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Rāwalpindi, Pakistan

Nuri M.M.,Army Medical College
JPMA. The Journal of the Pakistan Medical Association | Year: 2012

To evaluate the effects of autologous bone marrow stem cell transplant on clinical symptoms, overall left ventricle ejection fraction and myocardial perfusion in patients with recent anterior myocardial infarction in left anterior descending artery territory. The study was conducted in the department of interventional cardiology of Armed Forces Institute of Cardiology, National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi from June 2004 to November 2006. There were 26 male patients with recent anterior myocardial infarction, having anterior/apical hypokinesia and disease process involving only left anterior descending artery, who were recruited. The whole procedure was explained to the patients in the language of their best understanding and informed consent was obtained. Stem cell harvest was obtained from both posterior superior iliac crests, which were processed to note total and mean mononuclear cell counts. Stem cells were transplanted into the damaged myocardium using stop flow technique through lumen of over-the-wire balloon catheter, placed in mid left anterior descending artery. All patients tolerated the procedure well except for a few complications which were tackled by the experienced operators. The patients were advised to continue conventional medical therapy. The efficacy of stem cell transplant was objectively assessed by comparing effects on three parameters--clinical, left ventricle cineangiographic, and nuclear scintigraphic status--at baseline and at 12 weeks after transplantation. There is improvement in general well being, left ventricle ejection fraction and myocardial perfusion after stem cell therapy. Autologous bone marrow stem cell transplant seems to be a favourable and secure way of treatment for improvement of post-myocardial infarction ejection fraction and perfusion. There is dire need to conduct larger randomised controlled trials to assess efficacy of this cost-effective mode of therapy, especially in our part of the world.

Safdar C.A.,Army Medical College
Journal of the Pakistan Medical Association | Year: 2012

In the last few years, medical education has become evidence-based and structured. It has incorporated principles of learning used in professions other than medicine. Safety, simulators and checklists have been learned from aviation industry. Handover protocols are borrowed from oil industry. Legal profession has emphasized the importance of critical thinking. Even the modern war colleges have developed learning strategies like war games and mock scenarios which can be assimilated in our postgraduate medical education. Modern-day medical education is looking for new horizons and innovations. Many professions other than traditional medical education may provide the necessary guidelines for modernisation.

Fayyaz A.,Army Medical College | Ghani U.F.,PAF Hospital
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Hydatid disease has varied presentations and may involve any part of the body with hydatid disease of the liver being the most common site. Hydatid disease of lesser sac is a rare entity. Different treatment options of hydatid liver disease are available which include surgical, medical and radiological management. Surgical management has its limitations in terms of cost, morbidity, mortality, rate of recurrence and patient fitness to undergo surgery. Medical management alone carries a low chance of cure. Radiological management with PAIR therapy (percutaneous aspiration, injection and re-aspiration) of hydatid liver disease has been well described in literature. However, hydatid disease of lesser sac in itself is a rare entity and its treatment with PAIR procedure has not been described before. We describe a case of hydatid disease of lesser sac treated with the PAIR procedure.

Fayyaz A.,Army Medical College | Ahmed W.,AFIC NIHD
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Objective: To identify the referral factors for fetal echocardiography which are associated with congenital cardiac defects in the fetus. Study Design: Cross-sectional descriptive study. Place and Duration of Study:Radiology Department, CMH, Rawalpindi, from January 2007 to November 2010. Methodology: All patients referred for fetal echocardiography with one or more risk factors for the development of congenital heart disease, and those patients with incidental discovery of congenital heart disease on antenatal ultrasound were evaluated. Patients with no risk factors who were found to have normal fetal echocardiography were excluded from the study. Univariate logistic regression analysis was carried out for each variable. The variables with statistical significance of less than 0.05 were subjected to multivariate logistic regression. Fetal echocardiographic diagnosis was taken as the dependent variable and all other variables were the independent variables. Results: Two hundred and sixty four patients were evaluated by fetal echocardiography for congenital heart disease. The statistically significant factor was detection of congenital heart disease on routine ultrasound examination. Conclusion: A routine obstetric scan should include evaluation of the heart with four-chamber and base-of-heart views to exclude cardiac anomalies. A cardiac anomaly picked up on routine ultrasound scan is the most important indication for referral for fetal echocardiography. Fetal arrhythmias and echogenic focus in the left ventricle do not have a significant association with structural cardiac malformation.

Saadia A.,Army Medical College
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2011

Abnormal uterine bleeding is one of the most frequent problems in life of an adult female. Uterine curettage or biopsy remains a preferred sampling procedure for diagnosis of the endometrial pathology. The objective of this study was to compare the sensitivity, specificity, positive and negative predictive value of endometrial curettage. This validation study was carried out at the Department of Histopathology, Army Medical College Rawalpindi in collaboration with Military Hospital, Rawalpindi from January to December 2010. The study included 50 curettage and subsequent hysterectomy specimen of the same patients. Non-probability sampling technique was used to divide patients into two groups with 50 patients in each group. One group was of endometrial curettage having endometrial pathology (group A). Second group was of subsequent hysterectomy specimen of the same patients (group B). Endometrial curettage was found most accurate in diagnosing endometrial carcinoma. Sensitivity of endometrial curettage was found to be 33% whereas specificity and positive predictive value was found to be 100% each. Negative predictive value was found to be 93.1%. Endometrial biopsy is a sensitive and a specific test in and is accurate in diagnosing endometrial pathology. It is found most accurate in diagnosing endometrial carcinoma.

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