KRL General Hospital

Islamabad, Pakistan

KRL General Hospital

Islamabad, Pakistan
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Ajmal M.,Institute of Biomedical and Genetic Engineering | Mir A.,International Islamic University, Islamabad | Shoaib M.,KRL General Hospital | Malik S.A.,Quaid-i-Azam University | Nasir M.,Institute of Biomedical and Genetic Engineering
Diagnostic Pathology | Year: 2017

Background: The dimerization efficiency of FGFR3 transmembrane domain plays a critical role in the formation of a normal skeleton through the negative regulation of bone development. Recently, gain-of-function mutations in the transmembrane domain of FGFR3 has been described associated with an aberrant negative regulation, leading to the development of achondroplasia-group disorders, including achondroplasia (ACH), hypochondroplasia (HCH) and thanatophoric dysplasia (TD). Here, we describe a non-consanguineous Pakistani family with achondroplasia to explain hereditary basis of the disease. Methods: PCR-based linkage analysis using microsatellite markers was employed to localize the disease gene. Gene specific intronic primers were used to amplify the genomic DNA from all affected as well as phenotypically healthy individuals. Amplified PCR products were then subjected to Sanger sequencing and RFLP analysis to identify a potentially pathogenic mutation. The impact of identified mutation on FGFR3 protein's structure and stability was highlighted through different bioinformatics tools. Results: Genetic screening of the family revealed a previously reported heterozygous c.1138 G > A (p.G380R) mutation in the coding exon 8 of FGFR3 gene. Identified genetic variation was confirmed in all affected individuals while healthy individuals and controls were found genotypically normal. The results were further validated by RFLP analysis as c.1138 G > A substitution generates a unique recognition site for SfcI endonuclease. Following SfcI digestion, the electrophoretic pattern of three bands/DNA fragments for each patient is indicative of heterozygous status of the disease allele. In silico studies of the mutant FGFR3 protein predicted to adversely affect the stability of FGFR3 protein. Conclusions: Mutation in the transmembrane domain may adversely affect the dimerization efficiency and overall stability of the FGFR3, leading to a constitutively active protein. As a result, an uncontrolled intracellular signaling or negative bone growth regulation leads to achondroplasia. Our findings support the fact that p.G380R is a common mutation among diverse population of the world and like other countries, can be used as a molecular diagnosis marker for achondroplasia in Pakistan. © 2017 The Author(s).


Taqi A.,Hameed Latif Hospital | Khan T.H.,KRL General Hospital
Anaesthesia, Pain and Intensive Care | Year: 2013

The journal presents this special issue dedicated to drug errors, with just two aspects highlighted; syringe swap and inadvertent wrong drug administration due to look-alike drug containers. This article gives the background of this decision and a victim's vivid narrative of her terrific experience related to drug error during anesthesia.


Khan T.H.,KRL General Hospital | Khan T.H.,Pakistan Institute of Engineering and Applied Sciences
Anaesthesia, Pain and Intensive Care | Year: 2011

AIMS: The purpose of this study is to provide empirically-based evidence about Pakistani anesthesiologists' job satisfaction, upon which recommendations can be made to physicians, managers, and policy makers. Type of study: A questionnaire based, cross-sectional study. Place & Duration: Islamabad; July 2008-January 2010. Methodology: A questionnaire was designed so as to accumulate evidence about the level of JS, mailed by post to known addresses of all anesthesiologists across the country and was also e-mailed to anesthesiologists via direct e-mailing. All heads of anesthesiology departments of major hospitals were requested to get the questionnaire filled by all the anesthesiologists in their departments. Results: A total of 40 responses were received. Mean age of the respondents was 41.77 years (SD = 10.39) with a range of 27-69 years. Among the respondents, 21(52.5%) were higher diploma holders, 12(30%) were lower diploma holders and 7(17.5%) were postgraduate trainees. The respondents ranged from a professor to PG trainees, including 6(15%) senior anesthesiologists, 27(67.5%) junior anesthesiologists and 7(17.5%) PG trainees. Anesthesiology was the first choice specialty of 19(47.5%). 13 (32.5%) of the respondents repented at some point after joining the specialty. 50% of anesthesiologists were fully satisfied with their job, the great majority of senior consultants were satisfied as compared to juniors 12 (63%) vs. 8(38%). 20(50%) of the respondents were satisfied with the working conditions in the operating rooms. Only 5(12.5%) of the respondents were satisfied with anesthesia fee paid to them as compared to 35 (87.5%), who were not. 36(90%) including a majority of PG trainees (71%) opined that the anesthesia fee should be based on ASA physical status of the patients. 35(87.5%) of the respondents expressed their dissatisfaction about the public awareness about their role in the operating rooms and the healthcare system. The rating of public awareness about their role in operating rooms, intensive care, pain management and resuscitation was 3.52±.28, 2.92±.26, 2.18±.25 and 2.88±.37 respectively on a scale of 1-10. Various measures suggested to improve it included pre-anesthetic rounds (25%) and media talks (37.5%). Others favoured public awareness meetings, television programs + writing article in newspapers and proper legislation etc. 33(82.5%) suggested that PSA could play a role in improving public perception. Conclusion: We conclude that JS in anesthesiologists in Pakistan is low and correlates with low anesthesia fee as well as low public awareness about the vital role played by them in the patient care in the operating rooms as well as other fields e.g. in intensive care setting, pain management and resuscitation. JS can be improved with more attention to improving working conditions, improving fee structure and public awareness about the specialty and the players in this specialty.


