1, GUL AFSHAN2, SHAHZAIB PERVEZ3, ERUM 2. Proper selection of cases
3. Updating / modifications in treatment protocols
IMRAN5, NAVEED AHMED6, NARGIS ANJUM4
1Dept. of Medicine, Karachi Medical & Dental College, and Abbasi Shaheed

Hospital, Karachi,
2,4,5Dept. of Physiology, Karachi Medical & Dental College, and Abbasi Shaheed

Hospital, Karachi,
CORNEAL ENDOTHELIAL CELL DENSITY IN OPEN ANGLE
3Fourth Year & 6Second Year Medical Students, Karachi Medical & Dental GLAUCOMA PATIENTS USING SPECULAR MICROSCOPY
College, Karachi
DR.SAIMA MAJID, DR.ALYSCIA M.CHEEMA, DR.VASDEV HIRANI, DR.JAVED
AIMS AND OBJECTIVES: The study aims to find out the prevalence of sub- HASSAN NIAZI
types and severity of red-green color vision deficiency in medical students of Department of Ophthalmology
Karachi. Jinnah Postgraduate Medical Centre, Karachi

MATERIAL & METHODS: It was a cross sectional study conducted on the OBJECTIVES: To study corneal endothelial cell density in open angle glaucoma
students of Karachi Medical & Dental College and Dow University of Health patients using specular microscopy.
Sciences. With Convenient sampling, 550 healthy medical students (185 males
MATERIAL AND METHODS:
and 365 females) were tested by using pseudo-isochromatic plates of 24-plates Study Setting: Department of Ophthalmology, Jinnah Postgraduate Medical
Ishihara chart. The data is presented in the form of numbers and percentages. Centre, Karachi, Pakistan
Study Duration: Six months.
RESULTS: 10 (5.4%) out of 185 males while only 01 (0.26%) out of 365 females Study Design: Retrospective study of patients registered in glaucoma clinic
were found to have red-green color vision deficiency. In males, 03 (1.62%) were within 6 months.
Protans and 07 (3.78%) were Deutans. Protanomaly was detected in 01 (0.54%),
protanopia in 02 (1.08%), deuteranomaly in 02 (1.08%), deuteranopia in 05 SAMPLE SELECTION:
(2.70%). In females, the only case found was deuteranopia, 01 (0.26%).
Inclusion Criteria:
CONCLUSION: By conducting screening for all medical students for diagnosing Open angle glaucoma patients.
and detecting the sub-types and severity of CVD and provision of adaptive Either sex
strategies and behavioral support will help them to deal with the potential No co-morbid.
difficulties, which could be overcome by awareness, self-training and effort.
Moreover it is strictly advisable to avoid certain subspecialties as a career of Exclusion Criteria:
choice. History of trauma.
Corneal disease
KEY WORDS: Congenital color vision deficiency, Red-green CVD, Protan, Ocular inflammation.
Deutan, Ishihara charts. DATA COLLECTION PROCEDURE: Data were entered from patient’s files in
glaucoma clinic i.e. were glaucoma types, duration, laser treatment, glaucoma
medication, documented intraocular pressure measurements.
BETA RADIATION THERAPY FOR APPROPRIATE OCULAR Specular microscopy was performed on central cornea, endothelial margins were
LESIONS analyzed by computerized perimetry and cell counts were calculated.

*DR. MUHAMMAD ALI MEMON, KHALID MEHBOOB, DR. SHAHID KAMAL,

SALMAN FURRUKH**, MUNIB AHMED***
*Clinical Oncologist / DCMO, Health Physicist**, Medical Physicist***
Atomic Energy Medical Centre
Jinnah Postgraduate Medical Centre, Karachi OUTCOME OF EXTERNAL DACRYOCYSTORHINOSTOMY FOR
ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION AT FOUR
OBJECTIVE: To share & update the experience.
MONTHS FOLLOW UP
INTRODUCTION: Beta Radiation therapy is a unique form of treatment modality
for superficial lesions. Radiosensitive Conjuctival lesions i.e. Pterygium & DR. ATIQ UR REHMAN, DR MUHAMMAD ALI TAHIR, DR ALYSCIA MIRIAM
Conjuctival Carcinoma are difficult to treat on conventional Megavoltage External CHEEMA,
Beam RadioTherapy (EBRT) due to very delicate & sensitive structures in the DR VASDEV HARANI, DR JAVED HASAN NIAZI
Department of Ophthalmology
vicinity of conjuctiva.
Jinnah Postgraduate Medical Centre, Karachi
Strontium-90 is essentially a beta ray emitter and most suitable for such lesions.
OBJECTIVE: To determine the success of dacryocystorhinostomy in patients
MATERIAL & METHOD: This is a retrospective analysis of 23 patients treated with pre sac and post sac obstruction at four months follow up.
during 1995 to 2003 at NIMRA Jamshoro. Male were 18 & female 5. Age ranges
METHODS: It is an ongoing study of so far 23 dacryocystorhinostomies with
from 20-85 years with mean 44.3 & median 45.
silicone intubation performed for partial nasolacrimal obstruction.pre operative
Pterygium was the most common lesion i.e. seen in 11 patients treated. Surgical syringing and probing was done to see obstruction in all cases and lacrimal
attempts i.e. excisions were 50 in 21 patients. scintigraphy will be done to see pre sac and post sac delays.post operative
success was determined by lacrimal patency to irrigation and subjective resolution
Beta radiation therapy was given to 23 patients. External beam therapy for two of epiphora.
patients and Chemotherapy for 1 patient was also given during course of treatment
for residual / progressive disease. Follow-up ranges from 02 to 156 weeks with RESULT: A patent DCR system was achieved in 88% of patients.
median follow up of 06 weeks.
CONCLUSION: External dacryocystorhinostomy with silicone intubation is an
Being a referral institute, most cases were referred back to referring surgeon. effective procedure for partial nasolacrimal obstruction.
However in evaluated patients, 10 were disease free on last visit, 2 left treatments
incompleted, 2 had progressive disease. 9 had no follow-up.

An experience of 11 patients with conjuctival lesions treated with beta radiation

at AEMC, JPMC, Karachi will also be shared.

REMARKS / COMMENTS: Available costly but cost effective facility is under

utilized due to lack of co-ordination between concerned departments. Monotony
of treatment protocols over a long period of time has now standardized as per
current schedules in practice.
OCCUPATIONAL EXPOSURE TO NEEDLE STICK INJURIES AND
THEIR ASSOCIATED FACTORS AMONG HEALTH CARE WORKERS
IN A DEVELOPING COUNTRY
1AMEET
KUMAR LOHANA; 2ALI KHAN KHUWAJA; ASAD AFRIDI;
MUHAMMAD QASIM MEMON
1House Officer, Jinnah Postgraduate Medical Centre, Karachi
2Assistant Professor and Convener Research,
Family Medicine, Aga Khan University, Karachi
INTRODUCTION: The health care workers (HCWs) are at substantial risk of
acquiring blood borne infections such as HIV, Hepatitis-B and Hepatitis-C through
needle stick injuries (NSIs). This study was aimed to assess the proportion of
NSIs and their associated factors among HCWs and also to identify the areas
in which preventive efforts might be directed to protect against this occupational
hazard.
METHODS: A cross-sectional study was conducted in two tertiary care hospitals
of Pakistan representing both private and public health sector. During the months
of January to May, 2008, trained medical graduates interviewed 497 HCWs
(Doctors and Nurses) who were working in those particular hospitals for > one
year and willing to participate in the study.
RESULTS: Overall, 63.6% of the HCWs were exposed to at least one NSI during
his/ her carrier; among them 73.4% reported NSIs for two or more times. Factors
found to be highly associated with NSIs were those practicing this occupation
for > five years (p < 0.001: OR = 5.8; 95% CI = 3.4 - 9.8) and working as Nurse
than Doctor (p < 0.001: OR = 1.9; 95% CI = 1.3-2.8). Working in surgical specialty
and being a female were also found to be associated with NSIs (p < 0.05). Most
commonly (54.7%) reported reason for NSIs was two-handed recapping of
needle. Only, 35% of study subjects were vaccinated for hepatitis B infection.
Overall, only 39.8%, 40.2%, 10.7%, 25.8% and 9.9% of study participants reported
to have availability of anti-septic solutions, gloves/protective cloths, sharp/disposable
containers, trays/syringe containers and infection control guidelines/protocols
respectively in their working places.
DISCUSSION: In addition to very high rates of NSIs, low safety practices including
vaccination coverage, unavailability of infection control guidelines and other
preventive facilities were reported in this study. Prevention of occupational
infections among HCWs should be a priority. Training about safe practice and
availability of preventive facilities should be ensured against NSIs among HCWs.
KEY WORDS: Health care workers; Needle stick injuries; Occupational exposure
DEPRESSION IN DIABETICS
*DR. FIRDOUS JAHAN, DR. ABDUL JABBAR, DR. HAIDER NAQVI, DR.SAFIA
AWAN
*Assistant Professor, Department of Family Medicine
Aga Khan University Hospital, Karachi
{Email: }
OBJECTIVES: Depression in patients with diabetes mellitus and its Relationship
with diabetes self-care, medication adherence and glycemic control.
BACKGROUND: The prevalence of diabetes is growing significantly. The World
Health Organization estimates that at least 170 million individuals suffer from
diabetes globally, this figure is likely to double by 2030. Depression is an
independent risk factor for the onset of type 2 diabetes. It negatively affects the
course of diabetes and is associated with increased risk of complications
(especially heart disease), hyperglycemia, and mortality.
METHOD: Cross sectional study done in ambulatory care . Three hundred forty
diabetic patients were screened for depression and clinical characteristics of
complication. All analyses was done by using the Statistical package for social
science SPSS.
RESULT: A total of 320 patients with Diabetes were identified during the study
period. The mean age was 55±12 years and 138 (43%) were females. Hypertension
197(61.6%) and IHD 68(21.3%) were the most common co-morbids. Overall,
283(88.4%) received oral agents, and 134(41.9%) received insulin alone.
Depression was present among 17% of patients with diabetes and was more
common in 158(86.8%) male than females 106(76.8%) with diabetes (p=0.02),
more prevalent among hypertensive 152(77.2%) patients (p=0.001), duration of
diabetes >10years (p=0.06), family history of depression (p=0.008). Depression
was more prevalent in patients with Neuropathy 126(74.6%) complication
(p<0.001). Depression was associated with infrequent fruit and vegetable intake
(76% vs. 87%).
CONCLUSION: Depressed diabetics had more complications and sub optimal
self care. Coexistence of Depression had poor glycemic control.
THE ANALYSIS OF ACUTE POISONING CASES DURING FOUR
YEARS PERIOD (2005-2008) IN NATIONAL POISON CONTROL
CENTER IN WARD-V, JINNAH POSTGRADUATE MEDICAL CENTER,
KARACHI
JAMAL ARA, RUBABA KHAN
Medical Unit-I, Ward 5
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVES: The aim of the presented study was to determine the trends and
characteristics of acute poisonings in national poison control center, ward-V
JPMC including the rate, type, and causal agents over a period of four years
(2005-2008).
MATERIALS AND METHODS: The analysis was based on the data obtained
from the patients' records register of ward-v maintained during 2005-2008.
DURATION OF STUDY: Two months.
RESULTS: There were a total of 6827 admissions with acute poisoning in four
years and out of these organophosphorus contributed the largest chunk (32%),
second was drugs (15.14%) including benzodiazepine, anti-psychotics, Nsaids
etc, third most common was unknown (13.54%). Venoumous animals, heroin
addicts , alcohol, petrol/kerosene, bleach, acid, dhatura, rat killer, anti-lice and
metals contributed 11.0%, 5.81%, 1.94%, 1.61%, 4.67%, 3.04%, 1.53%, 4.55%,
2.81% and 2.27% respectively. Organophosphorus was found fatal in majority
of cases (36.74%), unknown second most common (14.91%) followed by heroin
(13.53%).
DISCUSSION: Studies in Poland1-2 by Czerczaks et al and Kotwica M et al;
have shown alcohol and drugs with most lethal outcome. While studies in India3,
Japan4 and Punjab 5-6(Pakistan) have found pesticides the most lethal agent.
Our study revealed a striking preponderance of intoxication with organophosphorus
compounds which is comparable to national and international studies. This
studies also supports organophosphorus being the most used and lethal agent
most probably due to its easy availability being an agriculture country, effectiveness
and low cost.
CONCLUSIONS: A constantly growing number of acute poisonings in ward-v
national poison center, JPMC Karachi makes it necessary for all the medical and
other professionals involved (clinical toxicologists and diagnostic laboratory staff)
to enhance and coordinate their efforts. These activities should be focused on
(a) selection of the most effective methods to eliminate poisons from the system
and improve further therapy, and (b) prompt availability of antidotes (c) psychiatric
care for people must be recommended by all physicians suffering from mental
problems or depression and for the unsuccessful or potential suicide.
RECOMMENDATIONS: Studies, which unveil the root causes of growing and
constant increase in poisoning, are needed. Awareness of harmful effects of all
poisonous agents might help to avoid accidental poisoning. Poverty elimination
and education need special attention.
PATTERN OF PHYSICAL ACTIVITY AND ITS DIFFERENCES AMONG
SCHOOL GIRLS AND BOYS IN PAKISTAN
ADEEL AKBAR KHOJA*, KOMAL MOTWANI*, SALEEM KHAWAJA*, ALI
KHAN KHUWAJA**
*Students, Dow University of Health Sciences, Karachi
**Assistant Professor and Convener Research
Department of Family Medicine
Aga Khan University, Karachi
BACKGROUND: Obesity among school going children is one of the major global
health challenge. The objectives of this study were to identify the pattern of
physical activity and its difference among adolescent girls and boys.
METHOD: A cross-sectional, questionnaire based survey was conducted in five
inner city secondary schools serving predominantly middle and lower
socioeconomic class in Karachi and Quetta. In all, 314 adolescents (13 to 17
years) completely responded to the questionnaire. All the data was collected and
managed by trained medical graduates. Chi-square test was used to calculate
the differences of physical activity pattern among girls and boys.
RESULTS: Questionnaire was administered to 159 boys (50.6%) and 155 girls
(49.4%). Large majority (83.7%) of adolescents were using vehicle to and from
school and over half (55.1%) of respondents spent three hours and more on
watching television, playing computer games or doing other sitting activities.
Only 20.1% of adolescents were involved in vigorous activities; more boys
compared to girls (34.0% vs. 5.9%; p<0.001). Similarly, boys were found to be
more physically active for at least thirty minutes per day as compared to girls
(27.7% vs. 16.8%; p=0.01). Less than half of the study participants were taught
about physical education and 38.8% of them had accessibility of play ground
other than school.
CONCLUSION: Substantially large proportion of adolescents particularly girls
were physically inactive in this study. There is a need for those with responsibility
for adolescent’s health, including parents, schools, and community health
providers, to consider and address the need for effective interventions to encourage
increased physical activity level among adolescents.
KEYWORDS: Physical activity, Adolescents, Pakistan
THALASSAEMIA PREVENTION PROGRAMME: PLANNING &
DEVELOPMENT DEPARTMENT, GOVT. OF SINDH – FATIMID
FOUNDATION
DR. AIYESHA HUMAIRA
Consultant Haematologist & Director Haemophilia Department
Fatimid Foundation, Karachi
INTRODUCTION: About 5% of Pakistani population is the carrier of â-thalassaemia
and there are 25% chances that a thalassaemia major baby will be born to carrier
parents. To add to the disaster 5000+ infants with thalassaemia major are born
annually. Experience of targeted screening has shown that around 40% of
extended family members with the history of thalassaemia child may be
thalassaemia carriers. The permanent cure of thalassaemia, Bone Marrow
Transplantation is expensive and results not so encouraging in our set up.
Therefore, the prevention is the only option to tackle this menace effectively.
AIMS & OBJECTIVES: Our main objective is the screening for thalassaemia
minor trait in the extended family of diagnosed thalassaemia major patients.
TARGET: Ppopulation of Karachi, Hyderabad (initial stage)
TASK: Prevention and Prenatal diagnosis which help us in prevention of birth
of thalassaemia major patients. Premarital screening and discourage
consanguineous marriages, it is simple in implementation and very effective in
preventing marriage between two thalassaemia carriers.
APPROACH:
a. Close Relatives (Brothers + sisters, maternal + paternal relatives)
b. Selection of high risk families (H/O thalassaemia major patients in family)
METHOD AND DIAGNOSTIC CRITERIA: We started extended family screening
of registered thalassaemia major patients to identify the carrier of the disease.
Carrier is asymptomatic condition, often detected only when iron therapy for mild
microcytic hypo chromic anaemia fails.
FIRST STEP: Blood Complete Picture: A film showing microcytic hypo chromic
picture required haemoglobin electrophoresis and hence patient is advised for
it.
DIAGNOSTIC CRITERIA: Haemoglobin Electrophoresis/HPLC: This is the
diagnostic test which identifies the nature of haemoglobin chain deficiency and
hence segregates minors (or carriers) from normal persons.
PRENATAL DIAGNOSIS: In case of married individuals, if both are carriers,
they are advised for prenatal diagnosis (Chorionic villus sampling). The expected
mother is advised to undergo Chorionic Villus Sampling (CVS), in first triamister
to detect whether fetus is major carrier or normal.
RESULTS: Attached with presentation
CONCLUSION: In order to achieve our goal of a thalassaemia free society, we
need collaboration among NGO’s and different relevant sectors of our society
in order to overcome the various hurdles in implementation of the prevention
programme.
CLINICAL CHARACTERISTICS AND LIVER BIOPSY OF CHRONIC
HEPATITIS C: NONRESPONDERS AND RELAPSERS TO PREVIOUS
CONVENTIONAL INTERFERON PLUS RIBAVIRIN THERAPY
1 DR.AMANULLAH ABBASI, 2 DR. NAZISH BUTT, 3 DR. ABDUL RABB
BHUTTO, 4PROF. S.M. MUNIR
1Senior Registrar, 2Postgraduate, 3Postgraduate, 4Head of Department
Department of Medicine (Ward-7)
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and
liver histology of chronic hepatitis C patients, nonresponders and relapsers to
previous conventional interferon plus ribavirin therapy.
DESIGN: Descriptive case series
PLACE AND DURATION OF STUDY: Jinnah Post Graduate Medical Centre
Karachi. Hepatology section of Medical Unit-III, Ward- 7 from January 2008 to
December 2008.
PATIENTS AND METHODS: We recruited 109 male and female outpatients
aged =17 years old with serological evidence of chronic hepatitis C by an anti
HCV antibody test and quantifiable serum HCV RNA, who had previously received
one course of conventional interferon 3 million units thrice per week plus ribavirin
800-1200 mg daily for at least 24 weeks were considered eligible for this study.
All patients were required to have a liver biopsy that showed findings consistent
with a diagnosis of chronic hepatitis C infection according to Batts-Ludwig and
Histology Activity index classification. The biopsies were done by trainees under
supervision of consultant after taking informed written consent inpatient for 8
hours.
Patients had previous course of conventional interferon monotherapy, age below
18 years, concomitant evidence of B or D virus infections, HIV virus infection,
decompensated cirrhosis, alcohol or intravenous drug abuse, pregnancy,
malignancy, autoimmune disease, hemoglobin , pre-existing psychiatric disease,
and seizure disorders were not included. Computer program SPSS version 15
was used to manage and analyze data.
RESULTS: Out of 109 patients 57 (52.3%) were female and 52 (47.7%) were
male. Mean age 38.9±8.8 years. Among these, 100 (91.7%) patients never
achieved undetectable HCV RNA (qualitative PCR testing) during the first
treatment nonresponders and 9 (8.3%) patients showed undetectable HCV RNA
during the therapy but became HCV RNA positive after discontinuing medication
relapsers. Genotype 1 was seen in of 29 (26.6%) patients and 3 in 78 (71.6%)
of patients. Genotype of 1 patients was missing and one patient was untypable.
Grade 1 inflammation were present in 51 (46.8%), grade 2 in 47 (43.1%), grade
3 in 10 (9.2%) and grade 4 in 1(0.9%) of patients. Stage 0 fibrosis were present
in 10 (9.2%), stage 1 in 34 (31.2%), stage 2 in 36 (33.0%), stage 3 in 13 (11.9%)
and stage 4 in 16 (14.7%) of patients.
CONCLUSION: Majority of nonresponder and relapser patients were female
most of them had grade 1 and 2 inflammation with stage 1 and 2 fibrosis.
KEY WORDS: Conventional interferon. Nonresponder. Relapser.
NON-INVASIVE PREDICTORS OF ESOPHAGEAL VARICES IN PATIENTS
WITH HEPATITIS B AND HEPATITIS C RELATED CIRRHOSIS
DR. ASMAT, DR. JAMAL ARA, DR. LIAQUAT ALI, DR. RUKHSANA, DR.
SHAHNAZ, DR. TARIQ, DR. RASHEED, DR. TAHIR, DR. SHAM
Department of Medicine (Ward-5)
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: To identify noninvasive predictors of esophageal varices in patients
with Hepatitis B & C related cirrhosis.
METHODS: All patients with Hepatitis B & C related cirrhosis who presented to
the Medical Unit 1 via OPD from July 2009 to December 2009 were enrolled in
the study. All patients underwent endoscopy to see the presence of varices which
were graded following the standard criteria & haematological, biochemical and
ultrasonographic variables.
RESULTS: A total of 64 patients were enrolled in the study, mean age was 40+_
20, male to female ratio was 2:1.Portal vein diameter, Spleen size, Platelet count
& Platelet count/Splenic size ratio was strongly correlated with varices.
CONCLUSION: Portal vein diameter, Platelet count, Splenic size & Platelet
count/Splenic size ratio are good predictors of esophageal varices in patients
with Hepatitis B & C related cirrhosis
ELECTROCARDIOGRAPHIC FINDINGS IN ACUTE STROKE
SHAFQAT HUSSAIN, JAMAL ARA, LIAQUAT ALI, RUKHSANA A. SATTAR,
RASHEED DURRANI, SHAM KUMAR, TAHIR ANSARI, TARIQ AZIZ, SHAHNAZ
SHAH, NARESH MODI
Department of Medicine (Ward-5)
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: Stroke is defined as focal neurological deficit due to vascular
lesion lasting longer than 24 hours. It is third most common cause of death in
developed countries. There are different pathological processes involved in
causing stroke but leading cause is vascular in origin. Hospital mortality in stroke
patients is mostly of cardiac origin. Repolarization and ischemic like ECG changes
observed during acute phase of stroke may cause diagnostic and management
dilemmas for the clinician. Such ECG changes were present in more than 90%
of unselected patients with stroke3. Patients with ECG abnormalities in acute
stroke should be advised for long term follow up to predict outcome as well.
OBJECTIVES: To determine frequency and significance of ECG changes in
acute stroke.
METHODOLOGY: Cross sectional study in Medical Unit-1 (Ward-5), Jinnah
Postgraduate Medical Centre, Karachi, Pakistan from June, 2009 to November
2009. Patient with CVA within 24 hours with history of Hypertension, Diabetes
Mellitus, Peripheral vascular disease were included. Other causes of stroke
(cerebral tumors, tuberculosis) were excluded from the study.
RESULTS: Out of 100 patients 70% were male, 30% were female, 40% has
ischemic stroke, 60% had haemorrhagic. It has been observed 68% had
Tachycardia, 54% had T-wave inversion, 18% has LVH, 16% has Myocardial
Infarction and remaining of sample size were found to be within normal limits.
CONCLUSION: Most of patients with ischemic stroke had ischemic changes on
ECG while the patients with haemorrhagic stroke had rhythm abnormalities.
Patient with rhythm abnormalities has high mortality whereas patient with other
ECG changes had a good outcome
CHANGING TREND OF VIRAL HEPATITIS – “A TWENTY ONE YEAR
REPORT FROM PMRC RESEARCH CENTRE, JPMC KARACHI”
WAQUARUDDIN AHMED, HUMA QURESHI,* AMBREEN ARIF, SYED EJAZ
ALAM
Pakistan Medical Research Council, Research Centre, Jinnah Postgraduate
Medical Centre, Karachi *Pakistan Medical Research Council, Islamabad
OBJECTIVE: To see the frequency and pattern of Viral Hepatitis over the past
twenty one years, in a Liver Research unit of Karachi.
SETTING: Out patients department of a Liver Research unit of Pakistan Medical
Research Council, Jinnah Postgraduate Medical Centre, Karachi.
SUBJECTS AND METHODS: Retrospective analysis of the records of PMRC,
Research Centre, Jinnah Postgraduate Medical Centre, Karachi, from 1987 to
2007 were reviewed. A special flow sheet was made where information of all
patients with viral liver disease was entered. Only patients having complete
information of viral markers were finally included in the analysis. Cases with
HBsAg and Anti HBc IgM positive and raised ALT were considered acute Hepatitis
B. HBs Ag/ Anti HBc IgG positive were considered chronic Hepatitis B, Delta
antibody positive with or without HBsAg were considered as Delta Hepatitis Anti
HCV positive and raised ALT more than ten times for less than 6 months were
considered as acute Hepatitis C, whereas Anti HCV and HCV-RNA positive with
or without raised ALT for more than six months were considered as chronic
Hepatitis C, Anti HEV IgM and Anti HAV IgM positive were considered as acute
Hepatitis E and A respectively.
RESULTS: A total of 5193 cases fulfilling all criteria of viral hepatitis were seen
in the past 21 years. Of the total 3247 (62.5 %) were males and 1946 (37.5 %)
females giving a male to female ratio of 1.7:1 Hepatitis C was the most common
infection seen in 2896 cases (55.8 %), followed by Hepatitis B in 1691 cases
(32.6 %). Hepatitis B and C both were more prevalent amongst males. Seventy
five percent (75%) cases of Hepatitis B were males and 25 % females while 55%
Hepatitis C cases were males and 45 % females. Hepatitis B was seen a decade
earlier than hepatitis C all over . Out of a total of 5193 cases 2294 (44.1%) were
chronic hepatitis, 1430 (27.5%) cirrhosis, 1083 (20.8%) carriers and 346 (6.7%)
cases were having acute hepatitis(( hepatitis B 214(61.8%),hepatitis C 21(6.0%),
HBV& HCV both 3 (1.3%), hepatitis E 70 (20.2%) hepatitis A 12 (3.5%)and all
markers negative 26 (7.5%)cases)). Forty cases (0.7%) were of Hepatocellular
carcinoma. Year wise analysis of proportion of Hepatitis B and C showed gradual
decline of Hepatitis B and rise of Hepatitis C with a transition period between
1995 and 1996.
CONCLUSIONS: Hepatitis C is the most common viral hepatitis, followed by
hepatitis B both are more common in males. Hepatitis B is seen a decade earlier
than hepatitis C. Rising trend of hepatitis C and declining evidence of hepatitis
B could be due to increased awareness and detection of hepatitis C and effective
vaccination for hepatitis B in the country.
PREVALENCE AND FATALITY RELATED TO METHANOL
POISONING A STUDY CONDUCTED IN NATIONAL POISON
CONTROL CENTRE JPMC KARACHI.
PROF. JAMAL ARA, *DR. AYESHA WAGGAN, DR. LIAQUAT ALI, DR.
RUKHSANA SATTAR, DR. ABDUL RASHEED DURRANI, DR. TAHIR ANSARI,
DR. TARIQ, DR. SHAAM, DR. SHEHNAZ SHAH
*Resident Medical Ward-5
Jinnah Postgraduate Medical Centre, KARACHI
BACKGROUND: Methanol poisoning is rare but undeniably the most life
threatening. Studies have been done and Data has been published on the
treatment options but we felt a need for the study emphasising on the prevalence
and major causes predisposing to and associated with fatality even after efficient
hospital management. Therefore we conducted a survey in the National Poison
Control Centre JPMC Karachi focusing on mortalities due to methanol poisoning
during the year 2009 including the methanol poisoning outbreak in Sept’ 2007.
OBJECTIVE: To ascertain the causes of high prevalence and determining the
factors related to mortality following methanol intoxication by observing the
condition of patients at the time of admission and following their step by step
management.
METHOD: Patients admitted in Poison control centre after alcohol ingestion were
traced out through hospital records, out of those the cases of methanol intoxication
were segregated. Special emphasis was given to the presenting signs and
symptoms and those patients were followed throughout their course of treatment.
Data were categorized in a statical manner starting from the time of arrival at the
hospital and the treatment given, up until the final outcome of the patient.
RESULTS: In the year 2009 including 41 patients admitted during the outbreak
of methanol ingestion in Sept’ 2007 a total of 69 patients were hospitalised with
methanol poisoning. With ages ranging from 19-60 years, 36 of them were Non-
Muslims and 33 Muslims majority of them belonging to low socioeconomic strata.
38/69(55%) patients after successful emergency treatment were discharged.
Out of those 38 survivors 12(31%) developed CNS effects and optic neuritis as
a sequel. 31/69(45%) died despite prompt and vigorous treatment within a few
hours of admission almost all of them were the ones who had presented late
after ingestion 30/31(97%) presented with stupor or coma at the time of admission
29/31(93%) patients had a blood PH < 7, 27/31(87%) patients had a blood
Bicarbonate level < 5 all of them with a compensatory metabolic alkalosis,
25/31(80%) of them had ingested large amounts of methanol according to the
attendants.
CONCLUSION: Methanol intoxication is common in low socioeconomic strata
due to easy availability and at lower price then ethanol containing beverages.
Factors determining poor prognosis were, late presentation, stupor or coma at
the time of presentation, degree of metabolic acidosis especially when there is
a rising carbon dioxide (loss of compensatory respiratory alkalosis) as well as
on concentration or amount of methanol ingested.
CLINICAL SPECTRUM OF TETANUS AND FACTORS INFLUENCING ITS
MORTALITY IN A TERTIARY CARE HOSPITAL
TASNIM AHSAN, ZEENAT BANU, NIAZ AHMED, ALI SHAHEER, SUBHEEN
KANWAL
Department of Medicine, (Medical Unit-II)
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: To determine frequency of various clinical manifestation of tetanus
and the effect of different factors on its outcome and hospital stay
STUDY DESIGN: Descriptive, Case Series
SETTING AND DURATION: Department of Medicine, Medical Unit II, Jinnah
Postgraduate Medical Centre, Karachi, from 1st July 2009 to 31ST December
2009
PATIENTS AND METHODS: Nine patients admitted with clinical diagnosis of
tetanus were included in the study. In our study we followed standard protocol
of treatment. Effect of study variables like age, history of injury, type of wound,
time to reach hospital, time to receive immunoglobulin after the onset of suymptoms,
autonomic instability, fits, asphyxia and history of immunization, on outcome and
hospital stay was assessed .The data was analyzed on SPSS version 12.Frequency
and percentage was computed for study variables. Mean and standard deviation
were calculated for quantitative variables. P-value of less than 0.05 was considered
significant.
RESULTS: Out of nine patients, eight (88.9%) were males and one (11.1%) was
female; the median age was 30.4 +/-15.1 years (range: 13-60 years). Eight of
them had history of injury. None had a definite history of previous vaccination
with tetanus toxoid. All patients had trismus, neck stiffness, abdominal rigidity
and constipation. Six (66.7%) of them had fits. The mean age of patients who
expired was older with 41+/- 15.3 years as compared to that of discharged
patients which was 22 +/- 8.9 years. Patients who expired were more serious
with a shorter hospital stay of 21 days as compared to 6.7 days in discharged
patients. Three patients had autonomic instability and all of them expired. The
time taken for patients to reach the hospital and to receive immunoglobulin had
no effect on outcome. The overall case-fatality rate was found to be 44.4 %.
CONCLUSION: Tetanus remains a major health problem world wide. Increasing
age and autonomic instability predicts poor outcome. Early diagnosis is necessary
to institute appropriate management and was found to be associated with good
prognosis and functional recovery.
KEY WORDS: TIG=tetanus immunoglobulin.
DENGUE FEVER RELATED ACALCULOUS CHOLECYSTITIS
TASNIM AHSAN, ZEENAT. BANU, UMAR FAROOQ, TARIQ MEHMOOD
Department of Medicine, (Medical Unit-II)
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: To determine the frequency of various symptoms, in particular
serositis and acalculous cholecystitis in patients with a diagnosis of dengue fever
(DF) and requirement of platelet transfusion in these patients.
STUDY DESIGN: Descriptive, Case Series.
SETTING AND DURATION: Department of Medicine, Medical Unit II, Jinnah
Postgraduate Medical Centre, Karachi, from October 2009 to December 2009.
PATIENTS AND METHODS: 18 patients admitted with diagnosis of DF according
to clinical manifestations and confirmed by a positive IgM antibody test, were
included in the study. Frequency of study variables like fever, rash, myalgia,
arthralgia, headache, abdominal pain, vomiting, chills, and diarrhea, were
recorded. Ultrasonography was performed to look for ascites, acalculous
cholecystitis, hepatosplenomegaly and pleural effusion. . Ultrasonographic criteria
for diagnosis of acalculous cholecystitisis include gallbladder wall thickening
(over 3mm), distention of gallbladder, pericholecystic fluid and sludge. The data
was analyzed on SPSS version 12.Frequency and percentage was computed
for study variables. Mean and standard deviation were calculated for quantitative
variables. P-value of less than 0.05 was considered significant.
RESULTS: Out of 18 patients, 10 (55.6%) were males and 8 (44.4%) were
females; the median age was 26.7±13.9 years (range: 14-57years). Seven
(38.9%) of them were found to have acalculous cholecystitis. Common features
were hepatomegaly in nine (50%) splenomegaly in eight (44.4%), bleeding in
eleven (61.1%) from either single (38.9%) or multiple (22.2%) sites, ascites in
three (16.7%) and pleural effusion in two (11.1%).Although these were seriously
ill patients, only eight (44.4%) of total patients required platelet transfusion.
CONCLUSION: Acalculous cholecystitis can occur in dengue fever and dengue
hemorrhagic fever but reports are rare. In our study, approximately 44.4% of the
DF patients had acalculous cholecystitis. Treatment is conservative unless there
is no resolution. Dengue fever and Dengue Hemorrhagic fever being highly
endemic, there is a need to be familiar with the atypical presentation of this
increasingly prevalent disease. Platelet transfusion is not required in all patients.
KEY WORDS: DF dengue fever, Acalculous cholecystitis.
RELATION OF BRAIN NATRIURETIC PEPTIDE, MEAN ARTERIAL
AND PULSE PRESSURES AMONG NORMOTENSIVE, PRE-
HYPERTENSIVE AND HYPERTENSIVE MALE COHORT
*MEH JABEEN; MUHAMMAD FURQAN; MRS.NUDRAT ANWAR ZUBERI
*Assistant Professor, Department of Physiology
Hamdard College of Medicine and Dentistry, Hamdard University, Karachi
BACKGROUND: Hypertension is an increasingly important medical and public
health issue. Individuals prone to the development of hypertension often have
a hyperdynamic circulation antedating the onset of hypertension by several years.
Brain Natriuretic Peptide is a new promising cardiovascular risk marker due to
its association with high blood pressure via its mechanisms of secretion and
actions. Both pulse and mean arterial pressures are independent markers of
cardiovascular diseases. This study was designed to find out any relation between
the rising values of pulse and mean arterial pressures among normotensives,
pre-hypertensives and newly diagnosed hypertensives with the changes in
plasma brain natriuretic peptide levels.
METHODS: This was an observational, analytical cross-sectional study conducted
in department of physiology at Basic Medical Sciences Institute, Jinnah Post
Graduate Medical Center, Karachi. Study included 85 adult males, aged between
20-60 years, non- smokers, non- diabetic and having no other chronic illness.
Pulse and mean arterial pressure values were found.Study participants were
divided into three groups on the basis of normotensive to hypertensive as stated
by Joint National Committee -7. Brain Natriuretic Peptide was assayed by AxSym
technology.
RESULTS: Brain Natriuretic Peptide developed a positive correlation with both
pulse and mean arterial blood pressures and was also found out to be significantly
raised in pre-hypertensive group.
CONCLUSION: This study concluded that Brain Natriuretic Peptide is positively
related with increasing values of both variables i.e. pulse as well as mean arterial
blood pressures. It also concluded Brain Natriuretic Peptide to be significantly
elevated in pre-hypertensive stage and not very different from the levels of
sustained hypertension.
KEY WORDS: Brain Natriuretic Peptide, Pre-hypertensive, Pulse pressure, Mean
arterial blood pressure.
DEPRESSION AND DIABETES IN HIGH-RISK URBAN POPULATION
OF PAKISTAN
*FAREEHA SHAIKH, SHAHEEN ASGHAR, M. ZAFAR IQBAL HYDRIE, ASHER
FAWWAD, ABDUL BASIT, A SAMAD SHERA, AKHTAR HUSSAIN
*Research Officer, BIDE-DAP-UIO Project
Baqai Institute of Diabetology and Endocrinology
Baqai Medical University, Karachi
INTRODUCTION: Diabetes prevalence is increasing worldwide with the major
burden occurring in the developing countries. Depression is a common public
health issue which has been recognized as an important co-morbid condition for
diabetes with relative risk of 1.3-3.0 times as seen in some studies.
OBJECTIVES: To determine the prevalence of depression and its association
with diabetes in a high risk population of Pakistan.
METHODS: A joint collaborative primary prevention study was initiated in 2007
between university of Oslo, Diabetes Association of Pakistan and Baqai Institute
of Diabetology & Endocrinology for a period of three years. Total 1,822 high risk
subjects aged > 30 yrs were screened by OGTT, out of which 1,246 were agreed
for the assessment of depressive symptoms according to Montgomery Asberg
depression rating scale. Demographic and socioeconomic information was
collected through a structured questionnaire. Subjects identified as having IGT
were invited to participate in the intervention program for a period of 18 months.
Depressive symptoms were assessed again at 18 months while OGTT, fasting
lipid profile, fasting insulin and HbA1c were done at 0, 9 and 18 months.
RESULTS: Out of 1,246 subjects (68.4%) were males and (31.5%)) were females.
Subjects with diabetes had high prevalence of depression (13% n=16/123) as
compare to non-diabetics (6.77%). Mean age of the cohort was 42 yrs (±9.37)
while mean BMI was 26.31 ±5 13 kg/m².One hundred and twenty three (9.9%)
were found to be diabetic and 92 (7.4%) had depression. Only 16(1.28%) had
depression with diabetes. In females depression rate was high (15.52%) as
compared to males (3.63%). Diabetes, female gender, non earners and obesity
were significantly associated with depression. (P value = 0.03)
CONCLUSION: Low prevalence of depression was seen in this population.
Significantly high percentage of depression was found in newly diagnosed
diabetics compared to non diabetics.
It is suggested that along with lifestyle modification, psychiatric intervention and
counseling of high risk individuals is needed for primary prevention of diabetes.
HYPERGLYCEMIC EMERGENCIES & ITS PRECIPITATING FACTORS
MUHAMMAD RIZWAN, TAHIR ANSARI, JAMAL ARA, LIAQAT ALI, RUKHSANA
A.SATTAR, TARIQ AZIZ
Department of Medicine (Ward-5)
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: Hyperglycemic emergency is a state of uncontrolled diabetes
in which the degree of metabolic derangement is such that immediate administration
of insulin and fluids is required to save the patient’s life. Diabetic ketoacidosis
DKA and hyperglycemic non-ketotic diabetic coma HONK are the main types of
hyperglycemic emergencies, these complications are life-threatening and therefore
require early recognition and immediate management.
OBJECTIVE: To determine the precipitating factors, clinical features & outcome
of hyperglycemic emergencies.
METHOD: Cross sectional study conducted at medical unit -1, JPMC, Karachi
from December 2008 to November 2009. All patients with symptoms of acute
metabolic decompensation & plasma glucose level > 250 mg/dl in previously
known to have diabetes or diagnosed with diabetes on admission were included.
All the relevant information i.e demographic & socioeconomic was collected
through a questionnaire.
RESULT: A total no. of 42 patients were enrolled, there were 24 males (57%)
& 18 females (43%). Age ranges from 14-72 years with mean age of 43±. Among
42 patients 38(90.4%) were diagnosed as DKA & 4 (9.6%) as HONK. On admission
majority (46%) of patients were irritable/restless, 28% comatose, 17% with
abdominal pain & vomiting & 9% with neurological deficit. Precipitating factors
noted in these patients were infections; 40%, poor compliance; 32%, CVA;12%,
trauma;8%, Unknown;8%. Total 7 (16.5%) patients died out of which 6(14.2%)
due to DKA & 1(2.3%) due to HONK.
CONCLUSION: Hyperglycemic emergencies are largely precipitated by infections
& poor compliance and are associated with considerable mortality.
SIGNIFICANCE OF LUNG FUNCTION TEST [SPIROMETRY] IN DIABETIS
PATIENTS
SULTAN AYOUB MEO
Professor and Consultant
Department of Physiology, College of Medicine
King Khalid University Hospital, King Saud University, Saudi Arabia
& Associate Editor International Journal of Diabetes Mellitus [Elsevier / Science
Direct]
{E-mail: sultanmeo@hotmail.com}
Spirometry is a widely used pulmonary function test (PFT), ideally suited to
describing the effects of obstruction or restriction on lung function. It is a powerful
diagnostic tool that plays a significant role in the early diagnosis of lung damage
and its associated structures. The Spirometric parameters have gained more
popularity when it has been reported that impaired Forced Vital Capacity (FVC)
and Forced Expiratory Volume in 1 s (FEV1) are emerging novel risk factors for
type 2 diabetes mellitus. These Spirometric parameter derangements have been
evident on spirometry long before the clinical diagnosis of diabetes mellitus or
insulin resistance. Therefore, the aim is to highlight the evidence based significance
of spirometry in this scientific symposium. It may serve as a brief reference for
diabetes management teams to enable spirometry to be included in the algorithm
of the routine assessment of diabetic patients.
HYPERGLYCEMIC EMERGENCIES & ITS PRECIPITATING FACTORS
(.6%) and thyrotoxicosis without goiter in 26(8..4%). Out of 201 patients who
came for follow-up after 6 weeks, irrespective of treatment received, 91 (45.27%)
patients became euthyroid, 39 (19.40%) were still toxic but there hormonal profile
was better than before, 32 (15.9%) had no change in their status and 39 (19.40%)
became hypothyroid.
CONCLUSION:
Thyrotoxicosis is more common in female patients.
Diffuse Toxic Goiter is the most common form of Thyrotoxicosis.
A substantial proportion of patients with Thyrotoxicosis had no goiter which
may cause delay in their diagnosis.
Most of the patients were rendered euthyroid on their first follow-up, but a
small number of patients were also rendered hypothyroid.
CONFUSING PHENOTYPES OF POLYCYSTIC OVARIES IN
ENDOCRINE CLINIC
TASNIM AHSAN, ZEENAT BANU, SAIMA GHAUS, RUKHSANDA JABEEN,
UMAR FAROOQ
Department of Medicine, (Medical Unit-II)
Jinnah Postgraduate Medical Centre, Karachi

MUHAMMAD RIZWAN, TAHIR ANSARI, JAMAL ARA, LIAQAT ALI, RUKHSANA
A.SATTAR, TARIQ AZIZ
Department of Medicine (Ward-5)
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: Hyperglycemic emergency is a state of uncontrolled diabetes
in which the degree of metabolic derangement is such that immediate administration
of insulin and fluids is required to save the patient’s life. Diabetic ketoacidosis
DKA and hyperglycemic non-ketotic diabetic coma HONK are the main types of
hyperglycemic emergencies, these complications are life-threatening and therefore
require early recognition and immediate management.
OBJECTIVE: To determine the precipitating factors, clinical features & outcome
of hyperglycemic emergencies.
METHOD: Cross sectional study conducted at medical unit -1, JPMC, Karachi
from December 2008 to November 2009. All patients with symptoms of acute
metabolic decompensation & plasma glucose level > 250 mg/dl in previously
known to have diabetes or diagnosed with diabetes on admission were included.
All the relevant information i.e demographic & socioeconomic was collected
through a questionnaire.
RESULT: A total no. of 42 patients were enrolled, there were 24 males (57%)
& 18 females (43%). Age ranges from 14-72 years with mean age of 43±. Among
42 patients 38(90.4%) were diagnosed as DKA & 4 (9.6%) as HONK. On admission
majority (46%) of patients were irritable/restless, 28% comatose, 17% with
abdominal pain & vomiting & 9% with neurological deficit. Precipitating factors
noted in these patients were infections; 40%, poor compliance; 32%, CVA;12%,
trauma;8%, Unknown;8%. Total 7 (16.5%) patients died out of which 6(14.2%)
due to DKA & 1(2.3%) due to HONK.
CONCLUSION: Hyperglycemic emergencies are largely precipitated by infections
& poor compliance and are associated with considerable mortality.
OBJECTIVE: To study the various phenotypes of polycystic ovarian syndrome
in our population.
METHODOLOGY: This is a descriptive study conducted in Medical Unit II of
Jinnah Postgraduate Medical Centre (JPMC), Karachi from February 2007 to
July 2009. All patients with clinical diagnosis of PCOS, visiting Endocrine Clinic,
JPMC, were enrolled in the study. Detailed history and clinical examination was
done and proforma was filled accordingly. They were assigned five different
phenotypes:
Phenotype A with ovulatory dysfunction, hirsutism and polycystic ovaries;
Phenotype B with ovulatory dysfunction and hirsutism;
Phenotype C with ovulatory dysfunction and polycystic ovaries;
Phenotype D with hirsutism and polycystic ovaries;
Phenotype E with solitary ovulatory dysfunction.
Patients with Congenital adrenal hyperplasia, Thyroid disorders, Cushing’s and
Turner’s syndrome were excluded from this study. The data was analyzed on
SPSS version 12.Frequency and percentage was computed for study variables.
Mean and standard deviation were calculated for quantitative variables. P-value
of less than 0.05 was considered significant.
RESULTS: Out of 77 patients, 40 (54.8%) were single and 30 (41.1%) were
married; the median age was 25.2 +/_ 6.0 years (range: 12-38 years). The most
common clinical presentation was menstrual irregularity 68 (88.3%), obesity 50
(63.3%) followed by hirsutism 41 (51.9%), infertility 25 (34.7%) and acne 24
(30.4%). The most commonly occurring phenotype was E, that was in 26 (33.8%)
patients, followed by phenotype B, that was in 22 (28.6%) patients.
CONCLUSION: PCOS has a variable clinical presentation in our population
ranging from features of irregular menstruation to features of insulin resistance
and infertility. The most common phenotype was E.
KEYWORDS: Polycystic Ovarian Syndrome, Hyperandrogenism, Oligomenorrhea,
Amenorrhea.

