Karachi, Pakistan
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Mazher W.,Civil Hospital Karachi | Rizvi A.H.,Dow University of Health Sciences | Adam A.M.,Dow University of Health Sciences
Journal of the Pakistan Medical Association | Year: 2017

Idiopathic Myelofibrosis is a rare myeloproliferative disorder. In children, it becomes even rarer. Herein, we report a case of idiopathic myelofibrosis of a 6-year old male patient who presented with complaints of pallor, petechiae and bleeding from gums. Bone marrow aspirate showed afragmented haemodiluted smears with erythroid and myeloid precursors scattered throughout. Trephine biopsy showed increased background fibrotic activity along with clusters of histiocytes. A diagnosis of paediatric primary myelofibrosis was made on biopsy. The patient also developed a stroke that resulted in left-sided hemiparesis. An MRI suggested an intraparenchymal haemorrhage along with meningeal extramedullary haematopoiesis. © 2017, Pakistan Medical Association. All rights reserved.


Shafique K.,Dow University of Health Sciences | Mirza S.S.,Dow University of Health Sciences | Mughal M.K.,Dow University of Health Sciences | Arain Z.I.,Isra University of Pakistan | And 3 more authors.
PLoS ONE | Year: 2012

Water-pipe (WP) smoking has significantly increased in the last decade worldwide. Compelling evidence suggests that the toxicants in WP smoke are similar to that of cigarette smoke. The WP smoking in a single session could have acute harmful health effects even worse than cigarette smoking. However, there is no evidence as such on long term WP smoking and its impact on chronic health conditions particularly cardiovascular and metabolic conditions. Therefore, we conducted this study to investigate the relationship between WP smoking and metabolic syndrome (MetS). This was a cross-sectional study carried out in Punjab province of Pakistan using the baseline data of a population-based study - Urban Rural Chronic Diseases Study (URCDS). Information was collected by trained nurses regarding the socio-demographic profile, lifestyle factors including WP smoking, current and past illnesses. A blood sample was obtained for measurement of complete blood count, lipid profile and fasting glucose level. MetS was ascertained by using the International Diabetic Federation's criteria. We carried out multiple logistic regressions to investigate the association between WP smoking and MetS. Final sample included 2,032 individuals - of those 325 (16.0%) were current WP smokers. Age adjusted-prevalence of MetS was significantly higher among current WP smokers (33.1%) compared with non-smokers (14.8%). Water-pipe smokers were three times more likely to have MetS (OR 3.21, 95% CI 2.38-4.33) compared with non-smokers after adjustment for age, sex and social class. WP smokers were significantly more likely to have hypertriglyceridemia (OR 1.63, 95% CI 1.25-2.10), hyperglycaemia (OR 1.82, 95% CI 1.37-2.41), Hypertension (OR 1.95, 95% CI 1.51-2.51) and abdominal obesity (OR 1.93, 95% CI 1.52-2.45). However, there were no significant differences in HDL level between WP smokers and non-smokers. This study suggests that WP smoking has a significant positive (harmful) relationship with MetS and its components. © 2012 Shafique et al.


Shamim M.,Baqai Medical University | Shamim M.,Civil Hospital Karachi
Indian Journal of Surgery | Year: 2013

Surgeons are still following the old habit of routine subhepatic drainage following laparoscopic cholecystectomy (LC). This study aims to compare the outcome of subhepatic drainage with no drainage after LC. This prospective study was conducted in two phases. Phase I was open, randomized controlled trial (RCT), conducted in Civil Hospital Karachi, from August 2004 to June 2005. Phase II was descriptive case series, conducted in author's practice hospitals of Karachi, from July 2005 to December 2009. In phase I, 170 patients with chronic calculous cholecystitis underwent LC. Patients were divided into two groups, subhepatic drainage (group A: 79 patients) or no drainage (group B: 76 patients). The rest 15 patients were excluded either due to conversion or elective subhepatic drainage. In phase II, 218 consecutive patients were enrolled, who underwent LC with no subhepatic drainage. Duration of operation, character, and amount of drain fluid (if placed), postoperative ultrasound for subhepatic collection, postoperative chest X-ray for the measurement of subdiaphragmatic air, postoperative pain, postoperative nausea/vomiting, duration of hospital stay, and preoperative or postoperative complications were noted and analyzed. Duration of operation and hospital stay was slightly longer in group A patients (P values 0. 002 and 0. 029, respectively); postoperative pain perception, nausea/vomiting, and postoperative complications were nearly same in both groups (P value 0. 064, 0. 078, and 0. 003, respectively). Subhepatic fluid collection was more in group A (P = 0. 002), whereas subdiaphragmatic air collection was more in group B (P = 0. 003). Phase II results were nearly similar to group B patients in phase I. Routine subhepatic drainage after LC is not necessary in uncomplicated cases. © 2012 Association of Surgeons of India.


