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Breymann C.,University of Zürich | Bian X.-M.,Peking Union Medical College | Blanco-Capito L.R.,University of the Philippines | Chong C.,Gleneagles Hospital | And 2 more authors.
Journal of Perinatal Medicine | Year: 2011

Anemia during pregnancy and the postpartum period is commonly caused by iron deficiency and is a significant worldwide issue with severe consequences for both mother and developing fetus. From a worldwide perspective, iron-deficiency anemia (IDA) during pregnancy is highest in the Asia-Pacific region; however, there has been little guidance in this region for safe and effective treatment. An expert panel was convened to develop a concise and informative set of recommendations for the treatment of IDA in pregnant and postpartum women in the Asia-Pacific region. This manuscript provides these recommendations and aims to reduce the morbidity and mortality associated with IDA in pregnant and postpartum women in the Asia-Pacific region. The consensus recommendations define anemia as a hemoglobin (Hb) level <10.5 g/dL during pregnancy and <10 g/dL during the postpartum period, and provide cut-off Hb levels to initiate therapy with oral iron, intravenous iron or red blood cell transfusion. © 2011 by Walter de Gruyter Berlin New York.


Shakoor M.T.,Baystate Medical Center | Ayub S.,University of Arkansas for Medical Sciences | Ahad A.,Nishter Medical College | Ayub Z.,Fatima Jinnah Medical College
American Journal of Case Reports | Year: 2014

Objective: Rare disease.Background: Serotonin syndrome is a potentially life-threatening adverse drug reaction that most commonly results from adverse interactions between drugs. Because serotonin syndrome can be fatal and is often difficult to diagnose, it is vital for health professionals to know about this reaction. We report a typical case of transient serotonin syndrome secondary to tramadol-Citalopram combination. This case report highlights the value of awareness of the early and subtle signs of serotonin syndrome.Case Report: A 44-year-old female with past medical history of chronic pancreatitis, back pain, and major depression was brought to the emergency room (ER) with altered mental status, jerky movements in extremities, generalized weakness, and vomiting.Conclusions: Most physicians are aware of serotonin syndrome secondary to antidepressants but do not think about other classes of medications such as analgesics. Clinicians should also be aware of the possibility of serotonin syndrome when encountering a patient taking serotonergic drugs who presents with characteristic symptoms of serotonin syndrome. © Am J Case Rep, 2014.


Shakoor M.T.,St Mary Mercy Hospital | Ayub S.,Harvard University | Ayub Z.,Fatima Jinnah Medical College | Mahmood F.,Aga Khan University
Journal of Medical Case Reports | Year: 2012

Introduction: Invasive aspergillosis is a serious complication in immunocompromised patients. It is an opportunistic disease, which predominantly occurs in the lungs, although dissemination to virtually any organ is possible. Invasive aspergillosis in an immunocompetent patient with extension to the mediastinum has rarely been reported. Here, we present the case of a patient with no apparent immunodeficiency state, who presented with Aspergillus endocarditis and fulminant invasive aspergillosis with extensive involvement of the mediastinal structures, which ultimately was responsible for her death. To the best of our knowledge, this is the first reported case in the literature on fulminant invasive mediastinal aspergillosis with extension to the pulmonary vasculature and concomitant Aspergillus endocarditis in an apparently immunocompetent patient without pre-existing lung disease. Case presentation: Our patient was a previously healthy 47-year-old Asian woman, who presented to our emergency room with severe progressive shortness of breath of one month's duration, associated with orthopnea and unstable vital signs. Conclusion: Invasive aspergillosis has been described in the presence of pulmonary disease, such as chronic obstructive pulmonary disorder, and one case has been reported in a patient without preexistent disease, but none of these have been fatal. Our case is therefore the first reported case of its kind. Our case shows that fulminant aspergillosis can occur in an immunocompetent host and can be fatal. We conclude that invasive aspergillosis should not be excluded from the differential diagnosis on the basis of immunocompetency. © 2012 Shakoor et al.; licensee BioMed Central Ltd.