C L I N I C A L S P E C T R U M A N D VA R I O U S FORMS
THYROTOXICOSIS IN ENDOCRINE CLINIC
TASNIM AHSAN, RUKHSHANDA JABEEN, ZEENAT BANO, M. UMAR
FAROOQ, MAHESH BATRA
Department of Medicine, (Medical Unit-II)
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: To study the frequency of various symptoms, signs and forms of
Thyrotoxicosis.
METHODOLOGY: This is retrospective study conducted in Endocrine Clinic,
Medical Unit-II, JPMC, Karachi. All patients with diagnosis of Thyrotoxicosis,
registered in Endocrine Clinic from April, 2007 to June 2009 were analyzed.
OF
AN AUDIT OF PITUITARY TUMORS IN PATIENTS PRESENTING
TO THE ENDOCRINE CLINIC OVER A PERIOD OF 3 ½ YEARS
TASNIM AHSAN, I. H. BHATTI, TAMSEELA AHMED
Department of Medicine, (Medical Unit-II)
Jinnah Postgraduate Medical Centre, Karachi
This is a descriptive study about pituitary tumors with reference to age of
presentation, sex distribution, clinical presentation, type of pituitary tumor classified
as macroadenoma, microadenoma and craniopharyngioma and by laboratory
investigations whether hormonal excess and/or failure, their management and
outcome of patients.

Detailed history and clinical examination were done and were recorded on a pre-
designed structured questionnaire.

