Lahore, Pakistan
Lahore, Pakistan

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Raja S.G.,Harefield Hospital | Akhtar S.,Abbottabad International Medical College | Shahbazc Y.,Jinnah Hospital | Masoodd A.,Canterbury Health Center
Interactive Cardiovascular and Thoracic Surgery | Year: 2011

Hydroxyethyl starch (HES) solutions are commonly used for volume replacement in cardiac surgery patients. The degree of impairment of the haemostatic system depends on the molecular weight and substitution degree of HES solutions. It is claimed that as HES 130y0.4 (Voluven ®) exhibits a lower in vitro molecular weight and a lower degree of hydroxyethyl substitution than HES 200y0.5 (HAES-steril ®) therefore it has less impact on haemostasis. A best evidence topic in cardiac surgery was written according to a structured protocol to verify this statement. The question addressed was: in cardiac surgery patients does volume replacement with Voluven ® impair coagulation less than other colloids? Using the reported search 12 papers, three in vitro and nine clinical studies, were found to represent the best evidence to answer the clinical question. The nine clinical studies were all randomised controlled trials. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The in vitro studies suggest that HES 130y0.4 has no significant effect on platelet variables, shows a faster clot formation process and a better clot retraction as compared with the other HES solutions. On the other hand, current best available evidence (level 1b) from clinical studies, limited by heterogeneity predominantly in terms of dosage of HES 130y0.4 administered and the sample size of individual trials, overwhelmingly suggests that HES 130y0.4 compared with HES 200y0.5 or gelatin-based volume replacement fluid affects coagulation to the same extent resulting in similar degree of blood loss. It can be concluded that contrary to in vitro studies HES 130y0.4 in clinical practice has comparable effects on blood loss after cardiac surgery. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.


Javed F.,University of Rochester | Vohra F.,King Saud University | Vohra F.,Jinnah Hospital | Al-Kheraif A.,King Saud University | And 2 more authors.
Oral Diseases | Year: 2015

Objective: The aim was to compare the periodontal inflammatory conditions among habitual gutka chewers and betel quid (BQ) chewers. Material and Methods: Forty-five gutka chewers, 45 BQ chewers and 50 non-chewers (controls) were included. Demographic data regarding age, gender, duration, and frequency of gutka- and BQ-chewing habits and gingival bleeding were collected using a questionnaire. Clinical periodontal parameters [plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (AL)] were recorded. Marginal bone loss (MBL) was measured on digital panoramic radiographs. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (α < 5%). Results: Periodontal inflammatory parameters [PI, BOP, PD (4-6 and >6 mm), clinical AL and MBL] were significantly high in gutka and BQ chewers than controls. There was no significant difference in periodontal inflammatory parameters among gutka and BQ chewers. The odds for gingival bleeding were six times and 13 times higher in gutka and BQ chewers, respectively, compared to controls. Comparison of gutka and BQ chewers did not significantly increase the odds of gingival bleeding. Conclusion: Periodontal inflammatory conditions were comparable among habitual gutka and BQ chewers; which suggests that gutka chewers and BQ chewers are equally susceptible to periodontal disease. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Aziz Z.,Jinnah Hospital | Iqbal J.,Jinnah Hospital | Akram M.,Jinnah Hospital | Anderson B.O.,Fred Hutchinson Cancer Research Center
Breast | Year: 2010

Two hundred and thirty-seven women, undergoing multimodality treatment for locally advanced breast cancer (LABC), were retrospectively analyzed for age, menopausal status, socio-economic status (SES), tumor size, nodal involvement, tumor grade, estrogen and progesterone receptor (ER, PR) status and tumor stage. Primary purpose was to assess outcomes of these patients treated in a low-income country as defined by the World Bank and using limited-level treatment resources as defined by Breast Health Global Initiative (BHGI) guidelines. Secondary objectives included correlation of predictive and prognostic features with event-free survival (EFS) and overall survival (OS) at 5. years.Predictors of decreased EFS or OS included lower SES [P=0.05 (95%CI 0.34-1.0) and P=0.1 (CI 0.29-1.14)], larger tumor size [P=0.01 (95%CI 1.06-1.59) and P=0.3 (CI 0.86-1.50)] and positive lymph node status [P=0.04 (95% CI 1.0-1.55) and P<0.0001 (CI 1.37-2.64).In women diagnosed with LABC in Pakistan, patients with lower SES had larger, more aggressive tumors with worsened survival outcomes. Optimal breast cancer care warrants consideration for health care policies that address access to diagnostic and treatment services for financially disadvantaged women. © 2009 Elsevier Ltd.