Naeem S.,Lahore Medical College | Bukhari M.H.,Fatima Jinnah Medical College
Journal of the College of Physicians and Surgeons Pakistan | Year: 2015

Objective: To analyze the expression of various antigens on the leukemic blasts and to determine the hematological parameters, in Acute Lymphoblastic Leukemia (ALL) patients at presentation. Study Design: Observational study. Place and Duration of Study: King Edward Medical University, Lahore and Hameed Latif Hospital, Lahore, from February2013 to March 2014. Methodology: A total of 50 newly diagnosed and untreated patients of ALL were selected from Mayo Hospital and Hameed Latif Hospital. These patients included both genders and all age groups. Hemoglobin, total leukocyte count and platelet count were determined on hematology analyser-Sysmex-Kx-2I. Blast cell percentage was estimated on Giemsa stained blood smears. Immunophenotyping was done on bone marrow samples by 5 colour flowcytometery on Beckman Coulter Navious Flowcytometer. An acute leukemia panel of 23 antibodies was used. The data was entered and analyzed in SPSS version 22. Results: Of the 50 ALL patients, 36 (72%) were B-ALL and 14 (28%) T-ALL. There were 18 (36%) children and 32 (64%) adults. T-ALL included 22% of the childhood and 31% of the adult cases. Immunophenotypic analysis showed that CD19, CD79a and CD20 were B-lineage specific markers whereas cCD3, CD3 and CD5 were T-lineage specific. CD10 was the most sensitive marker for B-ALL and CD7 was the most sensitive marker of T-ALL. TdT was expressed in 92% B-ALL and 71% T-ALL cases, CD34 in 58% and 43% cases and CD45 in 83% and 100% respectively. High leukocyte count (> 50 x 109/L) was present in 58% cases. Hemoglobin was < 10 g/dl in 74% patients and platelet count was below 20 × 109/L in 12% patients. Leukocyte count, hemoglobin, platelet count and blast cell % did not show a significant difference in the two ALL immunotypes. Conclusion: The frequency of T-ALL is higher in childhood as well as adult ALL in our population compared to the Western literature. Antigenic expression of the blast cells also shows some interesting differences. A large number of our patients present with high leukocyte count which is a known factor associated with poor prognosis.


PubMed | University of Punjab, Fatima Jinnah Medical College and Gujranwala Medical College
Type: Journal Article | Journal: Acta biochimica Polonica | Year: 2015

The protein kinase c-erbB-2 belongs to the family of receptor tyrosine kinase and is involved in oncogenesis. The present study predicts different phosphorylation sites of HER2/c-erbB-2 which are important in preventing or developing cancer, especially breast cancer. Sequence homology showed highest homology (77%) with epidermal growth factor receptor kinase domain. According to PROSITE search result, active sites of c-erbB-2 are N-lobe (glycine rich phosphate binding loop). Catalytic loop with presumptive catalytically active of Asp108 is phosphorylated by tyrosine protein kinase. A-loop, activation loop, becomes phosphorylated and activates the substrate binding. The study strengthens our knowledge regarding HER2 signaling by the detection of uncharacterized signaling proteins, establishing phosphorylation of an activation loop and helps us to make assumptions about the role of such previously unidentified proteins. On the basis of importance of HER2 in breast cancer as well as in other diseases, this study provides fruitful information for designing new therapeutic strategies.