RESULTS: Out of 310 patients, 258(83.2%) were female. Common presenting

symptoms were palpitation in 260(83.9%), heat intolerance in 213 (68.7%) weight
loss in 200 (64.5%) and tremors in 187 (60.3%). Common clinical features include
goiter in 257 (82.9%), tachycardia in 83 (25.77%), eye signs were present in 79
( 25.48%) patients. Exophthalmos was present in 64 (20.6%), lid lag in 12 (3.9%)
and lid retraction in 3 (1%) patients. Most common form of thyrotoxicosis was
diffuse toxic goiter in 159 (51.3%) patients followed by toxic multinodular goiter
in 62 (20%), solitary toxic nodule in 39 (12.6%), subclinical hyperthyroidism in
14 (4.5%), thyroiditis in 8 (2.6%), thyrotoxicosis with solitary cold nodule in 2
ASSESSMENT OF INSULIN RESISTANCE IN SOUTH EAST ASIAN
WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS)
MUSARRAT RIAZ, ABDUL BASIT, ASHER FAWWAD, MUHAMMAD YAKOOB
AHMEDANI, ASIM BIN ZAFAR, ZAHID MIYAN, AHMED SALMAN
Consultant Physician, Department of Medicine
Baqai Institute of Diabetology and Endocrinology
Baqai Medical University, Karachi
{Email: }
OBJECTIVE: To assess insulin resistance (IR) in South East Asian women with
PCOS.
METHODS: This cross sectional study was carried out at Baqai Institute of
Diabetology and Endocrinology (BIDE) from January 2006 to December 2008.
Patients fulfilling the revised 2003 Rotterdan diagnostic criteria for PCOS were
included. Data of 91 patients was available for statistical analysis. Descriptive
statistics were calculated using frequency and mean with standard deviation IR
was calculated using fasting blood sugar (FBS) and fasting insulin levels. Different
surrogate marker of IR like Homeostatic model assessment of IR (HOMA-IR)
and quantitative sensitivity check index (QUICKI) were calculated.
RESULTS: The mean BMI of patients with PCOS was 31.85 ± 7.93. 37% of
patients were infertile. Co-morbid like type 2 diabetes was seen in 12.7% patients
while 15.11% patients were hypertensive. Using HOMA-IR (=2.6) 70% patients
were insulin resistant while with QUICKI (=0.35) IR was seen in 88% patients.
Only 43.9% of patients were having typical cystic appearance of ovaries on
ultrasound.
CONCLUSION: Frequency of insulin resistance in patients with PCOS is quite
high in South East Asian women. Further large scale studies are needed to
validate the findings of this study, so that the long term sequel of IR can be
prevented.
DIABETES RELATED KNOWLEDGE AMONG RESIDENTS AND
NURSES: A MULTICENTER STUDY IN KARACHI, PAKISTAN
ASMA AHMED, LUBNA ZUBAIRI, MUHAMMAD ISLAM, KHUSRO SHAMIM,
ABDUL JABBAR
Endocrine Section/ Department of Medicine
The Aga Khan University Hospital
OBJECTIVE: To evaluate and compare the knowledge related to the management
of diabetes among nurses and trainee residents of internal medicine, family
medicine and surgery at tertiary care hospitals of Karachi, Pakistan.
METHODS: A validated questionnaire consisting of 20 questions related to
diabetes awareness was acquired through a study done at Thomas Jefferson
University Hospital, Philadelphia with the consent of primary author. The survey
was performed at five tertiary care academic hospitals i among residents and
nurses.
RESULTS: 169 internal medicine residents (IMR), 27 family medicine residents
(FMR), 86 surgery residents (SR) and 99 nurses (RN) participated. The overall
mean correct percentage was 50%. ÊThere was no difference in total mean
scores of IMR & FMR (64% versus 60%, p= 0.47), although the total scores of
SR and RN were quite low (39% & 31% respectively). R.N didn’t answer correctly
on most of the items regarding in patient management of diabetes (Mean correct
score 40%).
CONCLUSION: As there are no prior studies in our setting evaluating knowledge
related to diabetes management among trainee residents and nurses, this study
is quite significant. Based on these results, there are significant gaps in diabetes
knowledge among residents and nurses. Most current curricula in medical and
nursing schools do not include practical diabetes management.Ê Due to high
burden of disease and considering the fact that our residents and nurses are
actively involved in diabetes management this raises important concerns and
needs to be addressed.
COMPARISON OF METABOLIC SYNDROME PREVALENCE IN
TYPE 2 DIABETICS USING NCEP ATP III, IDF AND WHO CRITERIA’S
AHMED A, N ISLAM, T YASMEEN AND T E KHAN
Endocrine Section, Department of Medicine
Aga Khan University Hospital, Karachi
OBJECTIVE: Metabolic Syndrome has emerged as a significant burden on
health all over the world. Many Definitions have been put forward since the
inception of this Syndrome. Studies have looked into these differences in definitions
of metabolic syndrome generally, but only few studies have compared these
definitions in the diabetic population. We decided to determine the prevalence
of metabolic syndrome in Type 2 diabetics according to NCEP ATPIII, IDF and
WHO definitions and then to compare and contrast these traits within Pakistani
population.
RESEARCH DESIGN AND METHODS: This study was done at the Aga Khan
University Hospital Karachi. Data was collected prospectively by using a
questionnaire which included demographic characteristics and individual
components of metabolic syndrome i.e. waist circumference, serum triglyceride,
HDL etc. This data was analyzed separately according to NCEP ATP III, IDF and
WHO definitions and the results were then compared. The data were presented
as the mean +/- SD or percentage; continuous variables were compared using
the chi-square test. All analyses were conducted by using the statistical package
for social sciences SPSS 14. All p values were two sided and considered as
statistically significant ifÊÊ 0.05.
RESULTS: Two hundred and ten Type 2 diabetic patients were enrolled in the
study among which 112 were males and 98 females. The frequency of Central
Obesity by WHO were 96%, by NCEP ATP III (europoid) 61.4%, by NCEP ATP
III (southasian) and IDF definitions was 90.5%. Hypertension by WHO criteria
was present in 55.2% in comparison to prevalence of around 70% by both ATP
III and IDF definitions. Hypertriglyceridaemia was present in 41.4% by all
definitions. However prevalence of low HDL differed being 36.7% for WHO and
67.6% for ATP III and IDF definitions. The prevalence of Metabolic Syndrome
was 81.4% by WHO definitions, 75.7 and 91.9% by NCEP ATP III (europoid)
and NCEP ATP III (southasian) and 86.7% by IDF criteria. The degree of
agreement (kappa statistic) between WHO definition and NCEP ATP III (europid),
NCEP ATP III (southasian), IDF definitions were 0.465, 0.436 and 0.417
respectively. The degree of agreement between IDF and NCEP ATP III (europid),
(southasian) definitions was found to be 0.373 and 0.728 respectively.
CONCLUSION: Prevalence of Metabolic Syndrome in Type 2 Diabetics was
highest according to NCEP ATP III southasian criteria followed by IDF and WHO
definitions. NCEP ATP III europoid had the lowest prevalence. Maximum degree
of agreement was seen between IDF and NCEP ATP III southasian definitions
of metabolic syndrome.
IS SERUM ADIPONECTIN A PRECURSOR OF T2DM?
AHSAN S, KARIRA KA, HAQUE MS, ZUBARI NA, HYDRIE MZI, KHANAM R.
Baqai Institute of Diabetology and Endocrinology
Baqai Medical University, Karachi
BACKGROUND: Diabetes is the result of glucose dysregulation and it passes
from normal glucose tolerant (NGT) to prediabetes and then to diabetes. The
first phase of this spectrum from NGT to pre-diabetes is reversible and also
preventable. Therefore, it is imperative to understand the pathophysiology of
prediabetes.
Adiponectin is a peptide hormones synthesize exclusively from adipose tissues.
Studies revealed that adiponectin has insulin sensitizing property. Adiponectin
knock out mice were found to be insulin resistant and on administration of
adiponectin insulin sensitivity was restored. Studies found decreased adiponectin
in diabetic and insulin resistant subjects.
AIM: We attempted to find the status of serum adiponectin in individuals
progressing towards T2DM and compare it with NGT subjects, to determine the
stage where alteration of adiponectin occurred.
METHODS: This study was carried out in the Department of Biochemistry, BMSI,
JPMC, Karachi during Jan to Aug 2008. Subjects were invited through various
diabetes screening camps. A total of 608 subjects = 30 years of age with out
prior history of diabetes were screened through FPG and 2 hour OGTT. Individuals
with diabetes were excluded from the study.
Forty prediabetic subjects and forty age and sex matched NGT subjects were
included in the study. Anthropometric measurements were done. Serum insulin
and adiponectin were estimated by ELISA while HOMA-IR was calculated
mathematically.
RESULT: Mean BMI, waist, hip circumference and B.P were significantly raised
in prediabetics compared to NGT. Adiponectin was significantly decreased while
insulin and HOMA-IR were raised in prediabetics. Adiponectin showed significant
negative correlation with insulin (r= -0.73) and HOMA-IR (r= -0.71).
CONCLUSION: We found low adiponectin in prediabetic subjects and its estimation
may help in earlier identification of impending diabetes. However, casual link
between adiponectin and prediabetes remained unexplored due to small sample
size, which warrants longitudinal large scale studies.
ASSOCIATION OF FTO AND MC4R GENES WITH OBESITY-
RELATED TRAITS AND TYPE 2 DIABETES IN PAKISTANI
POPULATION
DR. SHAZIA KIRAN
Research Department
Baqai Institute of Diabetology and Endocrinology
Baqai Medical University, Karachi
OBJECTIVE: A number of studies have shown that common variants within the
FTO and MC4R genes are associated with obesity-related traits such as BMI,
weight and waist circumference. Recent studies of Indian population have also
revealed that variants within FTO appear to be associated with type 2 diabetes.
A joint collaborative study was conducted between Baqai Institute of Diabetology
and Endocrinology (BIDE),University of Birmingham and Diabetes Association
of Pakistan(DAP).Our aim was to observe the association of the above mentioned
SNPs with T2DM and obesity.
RESEARCH DESIGN & METHODS: Subjects with type 2 diabetes (N = 717)
were recruited from hospitals within Mirpur District or from specifically organized
Diabetes Awareness camps. Control subjects (N = 912) were recruited from
community screening camps set up through our team stationed in Mirpur. All
samples (N=1629), were genotyped for the FTO rs9939609 and MC4R rs12970134
single nucleotide polymorphisms (SNPs). Genomic DNA was extracted from
saliva using the Oragene® DNA sample collection kit and extraction protocol
(DNAGenotek Inc., Ontario, Canada). These kits greatly simplify the collection
and transportation of samples, as well as immediately stabilizing DNA, and so
were chosen instead of venous blood samples. Informed consent was obtained
from all study participants and the study was approved by the BIDE ethical review
board.
RESULTS: Both SNPs (FTO and MC4R) displayed an association with obesity-
related traits, but only within the normoglycaemic group, p values were significant
for BMI (0.008),waist (0.052) and weight(0.008) in FTO and in MC4R p values
for BMI (0.021),waist (0.011) and weight(0.013).No associations were found
within the type 2 diabetes group for BMI, waist and weight in both FTO and
MC4R.
CONCLUSIONS: In this study we observed that FTO and MC4R SNPs were
associated with obesity-related traits in Pakistani population, both individually
and multiplicatively.
These associations appear to be masked in the type 2 diabetes group.
LEFT VENTRICULAR HYPERTROPHY IN END- STAGE RENAL
DISEASE PATIENTS ON MAINTENANCE HEMODIALYSIS
BHAGWAN DAS, MANOHAR LAL, ABDUL MANAN JUNEJO
Department of Nephrology
Jinnah Postgraduate Medical Centre, Karachi
BACKGROUND: Cardiovascular disease is the principal cause of morbidity and
mortality in dialysis patients. Left ventricular hypertrophy is one of the commonest
structural abnormalities in patients on regular dialysis.
METHODS:
STUDY DESIGN: Single Center Case-Series Study.
PLACE AND DURATION OF STUDY: this study was carried out at hemodialysis
unit of Jinnah Post-graduate Medical Center Karachi. From May, 2009 to
November, 2009
Seventy three patients on regular hemodialysis were included in the study. ECG,
CXR, and two dimensional and M-Mode echocardiography was performed in all
patients irrespective of the cause of renal failure.
RESULTS: Total number of patients was seventy three. 33 patients were male
and 40 were female. Mean age of the patients was 44.19 years. Essential
hypertension was the commonest cause of renal failure that is observed in
29(39.7%) cases followed by Diabetes Mellitus and Chronic Glomerulonephritis
in 20(27.4%) in each. Renal stone 4(5.5%), unresolved acute renal failure 4(5.5%)
and Chronic Tubulointerstitial nephritis in 2(2.7%). Left ventricular hypertrophy
was observed in 19(26%) patients.
CONCLUSION: since left ventricular hypertrophy is a powerful cardiovascular
risk factor for increased morbidity and mortality in hemodialysis patients, its early
detection and regression of left ventricular hypertrophy will contribute to reduction
in cardiovascular mortality in uremic population.
KEYWORDS: Left ventricular hypertrophy, Hemodialysis, Echocardiography,
End-stage renal disease
F R E Q U E N C Y O F D I F F E R E N T PAT T E R N O F R E N A L
OSTEODYSTROPHY IN END STAGE RENAL FAILURE PATIENTS
ON MAINTENANCE HEMODIALYSIS
S. NOUSHEENA IQBAL, A MANAN JUNEJO, MANOHAR LAL DAWANI
Department of Nephrology
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: In chronic kidney disease renal osteodystrophy (ROD) is
highly prevalent. It is an important cause of morbidity, decreased quality of life,
and extra skeletal calcification that have been associated with increased
cardiovascular mortality. The disease is classified into following categories: 1)
high turnover bone disease (osteitis Fibrosa Cystica) (2) low turnover bone
disease (adynamic bone disease and Osteomalacia) (3) mixed uremic
osteodystrophy (combination of osteitis Fibrosa cystica and Osteomalacia).
OBJECTIVE: To determine the frequency of different patterns of renal
osteodystrophy in patients of maintenance haemodialysis.
MATERIAL AND METHODS: It was a prospective, cross-sectional study of
renal bone disease in patients receiving hemodialysis at JPMC. A variety of non-
invasive data (like parathyroid hormone, serum calcium, phosphate & alkaline
phosphatase) was obtained.
RESULTS: The study was carried out in 56 patients. Their average age was
45.85 ± 13.5 years. Out of 56 patients, 34 (61%) were male and 22 (39%) were
female. Male to female ratio was 1:1.5. 37 (66%) patients were on twice weekly
and 19 (34%) patients were on thrice weekly HD. Their mean duration of HD
was 20.2±13.6 months. Higher prevalence of ROD in 89.28% (50 patients) was
noted. The most common type was secondary hyperparathyroidism (osteitis
Fibrosa Cystica), observed in 32% of patients. Only 15 patients (27%) had iPTH
level within the target range. Hyperphosphatemia was observed in 35 patients
(62%) while hypercalcaemia in only 4 patients (7%). Osteomalacia was common
in adolescent age group (66%), osteitis Fibrosa cystica (OFC) in adult group
(36%) while mixed variety in elder group (50%). Similarly OFC was the most
common pattern in both genders.
FREQUENCY OF HEPATORENAL SYNDROME IN PATIENTS WITH
LIVER CIRRHOSIS ASSOCIATED WITH HEPATITIS C VIRUS AT
JINNAH POSTGRADUATE MEDICAL CENTER, KARACHI.
DR. POORAN MAL, DR.MANOHAR LAL DAWANI, DR. ABDUL MANAN
JUNEJO
Department of Nephrology
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVES: To determine the frequency of Hepatorenal Syndrome in patients
with cirrhosis associated with Hepatitis C virus.
STUDY DESIGN: Cross sectional
PLACE AND DURATION OF STUDY: Departments of Medicine and Nephrology
JPMC, Karachi, from1st December 2007 to 30th May 2008.
PATIENTS AND METHODS: Data was collected from patients admitted in the
medical and nephrology wards, through a pre-designed proforma. After meeting
the inclusion criteria. history and systemic examination was done and investigations
like blood urea nitrogen, serum creatinine, serum electrolytes, urine analysis,
Anti HCV antibodies done in all these patients.
RESULTS: A total of 100 patients with liver cirrhosis were included in this study.
Out of 100 patients, 32 patients (32%) had renal dysfunction manifested by raised
serum creatinine. Five patients (16.6%) out of 32 were diagnosed as renal
dysfunction due to hypovolumia. Five (16.6%) patients with renal dysfunction
were due to sepsis. Three (9.4%) patients with renal dysfunction also have the
history of nephrotoxic drugs. Similarly renal dysfunction were diagnosed as cases
of UTI in 2(6.3%), obstructive uropathy 1(3.13%) and shock with history of fluid
loss 1(3.13%).
Hepatorenal syndrome (HRS) was diagnosed in 12 patients, which is 37.5%
(12/32) and overall frequency of hepatorenal syndrome (HRS) was 12(12%) of
all 100 patients.
CONCLUSION: Hepatorenal syndrome is a dreaded complication in patients
liver cirrhosis and HCV is the major cause of end stage liver disease. There is
need to educate general population about the risk factors associated with spread
with hepatitis C virus.
KEY WORDS: Hepatorenal Syndrome, HCV, Cirrhosis
2 YEARS EXPERIENCE OF RENAL AMYLOIDOSIS
KUMAR DILEEP, A MANAN JUNEJO, MANOHAR LAL DAWANI
Department of Nephrology
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: Amyloidosis is a systemic disease characterized by deposition
of abnormal fibrillay proteins in the extracellular spaces of multiple organs. Renal
amyloidosis is not infrequently encountered in the practice of nephrology. The
kidneys are involved in almost cases of secondary amyloidosis. Its incidence
has varied from 3 – 12% in different biopsy series. The renal manifestation vary
with site of involvement. Most patients have predominant glomerular deposition
and present proteinuria.
OBJECTIVE: To detect the frequency and clinicopathologic presentation of renal
amyloidsis
MATERIALS AND METHODS: study was conducted at the department of
Nephrology. Renal biopsies were scrutinized over period of 2 years to detect the
frequency of secondary amyloidosis and pattern of the disease. Baseline labs
including CBC, UCE, Total protein & albumin , urine D/R , 24 hours urinary
proteins and renal biopsy were done.
RESULTS: On the basis of renal biopsy total 10 patients were found to have
secondary amyloidosis. Out of which 7 were male and 3 females. The age ranges
24 yrs to 55 years. 5 presented with heavy proteinuria with normal renal functions
while rest of the 5 had deranged renal functions wth significant proteinuria.
Tuberculosis was the most common cause of secondary amylodosis.
QUALITATIVE AND QUANTITATIVE ASSESSMENT OF CORONARY
ARTERIES IN PAKISTANI POPULATION ON ANGIOGRAPHIC
STUDY
DR. A RASHEED KHAN
A Professor & Head of Cardiology
Abbasi Shaheed Hospital, Karachi Medical & Dental College, Karachi
This is an observational type of study in which we have observe the origin of
Anomalous Coronary Artery and the diameter, type, severity and the site of lesion
involving them. We have studied 500 patient and the incidence of Anomalous
Coronary Artery was 04%, which is comparable to available International literature.
It was also found out that in Pakistani Population the diameter is of smaller size,
the lesion are of severe type as compare to European Countries
Anomalous coronary artery is found in 04% of all patients coming for coronary
angiography. The anomalous coronary artery may arise from contra-lateral
coronary sinus, separately, combined from one or same sinus, above or below
its normal sinus sites etc. The right coronary artery may arise from the proximal
left circumflex artery sinus or Circumflex artery originating from right Coronary
sinus and Left anterior descending artery from the right coronary artery sinus or
rarely all are originating from single sinus or ending in the same artery. In some
an anastomatic network of small arterial branches is found connecting the large
vessels indirectly. We tried in answering the questions of anomalous origin of
coronary arteries and then describe in detail their vascular relation with normal
coronary artery anatomy, lesion’s site, severity, and percentage of stenosis and
left ventricular function. In all of our cases, we observed anastomotic networks
of various sizes.
We found only 22 anomalous arteries out of 500 normal hearts (04%). Similar
percentages ranging between 01% and 04% have been reported in the literature,
in different coronary angiographic studies On the other hand, in anatomical
studies, the percentage ranged between 03% and 5.6 %. We believe that these
percentages probably included cases with a large anastomotic network. It is hard
to explain why other authors did not report any percentages in their studies. Our
results, in accordance with previous publications, clearly demonstrate that
anomalous coronary artery does not have a standard point of origin.
In our 22 cases, anomalous artery was found directly originating from anomalous
sites. The work in all 500 cases, shows the connection of coronary arteries
directly or indirectly the proximal and distal parts of the large coronary arteries.
These types of connections of the arteries have been described in most of the
studies.
In this study, we tried to resolve the confusion in the literature regarding the origin
of anomalous coronary arteries, there relationship with normal coronary artery
anatomy, type of the lesions, site, severity, and left ventricular function.
In conclusion, an anomalous artery plays an important role in management of
the patients. Also its relation with normal anatomic network, size of vessel, site,
percentage & number of lesions, LV functions, dominance of an artery all play
very important role in patient’s management. The normal coronary artery anatomy,
their relationship, origin, site, number and sizes of lesions and association with
left ventricular function are also needed to address.
FREQUENCY OF CORONARY ARTERY STENOSIS AMONG
PATIENTS OF STABLE ANGINA HAVING LEFT BUNDLE BRANCH
BLOCK: EFFECTS OF GENDER AND AGE
AHMED S, ULLAH E, AHSAN MB, ABBAS R.
{Dr Raees Abbas, 42-Doctor’s Hostel, BVH, Bahawalpur, Cell: 0321-6903704}
INTRODUCTION: The purpose of the study was too see the frequency of coronary
artery stenosis in the patients of stable angina having left bundle branch block,
and to see the effects of gender and age on this correlation.
MATERIALS & METHODS: The study design was Experimental case series at
Bahawal Victoria Hospital, Bahawalpur carried out from June 2006 to May 2008.
One hundred and forty one (141) patients of Stable Angina presenting with
atypical chest pain, both male and female of 30—70 years age, positive for LBBB
and with normal Cardio-Thoracic Ratio, normal echocardiography and negative
for conventional risk factors and family history of Coronary Artery Disease were
taken. All patients were angiographied.
RESULTS: A total of 141 patients were investigated through coronary angiogram
to see the frequency of coronary artery stenosis in these patients. Ninety five
(67.4%) patients proved to have coronary artery stenosis. The male patients
showed higher frequency (87.4%) of harboring coronary vessel blockade as
compared to that (35.2%) in females (P value <0.0005). There was no relation
between age and the frequency of coronary stenosis (P value >0.05).
CONCLUSION: There is significant difference (P value <0.0005) in coronary
artery stenosis among men and women having LBBB.
PROSPECTIVE CORONARY CATHETERIZATION REGISTRY
DATABASE AT KARACHI INSTITUTE OF HEART DISEASES,
KARACHI; NON-AVAILABILITY OF HUGE FUNDING IS NOT AN
ISSUE
JAVED ISMAIL, JUNAID ALAM ANSARI, MIRZA YOUSUF BAIG, GHULAM
ISHAQ KHAN, ATIF ZAFAR, FARHAN ULHAQ, ABDUS SAMMAD
Karachi Institute of Heart Diseases, F.B. Area, Karachi
BACKGROUND: Cardiac Catheterization is one of the most commonly performed
major invasive procedures throughout the world. A database in any hospital helps
in organizing the patient’s data. This information has significant importance in
data analysis. In western world the culture of electronic database registry has
established its usefulness as exemplified by NCDR Cath PCI Registry of ACC
Foundation. In Karachi Institute of Heart Diseases (KIHD) Angiography and
Angioplasty has been performed on 7634 and 920 patients, respectively since
year 2005–2009.
OBJECTIVE: To establish an Electronic Hospital Database for cardiac
catheterization patients with minimum amount of budget in a public sector hospital
of Pakistan.
METHOD: Registry enroll patients who had their PCI at KIHD from December
2009. A structured questionnaire was developed, with the help of intervention
cardiologist, and epidemiologist at KIHD. The questionnaire gather baseline
information of the patient, from different stages of PCI and Follow-ups, which
are scheduled after One week and then after every 3rd month. The questionnaire
contains information on variables, like socio-demographic, detailed patient’s
history including comorbids with in-depth cardiac history, physical review and
examination, provisional diagnosis, investigation reports and PCI specific
information. After filling questionnaire, a registration card containing date for the
next follow up was issued to the patient. Participating patients are reminded by
phone calls for their upcoming follow-ups. Simultaneously old patients up to June
2009 were also included in the database by inviting them on Phone for a follow-
up. All patients are being provided with a free Clinical Examination, BP recording,
Weight, Height and Cholesterol measurement at the time of follow-up. Data is
entered in Epidata software by a trained data entry operator. All of the volunteers,
research coordinators, research associate, data entry operator, and staff were
trained by a Principal investigator. The registry was established with the meager
amount of around PK Rs.30,000, which was mainly utilized for communication
charges, printing of questionnaires, and purchase of some basic equipment like
bath room weighing scale, wire less telephone, printing papers etc.
CONCLUSION: In western world the presence of database in Hospital setup
has helped in monitoring the overall progress of patient. Hence by introducing
this database in Karachi Institute of Heart Diseases, Karachi, will help us in
monitoring the patient’s outcome undergoing PCI, quality of management according
to the current guidelines, and carry out researches. We would also like to
emphasize that a quality data base can be established with meager amount of
funding, and volunteer participation.
CORONARY ARTERIES OCCLUSION SITES AND LEFT
VENTRICULAR DYSFUNCTION IN PATIENTS VISITING KARACHI
INSTITUTE OF HEART DISEASES
JAVED ISMAIL, FAREENA KHAN, MAHA MOHSIN, SYEDA TAHIRA NARJIS,
GHULAM ISHAQ KHAN, JUNAID ALAM ANSARI, MIRZA YOUSUF BAIG,
ABDUS SAMMAD
Karachi Institute of Heart Diseases, F.B. Area, Karachi
INTROCDUCTION: Coronary vascular disease is one of the leading causes of
mortality world-wide. It is estimated that around 262.5 per 100,000 deaths have
been caused Cardiovascular diseases in general, out of this 7.6 million people
are dead only due to Coronary artery diseases. Coronary Angiography is
diagnostic tool for the coronary vessel disease which allows us to measure the
extent and severity of atherosclerotic disease. Therefore the findings of this
diagnostic tool have immense importance in the prognosis of CAD and further
management of the patient.
OBJECTIVE: To find out the age related blockage of different locations of coronary
vessels with the help of coronary angiography.
METHOD: A cross-sectional study based on angiographic data of Karachi Institute
of Heart Diseases. We conducted a retrospective analysis of angiographic findings
in patient’s data present in the computer from May 2009 till August 2009. The
permission to use the data was granted by administration of KIHD.
RESULT: Angiographic results of total 405 patients, admitted in KIHD for their
angiography, were entered from their records. There were 76.8% male, and
mean age (±SD) of the patients was 50 years (± 8.82). Middle portion of the LAD
was the most occluded area in our study subject, which was occluded in 62.7%,
whereas proximal and distal areas were occluded in 40% and 20.5%, respectively.
Middle portion of RCA was occluded in 39%, and proximal LCX, proximal RCA,
Middle LCX, was occluded in 38.5%, 33.6%, and 29%, respectively. Left main
coronary artery was occluded only in 8.9% of patients, with least occluded area
of proximal part, 0.9%. LAD was occluded in 43.9%, RCA 33.08%, LCX 29.21,
and LM in only 3.05% of the patients. Right Coronary artery was dominant in
47%, whereas LCX was dominant in 15.1% of the patients. Majority of the patients
had Triple Vessels Disease, 39.25%, whereas 28.9% and 19.25% had double
vessels and single vessel disease. Normal vessels were diagnosed in 12.6% of
patients. Majority of the patients had normal LV function, 67.7%, whereas 24.47%
of the patients had moderate to severe LV dysfunction, and 7.81% suffered from
mild LV dysfunction. CABG was advised in 29.1%, PCI in 22%, medical
management in 47%, and thallium scan in 3.2% of the patients.
CONCLUSION: Results showed that our study population had coronary artery
disease at younger ages as compared to the western populations. Majority of
the patients suffered from LAD coronary artery occlusion, which supplies the
anterior major force generating part of the heart. Major occlusion at anterior part
indirectly shows the severity of the diseases, and higher degree of morbidity,
with restriction to heavy physical activity. The severity of the disease is further
validated by the observation that majority of our study patients had triple vessels
disease, followed by double vessel and single vessel diseases. Majority of our
study subjects were advised to undergo CABG, which in turn is relatively a very
costly procedure, as majority of the population consulting KIHD belong to low
or middle income group of the society. Our study indicates that majority of our
patients had normal LV function, if we focus on our secondary preventive strategies
to maintain the normal LV function of these patients we would be in a better
position to reduce the mortality, and can delay the serious complications.
COMPARISON OF RISK FACTORS OF CORONARY HEART
DISEASE IN YOUNG INDIVIDUALS AS COMPARED TO OLDER
PEOPLE AT AFIC RAWALPINDI
DR SIDRAH FAROOQ, DR ALI NAWAZ, BRIG DILSHAD AHMED, DR SAIRA
SHABBIR
OBJECTIVE: In this study we aimed to examine the angiographic findings,
traditional risk factors and natural history of Pakistani patients <45 and >45 years
old with coronary heart disease (CHD).
METHODS: The records of 195 patients with Myocardial Infarction, who had
undergone coronary angiography were reviewed. The patients <45 years (group
1) and >45 years (group 2) were compared.
RESULTS: The study population was classified as group 1 with 73 patients
(mean age 38.75±4.68) and group 2 with 122 patients (mean age58.3±7.56).
Smoking, family history, military occupation and Punjabi ethnicity were more
prevalent in group 1 while diabetes mellitus, hypertension, pathan ethnicity and
increased waist circumference were higher in group 2. Patients in group 1 showed
a preponderance of single-vessel disease whereas patients of group 2 showed
dominance of multi-vessel disease.
CONCLUSION: Our study shows a significantly different clinical and angiographic
profile in <45 years patients with coronary heart disease compared with >45
years patients. Smoking is an important preventable risk factor in premature
coronary heart disease and therefore healthy lifestyles should be encouraged
from childhood and preventive measures should be adopted against smoking.
KEY WORDS: Coronary heart disease, young adults, old adults, Pakistanis
SIZE OF RADIAL AND ULNAR ARTERY IN LOCAL POPULATION
SULTANA HABIB; TARIQ ASHRAF
National Institute of Cardiovascular Diseases, Karachi
INTRODUCTION: Trans-radial coronary angiography and angioplasty is becoming
more popular for diagnosis and treatment of coronary artery disease. It is now
increasingly being utilized as an alternative site of access for cardiac catheterization
.Different studies have mentioned diameter of radial & ulnar artery in their
population.
Our aim was evaluate radial & ulnar artery diameter in patients undergoing
diagnostic coronary angiography in our population for its suitability in performing
cardiac diagnostic therapeutic interventions.
MATERIAL AND METHOD: This was a cross-sectional study carried out at
National Institute Of Cardiovascular Diseases(NICVD) from February to September
2008.Patients who were advised to undergo coronary angiography via radial
artery as first time procedure were included. After written consent before the
study right, and left radial and ulnar arteries were screened with Duplex Doppler
ultrasonography with a 7.5 MHz probe, Toshiba Power Vision. The smallest
internal diameter in each one third segment of the radial and ulnar artery was
recorded after comparing the size at both the longitudinal and transverse section.
The average diameter of the radial and ulnar artery was used for analysis. Pre-
existing risk factors for coronary artery disease at the time of ultrasonography
were recorded i.e. Gender, diabetes mellitus, hypertension, smoking, height,
weight, body surface area(BSA) and body mass index(BMI)
RESULTS: Total of 251 patients were included. Their mean age was 51.9+9.8.There
were 33.5% diabetics, 31.9%hypertensive, and 57.8%smokersThe mean diameter
of right and left radial artery was 2.3 ± 0.4mm and 2.2+ 0.4mm and right and left
ulnar artery was 2.4 ± 0.4mm and 2.3 ± 0.3mm, respectively. The factors found
to be positively affecting the size of radial artery included sex, diabetes mellitus
and smoking. There was no co- relationship of radial and ulnar artery with body
size parameters (height, weight, BSA & BMI).
CONCLUSION: We concluded that ulnar artery diameter is larger than the radial
artery in our population. Ultrasound may be the tool for measuring size of radial
before the procedure Knowing the size will guide the interventional cardiologist
in using appropriate size sheaths and guiders and for the cardiac surgeons in
utilizing radial artery as conduits for arterial bypass grafting.
REASONS FOR MEDICAL NON-COMPLIANCE IN HEART FAILURE
PATIENTS
DR.S.FAYYAZ MUJTABA, DR. SAAD,DR. DANYAL, DR. DOST
MUHAMMAD,DR. TARIQ MASOOD
National Institute of Cardiovascular Diseases, Karachi
OBJECTIVE: To determine prevalence of non compliance in heart failure patients
and frequency of various reasons of non compliance.
STUDY DESIGN: Descriptive
SETTING AND DURATION: All medical wards of NICVD in 20 days
PATIENTS AND METHODS: All the patient already diagnosed and on heart
failure treatment admitted in medical wards of nicvd were included in study. After
informed consent they were interviewed and a preformed questionnaire filled.
Apart from their basic information their education ststus, self caring status and
their sense of recognition of prescribed medication were noted. Their compliance
level was assessed for individual drug was assessed along with correct dosage
and timing. In the end if found non compliant search for their reason was made.
RESULTS: Out of 114 patients 62 were male and 52 were female.40 educated
and 74 non educated.61 self caring and 53 were other were taken care by
otherd.46 could recognize medication and 68 cannot.33 were compliant and 83
noncompliant
CONCLUSION: About 70% of the patients were found non compliant. Educated
and self caring were found moiré compliant than non educated and when other
were care giver. 14% reason was inadequate prescription, 13% due to lack of
counseling and follow up 12% were non compliant due to financial reasons.13%
stopped medication because thy didn’t feel need as they were symptomatically
stable
PROGNOSTIC VALUE OF NORMAL EXERCISE 99mTC-SESTAMIBI
MYOCARDIAL PERFUSION IMAGING IN PAKISTANI POPULATION
HASAN RAZA, SUMAIRA MUSHTAQ, SHAHID KAMAL, SHAHEEN ZAREEN,
MINHAJ MAQBOOL, BASHIR AHMED, NAJMUDDIN, ZAFAR NASIR,
RAHEELA MEHMOOD, M. EJAZ, RUKHSANA MEMON
Atomic Energy Medical Centre
Jinnah Postgraduate Medical Centre, Karachi
BACKGROUND: Previous studies have documented the prognostic value of
normal exercise myocardial perfusion imaging in patients with no known coronary
artery disease (CAD). The purpose of this study was to investigate the prognostic
value of normal exercise Tc-sestamibi SPECT in Pakistani patients with no known
ischemic heart disease.
METHODS: 137 clinically suspected ischemic heart disease patients who
underwent 99mTc-MIBI stress-rest Myocardial Perfusion SPECT (MPS) were
followed up for 27 +/- 3 months after the scan about cardiac death and myocardial
infarct (hard events). They were divided into two groups according to their pre-
test probabilities for CAD.
RESULTS: Two patients were lost to follow up, rest showed an excellent survival
rate with hard cardiac event rate of 0.74%. However there was statistically non-
significant difference between the survival rates of low and high pre-test probability
groups.
CONCLUSION: Study demonstrated good prognosis for patients with normal
exercise myocardial perfusion scan.
5-AZACYTIDINE AND ZEBULARINE ENHANCE CARDIOMYOGENIC
POTENTIAL OF RAT BONE MARROW MESENCHYMAL STEM
CELLS IN VITRO
NADIA NAEEM, KANWAL HANEEF, HANA’A IQBAL AND ASMAT SALIM
Dr. Panjwani Center for Molecular Medicine & Drug Research,
International Center for Chemical and Biological Sciences,
University of Karachi, Karachi {Email: salimasmat@yahoo.com;
asmat.salim@iccs.edu}
INTRODUCTION: Mesenchymal stem cells have generated a great deal of
interest because of their potential use in the regenerative medicine and tissue
engineering. Mesenchymal stem cells can be converted into beating myocytes
after the treatment of 5-azacytidine (a DNA-demethylating agent).
METHODS: In the present study, rat mesenchymal stem cells were treated with
DNA-demethylating agents, 5-azacytidine and zebularine. The optimized
concentrations of these compounds were added into the culture medium and
the RNA was analyzed for specific cardiac proteins through RT-PCR.
RESULTS: We have found expressions of GATA4, NKX2.5 and Cardiac Troponin
T in the treated mesenchymal stem cells.
CONCLUSION: We therefore, conclude that pre-treating autologous mesenchymal
stem cells with either 5-azacytidine or zebularine before transplantation may
increase the likelihood of successful regeneration of damaged myocardium.
to emphasize that a quality data base can be established with meager amount
of funding, and volunteer participation.
COMPARISON OF DAILY VERSUS PARTIALLY INTERMITTENT
REGIMEN OF ATT (ETHAMBUTOL, PYRAZINAMIDE, INH,
RIFAMPICIN) IN NON HIV WITH NEWPULMONARY TUBERCULOSIS
(TB) IN DOTS PROGRAM
DR. SHAHINA QAYYUM, DR IFTEKHAR AHMED, DR GHAZALA ANSARI
Ojha institute of chest diseases Karachi
{E-mail: imshahina@yahoo.com}
INTRODUCTION: Intermittent regimens can be as effective as daily regimens,
and it has the advantage of convenient in directly observed treatment, was
reported in 1964. Intermittent regimens are considered essential for ambulatory
programs. They have been widely explored over the past 30 years. Isoniazid,
rifampicin, pyrazinamide, and streptomycin are efficacious when given intermittently
(two or three times per week), as when given daily, and ethambutol is usually
only given intermittently when also given with rifampin (Such regimens have now
been widely used, DOTS strategy was piloted at Ojha Institute of Chest Diseases
in april1995. In 1997- 98 a three times a week intermittent regimen was introduced
at two major out door clinics of Ojha Institute of Chest Diseases. When the nation
wide DOTS program was implemented daily regimen was adopted as
recommended by national tuberculosis program in all units of Ojha Institute of
Chest Diseases. The study was done to compare the efficacy of intermittent
regimen given in 1997-8 with daily regimen as being administered in same clinics
ten years later 2007-8.
OBJECTIVE: The primary objective of the study was to compare the efficacy of
two anti-TB regimens in terms of sputum conversion an the end of intensive
phase and treatment success rate
MATERIAL AND METHOD: It was a retrospective analysis. Documents used
were data entered in Tb 03 registers of 3rd and 4th quarter in of 1997 and 1st
and 2nd quarter of 1998 was compared with the data entered in 3rd and 4th
quarter of 2007 and1st and 2nd quarter of 2008 and Quarterly reports of case
finding Tb07, sputum conversion Tb 08 and treatment out come Tb 09
RESULTS: Total number of smear positive case in intermittent therapy group
was 702 in daily therapy group was 1120. Male to female ratio showed no
significant change. There was no significant change in pattern of age distribution.
Sputum conversion at end of intensive phase was achieved in 582 out of 702(83%)
in intermittent therapy and 896 out of 1120 (80%) in daily therapy group.Success
rate 78.83 % in intermittent therapy and 78% in daily therapy group Default rate
was 20.51 in intermittent therapy in 1997-8 and 13% in daily therapy group 10
years later. No of serious adverse event was reported with intermittent therapy.
Itching in 2(2.8%), jaundice in 3 (4.2%) and vomiting in 7(9.9%) patient in
intermittent therapy. Relapse was observed in 1.2% patients after one year follow
up. Total number of visits for DOTs required by DOTS’ supporter are 66 for daily
regimen and for intermittent therapy are 36 almost 46% less for category 1 cases.
Total cost of medicine is 33% less in intermittent therapy for category 1 cases.
CONCLUSION: TB control program has achieved 100% DOTS coverage in the
public sector is not far in achieving the target of treatment success rate in new
pulmonary TB case. However it is struggling to reduce the default rate. This can
be reduced by strong net work of DOTs supporters (persons who see that every
dose is supervised). Introduction of intermittent regimen can reduce the number
of visits so a person can supervise more patients with lesser effort. It will be
advantageous to introduce this regimen in areas where population is thin and
accessibility is difficult due to less developed roads.
TO DETERMINE THE FREQUENCY OF DEPRESSION IN CHRONIC
OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS
DR. FAKHIR RAZA, DR.NADEEM RIZVI
Department of Chest Medicine
Jinnah Postgraduate Medical Centre, Karachi
{E-mail: fakhir12@yahoo.com}
METHODS: We conducted cross sectional study between June 2008 to April
2009 in department of medicine, Jinnah hospital Karachi. The sample size of the
study was (n=63). All adult patients of presenting with sign and symptoms of
COPD confirmed by GOLD criteria giving informed consent following inclusion
and exclusion criteria were consecutively included. The primary outcome of the
study was prevalence of depression measured through Hamilton Depression
Rating Scale (HAM-D). The score was classified into 10-13= mild; 14-17=
moderate and >17 = severe.
RESULTS: The mean age of the sample was 60.87±10.93 years. There were
50 (80%) males and13 (20%) females. The severity of COPD was 6 (9.523%)
patients were mild, 22 (35.02) moderate, 27 (42.90) severe and 8 (12.70%) were
very severe. The mild to moderate depression was found in 10 (15%) of patients.
CONCLUSION: Our study found the prevalence of depression in10 (15%) of
COPD patients It is lower than what international studies have shown. We
recommend that all COPD patients would be also screened for depression in
order to reduce the morbidity associated with depression and COPD.
INITIAL DEFAULT OF PULMONARY TUBERCULOSIS PATIENTS
IN A CHEST CLINIC IN KARACHI
DR. NISAR RAO
Department of Pulmonology
Ojha Institute of Chest Diseases, Karachi
{E-mail: nisar.rao@aku.edu}
BACK GROUND: ‘Initial default’ is the terminology used to describe diagnosed
tuberculosis patients who default before initiation of anti-tuberculosis treatment.
OBJECTIVE: To assess the magnitude & reasons of initial default among smear
positive pulmonary tuberculosis patients diagnosed at Nazimabad Chest Clinic,
Ojha Institute of Chest Diseases, Karachi.
METHODS: Prospective study, conducted from 1st December 2007 to 30th April
2008. From the laboratory register we prepared the list of sputum smear positive
tuberculosis patients. Then the list was counterchecked with ‘District TB register’
and those who did not report for treatment initiation were labeled as ‘initial default’.
They were then contacted on phone number which was provided at the time of
registration. They were informed of the diagnosis and asked to get themselves
registered for the treatment. Patients, who registered at the clinic, were asked
about reasons for not reporting.
RESULTS: Out of 869 tuberculosis suspects, 224 were diagnosed as smear
positive pulmonary tuberculosis cases. Out of 224, one hundred sixty-two get
themselves registered for treatment. The remaining 62/224 (27.67%) was initial
defaulters. On telephonic contact, 55 (88.70%) were traceable while 07/62
(11.29%) was Untraceable-default. Twenty-four patients (38.70%) reported to
the clinic and they were registered for treatment. The most common reason for
default was ‘dissatisfaction with services at the clinic’.
CONCLUSION: The high initial default is a serious issue in the control of
tuberculosis and it needs to be addressed urgently.
TOBACCO CESSATION TREATMENT: KNOWLEDGE, ATTITUDE
AND PRACTICE OF PHYSICIAN IN KARACHI
DR FAROOQ OIGHUR MUHAMMAD IRFAN, HAQUE AS, M NAEEM, KHAN
JA.
Section of Pulmonary & Critical Care, Department of Medicine
Aga Khan University, Karachi
{E-mail: javaid.khan@aku.edu}
Intervention by physician increases tobacco cessation rates. Assessment of their
knowledge, attitudes and practices are fundamental in implementing effective
cessation strategies.
OBJECTIVE: To asses knowledge, attitude and practice of physician of Karachi
for tobacco cessation treatment
METHODS: A prospective cross-sectional questionnaire based study recruiting
practicing physicians from Karachi. A 19 item questionnaire, which included six
items each on attitudes and practice and seven on knowledge, was self-
administered.
RESULTS: One hundred and four physicians participated. 89 (85%) were men.
There was strong agreement amongst physicians regarding the perception of
tobacco use negatively impacting health outcomes 89 (88%) and their role in
discussing the issue with the patients 92 (88%). Physicians reported moderate
to low levels of comfort in discussing cessation 62 (59%), developing tobacco
cessation plan 3 8(36%) and recommending pharmacological treatment 30 (28%).
Self assessed knowledge of pharmacotherapy was judged by 56 (53%) to be
very good/ excellent. However, on objective knowledge assessment only 6 (6%)
physicians were able to correctly answer all items. With regards to practices, 79
(76%) reported that they identified tobacco use status in every patient; with most
73 (70%) advising the users “almost always/always” to quit.
CONCLUSION: Most physicians recognize the seriousness of the problem
associated with tobacco use and the need to address it. However, significant
gaps were identified in physician’s skills, objective knowledge and effective
methods in tobacco cessation treatment. There is a pressing need to enhance
physicians’ capacity to deal with tobacco related issues.
COMPARISON OF PLEUORSCOPY AND ABRAMS BIOPSY IN THE
DIAGNOSIS OF EXUDATIVE PLEURAL EFFUSION
RABIA AAMIR, NAUSHEEN AHMED, PROF NADEEM RIZVI
Department of Thoracic Medicine
Jinnah Postgraduate Medical Centre, Karachi
{E-mail: dr_aamir79@hotmail.com}
INTRODUCTION: Medical thoracoscopy/ Pleuroscopy is a minimally invasive
procedure that allows:
Access to the pleural space
For basic diagnostic procedure i.e. undiagnosed pleural effusion or pleural
thickening.
For therapeutic procedure i.e. pleurodesis.
MATERIAL AND METHODS: In this prospective cross sectional study, closed
pleural biopsy using Abrams needle immediately followed by pleuroscopy with
a flexible fiberoptic pleuro scope was performed from the same incision in a total
of 52 patients ,36 (62%)were male and 16 ( 31%) were female with age ranges
from 15-80years, mean age was 44 years. All tissue samples took for biopsies
were sent for histopathology.
RESULTS: All of the patients in this study underwent Abrams biopsy and
pleuroscopic biopsy as well; out of these 52 patients, Abram’s biopsy showed
TB in 13 patients, Adenocarcinoma in 15 patients, non specific inflammation in
8 patients, Empyma in 3 patients, lymphoma in1 patient, no pleura in 12
patients. While pleuroscopy of same group of patients showed TB 17 patients,
Adenocarcenoma in 21 patients, non specific inflammation in 8 patients, empyma
in 3 patients, lymphoma in 1 patient ,no pleura in 3 patients.
CONCLUSION: Pleuroscopy is a new and safer diagnostic tool with diagnostic
yield upto 93%. Therefore it should be used for diagnosis of undiagnosed cases
of pleural effusion.
A TYPICAL PATHOGENS IN ADULTS WITH COMMUNITY-
ACQUIRED PNEUMONIA IN PAKISTAN
DR. NADIA SHARIF ALI BIN SARWAR ZUBAIRI, AFIA ZAFAR, SHAHAN
WAHEED, SULEMAN HAQUE, JAVED HUSAIN, JAVAID KHAN
Section of Pulmonary & Critical Care, Department of Medicine,
Aga Khan University, Karachi
{E-mail: javaid.khan@aku.edu}
OBJECTIVE: The knowledge of microbial etiology of community-acquired
pneumonia (CAP) is limited from Pakistan. The objective of our study was to
determine the etiology of CAP and the prevalence of atypical pathogens in
patients presenting to the largest tertiary care center in Pakistan.
PATIENTS AND METHODS: A single center prospective study was conducted
at the Aga Khan University Hospital in all patients age 14 and above who
presented with CAP. Clinical data and specimens were collected for a period of
1 year (February 2007-March 2008). For pyogenic bacteria, specimens were
submitted for culture and sensitivity. The diagnosis of atypical pneumonia was
made using serologic methods to detect antibodies for Mycoplasma pneumoniae
and Chlamydia pneumoniae and urinary antigen for Legionella pneumophila
serogroup 1.
RESULTS: Among 124 recruited patients, 69 (55.6%) males and 55 (44.4%)
females mean age was 56 ± 20 years. Mycoplasma pneumoniae 21 (17%) was
the leading cause of illness, followed by Chlamydia pneumoniae 15 (12%).
There were no cases of Legionella pneumophila serogroup 1. Streptococcus
pneumoniae 9 (7.2%) was the most common cause of bacteremic pneumonia.
Haemophilus influenzae and Streptococcus pneumoniae were grown from sputum
of two patients 2 (1.6%each) and Klebsiella pneumoniae from one.
CONCLUSION: Atypical pathogens like Mycoplasma pneumoniae and Chlamydia
pneumoniae play a significant role in CAP in Pakistan.
TO ASSESS EFFECTIVENESS OF BIPAP IN COPD PATIENTS WITH
TYPE II RESPIRATORY FAILURE WITH DECREASED CONSCIOUS
LEVEL
DR. NOUREEN HANIF, PROF NADEEM RIZVI.
Department of Thoracic Medicine
Jinnah Postgraduate Medical Centre, Karachi
{E-mail: murtaza1999@yahoo.com}
BACKGROUND: Noninvasive positive pressure ventilation (NPPV) became a
routine method of treatment of acute exacerbation of COPD with type II respiratory
failure. Hypercapnic coma secondary to acute type II respiratory failure in COPD
is considered to be a contraindication to the use of treatment with Noninvasive
positive pressure ventilation (NPPV). However, intubation exposes these patients
to the risk of complications such as nosocomial pneumonia, sepsis and even
death.
MATERIAL AND METHODS: This is descriptive case series study. Data was
collected from Chronic obstructive Pulmonary Disease Patients of Type II
Respiratory failure with GCS =8 came to emergency and admitted in ICU of
chest ward JPMC,. Patients were given Bi-level positive airway pressure (BiPAP)
along with standard treatment of COPD. The patients were monitored in the ICU
and effectiveness was measured in terms of avoidance of endotracheal intubation,
consciousness (GCS 15) and normal respiratory rate (14-18 breath/ min).
RESULTS. Total of 30 patients included in the study with decreased conscious
level .Most of them responded well with the use of Noninvasive positive pressure
ventilation. Detail results shown in presentation.
CONCLUSION: We conclude that NPPV found to be safe and effective in patients
with hpercapnic coma in typeII respiratory failure secondary to COPD.
THE INFLUENCE OF AGE AND GENDER ON PROPER USE OF
METERED DOSE INHALER
DR. BABAR DILDAR MUHAMMAD NAEEM, AHMED SULEMAN HAQUE,
MUHAMMAD IRFAN, JAVAID A KHAN
Section of Pulmonary & Critical Care, Department of Medicine,
Aga Khan University, Karachi
{E-mail: javaid.khan@aku.edu}
BACKGROUND: Inhaled therapy remains the most effective and important
aspect of asthma maintenance treatment for patients of all ages. Therapeutic
benefit depends on a competent inhaler technique. Many older patients have
been shown to have poor inhaler technique. This might be a factor contributing
to the observation that death rates from asthma have not fallen in the older age
group. We conducted this study to assess influence of age & gender on proper
use of Metered Dose Inhaler.
SETTING: Chest clinic of Aga Khan University Hospital, a tertiary care teaching
hospital in Karachi, Pakistan.
OBJECTIVES: To assess the influence of age & gender on proper use of Metered
Dose Inhaler in patients with bronchial asthma.
METHODS: This was a cross sectional survey. 202 diagnosed asthma patients
using inhaler for =6 months were studied prospectively. Patients underwent a
questionnaire-based interview, medical records review & direct observation of
inhaler technique.
RESULTS: There were total 202 patients. 106 (52.5%) patients were female.
Mean age ± SD of all patients was 49.41 ± 17.9 years. Mean age ± SD of female
& male patients was 48.78 ± 17.8 & 50.10 ± 18.0 years respectively. 98 (48.5%)
patients were using inhaler with spacer device.
Out of all patients 130 (71.8%) patients self-perceived their inhaler technique as
being appropriate. Of 96 men, 18 (18.75%) were using a MDI+spacer & 10
(10.4%) without a spacer correctly. Among females 20 (18.8%) with MDI+spacer
and 12 (11.3%) without a spacer demonstrated correct inhalation technique.
Among the 98 patients who were using a spacer, the correct technique by age
groups was shown by 6 (42.8%) in the <30years, 19 (35.38%) in those between
31-60years & 12 (40%) in >60 years. Among patients using inhaler without spacer
the correct technique by age groups was shown by 5 (20%) in the <30, 13
(22.80%) in those between 31-60 years & 4 (18.18%) in >60 years.
CONCLUSION: Self perceived inhalation technique is inaccurate in a vast majority
our patients. On assessment only one fourth of the patients were found to be
acceptable. No significant influence of age and gender was found on correct
inhaler technique. Reassurance and checking on each visit can improve the
inhaler technique.
BLOOD PRESSURE, BODY MASS INDEX AND WAIST
CIRCUMFERENCE OF SCHOOL GOING CHILDREN OF KARACHI
ANJUM SHAHID, AFROZE RAMZAN*, MUHAMAD AYAZ MUSTUFA, SADIA
NASIM, ABDUL GHAFFAR PIRZADA, ASHFAQ MEMON
PMRC Specialized Research Centre on Child Health &
*National Institute of Child Health, Karachi
OBJECTIVE: To screen blood pressure, body mass index and waist circumference
of school going children in the city of Karachi.
METHODOLOGY: A descriptive cross sectional study was conducted on 500
children, comprising of 250 males and 250 females aged 8-14 years from schools
of Karachi during the years 2007-2009. Height, weight, waist circumference and
blood pressure of each child were recorded. Body mass index was calculated
as weight in kilograms divided by height in meters squared.
RESULTS: Hypertension i.e. SBP and DBP (=95th percentile) was found in 4.2
and 5.6 % children. With increasing BMI status there was an increase in both
systolic and diastolic blood pressure. Over weight (systolic: 107. ±9, diastolic
64.3 ±11.5) and obese (systolic: 108 ± 8.3, diastolic: 68 ±10.7) children had
higher blood pressure values than children with healthy weight (systolic: 98.94±9.4,
diastolic: 53.3±13.5). This association was present in overall and in males and
females. Means of SBP and DBP in obesity and overweight were significantly
(p< 0.001) higher than healthy weight. In the obese category, about 9% children
were hypertensive (SBP and DBP =95th percentile) and 6.6% (SBP) and12.2%
(DBP) were pre-hypertensive (>=90<95) while over weight was marked by
hypertension in 7.3% and pre-hypertension in 12.2%.Waist circumference = 90th
percentile was found in all obese children, followed by 87.8% in overweight.