Siddique O.,Dow University of Health Sciences | Sundus A.,Dow University of Health Sciences | Faisal Ibrahim M.,Civil Hospital Karachi
Journal of the Pakistan Medical Association | Year: 2014

Dengue fever is on the rise in developing nations like India, Pakistan, Sri Lanka and Bangladesh. There is no anti-viral chemotherapy or vaccine for dengue virus and management of the disease is done on supportive measures. The decline in the thrombocyte count leads to dengue haemorrhagic fever accounting for complications and mortality. Oral administration of Carica papaya leaves extract is said to have a positive impact on thrombocyte count. A 23-year-old man was administered a calculated dose for five days. Blood samples were tested for complete blood count before and after the administration of the juice. Thrombocyte count had increased from 28000/micro liter to 138000/micro liter at the end of five days. We present our experience here.


Bota R.,Dow University of Health Sciences | Ahmed M.,Dow University of Health Sciences | Jamali M.S.,Dow University of Health Sciences | Aziz A.,Civil Hospital Karachi
Journal of Infection and Public Health | Year: 2014

Background: Dengue is among the most common mosquito-borne viral diseases that affect humans. It has now become a major public health dilemma, annually affecting approximately 50-100 million people worldwide. This study aimed to assess the knowledge, attitude and perception of dengue fever among university students of interior Sindh. Methods: A cross-sectional study was conducted during the period of April-June 2012. Four hundred and fifty students were surveyed. A structured pre-tested questionnaire was used to collect data. The data were analyzed using SPSS version 17. Results: Overall, 94.6% of participants (43.3% male and 56.7% female, p-value 0.03) reported that they had heard about dengue, and 58.6% of participants reported ". Aedes mosquito" as a vector of dengue virus, with gender difference (37.5% male vs 62.5% females with p-value <0.001). The Aedes mosquito is ". A small dark mosquito having white stripes on its leg" was reported by 54.8% students. The Aedes mosquito breeds in ". Stagnant clean water" was reported by 47.6% (male 40.2% vs female 59.8%, p-value 0.003) and usually bites at ". Dusk" by 44.7% and at ". Dawn" by 51%. Regarding symptoms of dengue fever, ". Prolonged high fever" was reported by 52.6%, ". Muscular pain" by 39.6% (p-value 0.009), ". Bleeding" by 41.3% (p-value 0.001) and ". Headache, nausea and vomiting" by 44.7% (p-value 0.001). Conclusion: Approximately half of the participants in our study were unable to correctly identify the Aedes mosquito as a transmission source (41.4%), its appearance (45.2%), its breeding place (52.4%) and its bite time (52.2%). The enhancement of knowledge through different educational programs is needed to increase awareness of dengue fever. © 2014 King Saud Bin Abdulaziz University for Health Sciences.


Masood I.,Civil Hospital Karachi | Rafiq A.,Civil Hospital Karachi | Majid Z.,Civil Hospital Karachi
Tropical Doctor | Year: 2014

We hereby present the case of a 25-year-old man who presented at the emergency department of Civil Hospital Karachi, Pakistan with signs and symptoms of acute viral hepatitis. Serology tests revealed that the patient was suffering from hepatitis E viral (HEV) infection. Concurrently, the patient was also found to have thrombocytopaenia (TCP). His TCP became better after the resolution of his jaundice, with the patient requiring a transfusion of one mega unit of platelets. After ruling out other common causes of TCP and after a thorough literature search, we concluded that an immune-mediated mechanism secondary to HEV infection might have been the cause behind his low platelet counts. Hence, we propose considering the possibility of HEV infection in patients presenting with acute liver failure and TCP, irrespective of age, gender, and geographical location of the patient. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.


Mirza R.,Civil Hospital Karachi | Wahid Z.,Civil Hospital Karachi | Talat H.,Civil Hospital Karachi
Journal of the Liaquat University of Medical and Health Sciences | Year: 2012