Ashraf A.,Fatima Jinnah Medical College | Shaikh A.S.,King Edward Medical University | Kamal F.,Fatima Jinnah Medical College | Sarfraz R.,Allama Iqbal Medical College | Bukhari M.H.,King Edward Medical University
Diagnostic Cytopathology | Year: 2010

A prospective study was conducted to see the sensitivity, specificity, and accuracy of fine needle aspiration cytology (FNAC) for 100 salivary gland swellings in comparison with biopsy. These randomized samples were submitted and reported at the department of pathology, Allama Iqbal Medical College, Lahore. The male to female ratio was 1:1.5. Ages of the patients ranged from 8.5 to 58 years with mean age 33.39 ± 12.37 years. Maximum number of lesions was found in age group between 21 and 40 years. Parotid gland was involved in 68%, submandibular gland in 30%, and minor salivary glands in 2% patients. Sublingual gland was not involved in any of our subjects. There were 14% cases of non-neoplastic lesions and 86% cases of neoplastic lesions on biopsy. Non-neoplastic lesions included 12 cases of inflammations (three cases of granulomatous inflammation and nine cases of nonspecific chronic inflammation) and two cases of inclusion cysts. Among neoplastic lesions, biopsy revealed 68 cases of benign neoplasia and 18 cases of malignant neoplasia. Non-neoplastic lesions did not show any difference in diagnosis by both techniques. FNAC misdiagnosed four malignant and one benign lesion. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for benign neoplastic lesions were 98.52, 87.05, 94.36, and 96.55%, respectively, whereas for malignant neoplastic lesions they were 77.77, 98.78, 93.33, and 95.29%, respectively. In conclusion, FNAC is found to be a highly sensitive and specific technique for diagnosis of most of salivary gland swellings, except for malignant neoplastic lesions where its sensitivity is intermediate. We strongly recommend that FNAC should be adopted as an initial investigation for all salivary gland swellings. © 2009 Wiley-Liss, Inc.


PubMed | Fatima Jinnah Medical College and King Edward Medical University
Type: Journal Article | Journal: Pakistan journal of medical sciences | Year: 2015

To see the efficiency, adequacy and accuracy of toluidine blue stained smears of FNAC of Breast thyroid and salivary glands swelling with comparison to conventional stained FNAC smears with Papanicolaou.A total of 114 aspirates from various sites were included in the study. The smears were stained with toluidine blue and conventional Papanicolaou stain and the cytomorphology of both the smears were compared. The values were tabulated and statistical tests of significance was applied.Of the 114 aspirates included in our study the diagnostic accuracy by using papanicolaou was 78%, while it was upto 100% with supravital toluidine blue stained smears. The percentage of inadequacy was reduced to just 25%. The observations were statistically significant. Breast 37/48 (77%) and Salivary glands 11/48 (23%) respectively. The most commonly used categorization of a five-tier system was used for reporting of breast cytology, with categories ranging from insufficient materials (C1), benign (C2), atypical (C3), suspicious of malignancy (C4), or (C5) frankly malignant. Most of breast lesions were benign 25 (67.56%). There were only 9 (24.32%) malignant cases followed by 2 cases of C-4 and one case of C-3. Benign thyroid lesion were more frequent comprising of 51 (72.27%) cases. One case (1.5%) of papillary carcinoma was found while 13 case were follicular lesions. There were 4 (36.4%) cases of pleomorphic adenoma and 3 (27.3) cases of non-specific sialadenitis. There was one case (9%) of each lesion for mucoepidermoid carcinoma, adenoidcytic carcinoma and benign cyst.Toluidine blue stained study of FNAC improves the diagnostic accuracy by minimizing the smearing and drying artifact, loss of cell sample during fixation and staining which influences the diagnostic accuracy.