CONCLUSIONS: Present findings are in accordance with the definition that 5%
of children in any given population would be classified as having high blood
pressure. The study recommends a need for measuring blood pressure in children
during health maintenance visits.
KEY WORDS: Pediatrics, Hypertension, Body mass index.
ANTHROPOMETRIC MEASUREMENTS OF NEWBORNS IN URBAN
KARACHI POPULATION
KASHIF ABBAS
Pediatric Department
Liaquat National Hospital, Karachi
OBJECTIVE: To find out the mean birth weight, mean birth length and mean
head-circumference and to find out association between income of the family
and mean birth weight.
METHODOLOGY: This study was done in the Pediatric Department of Liaquat
National Hospital from March 2003 to September 2003. Hundred full terms,
normal, singleton newborn babies were included and birth weight, length and
head circumference were taken within 72 hours of birth.
RESULTS: Overall mean birth weight was 2.890 kg, mean birth length 48.245cm
and mean head circumference 34.232 cm. The LBW babies were 13%. The
mean birth weight of babies belonging to group A (born to families with income
>5000 Rupees/month) was 3.044 Kg and that of group B (born to families with
income <5000 Rupees/month) was 2.736 Kg. Group A had 8% LBW babies
whereas group B had 18 %. Mean birth weight, length and head circumference
of boys was 2.961kg, 48.776 cm and 34.316cm respectively. Mean birth weight,
length and head circumference of girls was 2.788 Kg, 47.480 cm and 34.109 cm
respectively.
CONCLUSIONS: It is recommended that community based studies should be
conducted from time to time in order to develop our own population data.
KEY WORDS: Anthropometrics, Children, Urban areas.
PENILE TOURNIQUET SYNDROME
SYED MUHAMMAD RAEES TAQVI, MUHAMMAD SAJJAD ASHRAF, JAVED
AHMED, MUHAMMAD SHAHAB ATHAR, MUHAMMAD TALAT MEHMOOD.
Department of Pediatric Surgery
Dow University Of Health Sciences, Karachi
OBJECTIVE: To find out clinical presentation and outcome of penile tourniquet
syndrome.
METHODOLOGY: It was a descriptive study conducted at pediatric surgery
department of Civil Hospital and DUHS Karachi, from January 2005 to December
2009. Data of all the patients admitted with penile tourniquet injury were reviewed
with special reference to the encircling object, nature of the damage andÊ their
management.
RESULTS: A total number of fifteen cases of penile tourniquet injury were found.
Patient’s age ranged from 11 months to 10 years. In 10 cases parents did not
know how the encirclement occurred.Ê Four cases were iatrogenic, and in one
case thread was tied by the child himself. Out of 15 cases, hair was found as
an encircling object in 10, post circumcision bandage in three and one case each
of plastibell and kite thread. Mild penile injury (swollen, inflamed tissue) was
found in 6 cases, while 9 cases had urethral injury (urethrocutaneous fistula 6,
complete urethral transaction 2, and urethral stricture 1). Cases of mild penile
injury were managed by removing the encircling objects and local wound
management. Urethral repair was done in eight patients and one patient did not
turn up for surgery. One patient developed urethral stricture, who responded well
on regular dilatation
CONCLUSIONS: Penile tourniquet syndrome is an uncommon clinical entity that
needs high index of suspicion especially by hair in circumcised pediatric population.
Early diagnosis and prompt treatment can prevent severe penile injuries.
KEY WORDS: Penile tourniquet syndrome, Children, Penile injury.
SCOPE OF PERCUTANEOUS CATHETER INTERVENTIONS IN
CHILDREN WITH HEART DISEASES
NAJMA PATEL
Pediatric Cardiology
National Institute of Cardiovascular Diseases, Karachi
In this era of percutaneous interventions, question arises that how many of those
who are suffering from congenital or acquired cardiac lesions can be treated by
this modality. There is a long list lesions which can be treated by this modality.
This is the big group and about 50-60%of all the patients who require treatment
can be treated by percutaneous method. In NICVD during last five years many
of these interventions have been performed. Results of these will be discussed
briefly. Main limitations in performing these interventions are lack of financial
support and shortage of skilled personnel.
CYTOGENETICS LAB AT NATIONAL INSTITUTE OF CHILD HEALTH:
IT’S VALUE TO PATIENTS AND PHYSICIANS.
NIZAM UL HASAN
President of Child Aid Association
National Institute of Child Health, Karachi
Human cytogenetics has opened avenues for diagnosing and monitoring many
diseases which at times are difficult to diagnose on clinical grounds and other
laboratory tests available. Only four cytogenetics laboratories are functioning in
Pakistan one of these is at the NICH. Prior to the start of this laboratory only
those patients who could pay for test at private facility were the lucky ones. At
the NICH lab the facilities for oncology patients is free and other patients of NICH
get these tests done free or at affordable cost thus making it available to
underprivileged patients. Results of two years working of the cytogenetics lab
at NICH will be presented.
ANEMIA IN CHILDREN WITH CHRONIC KIDNEY DISEASE AT
NATIONAL INSTITUTE OF CHILD HEALTH, KARACHI
SADAF ASIM, KHEMCHAND N MOORANI, MICHAEL KHOKHAR
Department of Pediatric Nephrology
National Institute of Child Health, Karachi
OBJECTIVES: To determine the etiology of chronic kidney disease in children
and the frequency of anemia in children with CKD.
METHODOLOGY: It was descriptive observational study, carried out at Pediatric
Nephrology department of National Institute of Child Health. Karachi from January
to December 2009. All children of age range from 1mo -15 yrs, diagnosed as
CKD were included. Patients were diagnosed as CKD based on clinical assessment
and serum creatinine and categorized ÊÊaccording to severity into I-V stages
(KDOQI Guide Lines). Urinalysis, CBC, Ultrasound KUB, and other appropriate
tests were done to establish cause of CKD.Ê Patients were labeled as anemic
if hemoglobin was < 11 G/dl. Iron profile for exclusion of iron deficiency was done
with serum Iron, Ferritin, Total Iron Binding Capacity and Transferrin Saturation%.
RESULTS: A total of 76 patients with CKD were admitted in ward during study
period. Among them 52(68.4 %) were males and 24(31.5 %) were females with
M to F ratio of 2:1.The age group of study population ranged fromÊÊ one month
to 15 years (mean age 5.4 yrs) .Most commonÊÊ age group was as 1 – 5 years
(26/ 34.2 %) followed by children above 5 to 10 years (19/25 %) andÊÊ older
than 10 years (15/ 19.73%). Ê
Majority of patients were in CKD Stage-III (17/22.3%), IV (18/23.6%)Êand V
(19/25 %) suggesting late diagnosis andÊlate referral. Most common etiology
of CKDÊwasÊhypoplastic / dysplastic kidney disease (17/22.3 %), followed by
urinary calculi (16/21.05%), congenital obstructive uropathies (13/17.10 %), reflux
nephropathy (12/15.7%), juvenile nephronophthiasis (J NN 11/ 14.4%) andÊchronic
glomerulonephritis (7/S9.2%). Fifty six children (73%) were anemic and among
them 34 (60%) had complete iron workup done. Iron deficiency anemia was
found in 22 children (64.7%).
CONCLUSION: Most common cause of CKD in this study was hypoplastic
dysplastic kidney disease followed by urinary calculi and congenital obstructive
uropathies. Majority of children were anemic and iron deficiency was responsible
for causing anemia in most of children.
KEY WORDS: chronic kidney disease, etiology, anemia, children
AUDIT OF NEONATAL SURGERY
YAQOOT JAHAN, NASIR SALEEM SADDAL, YOUSUF AZIZ KHAN
Department of Paediatric Surgery, Unit A
National Institute of Child Health, Karachi
OBJECTIVE: To find out pattern of neonatal admission to surgical unit in order
to devise improvement strategies in terms of mortality and morbidity.
METHODOLOGY: Data of all the neonates admitted to single surgical unit at
NICH from January 2009 to December 2009 was analyzed..Ê
RESULTS: A total 177 neonates were admitted to surgical unit in one year period.
A total of 154 neonates underwent surgery. Twenty three patients died before
any surgical procedure being performed. Number of patients with anorectal
malformations were 54. Four patients expired before any surgical procedure.
Thirty eight patients went for colostomy and anoplasty was performed in 14
cases. Total number of neonates with oesophageal atresia with TEF was 28.
Four patients expired before any surgical procedure. Definitive surgical procedure
was performed in 24 patients of whom 12 died post operatively.
Total number of neonates with diagnosis of intestinal obstruction was 51. Five
expired before surgery. Intestinal obstruction due to gut atresia was fpund in 24.
Intestinal obstruction due to meconium ileus was present in nine. Obstruction
due to malrotation in one and annular pancreas in two cases. Neonates diagnosed
as Hirschsprung’s diease were 15. Neonates with anterior abdominal wall defects
were 20.
CONCLUSIONS: This audit revealed survival of 87% after surgery. It has an
important message that earlier recognition and referral of these anomalies,
availability of neonatal intensive care services can improve survival even further.
KEY WORDS: Neonates, Audit, Mortality.
DOES PROPHYLACTIC USE OF DEXAMETHASONE HAS A ROLE
IN REDUCING POST-EXTUBATION STRIDOR AND RE-INTUBATION
IN CHILDREN?
ALI FAISAL SALEEM, SURRIAYA BANO, ANWAR-UL-HAQ
Department of Pediatrics and Child health, The Aga Khan University Hospital,
Karachi
{E-mail: ali.saleem@aku.edu}
OBJECTIVE: To determine the role of dexamethasone (DEX) in postextubation
stridor (PS) frequency and reintubation rate in critically ill infants and children
METHODOLOGY: This study was conducted in a pediatric intensive care unit.
This was a retrospective case-control study. All children aged from 4 weeks to
<5 year who were intubated for at least 48 hours (n=51) during 6 months were
included. Data of the patients treated with DEX (0.5 ml/kg every 6 hours for 3
doses, beginning 6-12 hours prior to extubation) (n=30) were compared with
control patients (who had not received medication) (n=21).
RESULTS: The DEX and control groups were similar in age i.e., mean ages of
DEX group were 16.85±14 months, and that of control group were 19.02 ± 19
months. Mean duration of intubation and mechanical ventilation in DEX group
was 5.17 ± 4.58 days, and that in control group was 3.98 ± 3.60 days. There
was no significant difference between DEX and control group in the incidence
of postextubation stridor [17% (5/30) vs. 10% (2/21); p = 0.5, OR (0.5)] and the
reintubation rate [7% (2/30) vs. 10% (2/21); p = 0.7, OR (1.7)].
CONCLUSION: Prophylactic use of dexamethasone in planned extubation of
children was controversial and unwarranted.
KEY WORDS: Dexamethasone, Stridor, Re-intubation.
PAN-RESISTANT ACINETOBACTER INFECTION IN NEONATES IN
KARACHI, PAKISTAN
ALI FAISAL SALEEM, IMRAN AHMED, FATIMA MIR, REHAN ALI, ANITA
ZAIDI
Department of Pediatrics and Child health & Microbiology, Aga Khan University
Hospital, Karachi
{E-mail: ali.saleem@aku.edu}
OBJECTIVE: To find out frequency and mortality associated risk factors in
Acinetobacter neonatal infection.
METHODOLOGY: This was a chart review of five year period (July 2003 – June
2008) of all neonates hospitalized in our Neonatal Intensive Care Unit and
developed Acinetobacter infection.
RESULTS: A total of 122 cultures from 78 neonates grew Acinetobacter. Source
sites of positive culture were in the following descending order; blood (n=57),
trachea (n=55), tissue/wound/body fluids (n=4), urine (n=1), eye (n=4) and
Cerebrospinal fluid (n=1). Twenty four (31%) patients had Acinetobacter isolated
from more than one site. At the time of admission the mean age was 2.08 ± 4
days and mean weight 1.77 ± 0.88 Kg, while seventy five percent were premature.
Pan-resistance (87/122; sensitive only to Polymyxin) was present in 71% of
Acinetobacter isolates. Crude mortality rate of this cohort was 47%, while 70%
of patients died within 4 days after their positive Acinetobacter culture. We
identified weight <1 kg on admission (p 0.06, adjusted Odds Ratio (AOR) 3.4),
poor perfusion (p 0.006, AOR 2.4), thrombocytopenia (p 0.01; AOR 1.8) and
metabolic acidosis (p 0.01; AOR 1.75) as predictors associated with poor outcome.
CONCLUSIONS: Pan-resistant Acinetobacter infection is exceedingly fatal in
newborns, particularly in premature and very low-birth weight neonates.
Rationalized antibiotics use and vigilant infection control in intensive care areas
is the key to control multi-drug resistant Acinetobacter infection and improve
clinical outcome.
KEY WORDS: Acinetobacter infection, Neonates, Mortality.
SURVEILLANCE FOR POST OPERATIVE WOUND INFECTIONS IN
GENERAL SURGERY WARD OF A TERTIARY CARE HOSPITAL
OF KARACHI.
SAFIA BIBI, GHULAM ASGHAR CHANNA*, TARANUM RUBA SIDDIQUI,
WAQUARUDDIN AHMED
Pakistan Medical Research Council, Research Centre, Jinnah Postgraduate
Medical Centre, Karachi, *Jinnah Postgraduate Medical Centre, Karachi
AIMS: To determine the frequency of post operative wound infections in surgical
ward-2 of JPMC and to identify common bacterial pathogens and their sensitivity
patterns to commonly prescribed antibiotics.
SETTINGS: The study was conducted in the surgical ward of Jinnah Post
Graduate Medical Centre, Karachi.
METHODS: This was a cross sectional study of one year duration. Sampling
was carried out from December, 2008 – November,2009. During the sampling
period data was collected for all the patients who underwent surgery in the
surgical ward of JPMC. Culture and sensitivity testing was performed only for
patients who developed infection according to CDC definition. Data was collected
on pre-designed performa which included details about patient’s demographics,
type of surgery, prophylactic antibiotic, any co-morbids, wound infection and
results of culture and sensitivity testing. Association of Postoperative wound
infections (PWI) with different variables was also studied.
RESULTS: Total 1120 surgical procedures were performed in the selected ward
during the study period, of which 82 (7.3%) patients developed PWI. Age of
patient, electivity of procedure, wound class and diabetes were found to be main
contributing factors to PWI. Frequency of infection in clean, clean contaminated,
contaminated and dirty procedures was 1.5%, 2.5%, 6.5% and 21.4% respectively.
Pathogen could be isolated in 52(73.2%) patients. The most commonly isolated
pathogens were E.coli (33.8%), Ps. aeruginosa (16.9%) and S. aureus (15.5%).
All the E.coli isolates showed 100%, 93%, 32% and 12 % resistance to Ceftriaxone,
Ofloxacin, Amikacin and Meropenem respectively. Pseudomonas aeruginosa
isolates were 100% resistant to Tetracyclin and Ceftazidime, 91.6% to Ofloxacin,
83.3% to Meropenem and 66.7% to Amikacin. S. aureus exhibited maximum
resistance to Cloxacillin(100%) followed by Ofloxacin(90.9%), Tetracyclin(45.5%),
Amikacin (45.5%), Chloromphenicol (36.4%) and Vancomycin (0%).
CONCLUSION: Frequency of post operative wound infections in surgical ward
of JPMC is comparable to other hospitals of Pakistan but is higher as compared
to developed countries and NNIS standards. The situation is further worsened
by increasing frequency of multidrug resistant (MDR) organisms. Pathogens are
continuously acquiring resistance against older and currently used antibiotics
which results in problem to control PWI.
EXTENDING THE SCOPE OF CARDIOPULMONARY BYPASS
SYED SHAHABUDDIN, MUNEER AMANULLAH, SAULAT FATIMI, HASANAT
SHARIF
Cardiothoracic Surgery, Department of surgery
Aga Khan University Hospital
{E-mail: syed.shahab@aku.edu}
INTRODUCTION: Traditionally cardiopulmonary has been used for addressing
congenital, valvular and ischemic heart disease. However, owing to technical
advancement and increase safety of cardiopulmonary bypass, its uses are
stretched for non traditional cases.
METHOD: All patients undergoing non traditional cardiac surgery utilizing the
cardiopulmonary bypass during the year 2009 were reviewed. Their preoperative
presentation, operative strategy and immediate postoperative status were
assessed.
RESULTS: A total of five such cases were identified. There were, three female
and two male patients. Two patients presented with road traffic accident having
aortic transaction along with other injuries. They under went repair utilizing partial
cardiopulmonary bypass. One patient presented with large PDA aneurysm and
symptoms related to its pressure effect on respiratory system predominantly. He
underwent repair first under partial left heart bypass and then hypothermic
circulatory arrest. These three patients were done via left thoracotomy. Two
patients underwent deep hypothermic circulatory arrest, one for removal of
thrombus from right atrium after complicated liver abscess and hepatic vein
thrombosis and other required vascular graft interposition in left internal carotid
artery for aneurysm extending into cranium. The former was done with complete
sternotomy and later was done with partial sternotomy. One patient required
exploration for bleeding. Overall postoperative course was unremarkable and
all patients were discharged home.
CONCLUSION: Our modest experience highlights the extension of the scope
of cardiopulmonary bypass, facilitating to perform complex, technically challenging
non cardiac procedures with safety.
THE EFFECT OF RAMADAN FASTING ON DUODENAL ULCER
PERFORATION: A RETROSPECTIVE STUDY
DR SHIREEN RAMZANALI DAMANI**, DR SYED SAGHEER HUSSAIN
SHAH***, DR ZIA-UL-ISLAM****, DR MASOOD RAZA*****
**Trainee MRCS-3 RCSED & Trainee RMO, ****Associate Professor & Head of
Department
****Assistant Professor, *****Senior Registrar
Surgical Unit-III (Ward 26) Jinnah Postgraduate Medical Centre, Karachi
{E-mail: dr_shireenramzanali@yahoo.co.uk
INTRODUCTION: Ramadan is the month of barakat for the Muslims all around
the world. Ramadan is the 9th lunar month of the Muslim calendar which is
obligatory for all healthy Muslims to fast during the day time.
OBJECTIVE: The aim of the study is to evaluate the relation between the
Ramadan fasting and to assess the risk factors for the peptic ulcer disease in
fasting Muslims.
DESIGN & SETTINGS: This Retrospective analytical study includes all the
patients who underwent surgery (laparotomy) especially in Ramadan for duodenal
ulcer perforation in the Accident & Emergency department on the day of call of
Surgical Unit III, Ward 26, JPMC, Karachi from 2004 to 2009.
METHOD & MATERIAL: Demographic, concomitant diseases & the predisposing
factors were analyzed. The comparison were made between the two groups,
Group 1 includes those who were operated in the month of Ramadan within 5-
years period (i.e. 5-month during the study period) and on the remaining period
(55 month during the study period ) were included in Group 2 .
RESULT: Two hundred and sixty patients were included in the study (60 in group
1 and 200 in group 2). The number of surgeries was higher in group1 than group
2 (12 patients per month in group 1 vs 3.6 patients per month in group 2).
CONCLUSION: To recapitulate the incidence of duodenal ulcer perforation is
relatively higher in Ramadan among the people who are fasting & has higher
predisposing factors especially the history of dyspepsia.
EVOLVING APPROACH TO NEOPLASIA OF THE ESOPHAGUS:
OVER A DECADE OF EXPERIENCE
*DR. K.M. INAM PAL, DR. FARRUKH HASAN RIZVI, DR. HASSAN BARI
*Associate Professor & Head Section of General Surgery
Department of Surgery, Aga Khan University Hospital
{Email: inam.pal@aku.edu}
The section of GS has been dealing with neoplastic disease of the esophagus
since its inception and over the years has acquired substantial expertise in its
treatment. We have reviewed our experience of past 13 years and changes in
our approach to its treatment.
A total of 128 patients were surgically. The mean age of patients was 52 years
(range 18-80yrs); 70 males and 58 females. Hundred and thirteen patients
underwent a two stage Esophagectomy (Ivor-lewis-tanner) and 15 patients had
a 3 stage Esophagectomy; for 92 tumors located in the lower 1/3, thirty two
tumors in the middle 1/3 and three tumors in the upper 1/3 of the esophagus.
There were 94 Squamous neoplasms, 32 adeno-carcinomas and 2 large cell
neoplasms. Twenty three patients were given neoadjuvant treatment. Elementary
track reconstruction was with a gastric tube in all patients. A total of 10 anastomotic
leaks were suspected in the post operative period on radiological or clinical
grounds. One leak delayed discharge due to sepsis needing prolonged antibiotic
treatment and jejunal feeding. Two were significant contributors to patient death.
The most common post operative complications were pulmonary and in some
form were seen in 30 (23%) patients. Three patients (2%) died due to post
operative complications in the 30 day post-operative period.
Over the years we have moved away from 3stage esophagectomy and extra-
anatomic placement of the conduit. We now perform a 2 field lymph node
clearance and prefer a single layer continuous suture technique for anastomosis.
Our approach to neoadjuvant treatment continues to evolve; this now is offered
as a combined modality treatment for locally advanced disease.
Conclusion: Surgery plays a central role in treatment of esophageal neoplasms.
It is a complex undertaking with a significant incidence of post operative
complications. We have acquired significant experience with this procedure over
the past decade, our peri-operative results are at par with well established high
volume international centers.
KEY WORDS: Esophagectomy, Esophageal neoplasm, Anastomotic leak,
OUTCOME OF RECONSTRUCTIVE PROCEDURES IN FOURNIER`S
GANGRENE AT LIAQUAT UNIVERSITY HOSPITAL JAMSHORO
*BILAL FAZAL SHAIKH, PROF. ABDUL RAZAK MEMON, **DR. MAHESH
KUMAR
*Department of Plastic Surgery and **Department of Plastic & Reconstructive
Surgery
Liaquat University Hospital, Jamshoro
{E-mail: bilalfazal@live.com}
OBJECTIVE: To determine the outcome of the reconstructive procedures utilized
for the genital area wound following Fournier’s gangrene and their complications
in our setup.
DESIGN & DURATION: Prospective observational study conducted from January
2005 to December 2008.
SETTING: Dept. of Surgery and Dept. of Plastic & Reconstructive Surgery at
Liaquat University Hospital, Jamshoro.
PATIENTS: A total of 18 patients with Fournier’s gangrene were included in this
study.
METHODOLOGY: Data was collected through a pre-designed proforma. Initially
all the patients were managed in the surgical ward and later on they were shifted
to the Plastic Surgery & Reconstructive ward for reconstruction of wound.
RESULTS: Split thickness skin graft (SSG) was carried out in 12 cases (66.66%),
followed by primary closure in six (33.33%) and medial thigh flaps in two (11.11%)
cases. Partial skin loss was seen in six (33.33%) and complete loss in one
(5.55%) patient. Diabetes mellitus was the commonest co-morbidity found with
Fournier’s gangrene.
CONCLUSION: Skin grafting is an easy option with acceptable aesthetic and
functional results. Primary closure of the scrotal wound by stretching and expanding
is ideal when up to 1/3rd of the residual scrotal skin is available.
MANAGEMENT OF SCALP DEFECTS
DR. MAHESH KUMAR
Assistant Professor
Department of Plastic & Reconstructive Surgery
LUMHS Jamshoro/ Hyderabad
BACKGROUND: Large scalp defects can be challenging to repair because of
the inelasticity of the scalp. While there are several methods to close this type
of wound, they result in either alopecia or unacceptable scarring.Ê
AIM: To assess the outcome of treatment options available for reconstruction
of scalp.
PATIENTS AND METHODS: A Prospective case series conducted at Department
of Plastic & Reconstructive Surgery, Liaquat University of Medical & Health
Science, Jamshoro from January 2003 to December 2007.
40 cases of scalp reconstruction operated from January 2003 to December 2007
were analyzed. The functional aspects of the reconstruction were reviewed
RESULTS: 3 cases (7.5%) of scalp defect were repaired with primary closure;
rotation flap was done in 25 cases (625%). S.S.G was done in 9 cases (22.5%),
outer table were removed in 2 (5%) cases, and periosteal flap was done in 1
case (2.5%).
CONCLUSION: Scalp reconstruction depends on the nature and the region of
the defect; a range of reconstruction techniques have been described. The quality
of the residual scalp is critical for performing a local flap. Scalp reconstruction
may be difficult in extensive defects and require a medical team when tumours
are involved.
TWO-PORT LAPAROSCOPIC CHOLECYSTECTOMY: AN EARLY
EXPERIENCE
1S H WAQAR & 2M A ZAHID
1Assistant Professor / 2Professor of Surgery
Minimal Access Surgery Unit (MASU), Department of General Surgery
Pakistan Institute of Medical Sciences, Islamabad
{Email: drshwaqar@gmail.com}
Laparoscopic cholecystectomy is the procedure of choice in all the gall bladder
diseases and there is increase in the expertise of surgeons with newer equipment.
Usually the laparoscopic cholecystectomy is performed by using three or four
ports. Two ports laparoscopic cholecystectomy is a rarely performed procedure
as it demands greater expertise and skills. Benefits of this technique include
being less expensive and less scar forming as compared to the conventional
approaches of laparoscopic cholecystectomy. We present a series of eight cases
of laparoscopic cholecystectomy performed by using only two ports.
KEYWORDS: Laparoscopic cholecystectomy, Gall bladder.
INTRACAVITARY DRAINAGE OF GIANT EMPHYSEMATOUS
BULLAE IN PATIENTS WITH POOR PULMONARY RESERVE
TANVEER AHMAD, S. WAQAR AHMED & NIAZ HUSSAIN
Department of Thoracic Surgery
Jinnah Postgraduate Medical Center, Karachi
INTRODUCTION: Patients with large emphysematous bullae with poor respiratory
reserve present a therapeutic challenge. Thoracotomy for definitive treatment
is not without a high risk of mortality. Monaldi introduced a two stage procedure
to obliterate the pleural space, drain and collapse these bullae. Later, modifications
like the Brompton procedure were introduced for the management of these cases.
PURPOSE OF THE STUDY: To evaluate the short and long term results of
intracavitary drainage of giant emphysematous bullae in patients with poor
respiratory reserve.
PATIENTS AND METHODS: All patients had preoperative chest X rays and
computed tomography to asses the size of the bulla, pneumothorax if present
and laterality. All procedures were done under local anesthesia except one which
was done under general anesthesia. Patients’ dyspnea was categorized in grades
0 to V (Hugh-Jones Criteria). A large size Foley’s catheter was used in all cases
to drain the bulla. Foley’s catheter was connected to underwater seal. In addition,
a size 36 chest drain was used to drain the pleural space when a Brompton
procedure was performed. Talc solution was used in 5 patients to obliterate the
bulla and achieve pleural symphysis.
RESULTS: Twelve patients (8 males and 4 females) underwent a total of thirteen
procedures (4 Monaldi procedures and 9 Brompton procedures) over a twelve
month period from July 2007 to June 2008. The mean age was 46.4 years (29-
67 years). Mean size of the bullae was 6.4 cm (5-15cm). The mean preoperative
FEV1 and FVC were 0.81l (0.69-1.2l) and 1.9 l (1.0-2.8), respectively.
Most bullae were located in the upper lobes (RUL=5, LUL=4, RLL=2 and LLL=2).
Symptoms improved (Dyspnea grade V to grade II) with a 40% to 90% improvement
in FEV1 and FVC, 2 weeks after the procedure with sustained recovery over the
next many months. Chest X rays also showed marked reduction in the size of
the bullae and in five (41.7%) cases complete disappearance of the bullae.
Drainage continued for a mean of 31 days (25-45 days) before the catheter was
removed. Since the improvement in symptoms, three patients have undergone
elective thoracotomy with bullectomy. Complications were blocked catheters in
3 patients and subcutaneous emphysema was seen in 2 patients with severe
COPD. Three patients (25%) were diagnosed as having tuberculosis and were
started on ATT. Recurrance of bullae was seen in 2 patients. There was no
mortality in this series. Average duration of surgery was 25 minutes. Follow up
of more than 6 months is available for 7 patients.
CONCLUSION: It is concluded that intracavitary drainage of giant bullae is a
simple, safe, quick and effective treatment of emphysematous bullae in patients
considered unfit for a thoracotomy.
INCIDENCE OF CHRONIC POST-OPERATIVE PAIN IN PATIENTS
OPERATED FOR INGUINAL HERNIA AND ITS IMPACT ON QUALITY
OF LIFE
*DR. SIJAD AHMED & **DR. SUGHRA PARVEEN
*Resident / **Assistant Professor
Surgical Unit-III
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: Chronic post-operative pain has emerged as a major post-
operative problem after hernia surgery2,4,5,7,8,9,10,15. Incidence of chronic
post-operative pain not only causes the discomfort but in severe cases it may
limit the abilities to fulfill activities of daily life and professional
performance1,2,3,10,17. Pain thus may result in negative social consequences
for the patient and family.
PATIENTS AND METHODS:
PATIENTS: This is a prospective analytical study that was carried out in follow
up clinic of surgical unit (III) ward 26, JPMC Karachi. From 15-06-2009 to 14-
12-2009. All the patients visiting follow up clinic after being operated for inguinal
hernia including obstructed and strangulated inguinal hernia were included.
METHODS: A questionnaire was formulated that covered all the aspects of study
and it was provided to the resident on duty in the follow-up clinic of surgical unit
(III) ward 26, JPMC, who was trained to fill in the questionnaire after interviewing
the post-operative patients of inguinal hernia, that are meeting inclusion criteria.
RESULTS: Out of 45 (n=45) patients 34 (75.6%) reported no or ignorable pain
after 3 months of surgery and 11 (24.4%) patients reported the pain that was not
ignorable. In 3 (6.7%) patients pain was severe enough to interfere with the
routine activities.
CONCLUSION: The results of this study emphasize the need of careful steps
to control pain among patients undergoing hernia surgery. Establishment of
potential risk factors and prevention of post-operative pain in patients undergoing
surgery for inguinal hernia are important potential fields of improvement and
research.
EARLY LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE vs
CHRONIC CHOLECYSTITIS: A PROSPECTIVE COMPARATIVE
STUDY
DR SHIREEN RAMZANALI DAMANI1, DR SAGHEER HUSSAIN SHAH2
1Trainee MRCS-3 RCSED & Trainee RMO, 2Associate Professor & Head of
Department
Surgical Unit III, (Ward 26), Jinnah Postgraduate Medical Centre, Karachi
{E-mail: dr_shireenramzanali@yahoo.co.uk}
INTRODUCTION: Laparoscopic cholecystectomy has now become a gold
standard treatment for patient with chronic cholcystectomy. Laparoscopy has a
lower morbidity; cost & hospital stay as compared to the open procedure.
Furthermore its believed that the laparoscopic cholecystectomy for the acute
cholecystitis is associated with the technical difficulties, higher conversion rate
and complications.
OBJECTIVE: The aim of this study was to assess the outcome and feasibility
of laparoscopic cholecystectomy in patient with acute cholecystitis (early
cholecystectomies) as compared to those with chronic cholecystitis (late
cholecystectomies).
DESIGN & SETTING: This Prospective comparative study was carried out at
Ward-26 (surgical unit III ) JPMC from June 2008 to Nov 2009. A total of 125
patients with acute cholecystitis & chronic cholecystitis were treated in this
duration.
Inclusion Criteria: All the patients with ASA score 1 & 2 were included in the
study.
Exclusion Criteria:* Patients with symptoms > 72 hrs prior to the admission (n=9)
, * Patient presenting with jauindice (n=7) and * Patient with incidential findings
of acute cholecystitis on elective laparoscopic cholecystectomies (n=4) and *
absolute contraindication to surgery i.e ASA score 3 & 4 (n=3) were excluded
from the study.
METHODOLOGY: Some 102 fulfilled the criteria & were included in the study,
among them 78 were women (76.5%) & 24 were men (23.5%). The age ranges
from 19 – 69 years, mean age was 38.4 yrs. These patients were recruited and
were divided into 2 groups.
Group 1 patients have acute cholecystitis and underwent laparoscopic
cholecystectomy (n=19)
Group 2 patients are those with chronic cholecystitis & underwent laparoscopic
cholecystectomy (n=83)
RESULT: The average time for laparoscopic cholecystectomy for acute cholcystitis
was 100 min as compared to the chronic cholecystitis which on an average took
45 min . There were only 2 conversions into open procedure from group 2 . No
major postoperative complications encountered in either groups. The average
hospital stay group 1 was 2.4 days while it was 1.8 days in group 2.
CONCLUSION: Both early laparoscopic cholecystectomy (for acute cholecystitis)
& late cholecystectomy (for chronic cholecystitis) performed by the experienced
surgeon are safe & effective and should be performed as soon as the diagnosis
is established preferably within 48-78 hours of the onset of the symptoms.
PAIRED ABDOMINAL FLAP: A RELIABLE HAND SANDWICH FOR
DEGLOVING HAND INJURIES
SYED KAMRAN AHMED, SADAF SAEED, MUHAMMAD AMIN CHINOY,
MANSOOR ALI KHAN
Department of Orthopaedic, Reconstructive and Hand Surgery
Jinnah Medical College Hospital & Department of Orthopaedic
The Indus Hospital Karachi, Karachi
INTRODUCTION: Despite the sophistication in microsurgical techniques, wound
coverage for an entirely degloved hand remains a substantial challenge. The
paired lower abdominal flap described by Miura and Nakamura provides
simultaneous and adequate coverage for the dorsal and volar surfaces of an
entirely degloved hand. It has been largely under utilized despite its extreme
usefulness.
OBJECTIVES: To justify the usefulness of paired abdominal flap in circumferential
degloving injuries of the hand.
STUDY DESIGN: Case series with review of literature.
PLACE AND DURATION OF STUDY: Department of Orthopaedic Reconstructive
and Hand Surgery, Jinnah Medical College Hospital and Department of
Orthopaedics, The Indus Hospital Karachi, from November 2004 to August 2009.
METHODS: Five patients with circumferential degloving hand injuries requiring
coverage with a paired lower abdominal flap were included. Three patients
underwent paired flap while two refused flap coverage and opted for coverage
with full thickness skin graft. The surgical technique is diagrammatically represented.
Overall hand function was evaluated through Quick DASH questionnaire.
RESULTS: Outcome assessment revealed satisfactory cosmetic and functional
recovery with paired abdominal flap.
CONCLUSIONS: We recommend this flap for mutilating hand injuries. It can be
easily learnt by a well trained orthopaedic or plastic surgeon for salvage of hand
in centres with limited microsurgery facilities.
KEY WORDS: Hand sandwich; Paired abdominal flap
OUT COME OF PNL AT JPMC, 05 YEARS EXPERIENCE
DR NARESH KUMAR
Department of Urology
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVES: To determine the efficacy and frequency of postoperative
complications of Percutaneous Nephro-Lithotomy (PNL) in clearance of
symptomatic renal stones
METHODS: A descriptive study conducted in the Department of Urology at jinah
postgraduate medical center.
The study included 175 patients (105 males, 70 females, aged 15-60 years)
Treated with PNL in our department between 2005-2009. The mean (range)
Stone diameter was 2.5 (1.5-3.5)cm.
RESULTS: Four weeks after treatment the total stone-free rate was 91.2%;
60.8% of all patients were primarily stone-free, 10,4% had clinically insignificant
residual stones that passed spontaneously within 4 weeks after PNL, and 29,8%
of the patients needed auxiliary measures (a second PNL, ESWL,
Ureterorenoscopy). Overall, the early complication rate was 26.4%, the most
common complications being transient fever (54.5), clinically Significant bleeding
(8, 0%) or both (3.2%); 3.5% of the paritnets developed urinary tract infections
(with no signs of urosepsis), 3.2% had Renal colic and 3.2% upper urinary tract
obstruction.01 patient needs Nephrectomy due to bleeding, 10 patients required
transfusions and there were no injuries to neighboring organs.
CONCLUSIONS: These results show that PNL causes no significant blood loss
or major complications in almost all patients. Using PNL in an experienced
center may especially reduce the potential complications: PNL is a highly efficient
procedure that provides fast and safe stone removal.
KEYWORDS: Percutaneous Nephro-Lithotomy (PCNL), Renal tract stones,
Complications.
SUPERFICIAL BLADDER TUMOR - RECURRENCE AND
PROGRESSION
DR MUHAMMAD MANSOOR
Department of Urology
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: To analyze the recurrence as well as progression of superficial
bladder tumors.
MATERIAL & METHOD: Retrospective analysis of superficial bladder tumor
patients presented at JPMC, between January 2005-December 2009. Total 125
patients were selected
All patients underwent TURBT followed by active surveillance. Risk factors were
analyzed. Recurrence and progression of the disease was noted during surveillance
which were dealt in accordingly.
RESULTS: Would be presented in scientific symposium session.
LAPAROSCOPIC PYELOPLASTY: STENTING TECHNIQUE
DR. KHURRAM SIDDIQUI
Section of urology, The Aga Khan University Hospital
Reconstructive laparoscopic procedures are challenging for even the most
experienced laparoscopic surgeons. Laparoscopic pyeloplasty is considered as
gold standard because of the lesser pain, early discharge and quicker return to
work. The incision size is minimal and when compared with open pyeloplasty
the difference is probably the most appreciated in this procedure.
The most daunting task after anastomosis is the insertion of stent. Pre operative
stenting collapses the system and make dissection difficult and post operative
stenting may be dangerous for the suture line. Intra operative stenting is the
most preferred way. How ever it has its own challenges.
We present a case of a young male who presented to us with left sided PUJO.
We performed left laparoscopic pyeloplasty. The operating time was 420 min
and the estimated blood loss for less than 100 cc. the patient was discharged
on the second post op day.
We present a short video of our technique and share the technical challenges
in the procedure.
URETHRAL STRICTURE DISEASE; A REVIEW OF 100 CASES
MANZOOR HUSSAIN, REHMATULLAH SOOMRO, ALTAF HASHMI, ZAFAR
HUSSAIN, ANWAR NAQVI, ADIBUL HASAN RIZVI
Sindh Institute of Urology and Transplantation Karachi
A prospective study on 100 cases of urethral stricture seen at Sindh Institute Of
Urology and Transplantation Karachi, revealed majority of them (41) to be in the
third to fifth decade of life. They belong mostly (78) to the Urban areas and the
commonest site was the bulbar part (43) followed by membranous urethra in 36
cases. Sixty two patients presented with retention of urine, 28 with stream
problem, and 10 with recurrent UTI. Road traffic accidents (42) and falls (21)
were the most common causes of stricture development. Fifty nine cases were
treated with urethral dilatation, 20 by Optical Urethrotomy, and 21 by Urethroplasty.
We recommended urethrotomy for simple and short strictures, urethroplasty for
complex stricture, and dilatation for superficial, post TURP, and sphincteric
strictures or elderly, unfit patients.
GRADING COMPLICATION FOLLOWING RADICAL CYSTECTOMY
AND ILEAL CONDUIT FOR BLADDER CANCER USING CLAVIEN
GRADING SYSTEM
SYED JOHAR RAZA, M H ATHER, F A KHAN, Z A KHAN
Resident Urology
Aga Khan University Hospital, Karachi
INTRODUCTION: It is now becoming imperative in surgery to report the
complications of any surgical procedure using a standard method, and modified
Clavien Grading system is one such method. Radical cystectomy and urinary
diversion is a major uroncological procedure, associated with various complications.
This study determined the 30 day complications of this procedure using a validated
system.
MATERIALS & METHODS: Patients who had undergone Ileal conduit formation,
following Radical Cystectomy for muscle invasive Transitional Cell Carcinoma,
were studied, using a prospectively maintained data base. Basic details were
determined, and complications noted. These complications were graded according
to the Modified Clavien Grading system (CG).
RESULTS: Of all the IC, performed at this hospital, complete data was available
from 73 patients who were analyzed. Of these 73 patients 65 were male and 8
were female. The mean age was 60 (range 32-88). The mean duration of hospital
stay was 14 days (S.D 6.1 days) (8-38 days being the range). Ten patients
received pre-operative chemotherapy and radiotherapy, respectively. The mean
duration of surgery was 8.4 hrs (S.D 1.5 hrs, range 5-12hrs), with mean estimated
blood loss of 1386 ml (SD 670ml).
Preoperative radiotherapy was associated with more complications (p=.035). No
other factor like ASA, co morbidities, blood loss or duration of stay influenced
the complications (p>0.05). Forty three (59%) patients did not have any acute
complications. Most common complication were of CG- 2, with 7 pts having
wound infection, followed by Uretero-ileal leakage (n 5 each), for which
percutaneous intervention under local anaesthesia was needed GC-3a. Mortality
rate was 2.7%, classified as CG-V.
CONCLUSION: Radical Cystectomy with Ileal Conduit is a major procedure with
a good safety profile at this institute. Long term follow up is still needed to look
into delayed complications and quality of life.
PREOPERATIVE STANDARD INFORMED CONSENT PRACTICE
AT A TEACHING, PRIVATE, TERTIARY CARE HOSPITAL SITUATED
IN A RURAL AREA
DR. REHMATULLAH SOOMRO
Department of Urology & General/Laparoscopic Surgery
Muhammad Medical College Hospital, Mirpurkhas
INTRODUCTION: To evaluate the standard preoperative informed consent
practice in a tertiary care private sector teaching hospital.
DESIGN: Prospective observational study.
DURATION: January 2007 to December 2007
PATIENTS AND METHODS: All patients who underwent elective surgical
procedures in Surgical Unit, Muhammad Medical College hospital, Mirpurkhas
from January 2007 to December 2007 were included in this study. A total of 1032
patients underwent elective surgical procedures during the study period. All of
these patients who had undergone elective surgery were interviewed randomly
during the study period under routine practice conditions. All the patients were
asked a set of standard questions post operatively related to the information they
were provided before the procedure as a part of standard informed consent
practice. Questionnaire included the patient’s knowledge about pathology,
operative risks, type of anesthesia given with its risks, alternate treatment option,
results of no treatment, patient’s satisfaction about the information given and
whether consent form was signed.
RESULTS: A total of 200 randomly chosen patients (121 males and 79 females)
were included in the study. In 16 (8%) of patients the surgeons were involved
in taking consent themselves. Only 90 (45%) of patients were told about the
nature and purpose of procedure and 89 (44.5%) of patients knew about the
possible complications of surgery. 143 (71.5%) of patients were told about the
type of anesthesia required but only 30 (15%) were informed about the risks of
anesthesia. 40 (20%) of patients were allowed questions to be asked while taking
consent. Interestingly, most of the patients 156 (78%) were still satisfied by the
information provided to them during informed consent.
CONCLUSION: This study highlights the poor quality of patient knowledge about
surgical procedures and the scarce information provided. The current standard
informed consent practice which is being practiced by the doctors in public/private
sector teaching hospital of Pakistan and the other world is below standard to
international and ethical acceptability. Yet, a large number of patients were
satisfied by the information provided during the informed consent process.
MALIGNANT PHYLLODES: IS RADIOTHERAPY MANDATORY?
DR ALIYA ISHAQ, DR SHADAB KHAN, DR RUFINA SOOMRO.
Department of General Surgery,
Liaquat National Hospital, Karachi
OBJECTIVE: To find out the impact and out come of radiotherapy in the treatment
of malignant phyllodes in terms of local and systemic recurrence.
METHODS: All patients who came to breast clinic of LNH from 1996 to 2009
and diagnosed as phylloides are reviewed retrospectively .Patient’s age,
histopathology, previous history of Fibroadenoma or benign phyllodes, surgical
treatment, radiotherapy, and rate of recurrence was reviewed to see the impact
of adjutant radiotherapy on rate of local recurrence.
RESULTS: Total 260 patients with diagnosis of phyllodes were included in study.
59 were found to have malignant phyllodes.35 patients were recommended to
take radiotherapy out of which 7 patients did not take radiotherapy and 28 took
radiotherapy. When recurrence rates were compared in both groups it was found
that those who did not take radiotherapy had a recurrence rate of 100% and
those who took had a recurrence rate of 32%.
CONCLUSION: For malignant phyllodes radiotherapy should be recommended
as adjuvant therapy if indicated.
MODIFIED RADICAL MASTECTOMY WITH AXILLARY CLEARANCE
USING HARMONIC SCALPEL
DR SHIREEN RAMZANALI DAMANI1, DR SUGHRA PARVEEN2,
DR SAGHEER HUSSAIN SHAH3
1Trainee MRCS-3 RCSED & Trainee RMO, 2Assistant Professor,
3Associate Professor & Head of Department
Surgical Unit III, (Ward 26), Jinnah Postgraduate Medical Centre, Karachi
{E-mail: dr_shireenramzanali@yahoo.co.uk}
INTRODUCTION: The surgical treatment of the breast cancer has shifted
dramatically from radical operation to the breast conserving surgical technique.
The most common complications of the conventional modified radical mastectomy
with axillary dissection, electrocautery (diathermy) & the suture ligation are
seroma, lymph oedema with the incidence of 11% to 85% and 2% to 50%
respectively
OBJECTIVE: This study was conducted to evaluate the feasibility, safety &
efficacy of modified radical mastectomy with axillary dissection using the harmonic
scalpel in terms of operative time, lymph vessel sealing, hemostasis and post
operative complications.
DESIGN & SETTING (METHODOLOGY): This prospective observational study
was conducted in ward – 26 (Surgical unit III) JPMC, from Dec 2008 to Dec
2009. A total of 40 patients underwent Modified Radical Mastectomy and Axillary
Clearance during this period.
INCLUSION CRITERIA: patients with unilateral , locally advanced breast cancer
(T2 AND T3) and ASA (American society of anaesthesia) score 1 and 2 were
included in the study.
EXCLUSION CRITERIA: patients with early breast cancers (T1) , previous breast
surgery, neo-adjuvant therapy , patient with diabeties and other co-morbids were
excluded from the study group.
RESULT: During one year 40 patients were operated by the same team of
surgeon and the lymph vessels sealing and hemostasis were achieved using
the harmonic scalpel in all the cases. No clips neither sutures nor diathermy
(electrocautery) was used.
Among 40 patients, 9 (22%) patients had positive axillary nodes: - 6 patients
(15%) had 1-2 positive lymph nodes and 3 patients (7%) had four or more nodes
positive.
The mean intra-operative blood loss was 45 ml and the mean operative time
was 100 minutes. No postoperative bleeding, haematoma, seroma, lymph oedema
or other complications occurred.
The mean drainage volume was 20 ml and 155 ml respectively and mean
drainage duration was 1.3 and 2.7 days respectively. The mean hospital stay
was 3.7 days .
CONCLUSION: The Modified Radical Mastectomy & axillary dissection using
the harmonic scalpel was safe, feasible, and effective. This device simplifies the
surgical procedure, reduces the operative time, peri-operative blood loss, drainage
volume and duration of drainage. Furthermore the incidence of seroma and
lymph oedema was also reduced.
CONGENITAL SKIN DISORDERS: A BRIEF OVERVIEW OF THE
MOLECULAR GENETIC POTENTIAL
ABID AZHAR1 AND AZAM SAMDANI2
1 Dr. A. Q. Khan Institute of Biotechnology & Genetic Engineering (KIBGE),
University of Karachi
2 Department of Dermatology, Jinnah Postgraduate Medical Centre (JPMC),
Karachi
Skin disease has been recently cited as one of the top 15 groups of medical
conditions for which prevalence and health care spending has increased manifold
recently. In spite of the growing incidences, the data profile on skin disease is
scarce and incomplete. The condition is even worst in developing countries like
Pakistan.
Skin bacterial/viral/fungal infections and hair/nail disorders; are highly prevalent
throughout the world. There are more than 3,000 identified varieties of skin
disease that can cause symptoms ranging from simple burning and itching, to
severe emotional and social effects, to physical disfigurement or even to death
where no specific data is yet available.
Genetic skin diseases comprise almost 300 rare but often severe/life-threatening
diseases and syndromes. Despite recent identification of causative genes in a
number of these disorders, the molecular basis of several others are still unknown,
and often the function of the identified disease-gene products has been hitherto
unsolved. Molecular genetics can provide answers to many unanswered
health/disease questions. This relatively young discipline allows research on;
i) improved early post-natal and pre-natal diagnosis by novel
immunohistochemical/biochemical and molecular tests, ii) identification of new
genes involved in genetic skin diseases, iii) definition of genotype-phenotype
correlation and characterization of newly identified gene product functions by
creation of a sample databank, and iv) stable non viral genetic correction of
heritable skin disorders. A brief overview of the avenues of this research and its
potential therapeutic applications shall be discussed in this presentation.
KEYWORDS: Skin disorders, Skin infections, Molecular genetics, Congenital
skin disorders
FREQUENCY OF DIFFERENT SPECIES OF CLINICALLY
DIAGNOSED TINEA CAPITIS IN CHILDREN REPORTING IN A
TERTIARY CARE HOSPITAL OF KARACHI
DR. MARIA FAROOQI, DR REHANUDDIN, DR. DILAWAR RIZVI &
DR. SIKANDAR AZAM MAHAR
Institute of Skin Diseases, Karachi
INTRODUCTION: Tinea capitis is an infection caused by dermatophyte fungi.
There are three recognized patterns:
1. Endothrix: The hair shaft is filled with fungal branches (hyphae) and spores
(arthroconidia) termed Black dot. It results from T.tonsurans, T. violaceum and
T.soudanense.
2. Ectothrix: The hyphae/spores cover the outside of hair. M.canis, M.Audouinii,
M.distortum, M gypseum, and T.verrucosum cause it.
3. Favus: It is a yellowish cup-shaped crust scutula caused by T. schoenleinii..
OBJECTIVE: To determine the frequency of different species of clinically
diagnosed Tinea Capitis in children in a tertiary care hospital.
STUDY DESIGN: Case series
SETTING: Department of Dermatology.
DURATION OF STUDY: Six months
MATERIAL AND METHOD: Hundred children up to 14 years of age, with tinea
capitis confirmed by skin scrapings using 10% potassium hydroxide were included
in the study. These were cultured on Sabouraud’s agar at 26-28°C for 4 weeks.
RESULTS: Hundred patients completed the study. Siblings of 42% of the patients
had dermatophyte infection. The most prevalent species isolated were found to
be T.soudanense in 12% of the patients, T.tonsurans in 11%, T.schoenlinii in 4%
and T.mentagrophytes 1%. 13% patients had pets at home
CONCLUSION: Anthropophilic species such T. soudanense, T. tonsurans, T.
shoenlinii and T.mentagrophytes were predominantly affected the population
belonging to low/ middle socioeconomic class.
AGE AND SEX DISTRIBUTION AND EFFECT OF VARIOUS
FACTORS ON THE COURSE OF ACNE IN PATIENTS ATTENDING
OPD AT JPMC
DR AZAM JAH SAMDANI & DR. AHSON GHIAS
Department of Dermatology
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: Acne is a common dermatologic condition that affects many
individuals in life. Although classically thought of as a disease of teenagers, it
can affect at any age. This study was designed to observe the distribution pattern
and various factors affecting the course of disease in our population.
MATERIAL & METHODS: This study included a retrospective questionnaire (45
questions), 10 regarding awareness, 15 for dietary factors, 20 for stress. Patients
with acne 14-40 yrs either sex and of different ethnic backgrounds were included.
RESULTS: This study involved 300 cases. 208 females and 92 males. 267 were
single and 33 married. There age distribution was 10-14yrs (44), 15-20 yrs (197),
21-25 yrs (40), 19 were above 30. Lesions were mostly chronic 118 of 1-5 years,
81 above 5 years, 52 (17.3%) 6 – 12 months. Interestingly 71% were not aware
that their disease was acne. Diet had significant worsening affect. Oily/spicy
affected 100 whereas combination foods affected 84, surprisingly 8 were affected
by sweets. Emotional stress was the commonest cause affecting 142 cases,
combination of both physical/emotional stress 67 and only 4 patients had physical
stress, 44% had premenstrual and 7% had both menstrual/post menstrual
worsening.
CONCLUSION: Oily & spicy food, emotional stress and menstrual cycle had a
worsening effect on acne and need to be considered in its management.
DERMATOSIS WITH KELOID/SCARS DUE TO DEET (N,N-DIETHYL-
META-TOLUAMIDE)
DR AZAM JAH SAMDANI, DR BAHRAM KHAN & DR QAISERA MASROOR
Department of Dermatology
Jinnah Postgraduate Medical Centre, Karachi
This 70 years old fair skin male presented with lesions starting as pruritic papules
on his back/hips/lower limbs/axilla which gradually become larger and ulcerated
within short period of time. Some of the lesions have healed with keloid formation.
He is a known case of diabetes/hypertension and has history of prostatic
hypertrophy. There are no known drug allergies or history of direct exposure to
chemicals in relation to his work. On examination, he had multiple well demarcated
lesions consisting of eczematous patches, juicy plaques with violaceous hue
some of them being ulcerated and some healed lesions with scar/keloid formation.
His CBC, LFT’s, urea, cretinine and urine analysis were normal. Serology for
ANA, dsDNA, Rh factor, cANCA & pANCA were unremarkable. Histopathology
from a lesion on buttock revealed hyperkeratosis/hypergranulosis, lymphocytic
perivascular infiltrate, and a few eosinophils in epidermis and near basal layer,
suggestive of non specific dermatitis. Immunofluorescence study was negative.
Special stains/tissue culture was negative. His clinical picture and histopathology
are suggestive of contact dermatosis with keloid/scar formation due to 29%
DEET being used by him in the insect repellant (MOSPEL) for the last 01 year
daily. There are reports in literature although rare regarding such local effects
from use of insect repellants containing this active ingredient in causcacians. It
is suggested that such material should be used minimally with extreme care and
not for prolonged use to prevent such complications specially in fair skin individuals
in our region.
TWO SISTERS WITH AN INTERESTING PRESENTATION OF LIPOID
PROTEINOSIS
DR AZAM J SAMDANI & DR. SOBIA LIAQAT
Department of Dermatology
Jinnah Postgraduate Medical Centre, Karachi
Lipoid Proteinosis is a rare autosomal recessive metabolic disorder of unknown
pathogenesis, characterized by deposition of an eosinophilic hyaline like material
in extra tissue cellular spaces involving blood vessels; skin, mucous membrane,
larynx, trachea, and internal organs.
We present two sisters Zara 15 yrs and Sidra aged 9 yrs with skin infections and
hoarsness of voice since childhood. Their hoarseness/ low pitch voice was so
severe that it is difficult to hear them. On examination they had eczema, with
multiple infections and scars involving face, chest and back. Both sisters had
characteristic features of Lipoid Proteinosis such as fissured lips, multiple beaded
papules along the eyelids, slight macroglossia with a hard woody tongue having
a homogeneous look. According to the mother, her husband died at the age of
35yrs with similar skin problem and hoarseness. Their only brother is normal.
Routine investigations (Blood CP, SUCE & LFT) along with Abdomen USG and
CT scan were normal however buccal mucosa biopsy with P/S stain was highly
suggestive of this condition.
In short lipoid proteinosis usually presents with a fairly constant, well- defined,