OBJECTIVES: The study was carried out to evaluate the prevalence of dermatological problems in patients undergoing haemodialysis and to document the pattern of these skin alterations. STUDY DESIGN: Prospective, descriptive. METHOD: The study comprised of a total number of 300 clinically diagnosed cases of chronic renal failure belonging to either sex being managed by haemodialysis. A detailed dermatological examination of these patients was carried out. The results were recorded on a preformed performa. RESULTS: There were 169 males and 131 females with the age range of 10-80 years. Maximum duration of dialysis was 9 years and minimum 1 month. Xerosis (90.66%) was the most common finding. Pruritus was present in (64.66%). Hyperpigmentation esp. diffuse (54%), oral lesions (69.3%) including xerostomia and gingival friability, nail changes (61.6%), including pale nails, polished nails and half and half nails and hair changes (56.6%), including dry coarse hair and loss of hair from scalp, arms and legs were also present. Other findings included haemorrhagic diathesis (easy bruisibility, bleeding gums and nasal bleeding), purpuric lesions, excoriation marks, lichenification, AV Shunt complications, cutaneous infections, hypopigmentation, delayed wound healing, hyperpigmented macules on palms and soles, calcinosis cutis, gynaecomastia, solar keratosis and kyrles disease. CONCLUSION: There is a high prevalence of cutaneous changes in patients undergoing haemodialysis. At least one cutaneous change was found in 96% of patients. Xerosis was the most common finding followed by pruritus, diffuse hyperpigmentation, xerostomia, easy bruisibility, pale nails and half and half nails.


Asim S.A.,Civil Hospital Karachi | Wahid Z.,Civil Hospital Karachi
Pakistan Journal of Medical Sciences | Year: 2012

Objective: To determine the nature and frequency of cutaneous manifestations in patients of Hepatitis C virus (HCV) infection. Methodology: One hundred HCV positive patients presenting at Dermatology department of Civil Hospital Karachi from January 2008 to December 2008 were enrolled and evaluated for cutaneous manifestations. Relevant data regarding history, physical examination including skin & its appendages and investigations (complete blood counts, liver function tests, Serum Anti HCV antibodies, ultrasound abdomen) were recorded and analyzed. Results: Out of 100 patients (43% males, 57% females) mean age 41 years (Range 12-70 years), pruritus was the most common dermatological feature seen in 35% patients followed by Lichen planus 12% and idiopathic thrombocytopenic purpura in 8% patients. Less common features were urticaria, alopecia areata, porphyria cutanea tarda & cryoglobulenemia. Conclusion: Pruritus, lichen planus and idiopathic thrombocypenic purpura are common Cutaneous manifestations in patients suffering from HCV infections. These are important and sometimes the only presenting feature of HCV infection, therefore health care providers should be vigilant while examining these patients for underlying HCV disease.


Qurrat-Ul-Ain,Civil Hospital Karachi | Khan S.A.,Dow Medical College
Journal of the Pakistan Medical Association | Year: 2015

Artificial sweeteners or intense sweeteners are sugar substitutes that are used as an alternative to table sugar. They are many times sweeter than natural sugar and as they contain no calories, they may be used to control weight and obesity. Extensive scientific research has demonstrated the safety of the six low-calorie sweeteners currently approved for use in foods in the U.S. and Europe (stevia, acesulfame-K, aspartame, neotame, saccharin and sucralose), if taken in acceptable quantities daily. There is some ongoing debate over whether artificial sweetener usage poses a health threat.This review article aims to cover the health benefits, and risks, of consuming artificial sweeteners, and discusses natural sweeteners which can be used as alternatives. © Pakistan Medical Association. All rights reserved.


Soomro J.A.,World Health Organization | Memon A.,Chest Specialist Fatima Bhai Hospital | Soomro T.K.,Civil Hospital Karachi
Journal of Medicine | Year: 2012

Objective: The inhalation route is widely used for the treatment of asthma. It is considered that inadequate inhaler technique is the leading cause of therapy failure. To determine the proportion of incorrect inhaler use and associated factors in asthmatic patients compromising quality of life. Methodology: It is a cross sectional study conducted at Specialist Chest Clinic Fatima Bhai Hospital Karachi from September 2010 to March 2011. A sample size of 215 was selected by Non-probability purposive sampling technique. Trained health care workers in presence Chest specialist requested patients to demonstrate their inhaler technique and assessed it according to the checklist. If any of the steps was missing or done incorrectly, it was marked as incorrect technique. Information was also collected through a structured questionnaire on socio-demographic variables such as age, gender, education, duration of asthma, duration of inhaler use, and patient education of inhaler technique. Data was entered and analyzed on SPSS-14. Results: There was an inverse relationship between education level and incorrect inhaler technique (p<0.05). Education of inhaler usage provided by doctors was more effective as compared to education provided by nurses (p<0.038). There was no significant relationship between age, sex, duration of asthma, duration of inhaler use, frequency of inhaler use and incorrect inhaler technique. Conclusion: Quality of life of a large percentage of patients is compromised by incorrect inhaler use and education level of patients had significant relationship with incorrect inhaler technique.

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