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Ishaq M.,Jinnah Medical College Hospital | Sualeh Muhammad J.,Jinnah Medical College Hospital | Sualeh Muhammad J.,Aga Khan University | Hameed K.,Ziauddin University
Modern Rheumatology | Year: 2013

Objectives: Our aim was to determine the frequency of restless leg syndrome (RLS) in rheumatoid arthritis (RA) patients from a low socioeconomic area of Pakistan and compare results with a control group to evaluate the effect of variables on RLS patients. Methods: A clinical observational study was carried out on 240 RA patients form low socioeconomic group. Controls (n = 210) were frequency-matched by age group to the RA patients. We evaluated the presence of RLS and collected information on characteristics believed to be correlated with RLS in the general population. Multiple logistic regression models were used to study the association between RLS and other risk factors such as age, smoking status, and obesity. Results: Among all rheumatic patients seen at our rheumatology clinic, 70.8 % were women. Our study shows that 20 % of RA patients were suffering from RLS compared with 10 % of the control group with other rheumatic diseases. Multivariate logistic regression adjusted for age, obesity, and smoking also showed that women with RA were more likely to have RLS than control patients. RLS was also significantly associated with increasing age, high body mass index, and smoking status. Conclusions: Approximately 20 % of RA patients were suffering from RLS. Hence, there is need of increase awareness of RLS among rheumatologists to enhance early RLS diagnosis and appropriate management of this treatable condition. © 2012 Japan College of Rheumatology.

Junaid M.,Jinnah Medical College Hospital | Suhail A.,Aga Khan University | Umer B.,Aga Khan University | Nawaz A.,Dar ul Sehat Hospital | And 3 more authors.
Journal of the Pakistan Medical Association | Year: 2013

Objective: To use toluidine blue intra-operatively to identify tumour involved margins after the removal of oral cavity squamous cell carcinoma, and to compare the findings with those of final histopathology. Methods: The study was conducted at the Aga Khan University Hospital from December 1, 2009, to March 14, 2010, and comprised 56 consecutive patients with biopsy-proven squamous cell carcinoma of oral cavity regardless of grade and stage of tumour. Intra-operatively toluidine blue was used on the resected tumour margins and the staining patterns were assessed. Results were then compared with the final histopathology report. Results: A total of 11(19.64%) margins were positive with toluidine blue staining out of which 8 (14.28%) were false positive. Sensitivity and specificity was found to be 100% and 84.9% respectively with a positive predictive value of 27.2%; a negative predictive value of 100%; and diagnostic accuracy of 85.71%. Conclusion: Toluidine blue costs only Rs25 (USD 0.30) and takes only 5 minutes for application and interpretation. It can be used with significant confidence in smaller lesions (T-I and T-II) as an alternative to frozen sections in developing countries where facilities are unavailable. Its use in larger lesions (T-III and TIV) remains the topic of controversy and awaits a multi centre trial with a larger cohort.

Ishaq M.,Jinnah Medical College Hospital | Muhammad J.S.,Jinnah Medical College Hospital | Hameed K.,Ziauddin University | Mirza A.I.,Ziauddin University
Modern Rheumatology | Year: 2011

In order to compare the efficacy and toxicity of methotrexate and leflunomide for the treatment of rheumatoid arthritis, a double-blind randomized clinical trial was carried out at the Department of Medicine, Jinnah Medical College Hospital, Korangi, Karachi. The sample size was 240 patients and the duration of the study was 1 year. The patients enrolled were randomly divided into two groups (methotrexate and leflunomide). RA activity was clinically assessed by noting changes in the four primary (tender joint count, swollen joint count, physician and patient global assessment score) and three secondary (morning stiffness, pain intensity, HAQ) clinical efficacy end-points. Data were expressed as the mean ± SD. A P value of<0.05, calculated by paired t test, was considered significant. A total of 368 subjects were enrolled in this study. Of these, 128 subjects were withdrawn during the screening phase. Of the 240 subjects who were randomized and treated, 129 received leflunomide and 111 received methotrexate. The difference between the baseline and 12 month end-point measurements of all primary clinical efficacy end-points was significantly greater in methotrexate-treated than in leflunomide-treated subjects. Both leflunomide and methotrexate resulted in significant improvements in all secondary clinical efficacy end-points after 1 year of treatment. In both treatment groups, the most common reason for withdrawal during the treatment was adverse events. The results of this study indicate that both leflunomide and methotrexate are effective drugs for the long-term treatment of RA. It was concluded that methotrexate, which is a much cheaper drug than leflunomide, is the drug of choice, especially for patients who belong to low socioeconomic groups. © Japan College of Rheumatology 2010.

Ishaq M.,Jinnah Medical College Hospital | Muhammad J.S.,Jinnah Medical College Hospital | Mahmood K.,Dow University of Health Sciences
Journal of the Pakistan Medical Association | Year: 2012

Objective: To find the causes and characteristics of uveitis and its subtypes among Pakistani population, and to create awareness that early diagnosis and treatment of uveitis requires a multi-disciplinary approach. Methods: The retrospective study involved 98 diagnosed uveitis patients. Data was analysed regarding associated systemic diseases, infections, ocular syndromes, anatomical localisation, age, and gender. Results: In 85% of the patients, a classified form of uveitis was observed: associated systemic diseases were found in 24%, the most frequent one being sarcoidosis (9.8%) and V-K-H syndrome (7.4%); ocular syndromes were present in 10%, the most frequent being birdshot retinochoroidopathy (6.1%) and pars planitis (3.7%); and infections in 48%, the most frequent being tuberculosis (50.6%) and hepatitis (4.9%). Among classified uveitis, posterior uveitis was found in 46%, intermediate uveitis in 10% and anterior uveitis in 7% of the patients. Panuveitis was diagnosed in 36% of cases. The remaining 1% showed extrauveal manifestations. Conclusions: Causes of uveitis vary considerably by geographic location around the world. Granulomatous diseases are the most frequent cause of uveitis in Pakistan. Hence, detailed and expensive investigations in our context are not justified in all patients. The data offer guidance to rheumatologists and consultant physicians to facilitate efficient diagnostic testing.

Nazir L.,Jinnah Medical College Hospital | Husain A.,Jinnah Medical College Hospital | Haroon W.,Dastagir Medical Center | Shaikh M.I.,Jinnah Medical College Hospital | And 2 more authors.
Journal of the College of Physicians and Surgeons Pakistan | Year: 2012

A middle-aged lady presented with sudden onset of unilateral central retinal vein thrombosis after completing 6 months course of interferon and ribavirin for chronic hepatitis C infection. She had no risk factors and all her thrombophilia workup was normal, however, she was found to be dyslipidemic which may have contributed to atherosclerosis and predispose to thrombosis. Despite anticoagulation, her visual acuity deteriorated. This case illustrates the possibility of unpredictable visual complication of interferon. Frequent eye examination should be undertaken in patients having underlying risk factors like diabetes, hypertension or dyslipidemia undergoing interferon therapy.

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