clinical, histological and radiological spectrum. This disease is compatible with
normal life span, having a stable and slowly progressive course. No curative
treatment is available to date. It is important that parents should be counseled
about the risks of having affected off- springs.
ASSESS EFFICACY OF COMBINATION OF TOPICAL 2% MINOXIDIL
LOTION AND ISOTRETINOIN 0.05% GEL IN TREATMENT OF
ALOPECIA AREATA
DR SANA AMIN, IJAZ AHMED*, ZARNAZ WAHID**, SARWAT NASREEN*
* Department of Dermatology, Ziauddin Medical University, Karachi.
** Department of Dermatology, Dow Medical College and Civil Hospital, Karachi.
BACKGROUND: Alopecia areata is a common cause of nonscarring hair loss.
The cause is unknown but it is associated with an alteration in the immunological
system. Treatment for alopecia areata includes topical corticosteroids, dithranol,
tretinoin, minoxidil, systemic cortisone, PUVA therapy, irritants and
immunosuppressive drugs.
OBJECTIVE: Our objective was to assess the efficacy of combination of topical
2% minoxidil lotion and isotretinoin (0.05%) gel in the treatment of alopecia
areata.
PATIENTS AND METHODS: From 1st October 2003 till 30th September 2004,
over a period of 1 year, clinically diagnosed, fresh cases of alopecia areata,
fulfilling the inclusion criteria were enrolled. All the patients were advised to apply
minoxidil (2%) solution in the daytime and isotretinoin (0.05%) gel in the night
to avoid photosensitivity. The daily treatment was advised for a period of four
months and thereafter every alternate day for another two months as a maintenance
therapy. Clinical assessment was carried out by patient’s self-assessment,
investigator assessment and clinical evaluation on follow up visits.
RESULTS: The total number of patients studied was 54 comprising 31 males
(57.4%) and 23 females (42.6%), male to female ratio being 1.3. Twenty-nine
patients (53.7%) had three lesions, 18 (33.3%) had two lesions and seven (13%)
only one lesion. Complete restoration of hair follicles was noted in 45 (83.3%,
p<0.001) by the end of therapy. All the patients with single patch responded
(100%), while 15 patients (83.3%) with 2 lesions recovered completely. Twenty-
three patients (79.3%) with 3 lesions had a complete restoration of hair follicles.
CONCLUSION: The combination therapy of minoxidil (2%) solution and isotretinoin
(0.05%) gel for alopecia areata is cost effective, stimulating hair regrowth within
a shorter interval and is well-tolerated.
KEY WORDS: Alopecia areata, minoxidil, isotretinoin, hair follicles.
FREQUENCY AND PATTERN OF NAIL CHANGES IN PATIENTS
WITH PSORIASIS VULGARIS
DR JUNAID RABBANI, *DR. IJAZ AHMED, **DR. SARWAT NASREEN
*Associate Professor, **Assistant Professor
Department of Dermatology
Ziauddin University Hospital, KDLB Campus, Karachi
AIMS AND OBJECTIVES: To determine frequency and pattern of nail changes
in patients with psoriasis vulgaris and to correlate them with severity of the
disease.
SETTING: Outpatient department of Dermatology, Ziauddin University Hospital,
KDLB Campus, Karachi.
DESIGN: Cross sectional study.
DURATION: Calendar year 2008.
MATERIAL AND METHODS: Clinically diagnosed cases of psoriasis vulgaris
fulfilling the selection criteria were enrolled after a written consent. All the patients
were subjected to a detailed history and clinical examination including systemic
and dermatological examination. Nail changes were also observed on examination.
Severity of the dermatological disease was graded as mild, moderate and severe.
Skin biopsy was performed in addition to other routine or relevant investigations
wherever required. All the findings were recorded, compiled and tabulated.
Statistical analysis was carried out using the micro software SPSS 13.
RESULTS: One hundred two patients fulfilling the selection criteria comprising
55 males (54%) and 47 females (46%), with minimum age of presentation 16
years and maximum 66 completed the study. Age range was 45 years, mean
age of presentation being 40.9 years (Standard Deviation: 12.7). Joint involvement
in the form of joint pain or restricted movements was observed in 55 patients
(54%). Nails were involved in 59 patients (58%) comprising 32 males (54%) and
27 females (46%). Of the 55 patients with joint involvement 39 (71%) had their
nails affected. Forty nine (83%) of the patients with nail psoriasis (59) had been
suffering from psoriasis for more then 5 years while remaining 10 (17%) for less
then 5 years. Among the 59 patients, 27 (46%) had their finger nails involved,
19 (32%) toe nail psoriasis while 13 patients (22%) had both sites involved. Of
the 59 patients with nails involved 5 (8.5%) had mild psoriasis, 38 (64.5%)
moderate skin disease and remaining 16 (27%) severe psoriasis vulgaris. The
most frequent nail finding was roughening seen in 55 patients (93%) followed
by transverse ridging and pitting, color change, thickening, dystrophy, subungual
hyperkeratosis, onycholysis and leukonychia.
CONCLUSION: Nail changes are a frequent feature of psoriasis vulgaris, ridging,
pitting and roughening being the most common. Nail dystrophy, color change,
onycholysis, leukonychia and subungual hyperkeratosis are the other associated
findings.
KEY WORDS: Psoriatic arthritis, nail psoriasis, subungual hyperkeratosis,
onycholysis, oil drop sign
A CASE OF NON HIV KAPOSI SARCOMA OF SKIN AND GASTRIC
MUCOSA
1 DR. SAADIA TABASSUM & 2 DR. ABDUL MANNAN
1 Assist Professor/Consultant, Department of Dermatology
2 Head of Department of Medicine
Liaquat National Hospital & Medical College, Karachi
Kaposi Sarcoma (KS) is an uncommon condition. We present a case of 62-year-
old male, Afghan patient presented to medical outpatient’s unit with multiple
subcutaneous nodules. The patient had no known comorbids. The sites of
involvement were the face mainly eyelids, forehead, retro-auricular region, left
hand, both legs and feet. The patient had lymphedema of both legs. There was
generalized ichthyiosis. Oral mucosa was spared. The patient had no visceromegaly
at the time of presentation.
A biopsy specimen from the left hand and gastric mucosa revealed Kaposi
Sarcoma with dermal lymphatic involvement. His serum was negative for the
common types of viral infections including Human Immunodeficiency Virus (HIV)
on routine serology.
In the north west of Pakistan and Aghanistan, Human Immunedeficiency Virus
(HIV) Infections are rare. We mostly come across non-HIV related Kaposi
sarcoma.
RETICULATED MULTIFOCAL FIXED DRUG ERUPTION DUE TO
MEFENAMIC ACID: A NEW MORPHOLOGICAL PATTERN
DR.SADIA MASOOD
Consultant Dermatologist
Aga Khan University Hospital, Karachi
Fixed drug eruption characteristically recurs in the same site each time the drug
is administered. It is a heterogeneous pattern of cutaneous reaction to certain
drugs. Different morphological patterns of fixed drug eruption can occur and
described in various studies. The main presentation of fixed drug eruption was
circular, hyperpigmented lesions. Less common presentations included non
pigmented erythema, bullous lesions. urticarisa like dermatitis and sometime
generalized hypermelanosis. We described a new morphology of fixed drug
eruption showing a reticulated pattern as a result of ingestion of Mefenamic acid
and discuss the possible mechanism underlying such an appearance. Our case
deserves to be mentioned because reticulated pattern is unusual and has not
been previously reported.
KEY WORDS: Fixed drug eruption, reticulated, mefenamic acid
FAMCICLOVIR EVALUATION PROGRAM
DR ZAFAR ALAM & DR SUNDUS
Department of Dermatology
Hamdard University Hospital, Karachi
STUDY PERIOD: January 2009 –ÊJune 2009
OBJECTIVE: To evaluate the role of Famciclovir in the management of its efficacy
& tolerability. Famiciclovir is an antiviral drug which is active against the Herpes
viruses, including herpes simplex 1 & 2 (cold sores & genital herpes) and varicella-
zoster (shingles & chickenpox).
Other drugs in the same class include acyclovir (Zovirax) and valacyclovir
(Valtrex). Famciclovir is active against the same viruses as acyclovir but has a
longer duration of action. Therefore, it can be taken less time each day.
Famciclovir relieves pain, burning, itching, tingling, heals and prevents sores
associated with herpes infections. Famciclovir was approved for use by FDA in
June 1994.
25 patients were on study and follow up with including and excluding criteria.
CONCLUSION: famciclover is a good choice of treatment for herpes infections
and is so with convenient dosage.
FREQUENCY OF SCABIES IN RURAL (DESERT) AREAS IS STILL
THE PRIMARY HEALTH CARE CHALLENGE
DR: JEWAT SUNDER, DR: SATTI JEWAT FIAZ AHMED JATOI, HAZOOR
BUX LAGHARI
Peoples Primary Health Care Initiatives, Sindh
{E-mail: dr_jewat@yahoo.com}
AIM & OBJECT: Our aim to promote health activities, health education
(Awareness) in the community and schools, and the object is to strength the
basic health facilities, with provision of free of cost medicine availability.
METHODOLOGY: Descriptive study of 3 month analysis on SPSS version 11.
RESULTS: There are many health problems (infectious diseases) for working
at grass root level regarding health especially primary health care, the skin
disease (scabies) is one of them. Analysis of three month data the results were:
Out of the total three month OPD (152754) the scabies were (20895) 13.67%
Under one year (12668) the scabies were (1311) 10.34%
Under one –four year (13383) the scabies were (4076) 30.45%
Under 5-over years (106703) the scabies were (15508) 14.53%
CONCLUSION: Though the health problems (infectious diseases) are more
challenging problem especially in rural (desert) areas scabies is also one of
them, for the scabies. The role of benzoyl benzoit along with chlorpheramine
was seen beneficial in above given data.
KEY WORDS: Rural (desert) areas, frequency of scabies disease, Primary health
care
REASONS FOR UNSCHEDULED ABSENTEEISM OF REGISTERED
NURSES
1 MUSARAT FATIMA & 2 RUKHSANA PARVEEN
1 Assistant Professor, National School of Nursing, LUMHS, Jamshoro
2 Staff Nurse, Bolan Medical College, Quetta
PURPOSE: To identify the factors that lead to unscheduled absenteeism in
registered nurses.
RESEARCH DESIGN: Descriptive exploratory research design
METHODOLOGY:
SETTING: Study was conducted at one of the leading Federal government
hospital at Karachi.
POPULATION AND SAMPLE SIZE: Thirty registered nurses including male and
females were randomly selected from various units of the hospital. All the selected
participants were full time employee of morning shift.
DATA COLLECTION TOOL: A survey questionnaire was comprised of 20 close
ended questions.
ETHICAL CONSIDERATION: A verbal consent was obtained from nursing
superintendent and the study participants of above mentioned hospital.
DATA ANALYSIS: Descriptive analysis was done in which frequencies and
percentages were calculated.
FINDINGS / RESULTS: Participants have different point of view for the reasons
of absenteeism against various problems, 86.67% participants responded that
conveyance problem; 80 % pregnancy related issues; 73,33% due to child
rearing; 80% because of unexpected events at home and 90% due to sickness
of family members.
MAIN OUTCOME MEASURE: A high rate of absenteeism of employee decreases
the productivity in any organization. The increase of absenteeism rate among
nurses affects the standard of nursing care services. There may be a number
of strategies which can be found to be successful in reducing absenteeism of
registered nurses.
CONCLUSION: It has been identified that the selective factors reflect the higher
rate of absenteeism in nursing profession that impacts on health care. By
identifying these factors the absenteeism rate could be reduced.
KEY WORDS: Absenteeism. Nurses
IMPORTANCE OF CONTINUING NURSING EDUCATION
HUSAN BANO CHANNAR
MScN Part-II Student
College of Nursing
Jinnah Postgraduate Medical Centre, Karachi
The nursing profession believes that learning needs to be a continuous process
throughout the lifespan. Learning is individual and diversified for each person.
Individual nurses are responsible for their own learning and should participate
in the identification of their own learning needs to meet these identified needs.
Providers of Continuing Nursing Education must have a commitment to involve
learners in the learning process from the initial stages of planning through the
evaluation of organized learning experiences. Continuing Nursing Education
should be provided in a well-planned, organized educational environment.
Continuing Nursing Education should serve as a viable means of improving the
professional competence of the practitioner with the outcome of improved health
care. The purpose of this study was to explore the importance of continuous
nursing education for enhancement of nursing profession and to assess the
awareness of continuous nursing education, in tem to raising the quality of
individual as nurse. The importance of Continuing Education for nurses has been
increasingly emphasized in the nursing literature since the beginning of the
profession. Learning opportunities are provided through classroom attendance,
one-to-one mentoring, self-study experiences and the application of other adult
education concepts. The National Nursing leadership, Nursing Administrators
and Nursing Educators are in agreement that there is a potential knowledge gap
between nursing education and nursing practice (Joyce-Nagata, Reeb, & Burch,
1989). Descriptive study design student was used and nurses of post RN BScN,
class of 2006 were included in sample population. Data was collected through
a survey questionnaire consisted of questions related to demographic profile of
the participants. Participants’ written consent was obtained to maintain the ethical
value of the study. Majority of the participants were female and it is a known fact
the nursing by profession is considered as female profession. Majority of the
participants responded that they agree that continues education is important.
After study group are able to conclude that the nurses have strongly agreed that
continuous education is a fundamental, long life process and knowledge obtained
through this process facilitates to provide quality care to their patients.
IMPLICATIONS OF FACULTY MEMBERS BECOMING STUDENTS
IN THE SAME INSTITUTION
DR. RAISA B. GUL, MS. SALIMA MOEZ, MS. RUBINA BAROLIA
Aga Khan University School of Nursing, Karachi
BACKGROUND: Approximately 30 % of the Master’s of Science in Nursing
(MScN) students at ABC School have been the faculty members before their
enrollment into the program. Transition of roles may lead to feeling of dislocation,
threat to identity or lost academic confidence. Nursing literature is replete with
research about the transition of nursing students to staff role. Limited work is
found about the transition of nurses from a staff nurse to a student role, but no
studies are found about the transition from a teacher to student role.
PURPOSE: The purpose of this study was to identify and describe the experiences
of students in the MScN program who undergo through a role transition from a
faculty to a student status in the same institution and how such experiences
affect their learning.
METHODS: In line with qualitative approach, purposive sampling method was
used to enroll 10 informants, MScN students and faculty members, in this study.
Following the inclusion and exclusion criteria, data was collected through semi-
structured interviews. With the individuals’ written consent, interviews were tape-
recorded and transcribed verbatim. Data was analyzed manually for themes and
categories.
Findings indicate multiple advantages and disadvantages for faculty members
becoming graduates students at their own institution. Familiarity with institutional
culture, people, and policies seems to ease the burden of adjustment in their
new role but also limit their freedom as students. They perceive to live in a dual
identity of student and faculty which has consequences for themselves, their
peers, and those who teach them.
CONCLUSION: Appropriate structures and thoughtful processes should be in
place to curtail the negative effects of faculty going for higher education in the
same institution.
PRACTICES OF PATIENTS’ TEACHING FOR DISCHARGE AFTER
A DAY SURGERY
DR. RAISA B. GUL* AND MS. NUZHAT SULTANA**
*Aga Khan University School of Nursing, Karachi
** Shifa International Hospital, Islamabad
BACKGROUND: The concept of day surgery has been introduced to bring
efficiency; however, the success of day surgery is strongly associated with
patients’ preparedness for self-care at home. This paper presents findings of a
study that aimed to explore the process and content of patients’ discharge
teaching for self-care at home after receiving their discharge teaching on a
surgical day care unit (SDCU).
METHODS: Following an exploratory descriptive approach, 60 patients, who
had undergone a day surgery at a private tertiary care institution, comprised the
study. Using a structured checklist and a questionnaire, data was collected
through participant observations and patients’ interviews respectively. Both
descriptive statistics and manual analysis were performed to interpret the data.
RESULTS: The findings revealed that none of the patients received complete
information on all the required aspects of teaching to prepare them for self-care
at home. Doctors and nurses both were involved in discharge teaching, but it
was fragmented and uncoordinated. In most of the cases, verbal information
was provided to the patients and or their family members at the unit reception
counter. Although 58% of the patients expressed satisfaction with the instructions
for self care at home, 95 % of all patients had questions/concerns about various
aspect of care including their pain management; take home medications, and
wound care.
CONCLUSION: The findings indicate that patients discharge teaching for self-
care after a day surgery has much room for improvement. Therefore, it calls for
an urgent attention of hospital management to improve the discharge teaching
process in the SDCU.
PERCEPTIONS OF NURSES ABOUT THE DIPLOMA IN TEACHING
AND ADMINISTRATION NURSING PROGRAMME KARACHI,
PAKISTAN
DURR-E-SHAHWAR PASHA
Nursing Instructor
College of Nursing
Jinnah Postgraduate Medical Centre, Karachi
{Email durreshahwarpasha@yahoo.com}
INTRODUCTION: Educated and well qualified nurses are the backbone of a
health system. Well-qualified nurses with higher education are a valuable resource,
as they are competent professionals and are essential in providing a high standard
of care to the public.
Literature highlights the need and importance of competent teachers for improving
nursing education and service in the country. In Pakistan, the nursing teachers
working in the schools of nursing in the government sector are graduates of the
Diploma in Ward Administration (DWA) and Teaching and Administration (DTA)
programs.
The previous evaluation studies on the general nursing programme indicated
dissatisfaction with the competencies of the nursing teachers, who were DTA
graduates. One of the reasons attributed to lack of competence in teachers was
ineffectiveness of the DTA programme.
METHODOLOGY: This study explored the nurses’ perception about the DTA
programme offered in a college of nursing in the province of Sindh. An exploratory
descriptive qualitative approach was adopted to answer research questions.
Using a semi-structured interview guide, nine study participants were interviewed.
The data analysis process involved several steps, and analysis was done
manually. Data was coded to form nine categories, which were further merged
to form four themes of course content, course implementation, utilization of
knowledge, skills and attitudes gained, and participants’ recommendations.
RESULT: Findings of the study indicated that participants generally perceived
their DTA programme as ineffective, and provided recommendations for revision
of the DTA curriculum to include courses at an advanced level, provision of
modern learning resources and enhancement of the academic environment.
They also provided suggestions for policy makers regarding utilization of the
graduates of the DTA programme in the country.
CONCLUSION: The recommendations for further research include obtaining
data from several stakeholders such as students, graduates, faculty, patients
(clients) and employers in Pakistan, to explore the DTA programme in depth.
The findings, recommendations and conclusion of the study will, therefore, be
beneficial for the preparation of future nurse.
WOMAN’S PERCEPTIONS OF NURSING SUPPORT DURING CHILD
BIRTH
MS. NASREEN GHANI, MS.SHAHEEN GHANI
Post Graduate College of Nursing
Peshawar
BACKGROUND: is a sentinel event and positive experience of woman’s life.
How the woman responds psychologically to this event to some extent depends
on the types of support she receives. The quality of support provided, influences
the woman’s satisfaction with the birth process
PURPOSE: The purpose of the study was to investigate women’s perception of
care and support during childbirth and how these experiences related to nursing
support affect their child birth process.
METHODS: In line with descriptive approach purposive sampling method was
used to enrolled 30 participants, primi and multi gravid. In this study, following
the inclusion and exclusion criteria, data was collected through semi-structured
interviews with individuals’ verbal consent, interviews were tape-recorded and
transcribed verbatim. Data was analyzed manually for themes and categories.
FINDINGS: indicate that Both primi and multi para have different expectations
during labor most of the women’s were praising there nurses who support them
during their child birth process ,while the major concern was found about
insufficient nursing care and changing of nurses during labor
CONCLUSION: No matter what the birth country or setting, the supportive
professional care giver at childbirth will help women to face with the stresses
and pain. Further qualitative studies with large samples are needed to improve
our perceptive of the individually supportive role of the professional care giver
during child birth.
DEVELOPMENT OF NURSING EDUCATION IN PAKISTAN
FOUZIA NAZ
College of Nursing
Jinnah Postgraduate Medical Centre, Karachi
The modern nursing profession in the world is relentless effectors of Florence
Nightingale's, who marked the beginning of modern nursing era for helping the
suffering humanity without distinction. Like other professions . There are mainly
five fields of study launching within the Nursing Graduate Program. Such as
Health of Population, Wellness and Healing Across the Lifespan, Health Services
and Policy, Nursing Leadership and Practice and Nursing Education. Today there
are about 57,646(2007) nurses in Pakistan as compared to 350 nurses at the
time of independence in 1947. Today
We have 162 school of Nursing, 98 school of Midwifery, C.M.W 79 .P.M 10 .L.H.V
30 and 02(F.GOV) college of Nursing in Pakistan, total nursing school in
panjab72,sindh59,.N.W.F.P19,Blochistan12, from where nursing gradates are
qualified and providing nursing services to the masses of Pakistan. We know
that nurses are the backbone of the medical profession which includes the
doctors, nurses and paramedical staff. But unfortunately the nursing institutions
are very much discriminated for many domains from the medical colleges. This
discrimination is result in many issues and problems which the nursing students
and nursing institution faulty faces in educating the nurses, this include the nurses
dependence on hospitals administration, No separate budget, Shortage of Faculty,
No establishment staff, No role in educational planning and Management, Students
are utilized for services, limited library services and Limited teaching learning
resources. The nurses are also confronting many Issues/problems which are
hindrance in the delivery of nursing services to the clients, these include,
Inadequate infrastructure, teaching and learning facilities, limited availability of
teaching/learning material and text books, shortage of nursing teachers and
subject specialist teachers, Inadequate standards of education, Language barrier,
Shortage of clinical instructor, Inadequate institutional policy,teacher students
ratio 1:23(PNC).teacher student 2:25 for diploma program ,1:1for post basic
level(subject) Students are used as workers,. The nursing education is also
facing many problems in admission in higher nursing education such as, B.Sc.N,
M.Sc.N and Ph. D Nursing, as there are few higher nursing education institutions
in private and public sector to accommodate the nursing professional to enhance
their profession.. Nursing faculty positions have upgraded to BS-20. B.S.C
Nursing programs have been initiated in public sector. Increase in sanctioned
number of budget position of student nurses. Up-gradation of chargeÊnursesÊBS-
14-16, HeadÊNurses BS-16-17. Establishment of nursing cells in all health
sciences universities. Scholarships for faculty development of degree and diploma
program.
PERCEPTIONS OF NURSES ABOUT THE DIPLOMA IN TEACHING
AND ADMINISTRATION NURSING PROGRAMME KARACHI,
PAKISTAN
DURR-E-SHAHWAR PASHA
Nursing Instructor
College of Nursing
Jinnah Postgraduate Medical Centre, Karachi
{Email durreshahwarpasha@yahoo.com}
INTRODUCTION: Educated and well qualified nurses are the backbone of a
health system. Well-qualified nurses with higher education are a valuable resource,
as they are competent professionals and are essential in providing a high standard
of care to the public.
Literature highlights the need and importance of competent teachers for improving
nursing education and service in the country. In Pakistan, the nursing teachers
working in the schools of nursing in the government sector are graduates of the
Diploma in Ward Administration (DWA) and Teaching and Administration (DTA)
programs.
The previous evaluation studies on the general nursing programme indicated
dissatisfaction with the competencies of the nursing teachers, who were DTA
graduates. One of the reasons attributed to lack of competence in teachers was
ineffectiveness of the DTA programme.
METHODOLOGY: This study explored the nurses’ perception about the DTA
programme offered in a college of nursing in the province of Sindh. An exploratory
descriptive qualitative approach was adopted to answer research questions.
Using a semi-structured interview guide, nine study participants were interviewed.
The data analysis process involved several steps, and analysis was done
manually. Data was coded to form nine categories, which were further merged
to form four themes of course content, course implementation, utilization of
knowledge, skills and attitudes gained, and participants’ recommendations.
RESULT: Findings of the study indicated that participants generally perceived
their DTA programme as ineffective, and provided recommendations for revision
of the DTA curriculum to include courses at an advanced level, provision of
modern learning resources and enhancement of the academic environment.
They also provided suggestions for policy makers regarding utilization of the
graduates of the DTA programme in the country.
CONCLUSION: The recommendations for further research include obtaining
data from several stakeholders such as students, graduates, faculty, patients
(clients) and employers in Pakistan, to explore the DTA programme in depth.
The findings, recommendations and conclusion of the study will, therefore, be
beneficial for the preparation of future nurse.
SWINE FLU: INFORMATION IS THE BEST PREVENTION
(The daily “DAWN” Thursday, December 31, 2009)
HIDAYATULLAH
College of Nursing
Jinnah Postgraduate Medical Centre, Karachi
Swine flu is a disease of respiratory system caused by a new influenza virus (H1
N1) spreading from person to person. in 1918 when human and pigs became
sick at the same time (disease related human influenza).in 1930 H1N1 was
discovered in pigs.1976 United state outbreak: united state army was died and
cause declared H1N1.
In 1988 Zoonosis killed women and infect one eight month pregnant women
after visiting Hog.1998 outbreak in the united state.2009 pandemic outbreak in
Humans:
ANALYSIS: Swine flu contain genetic material from Swine + avian + Human.
Mostly young adult older children, pregnant women and morbid obesity are at
high risk. General measure for prevention and protection cleanliness and avoiding
contaminated source Howe ever treatment is drugs are available in the form of
Tamiflu, Relenza (syrup, tablets and inhaler). For prior protection WHO provide
vaccine on priority basses.
RESULT: 208 countries were affected. WHO Director declared a “public Health
emergency of international concern”.) In 2009 out break10, 000 deaths occurs
world wide.
In Pakistan first case was detected on 10th august 2009 and till now it is 52.
Government trying to overcome problem through public awareness, health
education, constructing of isolation wards in hospitals, insuring of availability of
drugs and health personnel at different health centers and hospitals. The
government also develops an information system to speedy overcome this
hazardous problem.
SEVERITY OF MENOPAUSAL SYMPTOMS AND THE QUALITY OF
LIFE AT DIFFERENT STATUS OF MENOPAUSE: A COMMUNITY
BASED SURVEY FROM RURAL SINDH.
1 NUSRAT NISAR, 2 NISAR AHMED SOHOO
1 Department of Obstetrics & Gynecology,
Liaquat University of Medical and Health Sciences Jamshoro
2 District Coordinator National Programm for Family planning & Primary Health
Care,
Matiary Sindh Pakistan.
{Email: nushopk2001@hotmail.com}
INTRODUCTION: Menopause is the time in women’s life when her ovaries stops
producing Estrogen and Progesterone, the deficiency of these hormones elicit
various somatic, psychological, vasomotor and sexual symptoms that affect the
overall quality of life of women. Assessment of quality of life during menopause
deserves special attention as with increase in the life expectancy women lives
about one third of their lives with hormone deficient state. Studies on menopause
and quality of life of menopausal women are scarce and none is conducted
before among rural women of Sindh Province Pakistan.
OBJECTIVE: To investigate the severity of menopausal symptoms associated
with menopausal status and to determine the quality of life of menopausal women
from rural Sindh.
MATERIAL AND METHODS: This cross-sectional survey was conducted in 19
Union Councils of Matiary district, Hyderabad Division from November 2007 to
October 2008. Among 6, 29382 population dwelling in 1509 villages and 56,053
households of these Union Councils, 3062 women were selected by multistage
random sampling method within the age range of 40-70 years. Along with
collection of socio-demographic data the Menopause rating Scale (MRS) and
WHO Quality of life Brief (WHO QOL Brief) Questionnaire translated in Sindhi
Language were filled for each individual subject. Data was entered and analyzed
by SPSS V 15.
RESULTS: The mean age at Menopause was 49.38±14.29 years; the mean
scores of menopause rating Scale were high in all domains, the significant
difference was found in the mean somatic scores of women in Premenopause,
perimenopause and post menopause status (P=<0.001). The psychological
symptoms were more severe for women in perimenopause and post menopause
status while the scores for urogenital symptoms were found to be higher in
perimenopause women (P=<0.001). The mean scores for the physical,
psychological, social and environmental domains of WHO QOL questionnaire
were found significantly impaired for all women at different status of menopause.
CONCLUSION: To best of our knowledge this is the first attempt to provide data
on menopause and quality of life of women from rural Sindh. The mean scores
of all the domains of Menopause rating scale were significantly high in Peri and
postmenopausal women from rural Sindh. The severity of menopausal symptoms
decreases the quality of life in every day life of these rural women.
KEY WORDS: Menopause, Severity of symptoms, MRS, Quality of life, WHOQOL
RELATIONSHIP OF GESTATIONAL DIABETES MELLITUS WITH
POLYCYSTIC OVARIAN SYNDROME
SHAHZAIB PERVEZ 1, SADAF MANSOOR 2, YUSRA MIDHAT 2, SUMYYA
GHAZAL 2, MAHAK IRFAN 2, SUMERA SOHAIL 2, WASEEM SIDDIQUI 3,
FARAH ASAD MANSURI 3
1,2 Medical Students
3 Department of Community health Sciences
Karachi Medical & Dental College, Karachi
INTRODUCTION: Gestational diabetes is defined as glucose intolerance that
is first detected during pregnancy. The detection of GDM is important because
of its associated maternal and fetal complications. Gestational diabetes is
estimated to complicate 3-10% of all pregnancies
OBJECTIVE: To study whether Gestational Diabetes Mellitus is related with
Polycystic Ovarian Syndrome.
MATERIAL AND METHODS: It was a case control study conducted on pregnant
ladies with gestational diabetes mellitus (GDM) and their controls attending
antenatal clinics of Abbasi Shaheed and Lady Dufferin Hospital. A purposive
sample of 140 was selected from the two hospitals; out of which 35 were cases
of GDM and 105 were controls.
RESULTS: Out of 140 subjects 14% of cases and 11% of controls were in age
of 30.It was found that 17% of cases and 9% of controls had weight between
74-76.About 51% of cases and 56% of controls belonged to lower middle class.
Out of 35 cases, 22% (08) were with PCOs and 46% of them had family history
of diabetes. It was seen that 49% of them were obese as well.
CONCLUSION: This study proved that women with Gestational diabetes mellitus
were 5.9 times more likely to have clinically diagnosed polycystic ovarian syndrome
as compared to their controls. Age and weight were found to be the significant
covariates.
KEY WORDS: Gestational diabetes mellitus, polycystic ovarian syndrome,
polycystic ovaries, GDM
ROLE OF INTERVAL HYSTERECTOMY AND METHOTREXATE IN
PREVENTING MORTLAITY IN PLACENTA PERCRETA
SABA KHAN, SAMIA SHUJA, KHADIJA BANO, NAGINA FATIMA
Department of Obstetrics and Gynaecology
Jinnah Postgraduate Medical Centre, Karachi.
INTRODUCTION: Placenta percreta is a rare but life threatening obstetric
complication with a mortality in access of 6.5 % in most centers at the time of
delivery. Hysterectomy at the time of C-section is often complicated by severe,
uncontrolled hemorrhage resulting in life threatening morbidity and mortality.
Interval hysterectomy is often necessary to avoid this high rate of morbidity and
mortality. A study was conducted to determine the role of interval hysterectomy
in our centre.
PURPOSE: To determine the value of planned interval hysterectomy in preventing
mortality in placenta percreta cases.
MATERIALS & METHODS:- This case series includes well patients with placenta
percreta managed over a period of two years from January 2008 To December
2009 at the Department of Obstetric and Gynaecology, Jinnah Postgraduate
Medical Centre, Karachi.
RESULTS: There were 12 patients seen in the specified period. All were seen
beyond 33 weeks of pregnancy. All patients received 50mg methotrexate I/M.
The mean age was 30 years(25-35 Years) and parity was less than 4. There
was history of placenta previa in 4 patients (33.3%) C-section in all 12 patients
(100%), history of manual evacuation/curettage in 3 patients (25%) and hematuria
in 4 patients (33.3%). All patient under went planned interval hysterectomy in an
average of 3 weeks after the classical caesarean section. Bladder wall was
involved in 4 patients (33.3%) and it was primarily repaired in all four. Bilateral
Internal Iliac arteries were ligated in 5 patients (41.6%) during Classical C-section
because of threatened blood loss. A mean of 4 units of blood and FFP were
transfused. Post operative morbidity during the period between C-section and
hysterectomy included Postpartum Haemorrhage =2, Pelvic infection =2,
coagulation defect =1. Mean hospital stay after hysterectomy was 8 days (7-
12).There was no thirty days mortality in this series.
CONCLUSION: Interval hysterectomy helps in controlling both morbidity and
mortality in patients with life threatening placenta percreta.
KNOWLEDGE AND ATTITUDE OF MEDICAL STUDENTS OF DUHS
ABOUT CONTRACEPTION
DR HALEEMA YASMIN, TOOBA MALIK, USAMA AHMED
Department of Gynaecology & Obstetrics (Ward-8)
Jinnah Postgraduate Medical Centre, Karachi
OBJECT: To study the knowledge and attitude on various contraceptive methods
among medical students of DUHS.
STUDY DESIGN: questionnaire based study
SETTING: Sindh Medical College and Dow Medical College
Subjects: students of third, fourth and final year.
METHOD: A pre-structured proforma was given to the consenting students to
fill and return at the same time.
RESULTS: Out of the total responders majority were females almost 85%,they
knew very less about modern methods as well as emergency contraception,
majority felt that conventional and folk methods are effective ,knowledge about
side effects was judgmental mostly ,almost all of them felt that their knowledge
is not upto the mark ,30% felt that it is socially stigmatized factor to be discussed.
CONCLUSION: The first step towards achieving success in our family planning
programme lies in imparting correct knowledge and more information to this
target group by incorporating more lectures during medical education and
arranging interactive sessions.
KEY WORDS: Medical students, knowledge, attitude, contraception.
KNOWLEDGE REGARDING RH DISEASE AMONG FEMALES WITH
1ST PREGNANCY IN A COMMUNITY
*SADIA NASIM, MUHAMMAD AYAZ MUSTUFA, AND ANJUM SHAHID
*Research Officer, Pakistan Medical Research Centre, NICH, Karachi
{E-mail: sadianasim@yahoo.com}
BACKGROUND: Despite the introduction of Rhesus (Rh) immunoglobulin in
1968, hemolytic disease of the newborn (HDN) remains a serious concern. It
was reported that an overall incidence of HDN is 10.6 cases per 10,000 deliveries,
with a wide geographic variation. HDN was a significant cause of fetal mortality
and morbidity until the introduction of amniocentesis, intrauterine transfusion,
and exchange transfusion in the management of severely alloimmunised women
and their fetuses. As per procedures are very expensive and non-accessible in
our country so to prevent HDN, sufficient knowledge regarding blood group prior
to delivery will be helpful and there is evidence for the efficacy and effectiveness
of blood typing and anti-D antibody screening during pregnancy.
OBJECTIVES: The purpose of this study is to assess knowledge among females
with 1st pregnancy regarding Rh disease and their risk to mother and child and
to create awareness regarding importance of blood group during pregnancy.
SETTINGS: A questionnaire survey was conducted in Sector 33B, C, D, E, and
F of UC-7 of Korangi town representing low socioeconomic group. Systemic
sample plan was applied.
METHODS: 350 married females with 1st pregnancy were included in a study
after having a formal informed consent. A structured questionnaire was utilized
to assess the knowledge regarding Rh disease and HDN which include questions
comprising of maternal and child health, complications during pregnancy, whom
they consulted during pregnancy, have they ever visited health care centre during
pregnancy and some questions regarding importance of blood group.
Rh grouping was also done by rapid slide technique. For Rh Positive blood group
cards were issued at the spot while negative blood group was confirmed at
laboratory via reverse blood grouping and card was issued next day.
RESULTS: In our selected population 81.4% females had no knowledge about
their blood group. And only 4% knew their husband blood group. About 51%
females were married to blood relatives and only 2% knew about complication
(during pregnancy) related to negative blood group. Frequency of visiting health
care centre during pregnancy was by 43.7% while 8% never visited health care
centre. Blood group was determined in 350 females, the percentages of these
among Rh Positive were A (21.1%), B (31.7%), AB (9.7%), O (29.1%), and among
Rh Negative were A (2.0%), B (2.9%), AB (1.1%), and O (2.3%). Overall 8.3%
females were found to be Rh Negative and B blood group is commonest among
both Rh Negative and Rh Positive.
CONCLUSION: Awareness regarding blood grouping was very poor in females
of the study population.
FIRST TRIMESTER THREATENED MISCARRIAGES AND RELATED
OBSTETRICAL COMPLICATIONS
S AHMED, RN QURESHI
Department of Obstetrics and Gynecology
Aga Khan University, Karachi
INTRODUCTION: Threatened miscarriage defined as vaginal bleeding before
24 weeks of gestation is a complication affecting 15%-20% of viable pregnancies.
We hypothesized that it is associated with increased risk of obstetrical complications
OBJECTIVE: To assess the effect of first trimester threatened miscarriage on
pregnancy outcomes.
MATERIAL AND METHODS: A Prospective Cohort study was conducted from
March 2007-April 2008.A total of 1,365 women with singleton viable pregnancies
confirmed on ultrasound were recruited for the study. 273, pregnant ladies with
threatened miscarriage were considered in the Exposed group and 1,092 women
who had no threatened miscarriage were considered in Un- Exposed group.
RESULTS: Threatened miscarriage was found to be significantly associated with
complications like PPROM (RR=3.64, p <0.001), Abruptio placenta (RR=3.46,
p<0.001), Placenta previa (RR=2.57, p=0.001), Gestational hypertension (RR=1.96,
p<0.001), Preterm birth (RR=3.79, p<0.001), Intrauterine Growth Retardation
(RR=3.02, p<0.001) and Pregnancy loss (RR=4.31, p <0.001). It also increases
the risk of Cesarean sections (RR=1.43, p=0.025) and NICU admissions (RR=3.45,
p<0.001).
CONCLUSION: Patients with threatened miscarriage are at increased risk of
adverse pregnancy outcomes like PPROM, preterm birth, IUGR, gestational
hypertension and placental complications (abruptio placenta and placenta
previa).The risk of cesarean delivery, NICU admission and spontaneous pregnancy
loss is also increased in this group.
KEY WORDS: Threatened miscarriage, Preterm birth, Placental abruption,
Preterm premature rupture of membranes
FREQUENCY OF CERVICAL AND ENDOMETRIAL CARCINOMA IN
LOCAL POPULATION AT HYDERABAD DISTRICT
FARKHUNDA NADEEM* SAJIDA AGHA** S. HAIDER RAZA***
*Assistant Professor, Department of Pathology.
**Associate Professor, Department of Medical Education.
***Assistant Professor, Department of Pharmacology
Isra University Hyderabad
{E mail: drfarkhunda@hotmail.com}
OBJECTIVE: This study was conducted to know the frequency of cervical and
endometrial carcinoma in local population of Hyderabad district presented to Isra
university hospital Hyderabad, Pakistan.
METHODOLOGY: 500 hysterectomy specimens were received in the
Histopathology department of Isra University Hyderabad during the period of
January 2004 to December 2008. Out of these, 50 cases showed the presence
of cervical or endometrial carcinoma on histo-pathological analysis. Specimens
were preserved in 10% formalin and thorough naked eye examination was done.
Representative blocks were taken and processed for paraffin embedding.
RESULTS: A total of 500 hysterectomy specimens were received in the department
of Histopathology at Isra University Hyderabad. Out of these cases 50 specimens
showed the presence of either endometrial carcinoma or cervical carcinoma.
The mean age of these 50 hysterectomised patients was 51.62±10.64. The data
analysis showed that 60 percent cases belong to endometrial carcinoma while
40 percent cases showed the presence of cervical carcinoma with a p-value <
0.05.
CONCLUSION: This study was done in order to compare the frequency of
cervical versus endometrial carcinoma and it was concluded that endometrial
carcinoma is as common as cervical carcinoma in Hyderabad. This is in contrast
with the results of many studies conducted in USA which shows that endometrial
carcinoma is more prevalent in developed countries while cervical carcinoma is
common in developing countries. The factors leading to the increased frequency
of endometrial carcinoma in Hyderabad are yet to be discovered.
KEY WORDS: Endometrial carcinoma, Cervical Carcinoma, Hysterectomy
PATTERN OF CERVICAL CANCER CANCERS IN KIRAN, KARACHI
HINA HASHMI, SYED AMIR MAQBOOL, ADEEL AHMED, KULSOOM BEGUM
& TAHSEEN FATIMA
Karachi Institute of Radiotherapy and Nuclear Medicine Karachi
OBJECTIVE: Cancer of the Cervix is the second most common cancer in
females worldwide. According to the institution based data of KIRAN, it ranks
3rd most common cancer in females accounting for 5.5% of all female cancers
and 42.6% of all gynecological malignancies. The aim of the study is to summarize
the data of the patient suffering from cervical cancer and evaluate the risk factors,
stage and mode of presentation at our institute.
METHOD: In this retrospective study, case files of patients of last 6 months with
invasive cancer of cervix were studied with respect to personal profile, disease
related risk factors, stage and mode of presentation
RESULTS: 43 patients of cervical cancers ranging in the age group of 35-80
years (mean age 50.93) were registered in the cancer OPD. Of these, maximum
no of the patients were in stage II-B (26%). In rest of the stages were I-A (2%),
I-B (7%), II-A (23%), III-A (7%), IIIB (7%), IV-A (19%) and 9% had metastatic
disease to liver, lungs or bones. Early age at marriage (mean age16.8yrs), multi-
parity and multiple marriages of the spouse were the major risk factors identified
in our patients. Most patients belonged to low socio-economic status, with anemia
and poor nutritional status. Per vaginal bleeding was the universal presenting
complaint among all patients. Other major symptoms include pervaginal discharge,
post-coital bleeding, lower abdominal pain and urinary symptoms. One patient
also presented with recto-vaginal fistula
Most of the patients had incomplete treatment and were lost to follow-up because
of lack of awareness and ignorance.
CONCLUSION: Cancers of the cervix mostly present in advanced stage which
necessitates the implementation of screening programs at national level
VAGINAL HAEMOLYTIC ENTEROCOCCI AMONG WOMEN FROM
BALOCHISTAN: POSSIBLE INDICATOR OF BACTERIAL
VAGINOSIS
ARIFA JABEEN KAKAR1, NUSRAT JABEEN2,4, MUSHTAQ HUSSAIN2,4,
SYEDA QAMARUNNISA3, ZAFAR AHMED1, SHAKEEL BABAR1 & SHEIKH
AJAZ RASOOL4
1Department of Microbiology, CASVAB, University of Balochistan, Quetta,
2Department of Molecular Pathology, Dow University of Health Sciences,
3Institute of Biotechnology and Genetic Engineering (KIBGE),
4Department of Microbiology, University of Karachi-75270, Karachi
BACKGROUND: Bacterial vaginosis is characterized by whitish grey discharge
rendered by overgrowth of various bacterial species in the vagina and leads to
the disturbance of normal microbial flora of the system. Among half of the cases
of bacterial vaginosis, the disorder is asymptomatic and only detected by vaginal
swab. One prevalent form of bacteria found in this connection is haemolytic
enterococci.
OBJECTIVE: The present study is focused to explore the prevalence of haemolytic
enterococci in vaginal samples among the women inhabiting in the Balochistan
province.
MATERIALS AND METHODS: 450 patients attending Gynecology OPD of
tertiary care hospitals, BMCH Quetta and Sandeman Provincial Hospital Quetta
during May 2009 to August 2009 were requested for an Informed consent.
However, only 55 women agreed to volunteer in the study. From each subject
two vaginal swabs and one Pap smear were taken. One swab was subjected to
direct smear microscopic examination, gram staining and Whiff’s test while other
swab was placed in the transport medium. The later were streaked on 5% human
blood agar plates and haemolytic patterns were observed after 24-48 hours of
incubation.
RESULTS AND DISCUSSION: In total 160 aerobic bacteria were isolated from
different culture media. Of these 55 (34%) were identified as cocci, out of these
cocci 34( 62%)were gram+ve and 21 (38%) were gram-ve. The less percentage
of gram negative cocci may be inferred in terms of using blood agar rather than
the chocholate agar, a preffered medium for Neisseria isolation. Another possible
explanation could be the bacteriocinogenic potential of gram positive cocci. All
gram positive cocci were subsequently streaked on Bile Esculin agar plates and
incubated aerobically to check their esculin hydrolytic ability. Haemolysis of blood
in enterococci is only mediated by a bacteriocin or lantibiotic, cytolysin, which
to date has only been detected among enterococus faecalis strains. Thus, esculin
hydrolysis (resulting in black colour pin pointed colonies) and hemolytic pattern
conjointly delineate the isolates as E. faecalis. â- hemolysis was produced by
54% of isolates while 27% have exhibited á-hemolysis. The high prevelance of
hemolytic enterococci in these vaginal samples and their association with sign
and symptoms of bacterial vaginosis implicates the potential of enterococci to
be used as an indicator for bacterial vaginosis. Further studies in this connection
are underway.
KEY WORDS: Enterococcus, Vaginal flora, Bacteriocin, Hemolytic enterococci
fecalis
OUTCOME OF OCCIPITAL ENCEPHALOCELE
DR. ABDUL BASIT, A. M. MAMOON, DR. LAL REHMAN AND PROF. A.
SATTAR M. HASHIM
Department of Neurosurgery
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: Occipital encephalocele is a congenital anomaly which is due
to failure of closure of noto cord. There is swelling in the occipital region which
contains displastic brain and CSF. Antenataly can be diagnosed by Ultrasound.
CT scan and MRI of the brain tell us about the sac, it contents and any abnormality
of the brain. Surgical intervention is the best option of treatment and outcome
is excellent if operated on time.
OBJECTIVES: To find out the outcome of surgical intervention in occipital
encephalocele.
MATERIAL AND METHODS: It is a descriptive study conducted in the department
of neurosurgery JPMC Karachi from January 2009 to December 2009. Total
patients were 22. All of them were operated. elleptical incision given and outcome
detected. The information were conducted through a proforma including clinical
finding and investigations like CT scan or MRI. The operation finding and outcome
were noted. All patients came with recurrence were excluded. Data was analysed
using SPSS 10 version.
RESULTS: We have 22 patients male were 6 and females were 16. The age
was managing from 04 days upto 1½ years maximum of patients in age 2 months.
eighteen patients born in hospital while 4 born at home. Anterior Fontale (AF)
were open in 18 patients. There was hydrocephalus (HCP) in 8 patients. Post
operatively in 2 patients there was cerebrospinal fluid (CSF) leakage and 4
patient have HCP. only one patient expired.
CONCLUSION: Occipital encephalocele is a congenital anomaly. It is more
common in female outcome is excellent if operated in time.
Key Words: Encephalocele, Hydrocephalus, CSF leakage.
PAROXYSMAL DYSKINESIA, A RARE MOVEMENT DISORDER
WITH INTACT CONSCIOUSNESS: A CASE REPORT
KAUSAR MEHMOOD, MUHD FAROOOQ, MOAZAMA SHAH, HIBA MAHMUD
SHAUKAT ALI
Department of Neurology
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: To present a case report of a patient with a rare movement disorder
Paroxysmal Dyskinesia.
METHOD: 12 year old female presented in out patient department of Neurology
Ward with complains of multiple transient episodes of hemiplagia with side to
side shifting since the age of three months and abnormal paroxysmal contractions
of arms for last 1 year. Her examination shows hypotonia and hemiplagic gait.
Video EEG monitoring showing mild slowing of background. Ig E Levels done
at the age 4yrs were elevated.MRI with MRA was normal .A diagnosis of
Paroxysmal Dyskinesia was made.
CONCLUSION: Paroxysmal Dyskinesia, are a group of rare movement disorders
characterized by attacks of hyperkinesias with intact consciousness, with many
sub types.
ROLE OF EARLY DECOMPRESSIVE CRANIOTOMY IN THE
MANAGEMENT OF HEAD INJURY
ASIF A. QURESHI, A. SATTAR M. HASHIM
Department of Neurosurgery
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: To see the results of decompressive craniotomy in the treatment
of severe head injury.
PATIENTS & METHODS: Medical record of 63 patients with head injury having
either bifrontal or frontoparietotemporal contusions, who underwent decompressive
craniotomy were reviewed. There were 55 male and 8 female patients. Patient’s
mode of injury, type of injury, Glasgow coma score (GCS) score (pre and post
operatively) and early outcome was analyzed in respect to timing of surgery after
admission to neurosurgical care. Complications secondary to surgical intervention
were also noted.
RESULTS: Out of 63 patients, 55 had bifrontal contusions with severe brain
edema, 5 patients had unilateral frontoparietotemporal contusions and 3 patient
of post traumatic subdural empyema had gross midline shift. All patients had
been operated upon within 24-48 hours on injury with marked improvement in
GCS on first post op day. Early decompressive surgery resulted in recovery. Two
patients developed dysarthria and 1 patient with left sided frontoparietotemporal
subdural hematoma later on developed right sided hemiparesis.
CONCLUSION: Our results support that early decompressive craniotomy of
traumatic contusions not only reduces the brain edema but also aids in early
recovery.
KEY WORDS: Decompressive craniotomy, head injury, Glasgow coma score.
OUTCOME OF SPINAL MENINGIOMAS AND NEUROFIBROMAS
DR. SHAMSHER ALI, DR. LAL REHMAN, PROF. A. SATTAR M. HASHIM.
Department of Neurosurgery
Jinnah Postgraduate Medical Centre, Karachi
INTRODUCTION: Spinal tumors are divided into extradural and intradural, and
intradural tumors may be intradural extramedullary of intradural intra medullary.
Meningiomas and neurofibromas are intradural and extra medullary but very
rarely the neurofibroma may be extradural as well. These patients present with
backache, weakness in the limbs and sphincters involvement. Meningiomas are
more common in female and also dorsal spine. MRI is the investigation of choice.
Surgery is the best option of treatment. Most of the patients improve neurologically
after surgery. This study was conducted in the department of neurosurgery JPMC
Karachi to know about the importance of surgery in these tumours because their
surgery is easy and the outcome is excellent.
OBJECTIVES: To find out the neurological out come of spinal meningiomas and
neurofibromas after neurosurgical intervention. Methodology: It is a descriptive
study conducted in the department of neurosurgery JPMC Karachi from April
2008 to October 2009. Total patients operated were 22. Both male and female
patients of all age were included and patients with recurrent tumors were excluded.
Data was collected with the help of proforma including the clinical features MRI
findings, surgical intervention and out come of these patients. Data was analyzed
with the help of SPSS version 10.
RESULTS: Total 22 patients were operated for spinal meningiomas and
neurofibromas. Out of these patients, 12 were cases of neurofibromas and ten
patients had meningiomas. In neurofibromas, six were extradural and sex patients
had intradural neurofibromas. The male to female ratio was 7:5 and three patients
had cervical neurofibromas. In meningioma patients, 8 were females and two
were males. Nine patients had dorsal meningiomas and one patient had
meningioma at L1 level. There were no complications in the form of CSF leak,
wound infection or neurological deficit. All of the patients improved neurologically.
CONCLUSION: Spinal meningiomas and neurofibromas are intradural and
extramedullary but neurofibromas may be extradural as well. Surgery is the best
option of treatment. Outcome is excellent if these patients are operated in time.
KEYWORDS: Spinal Tumour, meningioma, neurofibroma.
DELIBERATE SELF HARM- GENDER BASED ANALYSIS IN TERMS
OF AGE, INTENT AND MOTIVATION
SHAKILA ATIF 1, M. IQBAL AFRIDI 2
1 Postgraduate Trainee / 2 Head of the Department
Department of Psychiatry
Jinnah Postgraduate Medical Center, Karachi
BACKGROUND: Traditionally rates of suicide and DSH were low but over the
past few years there has been a steady increase in these rates, so much so that
it has become a major public health problem in Pakistan. It was strange to see
that in a country with a population of approximately 162 million, no official data
on suicide or DSH is available. It has been estimated that for every suicide there
are at least 10 to 20 acts of DSH. Hence the need for this study was felt.
OBJECTIVES: to see the motivation factors and intent behind an act of DSH