Shore N.,Fatima Jinnah Medical College
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Tubular damage as suggested by tubular proteinuria is a recognised feature of glomerulonephritis. The objectives of the study were to compare the level of alpha-microglobulin in normal and diabetic patients, and also to find out whether the level of alpha-1 microglobulin could become a laboratory marker for tubulo-interstitial damage in diabetic nephropathy. Twenty-nine registered Type II diabetic patients of either sex were studied. The patients' age ranged from 41-50 years who were admitted in the medical ward, and those who visited the outdoor department of Sir Ganga Ram Hospital, Lahore were included in the study. The duration of study was one year from June 2006 to June 2007. Ten normal subjects with no history of diabetes were taken as controls. Blood samples and 24 hour urine samples of patients of all groups were collected. The levels of urinary protein and blood sugar were estimated by auto analyser. Proteinuria positive urinary samples were analysed by SDS-PAGE electrophoresis. The level of alpha-1 urinary protein was significantly increased in the group of diabetic patients as compared to the urinary protein level of normal subjects. Blood sugar level was also significantly increased in patients as compared to controls. Level of low molecular weight protein alpha-1 microglobulin showed an electrophoresis band of 28 Kda with an average volume of 6741.88 in the urine sample of patients. On the other hand, a very light, hardly recognisable band was observed in normal subjects. Urinary alpha-1 microglobulin provides a noninvasive and inexpensive diagnostic alternative for the diagnosis and monitoring of urinary tract disorders, i.e., early detection of tubular disorders of diabetic nephropathy. We propose that SDS-PAGE electrophoresis is a comparatively inexpensive diagnostic approach to detect this marker in the urine sample.


Khan A.Z.,Fatima Jinnah Medical College
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Objective: To identify the non-academic attributes developed during 5 years of training in medical school. Study Design: Sequential mixed method. Place and Duration of Study: The study was conducted on final year medical students of four medical colleges in the city of Lahore, from March to September 2010. Methodology: Probability random sampling was employed to identify public sector medical colleges for inclusion in the study through Lottery method. In the first phase, survey was done with the help of questionnaires, distributed amongst 280 students, selected on the basis of convenience sampling. It was triangulated with data collected by in-depth structured interviews on 46 students selected using purposive sampling after formal informed consent. For quantitative data percentages of the categorical variables were calculated through SPSS version 10. For qualitative data, themes and patterns were identified using Content Analysis technique. Results: Majority of the medical students (80%) learn the attributes of integrity, self-reliance, tolerance and independence during their schooling. Sixty five percent students thought that the values of humanity, forbearance, righteous attitude in face of adversities and sympathetic behaviour towards peers and patients helped them in being better medical students. Thirty five percent said they faced the negative influences of gender bias and gender discrimination which has led to their impaired professional growth. Eighty percent of the students believe that the teaching methodology employed is teacher centric which does not let them become problem solvers, team players, reflective learners and hampers development of effective communication skills. Conclusion: Medical schooling in our part of the world helps in developing untaught attributes such as integrity, selfreliance, tolerance, independence, sympathetic attitude and good communication skills which are the same as are developed in the medical students of advanced countries, which can be fostered further by formally addressing them in the curriculum.


Rashid A.,Fatima Jinnah Medical College
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Osteoporosis has emerged a major health hazard in postmenopausal women. The process of osteoporosis accelerates two year prior to menopause, reaching the peak level during first 3 years of menopause when women loss 3 (see symbol) 5% of their bone mass per year. This study tried to find out the role of phytoestrogne in improving the bone mineral density and bone related biochemical parameters in group of postmenopausal women. Fifty postmenopausal women with age range 50 (see symbol) 60 years were included in the study. Phytoestrogen with mineral supplement were given twice daily for 3 months. Biochemical parameters like serum calcium, magnesium, alkaline phosphatase, uric acid, total protein and oestrogen were determined before and after phytoestrogen therapy by autoanalyser and ELIZA (oestrogen assay). T-score before and after phytoestrogen were find out by densitometer DEXA. The level of serum calcium, magnesium, uric acid and oestrogen was increased in women after taking phytoestrogen but significant difference (p < 0.01) was only observed in case of serum calcium. Level of serum alkaline phosphatase and total serum protein were slightly increased with no significant different before and after phytoestrogen therapy. Value of T-score was although markedly decreased after phytoestrogen therapy but it showed no significant difference. It is concluded that as the early years of menopause are a period of rapid bone loss, and the risk for osteoporosis increases substantially, the habitual intake of soy protein and isoflavones may play a role in the retardation of bone loss.

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