Tahir M.N.,University of Sargodha | Khan A.H.,Jinnah Hospital | Shad H.A.,University of Sargodha
Acta Crystallographica Section E: Structure Reports Online | Year: 2014

The title Schiff base, C14H11NO3, crystallizes as a zwitterion (i.e. proton transfer from the carboxylic acid group to the imine N atom). The dihedral angle between the aromatic rings is 19.59 (6)° and an intramolecular N - O hydrogen bond closes an S(6) ring. In the crystal, inversion dimers linked by pairs of O - O hydrogen bonds generate R 2 4(24) loops. The dimers are linked by C - O interactions, generating (211) sheets.


Masood A.,Jinnah Hospital | Jafar S.S.,Jinnah Hospital | Akram Z.,Jinnah Hospital
Journal of the Pakistan Medical Association | Year: 2011

Objective: To assess the relationship between plasma high sensitivity C-reactive protein levels with severity of coronary atherosclerosis. Materials and Methods: The study included 80 patients subjected to coronary angiography. The extent of Coronary Artery Disease (CAD) was assessed using Gensini score. Patients were divided into three risk groups according to hs-CRP levels (<1mg/L - as low risk, 1-3mg/L - as average risk and >3mg/L- as high risk). Mean Angiographic Gensini scores were compared among the risk groups. Correlation between serum hs-CRP levels and angiographic Gensini scores was also assessed. Results: The 26 (32.5%) patients belonging to hs-CRP low-risk group had a mean angiographic Gensini score of 11.8 ± 5.8, 18 (22.5%) belonging to moderate-risk group had a mean score of 28.9 ± 7.9 and 36 (45%) belonging to high- risk group had a mean score of 78.7 ± 41.0. By applying ANOVA the mean angiographic Gensini scores showed increasing trend from lower to higher hs-CRP risk groups (p < 0.001). Serum hs-CRP levels showed significant correlation with respective angiographic Gensini scores by Pearson's correlation (p < 0.001). Conclusion: Serum hs-CRP levels show significant correlation with the severity of Coronary Artery Disease as assessed by angiographic Gensini score.


Sohail N.,Jinnah Hospital
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Objective: To determine the relationship of stress and academic performance in first year medical students and to identify sources of stress, levels of stress and relevant coping strategies. Study Design: Mixed method sequential. Place and Duration of Study: Allama Iqbal Medical College, Lahore, from March to December 2010. Methodology: Survey questionnaire and in-depth interviews were carried out in the first year students with their consent. Two hundred and fifty students were surveyed, out of whom 120 students responded. Twelve students with their consent were interviewed. Non-probability purposive sampling was employed for both types of data collection. SPSS version 20 was used. The qualitative data generated through structured in-depth interviews, were analyzed by content analysis. Results: Low level of stress was found in 7.5% (score 150), moderate level of stress was present in 71.67% (score between 150 and 300), and high level of stress was observed in 20.83% (score 300) of the students. There is moderate negative (-0.583) and significant (p < 0.01) correlation between academic performance and sources of stress. Similarly there is moderate negative (-0.478) and significant (p < 0.01) correlation between academic performance and levels of stress. There was strong positive (0.799) and significant (p < 0.01), correlation between stress level and number of stress sources. Conclusion: The study showed a diversity of stress sources and a high level of stress in the medical students. The results also show that higher level of stress is associated with poor academic performance.


Khan Z.I.,Jinnah Hospital
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Objective: To describe the management and outcome of patients with penile fracture. Study Design: Case series. Place and Duration of Study: Department of Urology and Renal Transplantation, Jinnah Hospital, Lahore, from March 2008 to March 2011. Methodology: Sixteen patients presenting with clinical findings / history of penile fracture were included in this study. Diagnosis was made on the basis of history and clinical findings. Surgical exploration and repair was done on the same day. In all patients, a subcoronal circumferential degloving incision was made. Rent location and dimensions management and postoperative complication were noted. Postoperatively, erection was suppressed for 4 - 5 days. All patients were discharged with advice of avoidance of sex for about 8 weeks. Patients were followed-upto 6 months. Results: Majority of the patients (87.5%) were married and 13 (81.25%) were aged 18 - 45 years. The typical findings recorded in 100.0% patients were erection at time of fracture, detumescence, swelling and ecchymosis. Audible crackling sound and pain was present in 13 (81.25%) patients. Ten (62.5%) patients had rent in the proximal part of penile shaft and right lateral tear was present in 11 (68.75%) patients. Blood clots were evacuated and closure of rent was done with vicryl 2/0 (interrupted stitches). 100.0% patients had uneventful recovery with only 3 (18.75%) patients developed right chordate of erect penis after treatment. All (100.0%) patients were potent and without any problem of erection. Conclusion: Penile fracture is under-reported. A trauma to erect penis is essential to cause fracture. Surgical exploration and repair is the treatment of choice.