in terms of age and gender.
METHODOLOGY: This is a descriptive (case-series) study which was conducted
at Liaquat National Hospital (LNH) in Karachi. Study duration was six months.
Hundred consecutive patients of DSH were included. Non-probability sampling
technique was applied. A structured questionnaire containing all personal
information regarding age, gender, education, marital status etc and also special
information regarding method and reason for DSH, intent and motivation behind
the act, history of previous suicidal attempt if any, was administered to all patients
after acquiring their consent. The data was entered and analyzed in the statistical
package for social science (SPSS 10.00) for windows. Frequency and percentage
was compiled to present all categorical variables like sex, marital status, occupation,
education, reason for suicidal attempt, previous suicidal attempt and psychiatric
diagnosis. Mean and standard deviation were computed for quantitative variables
like age and years of marriage.
RESULT: The sample of patients consisted of 56 % (n=56) females and 44%
(n=44) males. Most of the cases (55%) were in the age category of 20 -39 years.
65% (n=65) stated family issues / problems to be the reason for DSH, 22 %
(n=22) tried to harm themselves secondary to medical or psychiatric illness
followed by 13% (n=13) who had financial issues and resorted to DSH. 74%
(n=74) intended to die whereas for 26% (n=22) it was more of an impulsive act.
91% (n=91) had no final act before the act of DSH against the 9% (n=9) who
had made final acts.
DISCUSSION: Females outnumbered men by 56%. This could be attributed to
the fact that women in our part of the world usually have a low socioeconomic
status. The study showed significantly higher rates of DSH among young adults.
This could be attributed to the fact that this is the age when new relations are
made or broken with eventual bereavement problems. The participants cited a
number of bio-psychosocial reasons for DSH. Troubled interpersonal relationships
constituted the main reason for attempting suicide. 74% of all patients had clear
intensions to die with female pre-dominance of 42 followed by 32 males. The
rest of 26% had resorted to it as an impulsive act, or with the intention of putting
one to sleep or to put pressure on someone.
CONCLUSION: The young are particularly at risk. It is more prevalent in the
females. Most of the patients resorted to this act due to family issues / problems
and for most the intention was to die.
KEY WORDS: DSH, suicidal intent, gender.
PATTERN OF CO-MORBID SUBSTANCE USE AMONG FEMALE
PSYCHIATRIC OUT-PATIENT
M. IQBAL AFRIDI 1, ROZEEN DHARWARWALA 2
1Professor and Head of Department of Psychiatry, JPMC, Karachi
2Clinical Psychologist, The Mind Centre, Regent Plaza, Karachi
BACKGROUND: To Assessment of substance use among female psychiatric
patients is important in terms of treatment and outcome. The impact of female’s
addictions is enormous on family especially in our socio cultural setup.
OBJECTIVE: To assess the pattern of substance use in females with co-morbid
psychiatric illness in outdoor setup.
METHOD: All consecutive cases were taken from a local clinic.
PLACE AND DURATION OF STUDY: Carried out at TMC (The Mind Centre),
Karachi, over a period of 1years (2009).
METHOD AND MATERIALS: The sample 396 female with, depression somatoform
disorders, anxiety, phobia, sexual problem, addiction and infertility. All consecutive
cases that presented for psychiatric help were included. After consent, patients
were assessed in detail by a thorough History, Mental State Examination, Physical
and lab investigations supported on a diagnoses by ICD-10 criteria. Results were
analyzed through SPSS (version 12.00).
RESULTS: Total 396 females (mean age + SD=34+9.19) were assessed.
72(18.18%) of them were with substance use. Most of them (58, 41.8) were
married wile their mean age + SD was 39.4+14.14 years. The findings suggest
that female take every type of addiction. The most common substance use was
tobacco in the form of pan with tobacco (37.5%) followed by smoking (23.6%),
and Niswar (22.2%). The rest were using other form of substance including
benzodiazepines. The most common psychiatric co-morbidities were depression
(41.6%), conversion (11.1%), and bipolar disorders (9.7%)
CONCLUSION: Substance use as co-morbidity is quite prevalent among
psychiatric patients especially among cases with affective and conversion
disorders.
KEY WORDS: Co-morbid Substance Use, tobacco, mood and conversion
disorder.
INSOMNIA IN THE MEDICAL STUDENTS OF PUBLIC SECTOR
MEDICAL COLLEGE KARACHI: A PILOT STUDY
DR. DAULAT RAM & PROF. M.IQBAL AFRIDI
Department of Psychiatry
Jinnah Postgraduate Medical Center, Karachi
BACK GROUND: About one third of life is spent in sleep. Sleep is an active
state, which is essential not only for our physical, mental, and social well being,
but also for optimal cognitive functioning. When sleep is disturbed it results in
functional impairment, i.e decreased vigilance, impaired decision making, reduced
concentration, irritability, day time sleepiness, increased fatigue and difficulty in
thinking clearly.
OBJECTIVES: To determine insomnia in medical students of Sindh Medical
College Karachi.
METHODOLOGY. A total of fifty students were visited at S.M.C, out of them 32
students fulfilled the criteria (students above 18 years of age with out any history
of organic illness, substance use, or psychiatric disorder), for the cross sectional
study. 25 students gave consent to be included in the study. A questionnaire was
applied, which was optional for consenting students and the nature of insomnia
was assessed. 14 students were reported to have insomnia among 25 students.
RESULTS: 50% of the students, fulfilling the criteria for the study gave consent
to be interviewed & about 56% students were reported to have insomnia, as
having difficulty in initiating sleep.
CONCLUSION: My study substantially concludes that insomnia does exist among
medical students, which has serious consequence for health & well being.
ASSESSMENT OF SEXUAL DYSFUNCTION IN FEMALE
PSYCHIATRIC PATIENTS USING ANTIDEPRESSANTS REPORTING
AT JINNAH POSTGRADUATE MEDICAL CENTRE, KARACHI: A
PILOT STUDY
DR. SAIMA QURESHI, DR. M. IQBAL AFRIDI
Department of Psychiatry
Jinnah Postgraduate Medical Center, Karachi
{E-mail: syma.qureshi@gmail.com}
BACKGROUND: Sexual Dysfunction is a common occurrence and an
underestimated problem in psychiatric patients. It is associated with disorders
such as depression and anxiety. Antidepressants aggravate the pre-existing
sexual dysfunction. This can lead to psychological difficulties or medication
discontinuation. In our society, social taboos and feelings of shame and guilt
surround sexuality because of which it is a highly ignored subject.
OBJECTIVES: To determine the frequency and type of sexual dysfunction
affecting female patients using various types of antidepressants.
METHODOLOGY: A total of 25 female patients attending Out Patient Department
(OPD) at the department of psychiatry, J.P.M.C were approached out of which
13 fulfilled the criteria for the study and 10 gave consent to be included in the
study. A semi-structured questionnaire was applied which contained personal
information, type of antidepressant being used and nature of sexual dysfunction.
RESULTS: 76.92% of the females fulfilling the criteria for the study gave consent
to be Interviewed out of which 60% had sexual dysfunction. 66.67% of these
patients were using Selective Serotonin Reuptake Inhibitors (SSRIs) and 33.33%
were using Tri Cyclic Anti-depressants (TCAs). 83.33% reported lack of sexual
desire which was the most frequent complaint and 16.67% reported failure of
genital response.
CONCLUSION: Sexual Dysfunction can occur as a result of anti-depressant
use, especially with SSRI use. Patients rarely talk about this problem due to
social taboos surrounding this topic, and therapists are usually incapable of
initiating conversation regarding it. Further studies are needed in this area in
order to highlight it as an important component of mental health.
SINGLE DAY POINT PREVALENCE OF PSYCHIATRIC MORBIDITY
IN THE PSYCHIATRIC OUT PATIENT DEPARTMENT AT JINNAH
POSTGRADUATE AND MEDICAL CENTRE - A PILOT STUDY
DR. HIBA TOHID, DR. M. IQBAL AFRIDI, DR. SONIA AFTAB
Department of Psychiatry
Jinnah Postgraduate Medical Center, Karachi
{E-mail: tohid_84@hotmail.com}
BACKGROUND: A usual Psychiatric Out Patient Department (OPD) at JPMC,
receives approximately 200 to 250 patients each day. This number reflects on
the burden on our society. It also however, indicates the frequency of several
psychiatric illnesses thereby allowing us to review and modify our methods and
approach at the OPD.
OBJECTIVE: To determine the frequency of various psychiatric illnesses amongst
patients visiting the psychiatric OPD on a single day at JPMC as point prevalence
in order to organize future OPDs.
METHODS: Patients visiting the Psychiatric OPD on a single day were included
in this pilot study. Incoming patients were evenly distributed amongst the four
functional OPDs where each room assessed between thirty to fifty patients. A
verbal consent was obtained and the patients were evaluated psychiatrically.
Data regarding the patients was recorded orderly in log books maintained at
each of the clinics which served as a major data collection tool.
RESULTS: A total of 192 patients were assessed in the OPD. Results showed
that the three most prevalent psychiatric illnesses amongst the visiting patients
were Bipolar Affective/Mood Disorder 25.0% (48 patients), Depression 22.9%
(44 patients) and Schizophrenia 19.8% (38 patients) while other conditions such
as Epilepsy, Schizoaffective Disorder and Obsessive Compulsive Disorder
showed a prevalence of 7.3% (14 patients), 5.2% (10 patients) and 3.1% (6
patients) respectively. Several other conditions recorded as 'Miscellaneous'
constituted the remaining bulk of the patients. The logbook data also revealed
that 168 (87.5%)out of the total patient turnout came for a follow up while the
remaining 24 (12.5%) were visiting for the first time.
CONCLUSION: Psychiatric illnesses constituting the bulk at the OPD need to
be addressed extensively in our psychiatry curriculum and basic psychiatric
training at the hospital. Moreover, the OPD should be equipped to the hilt in order
to deal with these conditions.
FREQUENCY OF ANTE-PARTUM DEPRESSION IN PUBLIC AND
PRIVATE SECTOR
KHAN S.1, PERVEZ S.2, BATOOL B.1, IQBAL Z.1, MANSURI F.A.3
1Final Year Medical Student, 2Fourth Year Medical Student,
3Head of Department, Community Health Sciences
Karachi Medical & Dental College, Karachi
OBJECTIVE: To find out the frequency of ante-partum depression in public and
private sector.
MATERIAL & METHODS: It is a descriptive study: cross sectional type. The
study was conducted in Karachi at Abbasi Shaheed Hospital, Nazimabad
(Government sector), Liaquat National Hospital, Stadium road (Private sector)
and Aga Khan Maternity Hospital; Karim-a-bad (Private sector).A sample of one
hundred and fifty (150) subjects was selected. The survey was conducted by
self-administered questionnaire comprising of questions regarding Depression,
Gynecological, Obstetrical, History of Daily Interest, Medical, Emotional, Physical
and Mental symptoms. All patients were made to fill one more questionnaire that
is H.A.D. (Hamilton Anxiety Depression) scale of Abbasi Shaheed Hospital
(Department of Psychiatric Medicine). After selection of subjects from the Hospital,
their verbal consent was taken. They were asked questions and the questionnaire
was filled after translating it to them in Urdu.
RESULTS: The result of the study showed that in Abbasi Shaheed Hospital 23
(41.8%) out of 55 cases were in severe depression, In Liaquat National Hospital
14 (21.5%) out of 65 cases were in severe depression whereas in Aga Khan
Maternity Hospital, 4 (13.3%) out of 30 cases were in severe depression. It also
showed that 32.7% cases were diagnosed as mild depressive patient, while the
ratio of moderate depression is 17.3%, severe depression is 28% and no
depression is 22%.
CONCLUSIONS: It was found that a great proportion of pregnant ladies attending
either public/private sector hospital in Karachi experienced mild to severe
depression. Females with severe depression were more prone to be belonging
to low socio-economic group. Furthermore; our research showed that ratio of
depression was high among maternal age group of 18-28 years as compared
to older age group and was common among primi-para. It was also seen that
house wives were more depressed during pregnancy as compared to working
women.
DEPRESSION AND ITS ASSOCIATED RISK FACTORS IN MEDICAL AND
SURGICAL POST GRADUATE TRAINEES AT A TEACHING HOSPITAL:
A CROSS SECTIONAL SURVEY FROM A DEVELOPING COUNTRY
DR. AISHA YOUSUF
Family Physician
Aga Khan University Hospital, Karachi
BACKGROUND: Depression in doctors demands serious attention, otherwise
inability to cope efficiently with the stress of education and work may lead to
consequences at both personal and professional level. In recent years efforts
geared towards counseling are becoming more common within hospital settings
but unfortunately not for depression. And in case of doctors this may also affect
patient care and lead to preventable medical errors.
An extensive literature search revealed that there is a dearth of validated
information on this subject. This study was therefore undertaken to determine
the frequency of depression among post graduate medical trainees in a teaching
hospital in Pakistan and to explore the associated factors contributing to depression
in them.
METHOD: A survey was performed in a tertiary care teaching hospital in Pakistan.
Zung Self-Rating Depression Scale was administered among 172 post graduate
trainees for screening depression and self administered questionnaires were
used to assess the associated demographic and work related risk factors. Adjusted
odds ratios (OR) were calculated by logistic regression.
RESULTS: The survey response rate was 82.69%. Depression in the overall
sample was 58.72%, out of which 33.66% were moderate to markedly depressed.
Multiple logistic regression analysis revealed that working hours less than 76
hours (OR 3.71; CI=1.67, 8.23) and 76-90 hours (OR 3.15; CI= 1.42, 6.97) and
none or occasional peer support (OR 2.05; CI=1.01, 4.18) were independent
predictors for depression among the post graduate trainees.
CONCLUSION: More than half of our sample population is depressed. Therefore,
they should be encouraged to recognize and seek treatment. This study also
indicates that less working hours and lack of peer support cause depression.
We feel that depression among post graduate trainees is a relatively unexplored
area and more studies should, therefore, be conducted to gather more validated
information on the subject.
KEY WORDS: Depression, Post graduate trainee, risk factors, developing country.
ABUSE AMONG SCHOOL GOING ADOLESCENTS: IS IT
ASSOCIATED WITH SCHOOL PERFORMANCES AND MOOD
DISORDERS
SALEEM KHAWAJA* ADEEL AKBAR KHOJA,* KOMAL MOTWANI* ALI
KHAN KHUWAJA**
**Assistant Professor, Family Medicine/ CHS, Aga Khan University, Karachi,
Pakistan
*Medical Students, Dow University of Health Sciences, Karachi
BACKGROUND: Abuse is a major public health problem among adolescents,
globally. Adolescent’s mental and physical health, general well-being, and ability
to become a productive adult, all are being affected by exposure to abuse. The
objectives of this study were to assess the proportion of various types of abuses
and their association with school performances and persistent sadness among
adolescents in Pakistan.
METHOD: This was a cross-sectional school survey of 314 adolescent students
(age 13 to 17 years) conducted in four schools of Karachi and Quetta, Pakistan.
Data was collected using the self-administered and pre-tested structured
questionnaire. All the data was collected and managed by trained medical
students. Chi-square test was used to calculate the association of various types
of abuses with poor school performances and persistent sadness.
RESULTS: In all, 30.9% participants were physically abused and 50.0% participants
were verbally abused during the last 12 months. Over half of study participants
(55.1%) were involved in physical fight and 45.5% adolescents had suffered with
injury during the preceding year. Adolescents being bullied were 37.3% during
the same period. Verbal abuse (p=0.05), physical fight (p=0.05) and bullying
(p<0.001) were significantly associated with poor school performances among
adolescents. While physical abuse (p=0.05), verbal abuse (p=0.003), injury
(p=0.02) and bullying (p<0.001) were significantly associated with persistent
sadness among adolescents.
CONCLUSION: In this study, various types of abuse were quite prevalent in
adolescents which are significantly associated with poor school performances
and persistent sad mood. Further research is warranted to identify the causes
of abuse among adolescents. Interventions at various levels are also recommended
to prevent abuse among adolescents.
KEYWORDS: Abuse, Adolescents, Pakistan.
AN EARLY EXPERIENCE OF ENDOVASCULAR TECHNIQUES AT
FIRST-EVER PUBLIC SECTOR UNIT AT JPMC-KARACHI
DR. ARSHAD ALI
Assistant Professor
Department of Neurosurgery
Jinnah Postgraduate Medical Center, Karachi
Endovascular Neurosurgery is a rapidly developing field for treatment of
cerebrovascular diseases by minimal invasive techniques. Advancement in
catheter technology and improvement in imaging quality with ever increasing
experience in understanding of the vascular diseases has remarkably changed
the clinical outcome of the patients. Despite being recognized as an established
modality of treatment world over, this has not yet been made available to large
sector of population in Pakistan. It is partly because of lack of awareness both
among patients, their families and physicians and partly because of high level
of cost for consumable items used for embolization.
We at JPMC, Karachi started first ever public sector unit of neuroangiography
a year ago and had done over 100 cases of both diagnostic and therapeutic
neuro-intervention. This paper will only present our early experience of therapeutic
cases of Neuro-intervention along with focusing on difficulties that came across
to set up this unit. We will also concentrate how we are able to provide these
services on a subsidized cost to poor patients with public-private partnership.
ROLE OF CLOWARD TECHNIQUE FOR CERVICAL DISC
HERNIATION *DR. LAL REHMAN, DR A.SATTAR M. HASHIM
*Assistant Professor
Department of Neurosurgery
Jinnah Postgraduate Medical Centre, Karachi
{E-mail: drlalrehman@yahoo.com}
INTRODUCTION: Cervical disc herniation causes compression of the spinal
cord and cervical nerve roots which lead to sign and symptoms accordingly. The
patient presents with brachialgia, limbs weakness and other symptoms according
to the extent of cord involvement. MRI is the investigation of choice. It helps in
the diagnosis and planning for surgical intervention. There are many options for
cervical disc resection and cloward procedure is one of them. Disc is removed
by drilling the disc with a cloward burr and a dowel graft from the iliac bone is
inserted in the disc space followed by neck immobilization with collar. The
prognosis is excellent if these patients are operated in time. This study was
conducted to know about the effectiveness of cloward technique as it is simple
and has good results.
OBJECTIVE: To find out the outcome of cloward procedure in cervical disc
herniation in terms of neck pain, brachialgia and neurological deficit in the limbs.
STUDY DESIGN: Descriptive Study (Case – Series)
PLACE AND DURATION OF STUDY: The study was conducted in Neurosurgery
Department of Jinnah Post Graduate Medical Center, Karachi, from May 2008
to May 2009.
PATIENTS AND METHODS: It was a descriptive study in 35 consecutive
patients. These patients presented with neck pain, brachialgia, limbs weakness
and spasticity. All patients were clinically examined for pre operative neurological
status (assessed on the basis of power, reflexes and sensation), and
Neuroradiological investigations included cervical spine X-rays and MRI. All
patients were surgically treated for cervical prolapsed intervertebral disc with
anterior cervical discectomy and interbody fusion with Cloward technique. Post
operative neck immobilization done with the cervical collar for a period of 12
weeks. Drain removed on first postoperative day while check plain cervical
X–Rays taken on third day. Recurrent disc already operated through smith
Robinson’s method or through microdiscectomy were excluded.
RESULTS: Among 35 patients, 29 were males and 6 females. Male to female
ratio was 4.8: 1; mean age was 44.3 years while common age group was of 40
to 50 years. The commonest symptom was neck pain. The duration of symptoms
ranges from 2 to 6 months. On MRI, prevalent levels of cervical disc prolapse
were C 5- 6 (48.5%) and C 6 – 7 (22.8%). According to the MRI, 31 patients had
disc herniation causing thecal effacement with cord compression and 04 patients
showed ischemia of cord. Single level Cloward surgery done in 31 patients while
two levels Cloward performed in 04 only. About 83.3% patients improved and
13.3% not improved, 01 patient was re operated. No complications and mortality
was related to the surgical procedure.
CONCLUSIONS: This study provides the evidence that, Cloward technique for
cervical disc herniation is a relatively simple and safe surgical procedure with
favorable results. Hundred percent fusions occur after Cloward surgery, even
without instrumentation. The complications related to the cloward procedure are
less. Early mobilization of patient and short hospital stay is also possible. It
appears to be a safe alternative to currently used procedures.
KEY WORDS: Cloward procedure,ÊCervical Spine Fusion and Cervical Disc
Herniation
PROSTHODONTICS REHABILITATION OF DIABETIC PATIENTS
DR. MEHMOOD HUSSAIN
Incharge Department of Prosthodontics
Hamdard College of Medicine & Dentistry, Karachi
{E-mail: )
Patients having Diabetes Mellitus are more prone to develop various systemic
and oral lesions. Due to these oral lesions diabetic patients have problems in
maintaining adequate oral hygiene as a result these patients have early loss of
tooth / teeth which eventually leads to edentulous state. Prosthodontics is a
branch of dentistry deals with replacement of missing tooth/ teeth with bio
compatible material. In this paper oral features and Prosthodontics rehabilitation
of diabetic patients is discussed.
SURGICAL APPROACH IN ORAL SUBMUCOUS FIBROSIS
DR. ZUBAIR AHMAD ABBASI
Associate Professor of Oral and Maxillofacial Surgery
Karachi Medical and Dental College & Abbasi Shaheed Hospital
Oral Submucous fibrosis is a chronic, fibrotic, pre-malignant condition of oral
mucosa. It causes severe trismus and has potential for malignant transformation.
Patient’s quality of life is severely effected and normal oral hygiene and dental
care is nearly impossible in these patients.
Incidence and complaints of OSF patients was audited for three months attending
oral and maxillofacial surgery Dept. at Abbasi Shaeed Hospital is discussed.
Surgical correction by local flap can give satisfactory result as far as mouth
opening is concerned and patient’s quality of life can be improved. Rationale for
tongue flap is explained and results of patients undergone surgery is presented.
CAUSES OF TOOTH EXTRACTION AT A TERTIARY CARE CENTRE
IN PAKISTAN
MUHAMMAD HASEEB, KAMRAN ALI, FAISAL MUNIR
Dental Surgeon, Lahore
{E-mail: dr.haseeb@gmail.com}
OBJECTIVES: To document the causes of permanent tooth extraction.
MATERIAL AND METHODS: It was a descriptive study conducted at department
of oral and maxillofacial surgery, Punjab Dental Hospital, Lahore - Pakistan. 1026
patients were included in the study who were referred to the department of Oral
Surgery for extractions of permanent teeth. Extractions for orthodontic treatment
excluded. Oral hygiene was recorded using Simplified Oral Hygiene Index.
RESULTS: Mean age of study population was 46.60 (S.D +11.321). 59.6% were
males. Advanced dental caries was the leading cause of tooth extraction (52.5%),
followed by periodontitis (26.2%), endo-perio lesions (10.6%), restoration failure
(4.6%), trauma (3.2%) and miscellaneous local pathologies (2.9%). More than
half of the patients (52.6%) had poor oral hygiene.
CONCLUSION: Advanced dental caries is the most common cause leading to
tooth extraction.
KEY WORDS: caries, periodontitis, endo-perio lesions, tooth extraction, oral
hygiene.
EFFECT OF EXTRACTION OF FIRST FOUR PREMOLARS ON
SMILE ESTHETICS AFTER ORTHODONTIC TREATMENT
FARHANA GHAFFAR, MUBASSAR FIDA
Orthodontics
Section of Dentistry, Department of Surgery
The Aga Khan University and Hospital Karachi
INTRODUCTION: The objective of the present study was to assess smile esthetics
after orthodontic treatment in subjects with and without extraction of first four
premolars.
MATERIAL AND METHODS: Post-treatment colored printed frontal photographs
( 4 × 6" ) of 30 subjects were assessed. For half of the patients ( n =15 ), treatment
included the extraction of first four premolars, whereas the other half were treated
without extractions. Smile esthetic parameters were measured with the help of
seven variables and ratios amongst them were calculated in order to assess the
change in smile esthetics in subjects treated with and without extraction of first
four premolars.
RESULTS: All seven variables and ratios amongst them, measuring smile
esthetics in our study, namely smile width, smile height, visible dentition width,
maxillary intercanine width, visible maxillary first molars, visible mandibular teeth
and visible maxillary marginal gingiva showed no detrimental effects of extraction
of first four premolars on smile esthetics.
CONCLUSION: The effect of extraction and nonextraction treatment on smile
esthetics were very similar, indicating that treatment involving the extraction of
first four premolars does not have a detrimental effect on smile esthetics.
DENTAL CARIES AND DIABETES MELLITUS: ROLE OF SALIVARY
FLOW RATE AND MINERALS
MUHAMMAD JAWED1, SYED M. SHAHID2 AND ABID AZHAR2
1 Department of Biochemistry, Liaquat College of Medicine & Dentistry, Karachi,
Pakistan
2 Dr. A. Q. Khan Institute of Biotechnology & Genetic Engineering (KIBGE),
University of Karachi, Karachi, Pakistan
INTRODUCTION: This study was designed to evaluate the possible protective
role of salivary factors like salivary flow rate and adequate level of calcium,
phosphate and fluoride in patients of diabetes mellitus type 2 against dental
caries.
MATERIALS & METHODS: A total of 398 patients of diabetes mellitus type 2
with dental caries and 395 age and sex matched non-diabetic subjects with
dental caries were included as controls. All subjects were divided into four groups
according to their ages. Decayed, missed and filled teeth (DMFT) were scored
to indicate the severity of dental caries. Saliva was collected, flow rate was noted
and calcium, phosphate and fluoride were analyzed.
RESULTS: The FBS, HbA1c and DMFT indices were found to be significantly
high in diabetic patients as compared to controls. The salivary flow rate, calcium,
phosphate and fluoride were found to be significantly low where as no significant
difference was found in salivary magnesium in patients as compared to controls.
CONCLUSION: Optimum salivary flow rate is responsible for establishing
protective environment against dental caries. Adequate level of salivary calcium,
phosphate and fluoride is also involved in significant deposition of these minerals
in plaque which greatly reduces the development of caries in the adjacent enamel
of teeth.
KEY WORDS: Dental caries, diabetes mellitus, salivary flow rate, salivary
minerals.
APPLICABILITY OF THREE MIXED DENTITION ANALYSIS
METHODS IN ORTHODONTIC PATIENTS AT AKUH
SARWAT MEMON, MUBASSAR FIDA
Orthodontics, Section of Dentistry
Department of Surgery
The Aga Khan University and Hospital, Karachi
INTRODUCTION: Mixed dentition analysis forms a crucial part of an early
orthodontic evaluation and treatment planning. A review of orthodontic literature
reveals variability in tooth size in different population groups. Therefore, it is
important that prediction techniques should be interpreted relative to respective
racial norms, since failure to consider tooth size and racial variations would
render the interpretation of Moyers’ probability tables, Bernabé and Floris-Mir
and Tanaka and Johnston’s prediction equations8 as misleading. Therefore the
aim of my study is to observe agreement between actual sum of canine and
premolars and that predicted from three mixed dentition prediction methods in
orthodontic patients at AKUH.
MATERIAL AND METHODS: Data were collected using pretreatment records
including orthodontic files and plaster casts of 121 orthodontic patients 45 males,
76 female; average ages, 13.3 and 13.4years respectively. Digital caliper was
used to measure the mesiodistal widths of permanent teeth from 1st molar to
1st molar in mandibular arch, and central incisors and 1st molars in maxillary
arch. The methods of Tanaka and Johnston, Moyers, and Bernabé and Flores-
Mir were used to predict the mesiodistal widths of the canine and premolars.
Comparison between the actual and predicted sum of the mesiodistal widths of
canine and premolars was made for each prediction method, using paired sample
t-test.
RESULTS: For males statistically significant differences were found for Moyers
at the 75th percentile and Bernabé and Flores-Mir method whereas for females
only the Bernabé and Flores-Mir’s method showed significant results. However
no significant difference was found in both genders for Tanaka and Johnston
method.
CONCLUSIONS: In our orthodontic patients for males Moyers 50th percentile
and Tanaka and Johnston methods while for females Moyers 75th percentile
and Tanaka and Johnston methods can be applied for mixed dentition analysis.
MAXILLARY ARTERY PERFORATING INFERIOR ALVEOLAR
NERVE: AN ANATOMICAL STUDY
MUHAMMAD MUJAHID KHAN
Associate Professor
Department of Anatomy, College of Medicine
King Saud University, Saudi Arabia
{E-mail mm@ksu.edu.sa / dralkhan@hotmail.com}
The infratemporal fossa is a clinically significant anatomical area for the delivery
of local anesthesia in the practice of dentistry and maxillofacial surgery. A study
of the infratemporal fossae in Caucasian cadavers was conducted and the
topographical relations of the inferior alveolar nerve with the maxillary artery
were studied. In 3 out of 50 fossae dissected, the maxillary artery passed through
the inferior alveolar nerve, splitting it into superficial and deep divisions. Entrapment
of the maxillary artery may cause numbness or headache and may interfere with
injection of local anesthesia in the infratemporal fossa.
ANALYSIS OF P53 GENE MUTATIONS/POLYMORPHISMS IN ORAL
SQUAMOUS CELL CARCINOMA (OSCC) IN PAKISTAN
SAIMA SALEEM1, ABDUL HAMEED2, MUHAMMAD AJMAL2, NAVID RASHID
QURESHI3, ZUBAIR ABBASI4 AND ABID AZHAR1
1 Dr. A. Q. Khan Institute of Biotechnology and Genetic Engineering (KIBGE),
University of Karachi, Karachi
2 Institute of Biomedical and Genetic Engineering, 24-Mauve Area, G-9/1,
Islamabad
3 Liaquat College of Medicine and Dentistry, Karachi
4 Karachi Medical and Dental College, Karachi
INTRODUCTION: Oral squamous-cell carcinoma (OSCC) is among the common
neoplasm in Pakistan. Epidemiologic evidence indicates a direct relationship
between tobacco smoking, chewing of betel leaves (paan), betel nut (chaliya),
niswar and gutka, with oral carcinogenesis, suggesting that there may be specific
genetic targets of betel-quid ingredients. The p53 gene has been indicated to
be a tumor-suppressor gene that is found in mutated form in common human
cancers. However, there are few reports about "carcinogen-specific" p53 mutation.
MATERIALS AND METHODS: Tissue and blood specimens were collected from
250 OSCC patients, with informed consent, from local hospitals of Karachi and
were used for p53 mutation analyses. Exons 4, 5 and 6 of p53 genes were
examined by polymerase chain reaction-single-strand conformation polymorphism
(PCR-SSCP) and direct sequencing.
RESULTS: The PCR-SSCP analyses showing mobility shift bands in tumor
samples were purified and directly sequenced. In exon 4 of the p53 gene, a C
to G missense mutation at nucleotide position 215 of the coding sequence was
identified.
CONCLUSIONS: This change substitutes amino acid proline with arginine at
position 72 of p53 protein. The change was significantly observed in OSSC tumor
sample that may be responsible for causing OSCC in Pakistan.
KEY WORDS: p53, OSCC, PCR-SSCP, DNA sequencing, and mutation
DENTAL AGE TABLE FOR ORTHODONTIC PATIENTS AT THE AGA
KHAN UNIVERSITY AND HOSPITAL KARACHI
*RASHNA FIROZE AGA, MUBASSAR FIDA
Orthodontics, Section of Dentistry
Department of Surgery
The Aga Khan University and Hospital, Karachi
INTRODUCTION: Demirjian’s dental age assessment method is used worldwide
to assess a patient’s dental age. However this method was developed using
French Canadian population standards and has shown significant differences
in various populations. Therefore the aim of this study was to evaluate the
applicability of the Demirjian’s dental age assessment table in orthodontic patients
at the Aga Khan University and Hospital, and if not applicable, to formulate a
separate dental age table for Pakistani boys and girls.
MATERIAL AND METHODS: The study was conducted on a sample size of 438
subjects (180 males and 252 females) ranging in age from 7 to 17 years. Paired
t-test was used to assess any difference between chronological age and dental
age assessed according to Demirjian’s method. Linear regression with the
equation Y=100/1+e⺠- â1X was used to generate dental age tables for Pakistani
males and females.
RESULTS: Dental age assessed according to Demirjian’s method for our male
sample was over-predicted in the age group 11 – 15 years (p < 0.05). In our
female sample there was an over-prediction in the age group 10 – 14 years and
under-predicted in age groups 16 and 17 years (p < 0.05).
CONCLUSIONS: Statistically significant differences were found in the chronological
age and dental age assessed by Demirjian’s method for our study sample and
thus a new table was generated to convert dental maturity calculated according
to Demirjian’s method into dental age for our patients.
OUTCOME OF HIP RECONSTRUCTION OSTEOTOMY
*HASNAIN RAZA, HAROON UR RASHID, MASOOD UMER
*Resident Orthopedic
The Aga Khan University, Karachi
BACKGROUND: Instability of the hip joint can be secondary to congenital
pathologies like dysplatic dislocated hips (DDH) which are neglected and proximal
femoral focal deficiency or acquired such as sequele of infective or neoplastic
process. An unstable hip is usually associated with loss of bone from the proximal
femur, proximal migration of the femur, lower-extremity length discrepancy,
abnormal gait, and pain. In this study we report our results in the treatment of
the unstable hip joint by hip reconstruction osteotomy using the Ilizarov method.
This includes an acute valgus and extension osteotomy at the proximal part of
the femur combined with gradual distraction for realignment and lengthening at
a second, more distal, femoral osteotomy.
OBJECTIVE: To review our clinical results of hip reconstruction osteotomy by
Ilizarov method for unstable hip joint.
METHOD: It is a case series of 16 consecutive patients who underwent hip
reconstruction osteotomy for unstable hip at The Aga Khan University Hospital,
Karachi between May 2005 and July 2008. Six males and 10 females were
operated with an average age of 21yrs at time of surgery. Seven left sided hips,
eight right sided and one bilateral were operated. They have various etiologies,
six hips were diagnosed as neglected dysplatic dislocated hips(DDH), six were
sequele of septic arthritis, 2 had history of tuberculous arthritis and one case of
Giant cell tumour of femur head and proximal femoral focal deficiency each.
Outcomes were evaluated clinically by Harris hip scoring system.
RESULTS: At the time of follow-up, at a mean of 23 months, the post operative
Harris hip score was significantly improved as compared to preop. Mechanical
alignment and equal length of lower extremity were achieved in almost all cases.
CONCLUSION: The Ilizarov hip reconstruction can successfully correct a
Trendelenburg gait by stabilizing the hip and supporting the pelvis and
simultaneously restore knee alignment and correct lower-extremity length
discrepancy.
PELVIC DISSOCIATION IN REVISION TOTAL HIP ARTHROPLASTY:
DIAGNOSIS AND TREATMENT
Shahryar Noordin
Pelvic dissociation is a distinct but uncommon condition, which occurs in
association with total hip arthroplasty, in which the superior aspect of the pelvis
is separated from the inferior aspect by fracture. Because radiodense implants
and cement can obscure pelvic discontinuity on plain radiographs, not all
dissociations can be diagnosed preoperatively; therefore, a high index of suspicion
for this condition should be maintained. In selected patients, CT angiography
may be indicated. Successful treatment requires achieving initial stability of the
socket, establishing conditions for long-term stability of the socket, stabilizing
the pelvic dissociation, and producing conditions favorable for healing. Applying
a posterior pelvic reconstruction plate to the ilium and ischium will achieve
stabilization of the dissociation in most patients if sufficient posterior wall and
column are present. Occasionally, if there is adequate space, a second plate
may be applied. In selected patients, it may be feasible to place anterior column
fixation screws using image guidance, rather than the alternate option of using
anterior column plating through an anterior exposure. Residual bone loss is then
reevaluated and possible options such as a hemispherical socket, a jumbo cup,
or a highly porous metal component and augment can be considered. If there
is not enough room for a posterior pelvic reconstruction plate, a cup-cage construct
with or without an allograft can be used as a reconstruction option.
PAIRED ABDOMINAL FLAP:
A RELIABLE HAND SANDWICH FOR DEGLOVING HAND INJURIES
SYED KAMRAN AHMED, SADAF SAEED, MUHAMMAD AMIN CHINOY,
MANSOOR ALI KHAN
Department of Orthopaedic, Reconstructive and Hand Surgery
Jinnah Medical College Hospital & Department of Orthopaedic
The Indus Hospital Karachi, Karachi
INTRODUCTION: Despite the sophistication in microsurgical techniques, wound
coverage for an entirely degloved hand remains a substantial challenge. The
paired lower abdominal flap described by Miura and Nakamura provides
simultaneous and adequate coverage for the dorsal and volar surfaces of an
entirely degloved hand. It has been largely under utilized despite its extreme
usefulness.
OBJECTIVES: To justify the usefulness of paired abdominal flap in circumferential
degloving injuries of the hand.
STUDY DESIGN: Case series with review of literature.
PLACE AND DURATION OF STUDY: Department of Orthopaedic Reconstructive
and Hand Surgery, Jinnah Medical College Hospital and Department of
Orthopaedics, The Indus Hospital Karachi, from November 2004 to August 2009.
METHODS: Five patients with circumferential degloving hand injuries requiring
coverage with a paired lower abdominal flap were included. Three patients
underwent paired flap while two refused flap coverage and opted for coverage
with full thickness skin graft. The surgical technique is diagrammatically represented.
Overall hand function was evaluated through Quick DASH questionnaire.
RESULTS: Outcome assessment revealed satisfactory cosmetic and functional
recovery with paired abdominal flap.
CONCLUSIONS: We recommend this flap for mutilating hand injuries. It can be
easily learnt by a well trained orthopaedic or plastic surgeon for salvage of hand
in centres with limited microsurgery facilities.
KEY WORDS: Hand sandwich; Paired abdominal flap
SHORT TERM RESULTS OF LIGAMENT RECONSTRUCTION WITH
TENDON INTERPOSITION FOR CARPOMETACARPAL (CMC) JOINT
ARTHRITIS
KASHIF ABBAS, PERVAIZ HASHMI
Resident Orthopedic Surgery
Aga Khan University Hospital, Karachi
INTRODUCTION: Carpometacarpal joint of the thumb is the second most common
site afflicted by osteoarthritis. Non surgical measures forms the first line of
treatment with aim of preventing progression of disease, however, surgery
becomes an option when symptoms are refractory to nonsurgical methods.
Different procedures have been described in literature. Ligament reconstruction
with tendon interposition (LRTI) is the most commonly performed procedure in
North America for this problem.
OBJECTIVES: Aim of study is to evaluate early results of ligament reconstruction
and tendon interposition for CMC joint arthritis
MATERIAL AND METHODS: Case series of 10 cases done at a tertiary care
hospital from 2006 - 2008 Dec. All cases were operated by a single surgeon.
These patients were followed up using Quick DASH questionnaire.
RESULTS: All patients were female. Mean duration of follow up 18 months. Pain
and residual laxity recorded at each clinical follow up visit after removal of thumb
spica and Kirschner wire. Mean value for Quick DASH score is 31 in a 0 – 100
scale with 0 being no disability.
CONCLUSION: Ligament reconstruction and tendon interposition resection
arthroplasy is an effective method of controlling symptom with preservation of
motion at CMC joint axis.
CONCURRENT CHEMORADIATION WITH OR WITHOUT
CISPLATINUM AND GEMCITABINE BASED INDUCTION
CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER
MUTAHIR ALI TUNIO1,
ALTAF HASHMI2, ABDUL QAYYUM3, MANSOOR RAFI1
1Radiation Oncology, 2Urology, 3Medical Oncology
Sindh Institute of Urology & Transplantation, Karachi
BACKGROUND: Radical cystectomy is the gold standard treatment for muscle
invasive bladder cancer. Over last decade much enthusiasm has been exerted
on bladder sparing therapy. We evaluated the benefit of induction chemotherapy
followed by concurrent chemoradiation as bladder sparing therapy in muscle-
invasive bladder cancer.
MATERIALS & METHODS: During Mach 2006 to April 2007, patients with T2-
T4bN0M0 bladder cancer underwent complete transurethral resection followed
by Arm A: induction chemotherapy (cisplatinum+ Gemcitabine) q 28days four
cycles followed by concurrent chemoradiation and Arm B: concurrent
chemoradiation. Radiotherapy was given with shrinking field technique with total
dose 6500 cGy with weekly cisplatinum or Gemcitabine. Patients were followed
at 4weeks after radiation then every 3 months for any local recurrence or distant
relapse.
RESULTS: Among 45 patients (mean age 60.6 years), 23 and 20 patients in
arms A and B completed treatment, respectively. In arm A, 20 patients (86%)
achieved complete response (CR), out of 3 patients who did not achieved CR,
2 underwent salvage cystectomy. In arm B, CR was seen in 18 patients (90%);
1 patient underwent salvage cystectomy. During 25 months follow up period,
local recurrences were seen in 3 and 4 patients and distant metastasis were
seen 2 and 3 patients in arm A and B respectively. 2 year survival and progression
free survival were 65.2% & 60%; 78.2% & 65% in arms A and B respectively. Of
27 surviving patients, 23(85.2%) are retaining intact bladder functions.
CONCLUSION: TUR followed by sequential induction chemotherapy and
chemoradiation showed improves disease free survival without any impact on
survival. However further follow up is required.
H Y P O F R A C T I O N AT E D S C H E D U L E O F PA L L I AT I V E
RADIOTHERAPY IN THE MANAGEMENT OF GROSS HAEMATURIA
OF INVASIVE BLADDER CANCER PATIENTS
DR RAFIA TOOR1 & DR MUTAHIR A TUNIO2
Atomic Energy Medical Centre, JPMC, Karachi1
Oncology Unit, Sindh Institute of Urology and Transplantation, Karachi2
PURPOSE: To evaluate the efficacy of hypofractionated radiotherapy schedule
for the improvement of local symptoms in patients of advanced, recurrent or
metastatic urinary bladder cancer with the aim of palliation. Conventional radical
radiotherapy was inappropriate because of extensive disease, poor general
condition of the patients from muscle-invasive bladder cancer.
METHODS AND MATERIALS: Ten patients of tumor status (pT1- pT4, N+, M0,1),
were selected for the trial with gross haematuria due to progressive disease
(ECOG 3,4) and 21 Gy in 3 fractions were delivered on alternate days for
symptomatic improvement in patients considered unsuitable for curative treatment
through disease stage or comorbidity. Baseline investigations include Heamoglobin,
Urine C/S, Urea, Creatinine and imaging. The primary outcome measures were
overall symptomatic improvement of bladder-related symptoms at 6 weeks and
changes in bladder- and bowel-related symptoms from pretreatment to end-of-
treatment assessments. Overall improvement was defined prospectively in gross
haematuria, with no deterioration in any other bladder-related symptom.
RESULTS: Presently 10 patients were recruited, but data on symptomatic
improvement was available on 8 patients. Median age: 65 years, median survival
3 months. Questionnaire regarding the Quality of Life (QoL) filled by the patients
after 6 weeks of radiotherapy. Of these, 40% achieved symptomatic improvement
with minimum stress to the patient and acute side effects.
CONCLUSION: This is a prospective trial to date in the palliative treatment of
bladder cancer. The use of 21 Gy in 3 fractions (700cG each) regime appears
effective and generally well tolerated on an outpatient basis for this frail poor
prognosis group. Haematuria is particularly palliated with improving patient quality
of life and decreasing workload on the radiation unit.
COMPARISON OF THREE METHODS FOR SKIN MARKINGS IN
CONFORMAL RADIOTHERAPY, TEMPORARY MARKERS, AND
PERMANENT STERITATT CIVCO ® TATTOOING: PATIENTS'
COMFORT AND RADIOGRAPHERS' SATISFACTION
MANSOOR RAFI, MUTAHIR ALI TUNIO, ALTAF HASHMI
Sindh Institute of Urology & Transplantation (SIUT), Karachi
BACKGROUND: Skin marking is routinely performed at the time of simulation
before radiotherapy treatment. Worldwide different methods are used to mark
the isocenter; most commonly used are temporary marker pens, commercially
available tattooing needles pre-filled with non toxic India ink (Steritatt CIVCO®)
and henna. The aim of this study was to compare these three different methods
in the terms of durability, repetition of marking session, any allergic reactions,
patient comfort and radiographer satisfaction.
MATERIALS AND METHODS: Sixty patients with early prostate cancer were
selected who were due to undergo radiation for eight to nine weeks duration. At
the time of simulation, the participants' skins were marked by one of the three
methods: temporary marker pens, henna, and Steritatt CIVCO® needling. The
patients were evaluated for the durability of markings, number of times the
markings were repeated and allergic reactions. The patients' comfort was assessed
by using a scoring system: they were asked to assess the method of the marking
used. A rating scale was used: 1 = happy with marking method, 2 = seeking an
alternate option. The radiographers were asked to score one of the methods
using a scale 1-3: 1 = better, 2 = comparable, 3 = worse.
RESULTS: Mean duration of the skin markings was four days (2-5), 18 days (10-
27) and 40 days for temporary marker pens, henna, and Steritatt CIVCO®
needling, respectively. Patients with henna and permanent markings were equally
satisfied with the less number of repeated markings. However radiographers
were unsatisfied with henna because of the prolonged drying period (mean = 15
minutes). No skin allergies were seen in any procedure.
CONCLUSION: Permanent markings remain the standard for a radiotherapy
unit, patients and radiographers. Although patients were happy with the henna
markings it is not recommended due to prolonged drying period and the need
for repeated skin markings
ROLE OF MEDICAL PHYSICIST IN RADIATION ONCOLOGY
ASAD ZAMEER, SHOUKAT ALI, ZAEEM AHMED, MUTAHIR A. TUNIO
*Department of Radiation Oncology
Sindh Institute of Urology and Transplantation (SIUT), Karachi
BACKGROUND: A radiation oncology physicist brings a unique perspective to
the clinical team in a radiation oncology department: that of a scientist trained
in physics and also in clinical, basic medical and radiobiological sciences. The
physicist performs an important role working along with the radiation oncologist,
the radiotherapy technologists and others, to assure the accurate delivery of all
aspects of a treatment prescription. The modern computer based radiotherapy
technology warrants the adequate basic and technical knowledge of physicists
to assure proper quality treatment.
METHODS & MATERIALS: The physicists working in different radiation oncology
departments were asked to share their knowledge about basic medical, clinical,
radiobiology, scientific journal access and technical issues. The possible
controversies were resolved by telephone conversations.
RESULTS: Among 22 radiation oncology centers, wide variation was found in
terms of basic clinical and radiobiology knowledge, journal access which will be
discussed. They were found good in the equipment usage and program operations
what were available in respective center. Two centers were found in which
physicists see patients along with radiation oncologists for side effects during
weekly follow up protocol, so can revise their treatment plans. Better collaboration
was seen between physicists and radiation therapy technologists among all
centers.
CONCLUSIONS: Regardless of the employment situation and tools available,
the physicist should be an active participant in discussions, planning, and
decisions, particularly pertinent for physics involvement include: patient treatment
techniques and planning, the physicists’ relationships to institutional personnel,
negotiations for equipment and equipment acceptance testing and performance
verification.
BREAST CANCER HISTORY TO, TODAY
NOOR SOOMRO, SAUD BALOCH. NASEEM FATIMA, MOHINI RAJ, SAEED
QURESHI
To discuss on Breast cancer from ancient age till today. In this Presentation we
want to acknowledge the history of origin of world “cancer where it shows in
history that there was no treatment. This Presentation includes updates of Surgery,
radiation and chemotherapy. What are the major breakthroughs in the history
and in what dimensions the researches are going on.
Finally we will highlight our own scenario regarding protocols of breast cancer.
SAFETY AND TOLERABILITY OF FOLFOX, 4 IN THE ADJUVANT
TREATMENT OF COLON CANCER IN OUR POPULATION
HEERANAND, AHMED USMAN, KHALEEL MAHER
Department of Clinical Oncology
Jinnah Postgraduate Medical Centre, Karachi
AIM: The MOSAIC trial showed that FOLFOX 4 improves over all survival as
compared to 5-FU/LV and infeasible and safe in early stage colon cancer patients
worldwide. Based on these positive results, we decided to conduct a study to
evaluate the safety and tolerability of FOLFOX4 in postoperative adjuvant
treatment of colon cancer in our local population.
METHOD: In this open-label ,non randomize ,single arm feasibility study ,stage
II/III colon cancer patients who had undergone complete resection of a primary
tumor were treated using the FOLFOX4 regimen [2weeks /cycle,12cycles] and
followed up for 8 months.
RESULT: A Total of 37 patients [11 patients Stage II and 26 stage III] referred
to us from different hospitals were included in the study .Overall 28 patients
completed all 12 planned treatment cycle. The incidence of stage 3 and 4
neuropathy was 5.7 and 0 respectively. A Total of 9 serious adverse events [SAE]
were experienced by 4 patients. . At 8 months follow-up, one patient had relapse
or recurrence.
CONCLUSION: The study demonstrates a favorable safety profile of FOLFOX4
in our patient population. Based on these results FOLFOX4 may be considered
a standard for the adjuvant treatment of colon cancer.
KEY WORDS: 5-Fluorouracil, colorectal cancer, folfox4, leucovorin, oxaliplatin,
CONCURRENT CISPLATIN BASED CHEMORADIATION FOR
LOCALLY ADVANCED HEAD AND NECK CANCERS: EXPERIENCE
AT KIRAN
SYED AMIR MAQBOOL, CONSULTANT CLINICAL ONCOLOGIST
Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi
BACKGROUND: Head and neck cancer is a common malignancy in Pakistan.
Most of them present in locally advanced stage. For locally advanced head and
neck cancers, concurrent chemoradiation is most common option. We are
presenting this study to determine the benefit concurrent chemoradiation in
locally advanced head and neck cancers in our patients.
MATERIALS & METHODS: During January 2009 to December 2009 patients
with locally advanced head and neck cancer, underwent concurrent chemoradiation
with weekly Cisplatin 100mg/m2 on Day1, 22 and 43. Radiotherapy was given
with 3-DCRT technique, total dose 6600 cGy in 33 fractions. Response was
defined using recist criteria on clinical exam, laryngoscopy and CT scanning.
Toxicity was assessed using NCI-CTC criteria.
RESULTS: Among 30 patients, 23 patients completed CCRT of whom visible
complete response (CR) was seen in 55% patients and partial in 18% patients,
stable disease in 5% of patients 22 % of patients had progressive disease. No
grade III or grade IV hematological toxicity seen.
CONCLUSION: Concurrent chemoradiation is very effective and well tolerated
modality for locally advanced head and neck cancers.
MANAGEMENT OF PAIN DUE TO POLYTRAUMA IN BOMB BLAST
BRIG. M. SALIM
Professor of Anaesthesiology
Trauma is a major cause of mortality throughout the world. In recent years, major
advances have been made in the management of trauma, the end result of which
has been reduced mortality and enhanced function. One of these areas is pain
control. Improved pain management has not only led to increased comfort in
trauma patients, but has also been shown to reduce morbidity and improve long-
term outcomes.
The treatment of pain in the setting of acute injury and on pain management in
trauma patients who go on to develop chronic pain. Emphasis is placed on
pharmacologic interventions, invasive and noninvasive pain management
techniques, analgesia in challenging patients, and pain control in commonly
encountered trauma conditions.
Over the past two decades, researchers have discovered that the persistence
of severe, inadequately treated pain can lead to anatomic and physiologic
changes in nervous system The ability of neural tissue to change in response
to repeated incoming stimuli, a property known as neuroplasticity, can lead to
development of chronic, disabling, neuropathic pain when acute pain is poorly
treated .The stress response after multiple trauma is far greater than that after
elective surgery.
KEYWORDS: Pain Management, Trauma Patients, Chronic Pain, Pharmacologic
Interventions
BATTLEFIELD ANESTHESIA
DR FAZAL HAMEED KHAN
Mohammad Bhai Professor of Anesthesia
Medical Director and Associate Dean Clinical Affairs
The Aga Khan University Hospital Karachi
Battlefield anesthesia primarily describes a state of balanced anesthesia using
adequate amounts of anesthetic agents to minimize cardiovascular instability,
amnesia, analgesia, and a quiescent surgical field in a technologically difficult
environment.
Adapting anesthetic techniques to battlefield conditions requires flexibility and
a reliance on fundamental clinical skills. While modern monitors provide a wealth
of data, the stethoscope may be the only tool available in such environment.
Thus, the value of crisp heart sounds and clear breath sounds when caring for
an injured war wounded person should not be underestimated.
In addition, close collaboration and communication with the surgeon is essential
The practice of battlefield anesthesia is very different from that of civilian’s
anesthesia. Battle casualties are usually young men without pre-existing diseases,
and their injuries are often markedly different from those of civilian trauma patients
.The injuries reflect the ever developing arsenal used on present day battlefields
and may include missile fragments, which cause severe trauma because of their
irregular shape ,size and trajectory in the body, and high velocity gun shots,
which have increased wounding power .Other physical injuries include burns,
blasts, blunt injuries, inhalation of toxic fumes and the threat of non-conventional
chemical injuries. Additionally,a field hospital should be ready to care for traumatised