Khalid K.,Jinnah Hospital | Humayoun W.,Jinnah Hospital
Pakistan Journal of Medical and Health Sciences | Year: 2016

Aim: To determine the reliability of ulnar artery perforator flap for the coverage of electric injury defects at wrist. Methods: This descriptive study was conducted at Plastic Surgery Department Jinnah Hospital, Lahore, from October, 2013 to August, 2015. All male and female patients between 5-65 years of age, having post electric injury wounds or unstable scar exclusively on volar surface of wrist were included in this study. The patients with damaged proximal ulnar artery or having peripheral vascular disease were excluded from the study. Results: There were 15(79%) were male and 4(21%) were female with soft tissue defects or unstable scar over the wrist. Partial flap necrosis without dehiscence was noted in total of 2 patients out of which 1 was male and 1 was female. Partial flap necrosis with dehiscence was seen in only 1 male patient. No such complication was seen in females. There was no case of total flap necrosis in the study. Conclusion: Ulnar artery perforator flap is a reliable flap for coverage of soft tissue defects over wrist and distal forearm region. Ulnar artery perforators are quite consistent in their location.


Aziz Z.,Jinnah Hospital | Iqbal J.,Jinnah Hospital | Aaqib M.,Jinnah Hospital | Akram M.,Jinnah Hospital | Saeed A.,Jinnah Hospital
Leukemia and Lymphoma | Year: 2011

Imatinib mesylate (IM) is a first-line treatment of chronic phase-chronic myeloid leukemia (CP-CML). The primary objective of this study was to assess the quality of life (QOL) in patients with CP-CML treated with IM. Ninety patients with newly diagnosed CP-CML were assessed for QOL with first-line IM. Patients completed the cancer-specific FACT-BRM questionnaire (functional assessment of cancer therapy-biologic response modifiers) at baseline and at 3 and 6 months. FACT-BRM consists of subscales including physical well-being (PWB), social and family well-being (SFWB), emotional well-being (EWB), functional well-being (FWB), BRM-physical, and BRM-mental. The primary endpoint was the Trial Outcome Index (TOI), created as a measure of physical function and well-being. An increase of ≥5 from baseline was considered to be a clinically significant improvement. The mean TOI score increased from 75.5 at baseline to 85.2 (p<0.0001) at 6 months, representing a healthy QOL. When comparing the individual TOI subscales, there was a mean increase of 16.4 in the daily functioning and well-being score, and a mean decrease of 6.2, 4.9, and 16.1 was noted in fatigue, emotional/cognitive dysfunction, and side-effects scores at 6 months, respectively. Improvement was not affected by age, sex, or Sokal score. With prolonged treatment, IM results in a higher physical well-being, less fatigue and emotional and cognitive dysfunction, and very few side-effects. © 2011 Informa UK, Ltd.


Aslam M.I.,Queen Elizabeth Hospital | Pervaiz A.,Jinnah Hospital | Figueiredo R.,Queen Elizabeth Hospital
Asian Journal of Surgery | Year: 2014

Background Anal fissure is a common benign condition. An anorectal problem is defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge. Chronic anal fissure is defined by a history of symptoms present for more than 2 months' duration and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled edges, and a base exposing the internal sphincter. Because complications such as incontinence are associated with surgical treatment, chemical sphincterotomy is currently favored. Objectives The objective of this study is to compare the difference in outcome between open partial lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure. Methods This was a quasi-experimental study carried out between January 16, 2007 and January 15, 2008 in the Surgical Department of Jinnah Hospital, Lahore, Pakistan. Sixty consecutive cases with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients met the study inclusion criteria and were randomly assigned to one of the two groups. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open partial lateral anal sphincterotomy. Both groups were followed up at 1 week, 2 weeks, 4 weeks, and 6 weeks after the treatment. Results All the patients complained of pain. A total of 43 (71.7%) patients had pain with constipation, whereas 31 (51.7%) patients had bleeding per rectum. Upon clinically examining the anal area, tenderness was elicited in all 60 (100%) patients. Group A included 30 (11 females and 19 males) cases treated with topical 0.2% nitroglycerin ointment and Group B included 30 (11 females and 19 males) cases who underwent open partial lateral anal sphincterotomy. In Group A, only 15 patients with fissures were successfully treated (50%). By contrast, 28 (93%) patients with fissures in Group B were successfully treated, and only two (7%) remained uncured. These two patients (6.6%) in Group B suffered from incontinence due to flatus and feces as a complication of the procedure. Conclusion This quasi-experimental study demonstrates that open partial lateral internal sphincterotomy is superior to topical 0.2% nitroglycerin application in the treatment of chronic anal fissure, with good symptomatic relief, high rate of healing, fewer side effects, and a very low rate of early continence disturbances. © 2013, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.

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