patients of all ages. Casualties often arrive en masse, dictating fast and careful
establishment of resuscitation and surgical priorities. The improving techniques
of anesthesia, operations and transport system have augmented the number of
critically injured patients being resuscitated, thus increasing the challenge of
battlefield anestheia.
MANAGEMENT OF BURNS DUE TO BLAST INJURY-
ANAESTHETIST’S CONTRIBUTION
DR MUHAMMAD QAMARUL HODA
Professor
Department of Anaesthesia
The Aga Khan University Hospital Karachi
In the past, blast injuries were usually associated with conventional warfare or
unintentional accidents occurring in the workplace or at home. Bomb blast injuries
to civilians in a non-combat setting have become increasingly common over the
last decade, mainly as acts of terrorism. It is important to have an understanding
of explosives and explosive forces to understand the types of injuries that these
devices are capable of.
Blast injuries cause 4 distinct types of injuries; Thermal injuries from explosions
are classified as quaternary blast injuries; may cause flash burns over exposed
body parts (e.g., hands, neck, and face) or inhalational injury with exposures of
toxic substances such as asbestos dust, carbon monoxide, cyanide, white
phosphorus, and phosgene gas in cases of confined space explosions.
Burned patients are probably the sickest patients a physician will ever see.
Effective management of these thermal injuries associated with primary blast
injury, particularly blast lung injury, may be challenging due to conflicting fluid
requirements. The management of multidimensional burns patient, complicated
by other injuries, is a particular challenge, with implications in anaesthesia, acute
pain, intensive care and patient transfer services areas. The anesthesiologists’
Knowledge of physiology and pharmacology and their ability to resuscitate
critically wounded patients put them in the front line in a major explosion incident.
As their training and experience, are well-adapted to the early management of
all these forms of trauma, particularly in providing life-support stabilization for
physical trauma, and their understanding of the detailed physiology and
pharmacology of the respiratory, cardiac, and nervous systems makes them an
integral part and valuable member of disaster management and planning team.
Anaesthetists’ involvement for mass casualty includes a forward deployment of
anaesthesiologists to emergency department (ED) together with ED physicians
and surgeons are crucial. The anaesthesiologist’s ability to manage the airway,
initiate mechanical ventilation, administer fluids, insert intravenous and arterial
catheters, and treat shock and manage pain is important in the setting of burn
patients of blast injury.
ANAESTHETIC MANAGEMENT OF CARDIO THORACIC INJURIES
DUE TO BOMB BLAST
PROF. NAJMA AMJAD
Head of the department
Anaesthesiology & Intensive Care
National Institute of Cardiovascular Diseases, Karachi
Blast injuries caused by powerful explosion have occurred at a relatively steady
rate all over the world, often caused by home or work place accidents. Today
explosions due to intentional/suicide bombing is the most common cause of
injury associated with terrorism affecting the general population, particularly in
our part of the world. Blast victims often show a combination of 4 main groups
of trauma: (1)ÊBlast, (2) Blunt, (3) Penetrating, (4) Thermal.
There are four basic mechanisms of blast injuries: (i)ÊPrimary - direct effect of
pressure, (ii) Secondary - the effect of projectiles from explosion, (iii) Tertiary -
structural collapse, and (iv) Quaternary - burn and inhalation injury.
In a report following a suicide bombing in a mosque, the pattern of injuries were
as follows. Rupture of tympanic membrane 41%, chest injury 40%, shrapnel
wound 36%, fractures 18%, head trauma 12%, and abdominal injury 5%.
Cardiac thoracic injury accounts for at least 40% of injures due to bomb blast.
Despite being potentially life threatening, most thoracic trauma is managed non
operatively, with a chest tube. only 10 % of these patients requires emergency
thoracotomy.
Some of the pertinent cardio thoracic injuries due to bomb latest are:Ê Tracheo
bronchial injuries, haemo thorax, pneumo thorax Êpulmonary Êcontusion, flail
chest, blast lung, diaphragmatic injuries, cardiac contusion, penetrating cardiac
injury with cardiac tamponade, great vessel injury. e,g aortic injury.
Anaesthesiologist`s knowledge of physiology, pharmacology and their ability to
resuscitate critically wounded patients, puts them in the front line in a major
explosion incident. Cardio thoracic blast injuries are dynamic and it is crucial
Êfor an anaestheiologist to provide care to this group of Êpatients, in expanded
Êrange of scenarios and environments, starting Êfrom initial resuscitation and
optimization, anaesthetizing for emergency thoracotmy or damage control surgery
and management of these patients, post operatively in intensive care.
KEY WORDS: BLAST LUNG injury, damage control surgery, rapid sequence
induction, double lumen tube, major haemorrhage.
CHALLENGES FACED BY THE ANAESTHETIC TEAM IN
POLYTRAUMA DUE TO BOMB BLAST
BRIG. ASIF GUL KAYANI
Head Department of Anaesthesiology
Combined Military Hospital (CMH) Bahawalpur
In a bomb blast situation the trauma management team faces unique challenges.
There may be a mass casualty scenario involving high morbidity and mortality.
In addition to the obvious effects of major trauma, patients can have serious
multi organ damage due to the blast wave resulting in ‘blast injuries’. Blast injuries
result from the complex pressure wave generated by an explosion. Air-filled
organs (e.g. ear, lung, and gastrointestinal tract) and organs surrounded by fluid-
filled cavities (e.g. brain and spinal cord) are particularly susceptible to primary
blast injury. The pressure wave dissipates quickly, causing the greatest risk of
injury to those closest to the explosion. Injuries can also occur by other mechanisms
due to a blast, e.g. impact from blast debris, being physically thrown, burns and
inhalation of gases. Blast injuries are divided into 4 categories:
• A primary blast injury is caused by the direct effect of blast overpressure on
tissue. The injury almost always affects air-filled structures such as the lung, ear,
and gastrointestinal tract.
• A secondary blast injury is caused by people being hit by flying objects.
•A tertiary blast injury is caused by high-energy explosions and occurs when
people fly through the air and strike other objects.
•Miscellaneous blast-related injuries include all other injuries caused by explosions,
e.g. due to fire or collapse of buildings.
PRESENTATION
• Lungs may show evidence of pulmonary trauma and . Wheezing may be due
to pulmonary contusion, inhalation of irritant gasses or dusts, or (ARDS).
• Rupture of tympanic membrane may but not always indicate additional more
serious injury.
• Abdominal injuries from explosions may not be immediately obvious and serial
examinations are often required. Intestinal haematoma can take 12-36 hours to
develop. Abdominal x-ray (erect and supine) or CT to detect pneumoperitoneum.
OTHER ASSOCIATED COMPLICATIONS
• Injury to the renal tract.
• If the explosion occurred in an enclosed space or was accompanied by fire,
test carboxyhaemoglobin () and electrolytes to assess acid-base status.
• If significant , , or severe burns, may cause and myoglobinuric .
• Burns from military white phosphorous munitions may cause and . White
phosphorus is a widely used component of military munitions, including hand
grenades.
• Chest x-rays are required for all those who have been exposed to high-pressure
injury.
MANAGEMENT: The Anaesthetist Team should be physically and intellectually
ready to handle a highly demanding situation. Anaesthetists’ help may be required
in pre-hospital management but usually has to play a vital role in resuscitation
and peri-operative management within the hospital.
OPTIMISING POLYTRAUMA PATIENTS AT THE SITE OF BOMB
BLAST
DR. M. YOUNIS KHATRI
The Bomb Blast incidents are increasing day by day. The explosive devices
cause injuries through several mechanisms, like penetrating fragment wounds,
blunt injuries and hollow viscera injuries due to blast pressure. When blast
overpressure wave reaches the person causes direct tissue damage by Spallation,
Implosion and shearing forces, mainly involve lungs, gut and ear.
The patients are categorized and labeled as, immediate care (red), delayed care
(yellow) and unsalvageable (black). All patients with life threatening injuries
should be identified and provided appropriate trauma care. Repeated re-
assessment is required to prevent late diagnosis of potentially life and limb
threatening injuries.
Explosion forces can give rise to pulmonary haemorrhage, contusions, direct
barotraumas and arterial air embolism. Maintain and protect airway, place the
affected lung in the dependent position, needle decompression of the chest for
tension pneumothorax. Two large bore intravenous lines are passed for fluid
therapy in haemodynamic unstable patients. Abdominal solid organs and viscera
can give rise to intestinal perforation or ischaemia as the result of blast pressure.
Head injury, cervical injury and spinal injury need special care during transport
by applying cervical collar and placing the patient on long back board. Limb
injuries include amputation, fractures, crush injuries need immobilization by splint
and cover the wound if any with sterile dressing.
CONCLUSION: Maintain and protect the airway, protect the spine by collar or
long backboard, two large bore I/V lines for fluid resuscitation, immobilize fractures
and apply sterile dressing on open wound. Then shift the right patient to the right
hospital at the right time.
KEY WORDS: Polytrauma patients, bomb blast injuries, pre-hospital triage.
MANAGEMENT OF MAJOR HAEMORRHAGE IN POLYTRAUMA
PROF. SAEEDA HAIDER
Chairperson, Department of Anaesthesiology
Surgical Intensive Care & Pain Management
Dow University of Health Sciences, Karachi
Trauma has become the leading cause of death specially in the younger population
world wide. Uncontrollable haemorrhage accounts for 40% of trauma related
deaths which is a potentially preventable cause.
Coagulopathic bleed adding on to the Surgical vascular injury is multi-factorial,
“Bloody vicious cycle” and the “Lethal Triad” result in fatal exsanguination.
Combined Strategy of “Damaged Control Surgery” and judious management of
replacement of fluids & blood components formulate the contemporary approach
to this clinical issue. Re-evaluation of transfusion practices and understanding
of the end points of resuscitation improve outcome in polytrauma.
TRANSPORT OF PATIENTS FROM THE BOMB BLAST SITE
DR AKHTAR AZIZ KHAN
The Indus Hospital, Karachi
This is a very vast subject and involves multiple steps as well as multiple personnel
and severe logistical problems.
There have been multiple reports and papers out on handling mass casualties
and specially bomb blast injuries from both the developed countries and the
developing countries. All these reports seem to have one thing in common that
no country, city, county or even a small village can be prepared for a major
calamity (natural) or disaster (manmade).
It is a common feature that the first injured to arrive at the nearest medical facility
whether it is a trauma center or not are persons with minor injuries as cuts and
bruises and they seem to clog up the emergency room and hence leads to delay
in treating persons who are seriously injured and who can be salvaged. The
other thing which is very common is persons who cannot be savaged or are
already dead are transported first to the trauma center and this further adds to
the agony of medical personnel who cannot attend the patients who can be
saved.
All these issues need to be addressed and there should be a starting point. What
should be the starting point is very important.
• Teaching and training of medical personnel as to how to do triage
• Who should do triage
• Which patients to be shifted first
• Where to take the injured ( coordination between hospitals and ambulance
services)
I will be elaborating mainly on the last two points in the presentation with lessons
which we have learnt in recent past in our own city.
ROLE OF GRAY SCAL AND DOPPLER ULTRA-SOUND IN THE
DIAGNOSIS OF PAINLESS SCROTAL MASSES IN PATIENTS
PRESENTING AT CIVIL HOSPITAL KARACHI
1DR ZAHOOR AHMED KHATRI & 2DR SABA SOHAIL
1FCPS-II Trainee, 2Associate Professor
Department of Radiology
Dow University of Health and Sciences
Civil Hospital, Karachi
{E-mail: dr.zahoorkhatri@gmail.com}
INTRODUCTION: Patients presenting with scrotal or testicular mass require
diagnostic imaging which provide information which may not be available from
clinical examination alone .most frequent conditioned causing painless scrotal
masses include hydrocele, spermatocele, cyst, malignant and benign tumours.
Testicular and scrotum related disorders account for 3.7% of surgical admission
in a tertiary care hospital.
OBJECTIVE: The objective of this study is to determine the role of gray scale
and Doppler Ultrasound in the diagnosis of painless scrotal masses by taking
histopathology as gold standard.
STUDY DESIGN: Cross sectional study.
SETTING: Department of Radiology, DUHS/Civil Hospital, Karachi.
DURATION: from June 2006 to till June2007
PATIENTS AND METHODS: A total of 70 patients with painless scrotal mass
were included in the study. Sonographic and clinical examinations have been
preformed in both supine and erect position in a room affording privacy. All
subjects have been examined with a NEMO 17 Color Doppler scanner equipped
with 11 MHz biconvex and linear transducers patients were scanned in supine
position. The scrotal contents were elevated by folded towel positioned between
the patients’ legs. Penis was positioned over the supra pubic region draped with
second towel. Some patients were scanned in erect posture as per need. Doppler
ultrasound was done to assess and document the blood flow, spectrum, and
velocity of flow and indices in the epididymis, as well as in the lesion.
RESULTS: The average age of the patients was 38.51 ± 9.4 years (95%CI:
37.16 to 40.24). The most common scrotal mass was hydrocele 24(34.29%)
patients followed by varicocele 13(18.57%), testicular tumors 12(17.14%),
spermatocele 11(15.71%) and epididymal cyst was observed in 10(14.29%)
patients. Out of 12 testicular tumors, 05 cases of seminoma (41.7%) were seen;
embryonal cell carcinomas were detected in 02(16.7%) patients. Two cases were
epidermoid cyst (16.7%), 01(8.3%) case teratoma, 01(8.3%) choriocarcinoma
with metastasis and 01 case of testicular lymphoma (8.3%). Sensitivity and
positive predictive value of the gray scale and Doppler Ultrasound were 66.7%
and 100%.
CONCLUSION: Gray scale ultrasound in combination with colour Doppler ultra
sound is continuing to be a fast, effective and noninasive technique ofÊchoice
in the patients present withÊpainless scrotal masses.
KEY WORDS: Ultrasound, painless scrotal mass, testicular tumor
COMPARISON OF CT AND SONOGRAPHY IN THE DIAGNOSIS OF
ACUTE APPENDICITIS
DR. RUBINA ASHRAF, DR. MUHAMMAD AYUB MANSOOR
Liaquat National Hospital, Karachi
OBJECTIVE: Our objective was to compare the accuracy of CT and sonography
for the diagnosis of acute appendicitis in patients with suspected acute appendicitis
at our institute.
SUBJECTS AND METHODS: In this prospective study, 22 consecutive patients
with clinical signs and symptoms of acute appendicitis were examined with
sonography and CT. The primary sonographic criterion for diagnosing acute
appendicitis was an incompressible appendix with a transverse outer diameter
of 6 mm or larger with incompressible periappendicular inflamed fat with or
without an appendicolith. The primary CT criterion for diagnosing acute appendicitis
was the identification of an appendix with a transverse outer diameter of 6 mm
or larger with associated periappendiceal inflammatory changes. The results,
independently reported, were correlated with surgical findings.
RESULTS: Eighteen patients had acute appendicitis at surgery, and 4 patients
did not. The sensitivity of CT and sonography was 87.5% and 80% respectively;
the specificity was 66.6% and 75%; the positive predictive value was 100% and
57.1%; and the negative predictive value was 66.6% and 50%.
CONCLUSION: CT and sonography performed for the diagnosis of acute
appendicitis have comparable sensitivity and specificity.
FREQUENCY OF PENILE ARTERIAL INSUFFICIENCY AND VENOUS
LEAKAGE IN PATIENTS HAVING ERECTILE DYSFUNCTION BY
COLOR DOPPLER SONOGRAPHY
ADNAN HASHMI, JAVED MEHBOOB, ABID HAMEED
Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi
{E-mail: dradnanhashmi@hotmail.com}
OBJECTIVE: To determine the frequency of penile arterial insufficiency and
venous leakage in patients having erectile dysfunction by color Doppler sonography.
MATERIAL METHODS: The study was conducted at the radiology department
of KIRAN hospital , Karachi. A total of 30 patients between ages of 20 to 67 years
presenting with history of erectile dysfunction were evaluated with duplex color
Doppler ultrasound. Spectrum was obtained from each patient at 5 mins interval
for 30 mins following intracavernosal injection of 50 mg papaverine Hcl. Physical
clinical examination and endocrine profile was also done which was within normal
limits.
RESULTS: the mean age of patients were 37.3±12 yrs (20-67). Following 50 mg
papaverine Hcl , 23 of 30 patients (76%) had normal, while 7 out of 30 patients
(24%) had abnormal PSV and EDV. 2 out of 30 patients ( 6 % )had PSV of less
than 35 cm/s (Normal= >35cm/s) indicating arterial insufficiency. 5 out of 30 (
25% )patients had EDV more than 5 cms/s (Normal = < 5 cms/s) indicating
venous leakage.
CONCLUSTION: This study concludes that we detect by Doppler ultrasound
arterial insufficiency (6%) and venous leakage (25%) as a cause of erectile
dysfunction. Hence Doppler ultrasound can be used as baseline investigation
in these patients and can reliably rule out the vasculogenic cause of erectile
dysfunction from physical, psychological and pharmacological etiologies.
DIAGNOSIS AND STAGING OF OVARIAN CANCER; COMPARATIVE
S T U D Y B E T W E E N U LT R A S O U N D A N D C O M P U T E D
TOMOGRAPHY, CORRELATED WITH SURGERY
DR. SAIRA NAZ
Consultant Radiologist
Department of Radiology and Imaging
Liaquat National Hospital, Karachi
INTRODUCTION: Ovarian cancer is the second most common gynecological
malignancy. Ovarian cancer causes more deaths than any other cancer of the
female reproductive system. The incidence & mortality rate of ovarian cancer
increases with age & peak at the age of 80 years. Other risk factor include early
onset of menses, nulliparity, family history of ovarian cancer, breast cancer &
late menopause.
METHODS: The study was completed during 16 months, done from 02,10,2002
to 12,02,2004 and carried out for 50 patients Women over 18 yrs of age, referred
to Ziauddin Hospital were admitted to the study if they were suspected to have
ovarian cancer on the basis of abnormal results of a pelvic examination and/or
a preliminary pelvic US study.
Ultrasound was done with real time 3.5 MHZ convex scanner of Tosbee machine.
CT scan was done on Toshiba-CT system. Surgery was done in all 50 cases.
Staging was done according to Modified F.I.G.O.
RESULTS: The results of analysis of sensitivity and specificity pair suggest that:
• Ultrasound was more sensitive (100%) but less specific (27%) than CT scan
(50%, 87%respectively), for the detection of stage I.
• CT was more sensitive (75%) and almost equally specific (80%) than ultrasound
(10%, 95%respectively), for the detection of stage II.
• CT was more sensitive (54%) and almost equally specific (97%) than ultrasound
(27%, 100%respectively), for the detection of stage III.
• CT was more sensitive (100%) and almost equally specific (95%) than ultrasound
(75%, 100%respectively), for the detection of stage IV.
CONCLUSION: Our study shows that CT is consistently better then US in ovarian
cancer staging, especially for stage II, III, and IV.
KEY WORDS: Ovarian carcinoma, Ultrasound, Computed tomography, Surgical
staging.
ROLE OF ABDOMINAL ULTRASOUND INTRAUMA PATIENTS
VAQAR BARI & S M FAISALMOSHARRAF
Department of Radiology
Aga Khan University Hospital Karachi
OBJECTIVE: To evaluate sensitivity, specificity, feasibility and accuracy of
ultrasound in detecting hemoperitoneum in blunt trauma patients.
DESIGN: A prospective and descriptive study.
PLACE AND DURATION OF STUDY: Radiology Department, Aga Khan
University Hospital Karachi from Nov 2006to 30thFeb 2007.
SUBJECTS AND METHODS: All victims of blunt abdominal trauma presenting
to emergency room of Aga Khan University Hospital over the age of fifteen years
were included in the study. Patients were excluded if a bedside ultrasound
examination was not completed or expired in the early period before CT or other
imaging examinations could be done or if injuries were not confirmed by laparotomy
or autopsy.
RESULTS: Out of the 148 adult patients, 115 were males and 33 females.
Presenting age ranged from 16 to 74 years. There were 15 true positive and 131
true negative results. One case was false positive and 1 false negative. Sensitivity
was 93.75%, specificity 99.24%, accuracy 98.64%, positive predictive value
93.75% and negative predictive value99.29%.
CONCLUSION: Ultrasound is safe, cost effective, sensitive, specific and accurate
in detecting hemoperitoneum in patients with blunt abdominal trauma.
FIRST STUDY OF UTERINE ARTERY DOPPLER SCREENING IN
THE SECOND TRIMESTER FOR PREDICTION OF ADVERSE
PREGNANCY OUTCOME IN HIGH-RISK PAKISTANI WOMEN
NURUDDIN MOHAMMED, RAHAT QURESHI, ROZINA NURUDDIN*, LUMAAN
SHIEKH, AISHA WALI
Department of Obstetrics and Gynaecology, Aga Khan University, Karachi
Division of Epidemiology and Biostatistics, Department of Community Health
Sciences,
Aga Khan University, Karachi
INTRODUCTION: The aim of this prospective study was to assess the role of
uterine artery Doppler (UtAD) studies in high-risk pregnancies in the second
trimester for prediction of adverse pregnancy outcomes such as intra-uterine-
growth-restriction (IUGR), gestational hypertension (GH), pre-eclampsia (PE),
stillbirth and placental-abruption.
METHODS: UtAD studies were performed between 16-23 weeks of gestation
in singleton high-risk pregnancies. Each woman had only one UtAD ultrasound.
Pregnancies with diagnosed fetal abnormalities were excluded. Data from 219
high-risk women were evaluated.
RESULTS: Mean maternal age was 29 years (SD 5.1). Mean gestational age
for UtAD and for delivery was 20 weeks (SD 2.43) and 37 weeks (SD 2.85),
respectively. Average birth-weight was 2.63kg (SD 0.72). The estimated prevalence
of adverse pregnancy outcome was 45%. For all outcomes, the test positive and
negative predictive values were 59% (95%CI: 51%, 66%) and 96% (95%CI:
86%, 99%) respectively and the test sensitivity and specificity were 98% (95%CI:
92%, 99%) and 44% (95%CI: 35%, 53%), respectively. Sixty-nine women (32%)
had IUGR, 15 (7%) and 28 (13%) developed GH and PE respectively. There
were two (1%) placental abruptions and stillbirths, respectively. The conventional
positive and negative likelihood ratios were 1.75 (95%CI: 1.49, 2.06) and 0.05
(95%CI: 0.01, 0.18).
CONCLUSION: Uterine artery Doppler studies is a useful tool in the second
trimester for prediction of adverse outcomes in at-risk pregnancies with high
negative predictive values.
MRI IMAGING IN THE EVALUATION OF MEDICALLY INTRACTABLE
EPILEPSY
MAHREEN RASOOL, MUHAMMAD SALMAN, NADIRA ABID, SAIMA IMRAN,
TARIQ MAHMOOD.
Department of Radiology
Jinnah Postgraduate Medical Centre, Karachi
OBTECTIVE: To determine the efficacy of dedicated epilepsy protocol MRI in
the evaluation of medically refractory epilepsy.
INTRODUCTION: The imaging of epilepsy has changed during the last 15 yrs.
Prior imaging with Computed axial Tomography infrequently revealed the
pathological substrate for epilepsy. Routine MRI will exclude ominous structural
abnormalities that require intervention such as gliomas and arteriovenous
malformations, subtle structural substrates such as hippocampal sclerosis and
malformations of cortical development (MCDs) are usually missed. The advent
of the high-resolution magnetic resonance imaging with a dedicated epilepsy
protocol has significantly increased the frequency that a pathologic substrate for
epilepsy is identified. This has had a dramatic clinical impact on the evaluation
and management of epilepsy.
PURPOSE OF STUDY: Is to establish the importance of adding a dedicated
epilepsy protocol MRI in the evaluation of partial onset complex seizure also
known as temporal lobe epilepsy.
METERIAL AND METHODS: A descriptive cross-sectional study, conducted at
department of radiology, Jinnah Postgraduate medical centre, Karachi over a
period of six months ( July to Dec 09). Age ranged 20-50 yrs, patients with the
clinically proven partial complex seizures and long duration epilepsy with suspected
temporal lobe focus underwent MRI examination. MRI was performed using
conventional T1 and T2 weighted axial and FLAIR coronal images with 5 mm
slice thickness and gap of 1 mm, while dedicated epilepsy protocol includes
3mm coronal oblique images with a gap of 0.3mm through hippocampus.
Gadolinium was used when tumor or a vascular malformation was suspected
on routine imaging. MRI examination were evaluated for Mesial temporal sclerosis
using variables of change in signal intensity, atrophy or sclerosis of Mesial
temporal lobe and for other temporal lobe abnormalities including dysplasis,
AVMs and Tumor.
RESULTS: Out of 40 patients included in study, 27 patients had Mesial Temporal
sclerosis; out of them 23 patients presented with unilateral involvement. Bilateral
involvement found in 4 patients and 1 patient out of these 4 also had associated
periventricular leukomalacia. Dual pathology found in 2 patients having
arteriovenous malformation along with mesial temporal sclerosis. 3 out of 40
patients having enlarged temporal lobe, due to cortical dysplasia in 2 patients
while 1 had low grade tumor. No abnormality found in remaining 8 out of 40
patients.
CONCLUSION: Adding a high resolution dedicated epilepsy protocol MRI has
revolutionized the evaluation of Temporal lobe epilepsy.
Role of Radiology in the Management of Chronic Liver Disease:
Dr. Tanveer Ul Haq
Associate Professor,
Aga Khan University Hospital
Karachi.
Chronic liver disease secondary to viral hepatitis is endemic in Southeast Asia.
The prevalence is growing. Along with the disease the frequency with which
its complications are encountered in clinical practice are also increasing. The
common complications being portal hypertension and malignant transformation
with development of hepato-cellular carcinoma. Radiology plays a central role
in the management of chronic liver disease and its complications.
Tripahsic computed tomography is now the standard of care in the diagnosis of
hepato-cellular carcinoma with tissue diagnosis with biopsy only required in a
small number of equivocal cases. Similarly Radiorfrequency abalation (RFA)and
Transcatheter Chemo-embolisation, Radiofrequency ablation (TACE)give survival
benefits similar to hepatic resection .
The presentation will highlight the role of radiology in the diagnosis of conditions
such a hepatocellular carcinoma, portal hypertension and ascities. The role of
ultrasound, multiphase CT and MR in the diagnostic algorithms, and the role of
Transcatheter Chemo-embolisation, Radiofrequency ablation, alcohol injection,
trans jugular intrahepahtic porto systemic shunting and other interventional
radiology techniques in the treatment of the complication of CLD will be reviewed.
SECOND SESSION
2.2 Magnetic Resonance evaluation of the White Matter.
Zafar Sajjad
Visiting Professor
Jinnah Post Graduate Medical Centre.
Karachi.
Although Magnetic Resonance Imaging has revolutionised the entire field of
neuroimaging, one of its most significant impacts has been in the area of imaging
of the abnormalities of the white matter of the brain and the spinal cord.
With the MR imaging it was possible for the first time to differentiate between
the various pathological processes in the living brain that lead to disease states.
for example no other modality allows the rapid and accurate differentiation of
oedema, demylination and infarction (all of these would appear as low attenuation
areas on CT scanning) as does MRI.
Using this we are now able to detect and characterise disease of the white matter
very early in the course of the illness. In fact the sensitivity of MRI for white
matter lesions is so high that we sometimes detect abnormalities, the clinical
significance of which are doubtful. From this dilemma was born the entity called
Unidentified Bright Object or UBOs. Although it is convenient to label lesions
as UBO early plaques of Multiple Sclerosis also appear similar and the diagnostic
dilemma is not easy to resolve.
This review will not only try to answer the fundamental question of MS vs UBOs
but also highlight the features of the more common white matter disorders such
as ischaemic "demylination", Acute Disseminated Encephalo Mylitis, Progressive
Multifocal Leucoencephalopathy, and touch upon the metabolic and inherited
white matter disorders.
ABSTRACTS FOR FREE PAPERS
FIRST SESSION
1.1 EVALUATION OF CONGENITAL HEART DISEASE BY MULTIDETECTOR
CT
DR. RUKHSANA TARIQ, DR. SHAHZAD BABAR & DR. RASHID AHMED
Advanced Radiology Clinic (Pvt.) Ltd.
Behind Taj Medical Complex, Off. M. A. Jinnah Road, Karachi.
{E-mail: arcra@cyber.net.pk}
INTRODUCTION: Echocardiography is the diagnostic modality of choice in
patients with CHD. The aim of the study was to establish the role of multi-detector
CT complimentary to echocardiography in order to assess morphologic and
functional information especially in pre and post surgical evaluation and detection
of concurrent extra-cardiac anomalies.
MATERIAL AND METHODS: Thirty patients with known CHD of different ages
and both sexes were included in the study after a preliminary clinical examination
by a pediatric cardiologist and echocardiographic examination. All MDCT studies
were performed to resolve equivocal features on echocardiography and to answer
specific questions raised by an inconclusive echocardiography and assessment
of extra-cardiac abnormalities. The images were reviewed by two senior
radiologists.
RESULTS: All patients diagnosed with congenital heart disease on
echocardiography with an inconclusive on equivocal features were successfully
evaluated on MDCT. Generally complex and combination of anomalies were
seen. Extra-cardiac anomalies were seen in 17 cases. Intra-cardiac
communications were seen in 10 cases. Tetralogy of Fallot was noted in 6 cases.
Right sided aortic arch and isomerism were seen in 1 case each. Abnormal
vascular connections were observed in 5 cases. Anomalous coronary arteries
were seen in 3 cases. Bilateral SVC was seen in 2 cases. 4 Post surgical cases
included RSP shunts, aortic graft with mural thrombosis and pulmonary valve
replacement.
CONCLUSION: The study was able to present a wide variety of anatomic and
pathologic examples of CHD pertinent to the cardiac surgeon for pre-surgical
assessment and road mapping. MDCT has revolutionized the imaging spectrum
and successfully met the challenge.
1.2 CT GUIDED LUNG ABSCESS DRAINAGE
Dr MAHIRA YUNUS
Associate Professor
Department of Radiology
Sindh Institute of Urology & Transplantation, Karachi
OBJECTIVE: To determine the efficacy of CT- guided transthoracic catheter
drainage of intrapulmonary abscess considering success rate versus complications.
MATERIALS & METHODS: This prospective study was carried out at radiology
department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from 1.1.2003
to 31.12.2005 (about 2 years). 19 patients were selected for CT guided
percutaneous drainage. Under CT guidance catheter placement was carried out
using Seldinger technique.
RESULTS: Nineteen patients with lung abscess were selected in this study for
the percutaneous CT guided drainage. Out of these nineteen patients, in eight
patients (42.105%) no complications occurred and lung abscess was completely
resolved with no residual cavity. Five out of nineteen patients (26.31%) developed
pneumothorax, which is the most common complication occurred during this
study. These patients were kept under observation and followed-up by chest X-
rays. Three of them (15.78%) had mild pneumothorax, which resolved and
needed no further management, while two patients (10.52%) developed moderate
pneumothorax and chest tube was inserted. Two out of nineteen patients (10.52%)
developed mild hemoptysis and it was resolved within two hours, hence, no
further management was required. Two patients (10.52%) had residual cavity
left, surgery was performed in both cases and revealed congenital cystic
adenomatoid malformation (CCAM) in both cases.
Two patients out of nineteen patients (10.52%) developed bronchopleural fistula
and were operated. No mortality occurred during or after procedure.
CONCLUSION: CT allows optimal placement of catheter and hence enable safe
and effective percutaneous evacuation of lung abscess. The morbidity and
mortality of patients with percutaneous catheter drainage is lower than with
surgical resection. Hence, CT guided drainage should be considered the first
therapeutic choice in most patients of lung abscess who do not respond to
medical therapy.
1.3 MAGNETIC RESONANCE ARTHROGRAM:
A SCREENING TEST TO DIAGNOSE SHOULDER JOINT
INSTABILITY
*MUNAZZA SALEEM BAIG, ZAFAR SAJJAD
*Resident
Department of Radiology
Aga Khan University Hospital Karachi
INTRODUCTION: Magnetic Resonance Imaging (MRI) has been used with
inconsistent success to diagnose shoulder joint instability. As it has high soft-
tissue contrast, therefore it allows better discrimination of fat, muscle, tendon,
and cartilage.
Magnetic Resonance Arthrography (MR Arth) of shoulder, involving intra articular
contrast injection is the most accurate established imaging method for
demonstrating abnormalities of the glenoid labrum and associated structures.
It provides better anatomic detail than conventional MRI.
MR Arthrography can avert unnecessary diagnostic arthroscopies thereby reducing
the workload of an orthopedic surgeon and financial burden and anesthesia
related complications amongst patients. Besides this, it can also help surgeons
in preoperative planning by providing excellent anatomical and pathological
details.
MATERIALS AND METHODS: MR Arthrography shoulder and Arthroscopy
findings in 40 patients referred to the Radiology department AGA Khan University
hospital Karachi, by primary physicians with suspected shoulder instability
between September 2008 and August 2009 were recorded. Arthroscopy was
taken as gold standard. The data was collected on the proforma and analyzed
on SPSS Version 10 assessing the sensitivity, specificity, the negative and positive
predictive values and accuracy of MR Arthrpgraphy shoulder against the gold
standard.
RESULTS: MR Arthrography shoulder has a sensitivity of 94%, specificity of
100% positive predictive value of 100%, and negative predictive value of 60%
and diagnostic accuracy of 95 % in assessing shoulder joint instabilities.
CONCLUSION: MR arthrogram shoulder is highly accurate in the detection of
shoulder instability.
KEY WORDS: MRI shoulder arthrogram, MR Arth, labrum, gleno-humeral
ligaments, biceps tendon, rotator cuff.
1.5 AWARENESS OF RADIATION PROTECTION IN CLINICAL AND
NON-CLINICAL STAFF
SHAHEEN DHANANI, AFSHEEN MAHMOOD, AMIN RAJANI & FAREED
JUMANI
Department of Radiology
The Aga Khan University Hospital, Karachi
INTRODUCTION: Increasing concern has recently been expressed in the literature
that the referring clinical and non-clinical staff knowledge of radiation doses
incurred during radiological procedure is inadequate. Such information may be
particularly relevant when the expansion of imaging technology is considered.
To assess this, a survey was conducted of the awareness of radiation dose and
risk among health professionals.
OBJECTIVE: “To evaluate the level of awareness about radiation protection in
clinical & non-clinical staff.”
METHOD & MATERIAL: The authors develop two questionnaire level “A” & “B”.
Level “A” is for radiation technologist & level “B” is for non-clinical staff of AKUH.
The questionnaire of level “A” pertaining to radiation protection practices,
procedures, dose limits & existing of national & international standards. The
questionnaire of level “B” contained basic radiation protection awareness from
nurses of different wards, clinical receptionist, porters etc. 50% radiation
technologist & 50% non-clinical staff (1:1) evaluated prospectively.
RESULTS: Survey for Non- Clinical Staff: A total no. 50 questionnaires were
distributed in non-clinical area of radiology including radiological reception, ER,
C1, B1. Out of which 86% questionnaires were returned with answers, 14 % of
them refused.
Numerical Representation:
Location No. of Non- Clinical Staff
ER 14
C1 9
B1 12
Radiology reception 8
Survey for Clinical Staff: A total no. 50 questioners were distributed in Radiology
AKUH including radiographers and senior radiographers. Out of which 92 %
were returned with answer, 8 % of them refused.
• 55% males were evaluated.
• 45 % females were evaluated.
• 13% were not interested to give their data.
• 30% were senior radiographer.
• 69% were radiographers & trainee radiographers.
CONCLUSION: Our survey demonstrated that the awareness level of non-
clinical staff is 60% which is satisfied but they should have more knowledge
because they have little bit exposure during portable x-rays & departmental
procedures. Awareness level of clinical staff is 67.3% which is not satisfied
because they are continuously working in radiation area so they need more
attention regarding to the awareness of radiation protection. We increase this
level by arranging different sessions, quiz or by distributing pamphlet or handouts
regarding to the hazards of radiation.
SECOND SESSION
2.1 TO DETERMINE THE SENSITIVITY OF DIFFUSION WEIGHTED MR
IMAGING (DWI) IN DETECTION OF ENDOMETRIAL CARCINOMA (CASE
CONTROL STUDY):
ROLE OF ADC (APPARENT DIFFUSION COEFFICIENT) VALUES
*IMRANA MASROOR, DR. MUHAMMAD ZEESHAN, DR SHAISTA AFZAL, DR.
GULNAZ SHAFQAT, DR. NADEEM AHMED
*Department of Radiology
Aga Khan University Hospital, Karachi
PURPOSE: To calculate the sensitivity of MRI utilizing diffusion weighted imaging
(DWI) in detection of endometrial cancer and to investigate whether the ADC
values of endometrial cancer differ from normal endometrium.
INTRODUCTION: Endometrial carcinoma is currently the most common
gynecologic malignancy all over the world.It is usually diagnosed in early stages
because of postmenopausal vaginal spotting or bleeding.Its prognosis depends
on, histologic sub type, grade, depth of myometrial invasion and involvement of
lymph nodes.MRI has been used for proper surgical and therapeutic planning
with relatively high accuracy. Diffusion Weighted ( DWI) MRI is a recently prevailing
technique used to show tissue characteristics based on diffusion motion of water
molecules. The utility of this technique has been established in CNS and is
regarded as most sensitive tool for diagnosing acute cerebral ischemia.The
application of DWI has recently been applied to abdominal organs, and has
depicted malignant tumors with high conspicuity.The measurement of Apparent
Diffusion Co-efficient (ADC) values of tumor versus non tumor has shown great
promise in differentiating them from each other.
METHODS AND MATERIALS: A cross sectional study conducted at Radiology
Department, Aga Khan University hospital, Karachi. Study period was from
January 2007 to June 2009. A total of 30 patients and 30 controls were included
that underwent MRI examination . The patients had surgical diagnosis of
endometrial cancer, and the controls had normal endometrium after
surgery.Controls underwent surgery for indications other than endometrial
pathology. Data was analyzed using SPSS 16. The sensitivity of MRI for detection
of endometrial carcinoma was calculated, and the ADC values of normal and
abnormal endometrium were recorded. The statistical difference between ADC
(Apparent Diffusion Coefficient) values was calculated by two-sided student t-
test. P value of <0.05 was considered statistically significant with confidence
interval of 90%.
RESULTS: Out of 30 patients included in the study, 21 had hyperintense, 6
hypointense and 3 had isointense endometrium on T2 weighted imaging. On
DWI, all lesions were depicted as increased signal with hypointense myometrium.
The sensitivity for detection of DWI was 100%.The mean ADC value for abnormal
endometrium was 622 and of normal endometrium was 1234( p value of >0.0001),
at b-value of 1000nm/sec.
CONCLUSION: In this series of highly selective patients MRI examination utilizing
DWI is a very sensitive tool in detecting endometrial cancers. Determination of
ADC value is helpful in differentiating normal from malignant endometrium.
2.2 FLEXION / EXTENSION CERVICAL SPINE VIEWS IN BLUNT
CERVICAL TRAUMA
SADAF NASIR, MANZAR HUSSAIN, M. AYUB MANSOOR
Liaquat National Hospital, Karachi
INTRODUCTION: In the United States, 600,000 radiographic studies of the
cervical spine are performed annually for the evaluation of spinal trauma. The
use of flexion and extension radiographs in acute trauma, however, has infrequently
been subjected to a critical evaluation and many questions need to be answered.
The continued suggestion that flexion and extension views be obtained in cases
of blunt trauma does not appear to be based on scientific evidence but may
result from anecdotal case reports describing posttraumatic instability in patients
with normal standard radiographic evaluations of the cervical spine. Few studies
have compiled data with the purpose of directly evaluating the utility of the flexion
and extension radiograph of the cervical spine in the setting of blunt trauma. The
purpose of this study was to examine the contribution of flexion and extension
radiographs in the evaluation of ligamentous injury in awake adults with acute
blunt cervical spine trauma.
METHODOLOGY: All those patients who presented to the emergency department
following trauma, regardless of the nature of trauma were included in the study.
All these patients underwent cross table cervical spine x ray. The study was
conducted after the approval of hospital’s ethics committee. Since it involved
only collection of data it was conducted under waiver of consent. Patients of all
ages and both sexes were included, however, those patient who showed
neurological deficits or were less than 8 years of age, or had severe arthritic
changes were excluded from the study. Adequacy of flexion extension views was
checked prior to flexion extension views. All the demographic details including
age, sex were recorded. The mechanism of injury, the associated injuries, the
clinical findings relevant to cervical spine and x-rays findings in all the patients
were recorded. The results were tabulated using SPSS version 16.0.
RESULTS: 200 cases met the criteria for review. There were 50 female patients
and 150 male patients. Of the males 130 were adults and 20 were
children/adolescence .In females 45 were adults and 5 were children/adolescents.
The mean age was 31.68 (11.95) years, with a range of 12-62 years. Trauma
was secondary to motor vehicle crashes in 180 patients. Of these 140 were
either traveling in cars or motorcycles and 40 were pedestrians. Falls in 20
patients. All the x-rays were judged adequate for diagnostic purpose otherwise
they were repeated. The percentage of x-rays that were repeated was 90/200
because of either inadequate exposure or limited motion and 110/200 had
adequate motion/exposure of the cervical spine. None of the patients had positive
flexion extension views of cervical spine for instability. All patients were discharged
without any neurological sequel.
CONCLUSION: Loss of cervical spine lordosis alone should not be taken as an
indication for performing flexion and extension views.
2.3 ADDITIVE VALUE OF SUSCEPTIBILITY WEIGHTED IMAGING
(SWI) IN
NEURORADIOLOGY
Shaista Shoukat, Nadira Abid, M.Salman, Saima Imran, Tariq Mahmood.
Department of Radiology, JPMC Karachi.
OBJECTIVE: To determine the sensitivity of SWI in further characterization of
brain lesions identified on conventional MR imaging.
INTRODUCTION: SWI originally called BOLD venographic imaging emerged as
a powerful clinical tool to visualize vascular structures, iron content, blood products
as well as calcification. It can detect small amount of bleed which is even
undetected on routine CT\MR examination. The clinical application of SWI has
been described in vast neurological lesions like traumatic brain injury,
coagulopathies, vascular malformation, neoplasms and even in neurodegenerative
disorders providing valuable additional information in lesion delineation.
MATERIALS AND METHODS: A descriptive cross sectional study carried at
radiology department, Jinnah Post Graduate Medical Center Karachi over a
period of 3 months (November 2009 till January 2010). We retrospectively
reviewed MRI examination of 120 patients over a period of 3 months in whom
signal abnormality was picked on conventional T1,T2 and FLAIR images with
5 mm slice thickness and gap of 1 mm. SWI was then performed in these patients
with protocol of TR= Shortest, TE= 15 ms, flip angle=15degree and 120 slices
through brain. SWI was evaluated for presence of blood products, vascularity
and calcifications in these patients appearing as low signal.
RESULTS: Out of 120 patients with signal abnormality detected on conventional
MRI 90 (75%) were confidently characterized and 30(25%) were unclassified.
Out of these 90patients diagnosis of 76 (84.4%) remained unchanged after SWI
and in 14 (15.6%) patients diagnosis was changed. Out of 30 (25%) unclassified
patients 8 (26.6%) remained unchanged while 22 (73.4%) were diagnosed
confidently using SWI.
CONCLUSION: SWI is a new MRI sequence that exploits the magnetic properties
of tissues due to local inhomogenieties in the magnetic field and is extremely
sensitive to even traces of hemorrhage with potential diagnostic and therapeutic
implications in stroke patients as well as in other hemorrhagic conditions, brain
neoplasms, phacomatoses like sturge weber disease and neurodegenerative
diseases. SWI adds only a few minutes to the current protocol of brain MRI but
its use significantly improve the patient care and management and therefore
should be performed in patients with signal abnormality detected on conventional
MRI.
2.5 HEART: WHAT CAN BE SEEN ON NON CORONARY THORACIC
MULTI DETECTOR
COMPUTED TOMOGRAPHY SCAN?
ZAFAR JAMIL
Senior Charge Radiographer
Radiology Department
The Aga Khan University Hospital Karachi
INTRODUCTION
• Until recently although always present it was difficult to assess the heart on
thoracic CT due to marked motion artefact. With the increasing use of multi-
detector CT there is now sufficient temporal and spatial resolution to assess the
anatomy of the heart and look for any evidence of cardiac pathology. This may
be incidental but is often the source of symptoms and can explain other radiological
findings. Occasionally there are significant prognostic implications.
• Objective: MDCT systems with fast scanning capabilities can acquire images
of the thorax with reduced cardiac motion artifacts, enabling improved evaluation
of the heart and surrounding structures in the course of routine thoracic CT. This
describes the principles of including an evaluation of the heart in the course of
a chest CT examination in terms of both examination technique and image
interpretation. In addition, both the normal appearances and some of the most
common abnormal appearances of the cardiac structures will be described.
• By using cases collected from our hospital on multi-detector CT machines, we
present a structured approach to assess the heart on routine thoracic CT.
MATERIALS & METHODS:
• Study Duration: January 2008 to December 2008
• Study type: Retrospective study
• Study site: CT Scan Suite Radiology Dept. AKUH
• Study Population: All patients undergoing Thoracic CT.
• Machine model: 64 slicer MDCT Toshiba Aquillion
• No of patients: 100
• Source of data collection: Radiology information system (RIS)
CONCLUSION
• Whilst gated cardiac CT no doubt provides superior imaging of some cardiac
disease compared to conventional CT, extensive information is obtainable on
multi-slice imaging.
• It is significant to develop a method for looking at the heart on thoracic CT
MDCT ASSESSMENT OF ACETABULR FRACTURES: A
COMPARISON OF CONVETIONAL MPR AND 3D IMAGES WITH
MODIEFIED RECONSTRUCTION IMAGES
KAUSAR ILLAHI BUX , MUHAMMAD SALMAN, NADIRA ABID,SAIMA
IMRAN, TARIQ MEHMOOD
Department of Radiology.
Jinnah post graduate medical center, Karachi
Object: To establish a role of modified MPR images as a standard protocol for
the evaluation of acetabular fracture.
Study design: descriptive study.
Place and duration: Radiology department, Jinnah post graduate medical
center, from March to October 2009.
Subjects and method: A prospective study carried out in 22 patients in whom
acetabular fractures were demonstrated on initial radiographs underwent CT
examination. Patient’s age ranged from 16 to 49 years with male to female ratio
18: 4. All studies were performed on Toshiba aquillion helical 16 slicer, with 2
mm slice thickness, tube voltage120kvp and tube current ranged from 150-
225mAs, FOV is 250-350mm. Scans were performed form L5 vertebra to lesser
trochanter of femur with approximate scan time of 5 seconds. Beside conventional
MPR, modified thick slab (3-5 mm) MPR images were acquired with oblique
coronal & oblique sagittal views through anterior column, posterior column and
both columns using window length of 350 and window width 2000 HU.
Result: In all 22 patients elementary acetabular fractures were present, 12 out
of 22 patients had anterior column fracture, out of them 4 had associated anterior
wall fracture. 6 patients had both columns fracture, 2 patients had posterior
column fracture, and 2 patients had isolated posterior wall fracture. Associated
fractures also noted in 10 out of these 22 patients,1 patient with anterior column
injury had associated iliac bone fracture and ipsilateral sacroiliac diastasis.
Conclusion:
Conventional MPR images can appropriately classify the acetabular fracture but,
reformatted modified thick slab oblique images through anterior, posterior and
both columns, provide better visualization and maximum information of acetabular
fractures on single image. Fractures with less than 2mm diastasis which remain
inconspicuous on 3D reformates, are more evident on these modified reformatted
images.
RECENT DEVELOPMENTS AND FUTURE PROSPECTS OF SPECT
MYOCARDIAL PERFUSION IMAGING
DR. MASEEH UZ ZAMAN
Department of Nuclear Medicine KIRAN &
Department of Radiology
Aga Khan University Hospital, Karachi
Myocardial perfusion SPECT imaging is the most commonly used functional
imaging for assessment of coronary artery disease. High diagnostic accuracy
and incremental prognostic value are the major benefits while suboptimal spatial
resolution and significant radiation exposure are the main limitations. Its ability
to detect hemodynamic significance of lesions seen on multi-detector CT
angiogram (MDCTA) has paved the path for a successful marriage between
anatomical and functional imaging modalities in the form of hybrid SPECT/MDCTA
system. In recent years there have been enormous efforts by industry and
academia to develop new SPECT imaging systems with better sensitivity,
resolution, compact design and new reconstruction algorithms with ability to
improve image quality and resolution. Furthermore, expected arrival of Tc-99m
labeled deoxyglucose in next few years would further strengthen the role of
SPECT in imaging hibernating myocardium. In view of these developments it
seems that SPECT would enjoy its pivotal role in spite of major threat to be
replaced by fluorine-18 labeled PET perfusion and glucose metabolism imaging
agents.
PREDICTIVE VALUE OF PATHOLOGICAL Q WAVES FOR FIXED PERFUSION
DEFECT AND ITS IMPACT ON LV FUNCTION ESTIMATED BY GATED SPECT
NOSHEEN FATIMA1,2; MASEEH UZ ZAMAN1,2,3; ABDUS SAMAD1; M
ISHAQ1; S ZAHID RASHEED1; JAVERIA1; KAWISH REHMAN1,2; ASIF
WALI1
1Karachi Institute of Heart Diseases (KIHD), Karachi
2Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN)
3Dept. of Radiology, The Aga Khan University Hospital, Karachi
BACKGROUND: Sensitivity of pathological Q waves (pQw) has been questioned
by perfusion and metabolism imaging. Present study was conducted to find its
sensitivity and impact on LV function.
SUBJECT AND METHODS: This prospective study included 306 consecutive
cases (187 male; mean age 55.07 years) referred for same day (rest- stress)
gated SPECT study (MPI).
RESULTS: pQw were positive in 55/306 (18%) patients and 40/55 (73%) had
fixed perfusion defects while 15/55 (27%) had no fixed defect on MPI. In 47
patients fixed defects without pQw were seen. Overall sensitivity, specificity,
negative and positive predictive values (NPV and PPV) of pQw for MI were 46%,
93%, 81% and 73% respectively. pQw in anterior leads had highest sensitivity
than others regional leads. In patients with true positive pQw, mean LV ejection
fraction (%EF), mean end diastolic (EDV) and mean end systolic (ESV) volumes
were 36 % (±11.87), 170 ml (±70.28) and 114.38 ml (±67.40) respectively. More
severe LV dysfunction was seen with true positive pQw in anterior ± inferior and
lateral leads.
CONCLUSION: pQw has an overall high specificity, low sensitivity but positive
anterior leads have highest sensitivity. pQw has negative impact on LV function
and more pronounced when present in anterior leads.
PREVALENCE OF POSITIVE GATED MYOCARDIAL SPECT IN DIABETIC
AND NON-DIABETIC WOMEN AND IMPACT OF OTHER RISK FACTORS;
KIHD PERSPECTIVE
MASEEH UZ ZAMAN1,2,3; NOSHEEN FATIMA1,2; ABDUS SAMAD1; S ZAHID
RASHEED1;
M ISHAQ1; JAVERIA1; KAWISH REHMAN1,2; ASIF WALI1.
1Karachi Institute of Heart Diseases (KIHD), Karachi
2Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN)
3Dept. of Radiology, The Aga Khan University Hospital, Karachi
OBJECTIVE: The objective of the present study was to assess the prevalence
of coronary artery disease (CAD) among diabetic (DM) and non-diabetic (NDM)
women using Gated SPECT (GSPECT) and to study the impact of other risk
factors like hypertension (HTN), dyslipidemia, family history (F/H) and menopause.
SUBJECTS AND METHODS: This is a prospective cross-sectional study on a
consecutive sample of 287 women referred to Nuclear Cardiology Department
of Karachi Institute of Heart Diseases (KIHD) for GSPECT for evaluation of
known or suspected CAD (from January 2009 till June 2009). Women with a
history of DM diagnosed less than 5 years were excluded. Same day (rest-
stress) G SPECT study was conducted and fixed or reversible perfusion defects
were considered positive GSPECT for CAD.
RESULTS: GSPECT was positive for CAD in 41/115 (36%, p 0.002) diabetic
women and 37/172 (21%, p 0.005) non-diabetic cohort. In diabetic cohort,
GSPECT was positive in 5/9 (56%, p 0.013) women with diabetes only, 17/35
(48%, p 0.02) DM with HTN, 12/15 (80%, p value 0.02) DM with dyslipidemia
and 11/43 (26%, p 0.001) DM with =2 risk factors. GSPECT was normal in all
3 diabetic women with positive family history for CAD. In non-diabetic cohort,
GSPECT was positive in 9/32 (28%, p value 0.739) women with no risk factor,
15/58 (26%, p 0.866) HTN only, 2/5 (40%, p value 0.655) only dyslipidemic
women, 1/12 (8%, p 0.004) with family history only and 4/23 (17%, p value 0.166)
non-diabetic with =2 risk factors. Interestingly, 35/93 post-menopausal diabetic
(38%, p value 0.017) had positive GSPECT while 33/123 non-diabetic post-
menopausal women (27%, p 0.03) had positive perfusion scans. GSPECT was
positive in 6/26 (23%, p 0.006) and 4/49 (8%, p 0.05) in diabetic and non-diabetic
pre-menopausal women.
CONCLUSION: The prevalence of CAD in our diabetic women is as high as
internationally reported and diabetes is a strong risk factor for CAD. Dyslipidemia
with diabetes is a major contributor to CAD than HTN and F/H. Diabetes erases
the protective effect of estrogen in premenopausal diabetic women.
ROLE OF TC-99M MAG3 SCINTIGRAPHY IN MANAGEMENT OF
NON FUNCTIONING KIDNEY ON INTRAVENOUS UROGRAPHY
DR. NAUREEN NIZAR1, & DR. AKHTAR AHMED 1,2
1Sindh Institute of Urology and Transplantation (SIUT)
2Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN)
INTRODUCTION: Tc-99m MAG3 renal scan can quantitate absolute and differential
renal function. Even 5 to 10 per cent of the renal function can be detected, while
IVP reports a nonfunctioning kidney if the function falls by 60 per cent or more.
This information helps urologist to plan nephrectomy or more conservative
surgery. In identifying the urinary pathway obstruction, renal scintigraphy is
superior to the conventional IVP, particularly in units with impaired renal function.
MATERIALS AND METHODS: Sixty three patients of non-functioning kidney on
excretory urography were studied by Tc-99m MAG3 renal scan with age range
08-75 years (mean age of 34years). 42 patients (66.6%) were male and 21
patients (33.3%) were female with 2:1 ratio. Diuretic dynamic renal scintigraphy
(flow, function, delayed imaging) was performed after intravenous injections of
2-5mCi (74 - 185 MBq) 99mTc-MAG3 and 40 mg furosemide (at zero time, or
F0).
RESULTS: 23 (36.6%) patients showed no renal function and 18 (28.3%) patients
showed poor renal function. Where as 22 (35 percent) of these patients showed
significant renal function (split more than 15 percent) and thus could be candidate
for renal salvage by relevant surgical procedures.
CONCLUSION: Tc-99m MAG3 renal scan is mandatory before
declaring a kidney totally non-functional.
ROLE OF SPLIT DOSE BONE SCANNING FOR THE ASSESSMENT
OF SKELETAL METASTASIS IN PATIENTS WITH MALIGNANCY
KASHIF NIYAZ, MASEEH UZ ZAMAN, AKHTAR AHMED, ABID HAMEED
Karachi institute of radiotherapy and nuclear medicine (KIRAN),
Off University Road, Near Safoora Chowk, Scheme-33, Karachi,
{E-mail: }
OBJECTIVE: The objective of this study was to find out the effect of split dose
bone scanning on the pattern of uptake of 99mTc MDP in patients with proven
neoplasm and to differentiate between benign skeletal processes and skeletal
metastases.
MATERIAL AND METHOD: The study has been conducted in patients attending
the OPD of KIRAN Hospital, in the period of 6 months. A total of 50
histopathologically proven cases of malignancy were included, (Mean
age=50.32±15; age ranges=20-80), F=30(60%); M=20(40%). All patients underwent
2 bone scans (at 4 hours and 24 hours) using split dose technique in which 550
MBq of 99mTc MDP injection was given after first scan. The images were looked
for lesions, which were graded 1 to 5 accordingly on visual analysis. Three
computerized regions of interest (ROIs) were drawn over lesion (ROI 1), normal
bone (ROI 2) and soft tissue (ROI 3). The number of lesions, lesion to background
ratios and lesion to soft tissue ratios of both 4 hours and 24 hours delayed images
were calculated
RESULTS: There was significant difference observed at 4 hours and 24 hours
delayed bone scans for lesion to normal bone ratio and lesion to soft tissue ratio
of grade 5, 4 and 3 lesions, while no significant difference was observed for
grade 2 lesions. Same numbers of lesion were found both at 4 and 24 hours
bone scans and no difference was observed in terms of numbers of lesion
CONCLUSION: The data suggest that Split dose bone scan results in significantly
increased values of lesion to normal bone ratio and lesion to soft tissue ratio in
all metastatic lesions at 24 hours delayed imaging as compared to 4 hours bone
scan and it is a valuable technique for differentiating benign skeletal processes
from malignant lesions in patients with known malignancy.
DETECTION OF CORONARY ARTERY DISEASE IN HYPERTENSIVE
PATIENTS BY EXERCISE STRESS MYOCARDIAL PERFUSION
IMAGING USING TC-99M MIBI
DR. MUHAMMAD OBAID ARIF
Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN)
Off University Road, Near Safoora Chowk, Scheme-33, Karachi,
{E-mail: drcumengineer@hotmail.com}
BACKGROUND: Hypertension and coronary artery disease (CAD) are mutually
associated with one another and are a major cause of morbidity and mortality
in the present day life. The presence of hypertension may cloud the diagnosis
of CAD. Myocardial perfusion scanning can be used for non invasive detection
of coronary artery disease in hypertensive patients. The aim of our study was
to detect coronary artery disease in hypertensive patients who did not have a
previous history of MI. The study methodology included exercise stress myocardial
perfusion scan.
METHODS: A total of 150 patients (72 males and 78 females with mean age
53.9 ± 8 years), referred by the physicians to the KIRAN hospital for the detection
of CAD by exercise stress MPS, were enrolled into the study. Out of these 150
patients, 50 patients, who were normotensive, were registered as a control group
(group-A). The remaining 100 hypertensive patients were divided into two groups;
Group-B comprising of patients with hypertension as a solo risk factor for CAD
and Group-C in which patients were having at least one additional coronary risk
factor along with hypertension. Patients with positive scans for coronary artery
disease were followed up at the interval of 3 months along with their angiography
report and patients with negative scans were followed up for any cardiac event
that occurred within 3 months of myocardial perfusion scan.
RESULTS: Out of 40 scan positive patients 38 had their angiography positive
and two scans were found to be false positive. Insignificant differences found
between groups A & B (odds ratio 1.9, p = 0.202). Significant difference was
observed between groups A & C (odds ratio 3.76, p = 0.006). Normalcy rate was
found out to be 86%.
CONCLUSION: Exercise stress Tc99m MIBI scan is a reliable method for
detection of coronary artery disease in hypertensive patients. CAD is more
common in hypertensive patients associated with at least one coronary risk factor
than their matched normotensive patients. In patients with hypertension as a
solo risk factor the prevalence of exercise MPS abnormalities were similar to
control (normotensive)
UTILITY OF COMBINED TC-99M MIBI AND BONE SCAN IN
SOLITARY MUSCULO-SKELETAL PATHOLOGY
ZAFAR NASIR*, MUHAMMAD EJAZ KHAN, SHAHID KAMAL, HASSAN RAZA,
BASHIR AHMED, MINHAJ MAQBOOL, NAJAMUDDIN, SUMAIRA MUSHTAQ,
RAHILA MEHMOOD,
RUKHSANA MEMON, MUHAMMAD IQBAL, RAFIA TOOR
Atomic Energy Medical Centre
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: The aim of this study was to assess the utility of combined 99mTc-
MIBI scintigraphy and bone scan in patients with clinical and radiologic features
of solitary musculo-skeletal pathology.
MATERIALS AND METHODS: The scintigraphic findings for 50 patients were
compared with the surgical and histologic findings. Each patient underwent three-
phase bone scanning with 99mTc-methylene diphosphonate (MDP) and static
MIBI scintigraphy. The MIBI scans were evaluated by visual and quantitative
analysis. The count ratio of the lesion to the background (L/N) was calculated
from the region of interest drawn on the MIBI scan. Ratio > 1.5 was considered
positive test and < 1.5 as negative. The Chi square test was used to determine
the statistical significance.
RESULT: In 29 patients the test was positive and 21 patients had negative test.
31 patients came out malignant (osteosarcoma, ewings sarcoma, PNET,
chondrosarcoma, soft tissue sarcomas) and 19 benign (giant cell tumor, aneurismal
bone cyst, osteoid osteoma, fibrous cortical defect, simple bone cyst, fibrous
dysplasia). Although increased MDP uptake was not specific for bone malignancy,
a significant difference was found between benign tumors (L/N = 1.24 ± 0.45)
and malignant tumors (L/N = 3.3 ± 2.3) on MIBI scans. Sensitiviy of combined
MIBI and Tc-99m MDP bone scan for detecting benign vs malignant disease was
83% and specificity 84% with is statistically significant (p value <0.01).
CONCLUSION: Although not capable of replacing tissue biopsy as a definitive
diagnostic modality for musculoskeletal neoplasms, MIBI scintigraphy does
appear to have a role in better preoperative assessment and in distinguishing
between benign and malignant pathologies.
ATTENUATION CORRECTION IN MYOCARDIAL PERFUSION
SPECT IMAGING
BASHIR AHMED, EJAZ KHAN, SHAHID KAMAL, ZAFAR NASIR, BASIT
IQBAL, HASSAN RAZA, SHAHEEN ZAREEN, NAJAM UDDDIN, RUKHSANA
MEMON,SUMAIRAMUSHTAQ,
RAHILA MEHMOOD, MINHAJ MAQBOOL
Atomic Energy Medical Centre, Karachi
INTRODUCTION: Attenuation of photons is one of the most important factors
which degrade the quality of and destroys the quantitative accuracy in images
obtained in nuclear medicine scans especially in cardiac imaging. The specificity
of cardiac single photon emission computed tomography perfusion imaging is
significantly affected by internal photon absorption commonly referred to as
anterior wall breast and inferior wall diaphragm attenuation artifacts.
AIMS AND OBJECTIVES: The goal of this research project is to assess the
accuracy of attenuation correction in myocardial perfusion imaging.
MATERIALS AND METHODS: 60 patients underwent a single day 99mTC MIBI
protocol using Infinia Hawkeye gamma camera and ECG gated acquisition. The
reader interpreted gated attenuation-corrected and non-attenuation-corrected
rest/stress images. Wall motion abnormalities were assessed.
RESULTS: Diagnosis of fixed perfusion defects in 22 cases was changed after
interpretation of AC images and these perfusion defects were found to be
attenuation artifacts corrected with attenuation correction soft ware. In all of these
cases there was no wall motion abnormality on gated study. Out of these 22
artifacts, 14 were due to diaphragmatic attenuation and 8 due to breast attenuation.
CONCLUSIONS: Attenuation correction in addition to ECG gating with SPECT
myocardial perfusion images improves the image quality, interpretive certainty,
and diagnostic accuracy.
LEFT VENTRICULAR EJECTION FRACTION DERIVED BY ECG
GATED SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
VERSUS CORONARY ANGIOGRAPHY DETERMINATION IN
SUSPECTED OR KNOWN CORONARY ARTERY DISEASE
PATIENTS
SAJID SATTAR
Department of Nuclear Medicine
ÊDr. Ziauddin Medical University Hospital, Karachi
{E-mail:sajsky@yahoo.com / drsajidsattar@gmail.com}
Evaluation of the left ventricular function is an important parameter in the
assessment of cardiac mortality and morbidity. Quantifying the degree and extent
of the left ventricular functional abnormalities permit a systemic assessment of
the disease process on the myocardial performance, provides an objective basis
for the risk stratification and the therapeutic strategy, and allows for the sequential
follow up of the therapeutic response. ECG gated myocardial single photon
emission computed tomography imaging is an state of art technique that allows
quantitative or semi-quantitative assessment of the left ventricular function
simultaneously with the evaluation of myocardial perfusion1.In order to compare
ventricular function derived from ECG gated MP-SPECT with coronary angiography
,this study consisted of 47 patients ,their mean LVEF (S.D) 53% + 17.8 ranged
from 21%-89% was found in ECG-gated MP-SPECT group compared to mean(S.D)
46.26% + 16.7 ranged from 20%-80% in coronary angiography group as shown
in table-2.Statiscally no significant difference found in ejection fraction measured
by ECG gated MP-SPECT group and coronary angiography group(p-value >0.05)
as shown in table3-5.
KEYWORDS: LVEF (left ventricular ejection fraction), ECG gated myocardial
perfusion single photon emission computed tomography, coronary angiography.
DENTAL CARIES AND DIABETES MELLITUS: ROLE OF SALIVARY
FLOW RATE AND MINERALS
MUHAMMAD JAWED 1, SYED M. SHAHID 2 AND ABID AZHAR 2
1 Department of Biochemistry, Liaquat College of Medicine & Dentistry, Karachi,
Pakistan
2 Dr. A. Q. Khan Institute of Biotechnology & Genetic Engineering (KIBGE),
University of Karachi, Karachi, Pakistan
INTRODUCTION: This study was designed to evaluate the possible protective
role of salivary factors like salivary flow rate and adequate level of calcium,
phosphate and fluoride in patients of diabetes mellitus type 2 against dental
caries.
MATERIALS & METHODS: A total of 398 patients of diabetes mellitus type 2
with dental caries and 395 age and sex matched non-diabetic subjects with
dental caries were included as controls. All subjects were divided into four groups
according to their ages. Decayed, missed and filled teeth (DMFT) were scored
to indicate the severity of dental caries. Saliva was collected, flow rate was noted
and calcium, phosphate and fluoride were analyzed.
RESULTS: The FBS, HbA1c and DMFT indices were found to be significantly
high in diabetic patients as compared to controls. The salivary flow rate, calcium,
phosphate and fluoride were found to be significantly low where as no significant
difference was found in salivary magnesium in patients as compared to controls.
CONCLUSION: Optimum salivary flow rate is responsible for establishing
protective environment against dental caries. Adequate level of salivary calcium,
phosphate and fluoride is also involved in significant deposition of these minerals
in plaque which greatly reduces the development of caries in the adjacent enamel
of teeth.
KEY WORDS: Dental caries, diabetes mellitus, salivary flow rate, salivary
minerals.
PLASMA LEPTIN LEVELS IN SUBJECTS WITH PREMENSTRUAL
SYNDROME SYMPTOMS
SITWAT ZEHRA1, MANSOOR A. KHAN1, ABID AZHAR1, MASOOD A.
QURESHI2
1 Dr. A.Q. Khan Institute of Biotechnology and Genetic Engineering (KIBGE)
2 Department of Physiology, Dow University of Health Sciences (DUHS), Karachi
INTRODUCTION: Leptin, a 16 kD cytokine, encoded by the obese gene, is an
important metabolic signal affecting the brain energy balance. It is suggestive
to be involved in the neuroendocrine regulation of variety of reproductive events
and thus may be linked to menstrual cycle and its dysfunctions like Premenstrual
Syndrome but many questions remain unanswered.
MATERIAL AND METHODS: Female subjects (# 112; age: 21 years) participated
in the study to provide information about anthropometric profiles and PMS
symptoms on specified prescribed Questionnaire. Fasting blood samples were
collected during specific days of follicular and luteal phases on ovulation detection
by biphasic BBT pattern, and leptin was determined by EIA Kit.
RESULTS: About 60% frequency of PMS is reported. The major symptoms
mostly reported for PMS subjects (#68) include: irritability (71%), fatigue (87%),
breast tenderness (68%), bowel constipation and loose (37 & 18% respectively),
and appetite (up and down 43 and 51% respectively), abdominal bloating (48%).
The order of frequency was different from those reported for western population.
Circulating leptin concentrations vary considerably during the physiological
menstrual cycle presenting with higher values during the luteal phase. Further,
PMS patients depicted significantly higher plasma leptin levels (P .001) in both
follicular and luteal phases compared to the controls
CONCLUSION: Physiological importance of leptin increase during luteal phase
is not clear, but does document that leptin, may have a role in the regulation of
cyclic female reproductive functions. Such a rise as well as the difference of
leptin levels between control subjects and PMS patients may be due to highly
complex interactions between ovarian hormones and the neuroendocrine
mechanisms due to neuropeptides and neurotransmitters responsible for food
intake, energy expenditure and adiposity during the luteal phase of the menstrual
cycle.
KEY WORDS: Premenstrual Syndrome, Leptin, Menstrual Cycle Phases
EPIDEMIOLOGICAL AND DIETARY RISK FACTORS OF HEPATITIS
C DISEASE IN TANDO ALLAHYAR POPULATION
HIRA KHAN, NASEEM ASLAM CHANNA
Institute of Biochemistry, University of Sindh, Jamshoro
{E-mail: hirahanif85@yahoo.com}
INTRODUCTION: Globally 130 million people are infected with Hepatitis C virus
and it is increasing day by day. Hepatitis C virus enters the host (liver) cells and
provokes immunological and physiological changes in liver and if not controlled
ultimately leads to cirrhosis and Hepatocellular carcinoma. The most efficient
transmission is through percutaneous exposure to infectious blood. Some dietary
factors involve in prevention of HCV are vegetables, pulses, tomatoes and tea.
MATERIALS AND METHODS: 70 Hepatitis C patients and 71 controls (age,
sex and locality matched with no personal or family history of hepatitis C) were
randomly selected from the TandoAllahyar population during June 2007 to
December 2007. A standard questionnaire specially developed for that purpose,
was distributed among patients and controls. Accurate rapid card test was
performed to confirm HCV positive or negative patients and controls. O.R with
95% confidence interval was computed and p values were calculated by chi
square test.
RESULTS: Over all findings showed that among 70 HCV patients 64% were
females and 36% males (mean age range was 20-48 years). Our results showed
strong association of sedentary life style (OR=4, 95% CI, 1.48-10.6, p=0.005),
marital status, +ve family history, B+ve blood group, piercing, syringe use (70%),
multiple pregnancies (OR=4.72, 95% CI, 1.47-15.15, p=0.008), blood transfusion
(OR=4.4, 95% CI, 1.2-14.95, p=0.017), take out food debris by office pins (NS),
shave at barber’s shop (NS), dental procedures (NS), medicines used in past
(OR=3.08, 95% CI, 1.2-7.71, P=0.016), G.I.T diseases (OR =8.66, 95% CI, 1.28-
55.58, p=0.023), stones of kidney or gallbladder, jaundice, Tuberculosis and
psychological problems (OR =2.5, 95% CI, 1.04-6.13, P=0.04) with hepatitis C
disease. We have not found any association of surgery, BMI, ENT, diseases,
meat consumption and smoking with the disease. Vegetables OR =0.842, 95%
CI, 0.361-1.964, P=0.694), pulses, tomatoes (OR =0.31, 95% CI, 0.041-2.53,
P=0.31), and tea (OR =0.598, 95% CI, 0.251-1.431, P=0.25) were found to be
the protective factors for Hepatitis C disease.
CONCLUSION: Hepatitis C is blood born infection, cause inflammation and
destruction of liver. Improved strategies and disease awareness should interrupt
HCV transmission.
NEUROPROTECTIVE POTENTIALS OF AQUEOUS FRUIT EXTRACT
OF SEA BUCKTHRON (Hippophae rhamnoides L. spp.
Turkestanica) ON HALOPERIDOL INDUCED NEURONAL
ALTERATIONS IN THE STRIATUM
FARHAT BATOOL1, ASAD HUSSAIN SHAH2, SYED DILNAWAZ AHMED2 &
DARAKHSHAN JABEEN HALEEM1
1Neurochemistry and Biochemical Neuro-pharmacology Research Laboratory,
Department of Biochemistry, University of Karachi, Karachi-75270. Pakistan.
2Department of Plant Breeding and Molecular Genetics, Faculty of Agriculture,
Rawalakot, Azad Jammu and Kashmir Pakistan.
{Email: batool@uok.edu.pk}
INTRODUCTION: Increasing scientific evidence is available to support the
hypothesis that certain foods and food components have beneficial physiological
and pharmacological effects on brain chemistry. Effects of orally administered
aqueous fruit extract from fresh berries of Sea buckthorn (Hippophae rhamnoides
L. spp. Turkestanica) (SBT-FE) were investigated for their neuroprotective
potentials in the rat striatum (caudate nucleus and putamen) following repeated
administration of haloperidol.
MATERIALS & METHODS: Rats received daily haloperidol (3.0mg/kg I.P.) and
saline (0.9% NaCl) injections for a period of 15 days. 7-day post-treatment,
aqueous SBT-FE (40mg/kg) was also administered daily via feeding tube.
Hypolocomotive effects (home cage activity, exploratory activity and catalepsy)
were monitored consecutively in each group of rats. At the end of the behavioral
tests and on the last day of experiments, changes in extracellular levels of striatal
dopamine (DA), dihydroxyphenyl acetic acid (DOPAC) and homovanilli acid
(HVA) were also determined by HPLC-EC.
RESULTS: The results indicate that daily food intake and locomotor activities
in novel and familiar environments were significantly (p<0.01) increased in
haloperidol plus SBT-FE administered rats when compared with their respective
controls. Significant (p<0.01) decreases were also observed in cataleptogenic
effects following 7th and 15th last administration of SBT-FE in haloperidol treated
rats. Striatal levels of DA and HVA were also significantly altered in rats administered
with SBT-FE.
CONCLUSIONS: It is suggested that non-pharmacological stimuli from functional
food nutrient of Sea buckthorn may influence neuronal alterations in rat striatum
induced by haloperidol and may have the potential for the prevention of
neurodegenerative diseases.
KEY WORDS: Sea buckthorn (Hippophae rhamnoides), haloperidol, catalepsy,
postsynaptic DA-D2 receptors, striatum, schizophrenia.
ANTI MICROBIAL PROPERTIES IN FERULA FOETIDA
S. HYDER RAZA NAQVI , ASIF BIN REHMAN
Department of Pharmacology, Isra University, Hyderabad
Department of Pharmacology, Hamdard University, Karachi
{E-mail: razahaiderdr@yahoo.com / dr.haiderraza@ hotmail.com}
INTRODUCTION: The use of most common traditional medicine Ferula foetida,
is believed to be effective in curing bacterial and fungal infection. Therefore, this
medicinal plant was selected for the presence of anti microbial properties.
OBJECTIVE: Determination of antimicrobial activity of F. foetida.
METHODOLOGY: This experimental based study was conducted at Department
of Pharmacology, Faculty of Pharmacy, Karachi University, 2005 to 2006.
Antibacterial activity was carried out against gram +ve and gram –ve organisms
including candida and aspergillus species. Petri plates were prepared with Tryptic
Soy Agar and cultures of the organisms were maintained on the stock culture
agar. The results of this activity are measured in term of zone of inhibition of
crude extract against microorganism. Different fractions (ethyl acetate, chloroform,
n-butanol and aqueous factions) from gum resin of F. foetida were prepared for
screening the antibacterial and antifungal activities.
RESULTS: Ethyl acetate, chloroform and n-butanol fractions show antibacterial
activity against gram +ve organisms (zone of inhibition: 10-15mm, 05-10mm,
05-10mm respectively) except aqueous fraction (zone of inhibition: no activity).
Gram –ve organisms were found resistant to different fractions of F. foetida
except M. catarhalis (zone of inhibition; 01-05mm). Candida and Aspergillus
species were found sensitive for antifungal activity of F.foetida (zone of inhibition:
01mm-05mm and 05mm -10mm) respectively with p value (0.005).
CONCLUSION: The results reveal the fact that the drug has positive antimicrobial
effects and can be utilize against different micro-organisms at appropriate effective
dose range.
KEY WORDS: Antimicrobial effect, microbial organisms, Ferula foetida, Fractions.
HEMOGLOBIN STATUS OF PREGNANT WOMEN VISITING
TERTIARY CARE HOSPITALS OF PAKISTAN
DILEEP KUMAR ROHRA1, NAZIR AHMED SOLANGI 2, ZAHIDA MEMON 3,
NUSRAT H. KHAN 4, SYED IQBAL AZAM 5, KANYA LAL AHUJA1
1Department of Biological and Biomedical Sciences, Aga Khan University, Karachi
2Department of Pharmacology and Therapeutics, Nawabshah Medical College,
Nawabshah
3Department of Gynecology and Obstetrics, Dow Medical College and Civil
hospital, Karachi
4Department of Community Health Sciences, Aga Khan University, Karachi
{Correspondence: Dr. Nazir Ahmad Solangi, Professor of Pharmacology,
Liaquat National Medical College & Hospital, Stadium Road; Karachi. Cell #
03003331300}
OBJECTIVE: To determine the status of hemoglobin levels in pregnant women
who visited tertiary care hospitals of various cities in Pakistan for their antenatal
care from January 1 to April 30, 2007
Place and Duration: This was a descriptive cross sectional multi-center study.
METHODS: This study was conducted at the Aga Khan University Hospital
(AKUH), Civil Hospital, Karachi (CHK) and Nawabshah Medical College Hospital
(NMCH), Nawabshah. Copies of medicinal prescriptions given to pregnant patients
attending the antenatal clinics were collected from January 1 to April 30, 2007.
Reports or results of hemoglobin concentrations were also obtained from the
patients.
RESULTS: A total of 1709 pregnant women were recruited. Majority 1145 (67%)
were from the age group of 25 to 34 years and 1555 (-91%) had some degree
of anemia. The number of women with moderate to severe anemia (hemoglobin
levels < 8 or 8-9.9 gm/dl) was statistically more frequent in second and third
trimester, while mild anemia (hemoglobin levels of 10-10.9 gm/dl) was more in
first trimester of pregnancy. The distribution of severe anemia however; was not
different is the three trimesters. About 90-92% subjects received iron/vitamin/mineral
supplements irrespective of the hemoglobin status of the women.
CONCLUSIONS: Prevalence and severity of anemia in pregnant subject attending
the tertiary care hospitals of Pakistan is exceptionally high. Current findings
highlight the anemia in pregnancy as a priority area of concern.
KEY WORDS: Anemia, Hemoglobin, Pregnancy
LONG TERM CONSUMPTION OF SUGAR RICH DIET DECREASES
THE EFFECTIVENESS OF SOMATODENDRITIC SEROTONIN-1A
RECEPTORS
QURRAT-UL-AEN INAM1, BUSHRA JABEEN1, M.A Haleem2 & DARAKHSHAN
J HALEEM1
1Neurochemistry and Biochemical Neuropharmacology Research Unit, Department
of Biochemistry, University of Karachi, Karachi
2Department of Biomedical Engineering, Sir Syed University of Engineering and
Technology, Karachi
INTRODUCTION: 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT), a 5-
hydroxytryptamine (5-HT)-1A selective agonist was used to investigate a possible
role of somatodendritic serotonin-1A receptors in the precipitation of hyperphagia
and decreases of 5-HT metabolism associated with long term consumption of
sugar rich diet.
MATERIAL & METHODS: In the first part of study, dose related hyperphagic
effects of 8-OH-DPAT were monitored in freely feeding rats. In the second part
of study rats were fed freely on sugar rich diet [prepared by mixing standard
rodent diet with table sugar in the ratio of 3:1 (w/w)] for five weeks. Hyperphagic
effects of 8-OH-DPAT were monitored in sugar rich diet and normal diet treated
rats by injecting the drug at a dose of 0.25mg/kg body weight, a dose that
produced significant hyperphagia. Effects of 8-OH-DPAT on decreasing 5-HT
metabolism in the hypothalamus were also investigated in the two groups.
RESULTS: Showed that administration of 8-OH-DPAT at a dose of 0.25mg/kg
body weight elicited hyperphagia and decreased 5-HT metabolism in normal diet
treated animals but the effects in sugar rich diet treated animals were smaller
and not significant.
CONCLUSION: Suggesting a decrease in the effectiveness of somatodendritic
5-HT-1A receptors, which provide a feedback control over the synthesis and
release of 5-HT in terminal region. Possible mechanism involved in sugar diet
induced decreases of 5-HT metabolism is discussed.
KEYWORDS: Hyperphagia, 5-HT-1A receptors, sugar rich diet.
5HT-2C RECEPTOR RESPONSIVENESS IN RAT MODEL OF TD
HUMA IKRAM AND DARAKHSHAN JABEEN HALEEM
Neurochemistry and Biochemical Neuropharmacology Research Unit, Department
of Biochemistry, University of Karachi, Karachi
{E-mail: huma_biochemist@yahoo.com}
INTRODUCTION: Tardive dyskinesia (TD) is the major limitation of typical
neuroleptic therapy. Rats chronically treated with haloperidol exhibit vacuous
chewing movements (VCMs) and are widely used as animal model of TD.
MATERIALS AND METHODS: 24 male Albino Wistar rats (weighing 180-220g)
were randomly assigned to saline & haloperidol injected groups each containing
12 animals and were repeatedly injected with haloperidol (1mg/ml/kg; twice a
day for 2 weeks) or saline (1ml/kg). Two days after withdrawal; animals in each
group were again subdivided into m-CPP and saline injected groups each
containing 6 animals. m-CPP (3mg/ml/kg) challenge was given to monitor the
responsiveness of 5HT-2C receptors. Food intake by the rats (2hr & 4hr post
injection) was recorded. Animals were then decapitated (4hr post injection) to
collect dorsal striatum and ventral samples for the neurochemical analysis by
HPLC-EC.
RESULTS: Rats repeatedly injected with haloperidol at the dose of 1mg/ml/kg
twice a day for 2 weeks displayed VCMs that increased in a time dependent
manner as the treatment was continued for 5 weeks. VCMs were produced.
The intensity of m-CPP induced hypophagia was more in repeated haloperidol
+ m-CPP injected rats after 4hr but not after 2hr post m-CPP challenge. m-CPP
also attenuated haloperidol induced increased dopamine and 5-HT metabolism
both in dorsal and ventral striatum. However, these effects were more
pronounced in ventral striatum.
CONCLUSION: In conclusion, present study provides evidence that 5HT-2C
receptors become hypersensitive in a rat model of TD. Findings may help in
extending the therapeutics in schizophrenia.
ASH AS A UNIQUE NATURAL MEDICINE FOR WOUND HEALING
DIN MUHAMMAD SHAIKH* & HAMID ZIA SHAIKH**.
Department of Physiology, Isra University, Hyderabad*
Department of Physiology, Isra University, Hyderabad**
{E.mail: hamidziashaikh@yahoo.com}
BACKGROUND: In treatment of surgically induced wound in rabbit skin wound
model, the application of different ashes had a better all round response and
recovery observed in speculated time i.e. 11-13 days.
METHOD: Ashes were prepared from dried buffalo dung, wood and charcoal
and their contents were analyzed with Atomic Absorption Spectrophotometry.
Besides the application of an anti-bacterial ointment as control, all the three types
of ashes were used as experimental applications on the induced rabbit skin
wounds, on different sites respectively.
RESULT: Consistent healing was observed in all the experimental wound sites,
which was comparatively rapid than control wound site. The healing was deemed
complete on 11th day only with Charcoal Ash whereas for Dung-cake ash and
Wood Ash the completion time was approximately. 13 days.
CONCLUSION: Ashes have unique properties to influence and enhance safe
and sepsis free wound healing in rabbit skin wound model.
KEY WORDS: Ash, Rabbit, Skin Fibroblasts, Anti-bacterial ointment.
TO INVESTIGATE THE ASSOCIATION OF SERUM ADIPONECTIN
LEVELS IN CORONARY ARTERY DISEASE
DR. HUMAIRA NAWAB
Department of Physiology
Karachi Medical & Dental College
Block M North Nazimabad Karachi
AIM: To investigate the association between risk of coronary heart disease and
serum levels of adiponectin.
STUDY DESIGN: Cross-sectional, case control study.
PLACE OF STUDY: Department of Physiology BMSI JPMC in collaboration with
Abbasi Shaheed Hospital Karachi
METHODOLOGY: This study included total 100 subjects, 50 subjects with
angiographically confirmed coronary heart disease and 50 normal healthy age
and gender matched controls
RESULTS: Adiponectin serum concentration was found lower in coronary disease
patients when compared with control subjects. (7.10) versus (11.98).
CONCLUSION: This suggests that higher level of serum adiponectin is protective
against the development of coronary heart disease..
KEY WORDS: Coronary heart disease, Adiponectin, Case Control study.
RELATIONSHIP BETWEEN RESISTIN LEVELS IN HEALTHY
CONTROLS AND IN MYOCARDIAL ISCHEMIA
KHALID SAYEED, PERVAIZ SANDILA, AKBER KHOJA, SHAKOOR MEMON
Department of Physiology, BMSI
Jinnah Postgraduate Medical Centre, Karachi
BACKGROUND: The incidence and prevalence of coronary artery disease is
increasing worldwide. Alarmingly it is reaching epidemic proportions. Since the
1960s a number of risk factors have been implicated in the aetiology of Coronary
Artery Disease (CAD), from that time cardiovascular risk prediction has relied
on high blood pressure, smoking status, hyperlipidemia and diabetes mellitus
as the core risk factors, proposed by the Framingham Heart study in the 1960s
with corroborating evidence from major studies performed worldwide, these risk
factors and their interactions with age and sex were formally codified in the 1980s
into the Framingham Risk Score. However, it has become increasingly clear that
there are limitations to this approach. First it is widely recognized that 20% of
cardiovascular events occur among individuals in whom traditional risk factors
are not present. Moreover the specificity of traditional risk factors is limited.
Multiple studies additionally confirm that most vascular events occur among
individuals who on the basis of Framingham risk score are at intermediate risk
constitute a very large heterogeneous group which needs better methods for
risk stratification. Finally the relationship between Framingham scores and
absolute risk for CAD varies across populations. For all of the above reasons
there has been a need to develop novel risk factors that improve global risk
predication. The newly discovered hormone “Resistin” is one such novel risk
factor. Recent reports suggest that resisting is increased in CAD and obesity.
OBJECTIVES:
1. To investigate the correlation of circulating resistin levels with other metabolic
parameters (known to be consistently elevated in myocardial ischemia) in normal
subjects and subjects with CAD in the Pakistani population.
2. To correlate serum resistin levels with severity of CAD.
METHODS: Ninety patients with CAD were enrolled and divided into three equal
subgroups: Acute Myocardial Infarction (AMI), Unstable Angina Pectoris (UAP),
and Stable Angina Pectoris (SAP). Thirty healthy people were recruited as controls
in this cross sectional study. Serum resistin and hsCRP were determined by
ELISA (Enzyme linked immunosorbent assay) and Creatinkinase MB, Troponin
I, CBC, Lipid profile and fasting blood sugar were measured using standard
laboratory methods.
RESULTS: Serum resistin levels were highest in patients with AMI, less in UAP
and still less in SAP ad lowest in controls (p=0.001). Therefore weshow that
serum resistin increases with increasing severity of CAD. Serum resistin levels
also correlated with hsCRP(p=0.001), WBC count (p=0.001), CKMB (p=0.001)
and Trop I (p=0.001), Results also show that serum resistin levels increase with
increasing FBS.
CONCLUSION: Serumresistin levels increased with increasing severity of CAD.
Serum resistin levels were also found to increase in parallel with otherinflammatory
markersknownto be increased in myocardial ischemia such as hsCRP, WBC
count, CKMB and Troponin I, These results suggest that the hormone resistin
might play an important role in the pathogenesis of atherosclertosis and AMI as
a inflammatory marker.
DNMT1 SILENCING AFFECTS LOCUS SPECIFIC DNA
METHYLATION AND INCREASES PROSTATE CANCER DERIVED
PC3 CELL INVASIVENESS
SALMAN FAROOQ, AHMED YAQINUDDIN, SOHAIL A. QURESHI, ROMENA
QAZI, & FARHAT ABBAS
Aga Khan University Hospital, Karachi
PURPOSE: DNMT1 maintains genomic DNA methylation at 5'-CpG-3' residues
in somatic cells. Recent findings revealed that DNMT1 depletion causes distinct
phenotypic changes in colon and gastric cancer cell lines, suggesting that the
extent to which DNMT1 influences the expression of its target genes is cell-type
specific. We determined the impact of DNMT1 depletion in prostate cancer
derived cells on their gene expression profiles and cellular phenotype.
MATERIALS AND METHODS: Small interfering RNA was used to silence DNMT1
expression in prostate cancer derived PC3 cells (ATCC™). The resulting cell
line was validated by reverse transcriptase-polymerase chain reaction and
Western blotting. Proliferation, migration and invasion assays were done in
engineered cells to asses the effect of DNMT1 silencing on cellular phenotype.
DNA microarrays were done to monitor changes in gene expression.
RESULTS: Our data showed that DNMT1 loss dramatically decreased cell
proliferation but significantly increased cell migratory and invasive potential.
Additionally, in the limited set of genes whose expression and DNA methylation
status were determined DNMT1 loss was associated with increased CDKN3 and
claudin-3 expression, and also culminated in specific demethylation of Rb1 and
RAR-â promoters.
CONCLUSIONS: These results show that the genetic and phenotypic
consequences of silencing DNMT1 in PC3 cells are markedly different from those
in colon and gastric cancers, indicating that DNMT1 preferentially targets certain
gene promoters. Our findings also suggest that decreasing DNMT1 levels or
activity can potentially enhance prostate cancer cell invasiveness.
ANALYSIS OF P53 GENE MUTATIONS/POLYMORPHISMS IN
ORAL SQUAMOUS CELL CARCINOMA (OSCC) IN PAKISTAN
SAIMA SALEEM1, ABDUL HAMEED2, MUHAMMAD AJMAL2, NAVID RASHID
QURESHI3, ZUBAIR ABBASI4 AND ABID AZHAR1
1Dr. A. Q. Khan Institute of Biotechnology and Genetic Engineering (KIBGE),
University of Karachi, Karachi
2Institute of Biomedical and Genetic Engineering, 24-Mauve Area, G-9/1,
Islamabad
3Liaquat College of Medicine and Dentistry, Karachi
4 Karachi Medical and Dental College, Karachi
INTRODUCTION: Oral squamous-cell carcinoma (OSCC) is among the common
neoplasm in Pakistan. Epidemiologic evidence indicates a direct relationship
between tobacco smoking, chewing of betel leaves (paan), betel nut (chaliya),
niswar and gutka, with oral carcinogenesis, suggesting that there may be specific
genetic targets of betel-quid ingredients. The p53 gene has been indicated to
be a tumor-suppressor gene that is found in mutated form in common human
cancers. However, there are few reports about "carcinogen-specific" p53 mutation.
MATERIALS AND METHODS: Tissue and blood specimens were collected from
250 OSCC patients, with informed consent, from local hospitals of Karachi and
were used for p53 mutation analyses. Exons 4, 5 and 6 of p53 genes were
examined by polymerase chain reaction-single-strand conformation polymorphism
(PCR-SSCP) and direct sequencing.
RESULTS: The PCR-SSCP analyses showing mobility shift bands in tumor
samples were purified and directly sequenced. In exon 4 of the p53 gene, a C
to G missense mutation at nucleotide position 215 of the coding sequence was
identified.
CONCLUSIONS: This change substitutes amino acid proline with arginine at
position 72 of p53 protein. The change was significantly observed in OSSC tumor
sample that may be responsible for causing OSCC in Pakistan.
KEY WORDS: p53, OSCC, PCR-SSCP, DNA sequencing, and mutation
INDUCTION OF PLURIPOTENT STEM CELLS FROM HUMAN
FIBROBLASTS AND HEPATOCYTES BY ECTOPIC EXPRESSION
OF DEFINED TRANSCRIPTION FACTORS USING ADENO
ASSOCIATED VIRUS (AAV)
1AFTAB AHMAD, 2EDILAMAR D OLIVERA, 3KEPING QIAN, 1A.R. SHAKOORI,
3IAN M PHILLIPS
1School of Biological Sciences, University of the Punjab, Lahore, Pakistan
2University of São Paulo , Brazil
3Keck Graduate Institute of Applied Life Sciences, CA. USA
INTRODUCTION: Production of induced pluripotent stem cells (iPSC) is a
breakthrough in biological sciences. iPSC generation has great potential for
basic and clinical sciences. There is a possibility of nuclear reprogramming using
somatic cell nuclear transfer technology and fusion of embryonic stem (ES) cells
with mature cells but potential of these approaches was hindered by technical
complications and ethical concerns. Main objective of iPSC production is the
derivation of “customized” embryonic stem cells for patient specific cell treatment.
MATERIAL AND METHOD: An attempt has been made to induce in vitro
reprogramming of human fibroblasts and hepatocytes by ectopic expression of
four transcription factors, Oct4, Sox2, Klf4 and c-Myc by Adeno Associated Virus
(AAV). Exogenous expression of these genes was studied by PCR. iPSC
production was also analyzed with or without expression of c-Myc (a transcription
factor). Immunostaining of colonies was done.
RESULTS: ES cells like colonies were observed in both fibroblasts and
hepatocytes. iPSC colonies were confirmed by immunostaining with ES cell
markers (Oct-4, SSEA-4,TRA-1-60 and TRA-1-81). iPSC colonies were also
generated using Oct-4 promoter and Geneticin (G480) as selectable marker.
CONCLUSION: Our results indicate that iPSC can be generated by ectopic
expression of three TF in mature human cells. There is further need of in vivo
study to test these iPSC for germ line transmission and teratoma formation and
in vitro differentiation into all the three germ layers.
KEYWORDS: Embryonic stem cells, Induced pluripotent stem cells, Transcription
factors, gene expression.
IMMUNOPROTECTION OF HEAT-INDUCED SPLENIC-TISSUE BY
CYANOCOBALAMIN IN ALBINO RATS: AN IMMUNOHISTOLOGICAL
STUDY
DR. ABDUL HAFEEZ & DR. ANJUM NAQVI
Department of Anatomy, BMSI
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: The aim of study was to evaluate the immunoprotective role of
Cyanocobalamin on the detrimental effects of heat-induced stress on splenic-
tissue.
INTRODUCTION: In these days of global warming the heat injury is a major
public health issue. Heat stress had more effects on immune responses, lymphoid
organs and pathophysiology of white blood cells. Elevated plasma ACTH and
corticosterone are the key indicators of the stress condition. Studies on the spleen
have increased owing to the immune system with which it is involved. The
concentration of the antioxidant vitamins decrease with heat stress.
Cyanocobalamin is essential for DNA metabolism, a necessary step in the
replication of genes. Cobalamins are intracellular antioxidants; prevent apoptosis
of lymphocytes, and acts as an antimutagenic agent.
MATERIAL & METHODS: The study was conducted from December 2008 to
July 2009. A total of 30 male albino rats between 60-90 days were selected and
divided into control (A), heat-induced (B) and protective (C) groups. Group B
animals received heat between 40-45 C for 6 hours daily and group C animals
received heat and protection with Cyanocobalamin 0.8 mg /kg daily for 6 weeks.
Animals then sacrificed, blood samples were colleted in EDTA K3 containing
vacutainers for plasma ACTH assay, Formalin fixed paraffin-embedded, splenic-
tissue sections were obtained on Poly-L-Lysine coated glass slides. Antigents
retrieved by HIER techniques and stained with immunostins anti CD3 and CD79
a for the precise localization of T and B-lymphocytes.
RESULTS: Immunostaining shows decreased size and cellularity with apoptosis,
necrosis and mitotic figures on H & E stain in-group B. Where as group C, shows
comparable structure with the control group. The plasma ACTH level in Group
B increased significantly (67.63 +- 0.69 pg/ml) in-group C.
CONCLUSION: These findings suggest that Cyanocobalamin has important
immunomodulatory effects on immunity and abnormalities in the immune system
in heat-stressed models are restored by Cyanocobalamin therapy.
KEY WORDS: Heat, Stress, Spleen, ACTH, Cyanocobalamin.
FORMALDEHYDE EXPOSURE LEVEL IN THE GROSS ANATOMY
DISSECTING ROOM AT COLLEGE OF MEDICINE KING SAUD
UNIVERSITY RIYADH
MUHAMMAD SAEED VOHRA
Assistant Professor, Stem Cell Unit
Department of Anatomy, College of Medicine
King Saud University, Saudi Arabia
{Email: vohra@ksu.edu.sa}
INTRODUCTION: This study was conducted to correlate the personal
formaldehyde (FA) exposure levels of instructors and students with the indoor
FA concentrations in gross anatomy laboratory at College of Medicine, King Saud
University. The personal FA levels of instructors and students are higher than
the indoor FA concentration in the gross anatomy laboratory.
MATERIALS AND METHODS: The gross anatomy laboratory at college of
medicine, King Saud University Riyadh, was observed for indoor FA concentration
and the personal exposure levels of instructors and the medical students during
the 4th 10th and 14th weeks of the dissection sessions. All air samples were
collected by the diffusive sampling device and analyzed by using high performance
liquid chromatography (HPLC).
RESULTS: The personal exposure level of FA was higher than the indoor
concentration, and the personal exposure levels of instructors were higher than
that of the students. The concentration of FA was also higher in the center of the
room than the corners and near the doors.
CONCLUSION: Both the indoor FA concentrations and the degree of personal
FA exposure levels are higher near the dissecting table than a point away from
it during the gross anatomy laboratory sessions. Thus the instructors and students
are exposed to the higher concentration of FA than the general population.
EXPRESSION OF CD CELL SURFACE MARKERS FOLLOWING
GABAPENTIN TREATMENT IN MODEL OF AIA RATS
SAMEERA KHURSHID AND SHABANA USMAN SIMJEE
H.E.J. Research Institute of Chemistry, International Center for Chemical and
Biological Sciences,
University of Karachi, Karachi
INTRODUCTION: Chronic pain is a group of heterogeneous persistent symptoms
that may arise due to imbalance of neurotransmitter release of excitatory
(glutamate) and inhibitory (GABA) origin. Moreover, cluster differentiation (CD)
markers are also reported to be involved in the progression of chronic inflammatory
pain. During inflammatory process, the expression of CD markers has been
shown to be altered due to the alteration in GABAergic neurotransmission. In
the present study, we have investigated the effect of GABA analog “gabapentin”
(GBP) treatment alone or as an adjunct therapy on the modulation of chronic
arthritic pain and on the expression of CD29, CD44 and CD90 markers in the
arthritic rats. To our knowledge, much of the work done on the up-regulation of
CD markers was carried out in the synovial fluid aspirate from the inflamed joint.
However, we have evaluated the effect of GBP on the expression of these
markers in the brain of arthritic rats.
MATERIAL AND METHODS: The arthritis was induced in SD rats using complete
Freund’s adjuvant. The progression of the disease was monitored by measuring
body weight and paw volume, whereas, the nociception was measured by Plantar
Test. At the end of the study, animals were sacrificed and the brain samples were
collected for immunohistochemical analysis of CD markers.
RESULTS: It was observed that however, the treatment of GBP as a single agent
did not inhibit the macroscopic changes i.e., erythema and swelling of limbs, but
it significantly reduced the hyperalgesia in the arthritic rats measured by Plantar
Test. Moreover, when it was given as a combination therapy with low dose of
indomethacine, a significant reduction (P<0.05) in the paw volume was observed.
Immunohistochemical analysis revealed a marked decrease in the CD29, CD44
and CD90 expression in the GBP treated arthritic rats compared to the arthritic
control group.
CONCLUSION: Based on these results, we suggest that GBP might control the
underlying mechanism of the inflammatory processes associated with arthritis.
When given as an adjunct therapy with NSAIDs (indomethacin), GBP has profound
effect on both the nociception and inflammation where NSAIDs act to relieve the
underlying inflammatory reactions and GBP act centrally to inhibit the pain
transmission. In addition, the determination of CD molecules in brain samples
can also be a strong predictive marker of the inflammatory processes involved
in arthritis.
AC-31B SUPPRESSES THE ALTERATIONS IN BONE MARROW
CELL FUNCTIONS INDUCED BY KINDLED SEIZURES
SYED UZAIR ALI SHAH1, RAHEELA KHAN1, SIDDIQUA JAMALL3, ASMAT
SALIM2, & SHABANA U. SIMJEE1,2
1H.E.J. Research Institute of Chemistry
2Dr. Panjwani Center for Molecular Medicine & Drug Research, International
Centre for Chemical & Biological Sciences, University of Karachi, Department
of Biochemistry, University of Karachi, Karachi
INTRODUCTION: The bone marrow (BM) provides microenvironment for
proliferation and differentiation of hematopoietic stem cells and any changes in
the BM microenvironment could have an impact on the immune system. Studies
have suggested a linkage between seizure activity and alterations in immune
functions which may be due to disruptions of BM functions. The present study
was carried out in order to determine the effects of chronic seizures on the BM
cells and whether such changes are likely to be controlled by treating the kindled
mice with AC-31B (oil from Allium cepa).
MATERIALS AND METHODS: NMRI mice were kindled by injecting
pentylenetetrazole (PTZ, 50mg/kg) on alternate days until seizure score 4-5
develops. At the end of each experiment, animals were sacrificed and cell
suspension from femurs were prepared and cultured until cells attained confluence.
The cultured cells were used for immunostaining and RT-PCR analysis of CD29,
CD44 and CD90. The whole blood and BM aspirate was also used to isolate the
mononuclear cells for clonogenic assay.
RESULTS: A significant increase (P<0.05, F=5.36) in the cellularity of the BMCs
from untreated kindled animals was observed compared to normal control group.
We also observed a marked reduction of BM cellularity in diazepam treated
animals (P<0.02) compared to normal and AC-31B treated animals. After observing
hyperproliferation of BM progenitors in PTZ-kindled mice, we next determine if
there was change in the marrow stroma. An increase in stromal cells in the PTZ-
kindled animals (P<0.01) relative to the normal control mice supports the
hyperproliferation of BM progenitors observed in this group. Since we observed
changes in BM cellularity, we next determined if the effects of seizures were
extended to dysfunction in the immature progenitors. One-way ANOVA for
clonogenic assays from peripheral blood and BMNCs showed that the groups
differed significantly in total numbers of colonies. Post hoc analysis indicated
that untreated kindled mice had a significantly higher colony number (P<0.02,
F=4.81) relative to normal and AC-31B treated animals. In contrast, kindled and
un-kindled mice treated with diazepam showed reduced number of clones
compared to other groups. Immunohistochemical and RT-PCR analysis of cultured
cells demonstrated increased expression of CD29, CD44 and CD90 in PTZ-
kindled group. In contrast, the expression of these molecules was found to be
reduced in diazepam and AC-31B treated kindled animals.
CONCLUSION: The present study has provided evidence suggesting that immune
alterations in epilepsy could be due, in part, to changes in BM functions and it
can be modulated by appropriate anti-convulsant use which avoids the effect on
normal hematopoiesis.
GENETIC VARIANTS OF HDV STRAINS IN PAKISTAN
SHADAB PERVEEN1, WAQARUDDIN AHMED2, AMBREEN ARIF2, ISRAR
NASIR3 SYED M. SHAHID1, ABID AZHAR1 HUMA QURESHI 2 & OBAID
YUSUF KHAN3
1The Karachi Institute of Biotechnology & Genetic Engineering (KIBGE), University
of Karachi, Karachi
2PMRC Jinnah Hospital
3Department of Genetics, University of Karachi, Karachi-Pakistan
INTRODUCTION: HDV is the smallest identified animal virus that is composed
of 1.7kb circular negative sense RNA genome that requires Hepatitis B surface
antigen for its replication and assembly. The infection caused by delta virus is
called hepatitis D which essentially requires the presence of Hepatitis B virus.
Presence of hepatitis D virus increases the severity of infection by about 70-
80%, compared to hepatitis B alone. The variable patterns of Hepatitis D from
mild to severe depend on three genetic variants of delta virus that have been
identified so far. The incidence of Hepatitis D infection in Hepatitis B patients
and carriers is rising in Pakistani population. A study carried out in Karachi,
showed the prevalence of Hepatitis Delta Virus (HDV) which is about 17% of 4.9
million HBV carriers. There is no data available yet on prevailing genotypes of
the HDV strains in Pakistan. The present study was aimed to identify the most
prevalent genetic strain of Hepatitis Delta Virus in Pakistan.
MATERIALS & METHODS: In this study hepatitis delta virus RNA of 200 patient’s
sera were analyzed by RT-nested PCR. It is based on sequence variation within
the coding region of hepatitis delta antigen of delta virus RNA genome. DNA
amplified from patients was digested with restriction enzymes to detect any
Restriction Fragment Length Polymorphism.
RESULTS: Out of 200 HBV ELISA positive patients 76 (38%) were positive for
hepatitis delta virus RNA by RT-nested PCR while genetic variants of type I have
been found by RFLP.
Conclusion: In present study, data indicate the prevalence of genotype I among
delta positive sera which is about 97.5%.
KEYWORDS: HDV, genotype, RT-nested PCR.
COMPARISON OF POTASSIUM HYDROXIDE MOUNT AND
M Y C O L O G I C A L C U LT U R E W I T H H I S TO PAT H O L O G I C
EXAMINATION USING PERIODIC ACID-SCHIFF STAINING OF THE
NAIL CLIPPINGS IN THE DIAGNOSIS OF ONYCHOMYCOSIS
RAZIUDDIN AHMED, SALEEM AHMED KHARAL, MUHAMMAD ASIF
DURRANI, FAKHARUDDIN
Department of Microbiology, BMSI
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: Comparison of potassium hydroxide mount and mycological culture
with histopathologic examination using periodic acid-schiff staining of the nail
clippings in the diagnosis of onychomycosis
SETTING: Study is carried out on fifteen patients in the Department of Microbiology,
who were clinically diagnosed as a case of Onychomycosis with the collaboration
of Dermatology department (JPMC) and Pathology Department, BMSI, JPMC.
METHOD: Specimen were taken from the department of dermatology and
processed for the diagnosis by potassium hydroxide mount and mycological
culture in the department of Microbiology, BMSI, while histopathological examination
using Periodic acid-Schiff stain were performed in Pathology department, BMSI.
Potassium hydroxide mounts was microscopically evaluated for the presence of
thread-like branching structures (hyphae) or beaded spherical structures (spores).
If present, it was considered as a positive test. Mycological culture was done
using Sabouraud's dextrose agar at 25ºC and at 37ºC. Observation for growth
was done periodically for 4 weeks; if growth was present then the pathogen was
identified by cultural characteristics and microscopy. PAS staining was done in
Pathology department, BMSI. Presences of intensely stained reddish dots or
threadlike structures in between the cells of the nail plate were considered to be
a positive result. One was immunocompromised patient having Diabetes mellitus
Fifteen patients who were clinically diagnosed as a case of onychomycosis were
included in the study. Among these patients ten (66.66%) were female and five
(33.33%) were male. Age distribution was; eight (53.33%) patients were between
the ages 14-24 years and four (26.66%) were between 25-35 years of age, two
(13.33%) between the ages of 36-50 years while one (6.66%) patient was of
more than 50years of age. Minimum age was 14 years while maximum was 60
years. All were immunocompetent patients while only.
RESULT: KOH mount shows fungal element in ten specimens while in six patients
the culture was positive. Histopathological examination using Periodic acid-Schiff
stain was positive in specimens.
CONCLUSION: KOH mount is more effective than the fungal culture.
KEY WORD: Onychomycosis, KOH mount, Fungal culture, PAS stain
EMERGING RESISTANCE IN HELICOBACTER PYLORI ISOLATED
FROM GASTRIC BIOPSIES IN PUBLIC SECTOR
GASTROENTEROLOGY UNIT OF KARACHI, PAKISTAN
TARANUM RUBA SIDDIQUI, WAQUARUDDIN AHMED, SAFIA BIBI
Pakistan Medical Research Council
Jinnah Postgraduate Medical Centre, Karachi
OBJECTIVE: The aim of this study was to estimate the susceptibility pattern of
Helicobacter pylori against commonly prescribed antibiotic.
METHOD: It was a prospective study carried out in gastroenterology unit of
PMRC, JPMC, Karachi from March 2008 to June 2009. Total 445 patients
presenting symptoms of gastroduodenal diseases underwent endoscopy for the
diagnosis. Biopsies were taken for CLO, Culture & sensitivity test. Sensitivity
was performed by disc diffusion method. MacfarLand 4 of Helicobacter pylori
culture suspension was used to make lawn prior to place antibiotic disc. The
Sensitivity test was done for following commonly prescribed antibiotic, Amoxicillin,
Clarithromycin, Tetracycline, Metronidazole, Ofloxacin, and Furazolidone. Plates
were incubated at 37 C in microaerophilic condition for three days.

RESULTS: Total of 445 cases in which 211 (47.4%) were male and 234 (52.58%)
were female. Helicobacter pylori were isolated from 80 cases (17.9%).

Resistance pattern was 27.2%, 16.36%, 98.18%, 9.0%, 1.8%, & 5.4% against
Clarithromycin, Furazolidone, Metronidazole, Ofloxacin, Amoxicillin, & Tetracycline
respectively. Intermediate pattern of isolates were seen 1.8%, 7.27%, 21.8%, &
10.9% against Tetracycline, Amoxicillin, Ofloxacin, Furazolidone, respectively.
The frequency of triple- & quadruple resistant Helicobacter pylori isolates was
9.05% and 36.36% were resistant to more then one drug.

CONCLUSION: The increased resistance of Helicobacter pylori against commonly

prescribed antibiotics is very alarming. Present study shows Amoxicillin and
tetracycline is effective against Helicobacter pylori and it can be use as an
alternative for the treatment of H.pylori infection.