PubMed | KRL General Hospital and IBM
Type: Journal Article | Journal: Journal of neonatal surgery | Year: 2016

Intestinal atresia has still significant morbidity in developing countries. Stomas are now not recommended in every case of intestinal atresia; primary anastomosis is the goal of surgery after resection of dilated adynamic gut. A new type of stoma formation along with primary anastomosis is being presented here.This report is based on our experience of many cases with this technique in last 12 years but all the details and long follow-up of each case is not available. However the method of surgical procedure, progress, complications, and advantages encountered have been highlighted.Presently we have data of 7 patients; others are lost to follow up. Three had died with other associated problems, namely one with multiple atresias, two with septic shock and prematurity. Two stomas did not require formal closure because stoma shriveled and disappeared. Two other stomas had grown very long like a diverticulum when these were closed after 5 and 8 months.This technique is another attempt to decrease morbidity of patients of intestinal atresia especially in those cases where short bowel syndrome is feared after resection of proximal dilated gut.


Khan T.H.,KRL General Hospital
Anaesthesia, Pain and Intensive Care | Year: 2013

The incidence of transfusion has increased day by day due to many factors, including increasing population, enhanced expertise and facilities to operate once inoperable conditions and the willingness of the public to pay high cost of advanced surgical procedures. Trauma services have been well-organized now and victims may have massive transfusion. Many authors have pointed out the need of protocols and guidelines to be followed to avoid transfusion associated risks and complications. Under-transfusion has been preferred to over-transfusion and a need to have a 'Maximum Surgical Blood Order Schedule' has been stressed.


Khan T.H.,KRL General Hospital
Anaesthesia, Pain and Intensive Care | Year: 2012

Plagiarism is a universal phenomenon, not strictly restricted to medical writing, but encompassing almost all fields of life. Over a period of time, it has become customary to talk very loudly about it and even condemn it as a sin. A review of the past and present scientific knowledge as well as literature confirms that plagiarism has been and is still in wide practice in developed as well as undeveloped countries. The availability of scientific knowledge on the internet has made it easier to plagiarise as well as to identify plagiarized material. On the other hand much of the research methodology, reviews, discussion pans of original articles and even larger books and monographs do contain parts of copied material from already published material. This editorial review the prevalence of and the measures to control the plagiarism, and stresses a need to draw fresh lines in between good and bad plagiarism.


Khan T.H.,KRL General Hospital
Anaesthesia, Pain and Intensive Care | Year: 2016

Malignant hyperthermia is a genetically transmitted hypermetabolic syndrome, and thus will always continue to surface and test the wits of the anesthesiologists. This editorial compliments two case reports published in this issue, as well as a brief story on the related topic in the journal's permanent chapter 'My Most Unforgettable Experience'©. The high rate of mortality due to non-availability of dantrolene, and thus the need to chalk out a well-linked system to make dantrolene available even in the farthest corner of the country, with the help of army aviation, when the need arises, is emphasized.


Jadoon H.,KRL General Hospital | Khan T.H.,KRL General Hospital | Ahmed F.,KRL General Hospital | Tasneem S.,KRL General Hospital
Anaesthesia, Pain and Intensive Care | Year: 2016

We encountered a case of malignant hyperthermia in a 52 year old male undergoing open reduction/internal fixation of humerus fracture under general anesthesia. Isoflurane has been reported as a potent triggering agent of malignant hyperthermia. Dantrolene remains the gold standard for treating this life threatening syndrome but it is not available in many countries including Pakistan. However, we successfully managed our patient by timely recognition of this syndrome and administering prompt and effective symptomatic treatment.


Raza A.,KRL General Hospital | Khan T.H.,KRL General Hospital
Anaesthesia, Pain and Intensive Care | Year: 2014

Objective: Various supraglottic devices (SGD's) have been used as a conduit for tracheal intubation particularly in difficult airway situations when an endotracheal tube is a must. Various SGD's tried for this purpose include Intubating Laryngeal Mask Airway also called the C-Trach™ laryngeal mask, LMA Fastrach™, air-Q™ intubating LMA and the i-gel™ supraglottic airway. In this study we used air-Q™ LMA and i-gel™ for blind tracheal intubation in patients with normal airways and compared the rates of successful intubation. Methodology: 100 patients were randomly divided into two groups. For Group A, air-Q™ was used for blind tracheal intubation while for Group B i-gel™ LMA was used. Correct placement of ETT was confirmed by capnography. Results: Success rate for blind tracheal intubation through air-Q™ was 82% while that for i-gel it was 54% (p-value 0.003). Conclusion: The success rate for blind tracheal intubation through air-Q™ intubating laryngeal mask airway is higher as compared to that for blind tracheal intubation through i-gel™.


Khan T.H.,KRL General Hospital
Anaesthesia, Pain and Intensive Care | Year: 2015

Pain is usually regarded as of two types, pain caused by tissue damage, also called nociceptive pain, and pain caused by nerve damage, also called neuropathic pain. A less known third category is psychogenic pain, which becomes an integral part, in due course of time, of the first two types. It is pain that is affected by psychological factors. Pain physicians tens to focus usually on the first, less commonly on the second and very rarely on the last type of pain. This ignorance may be the prime factor in failure of otherwise more rational pain management regimen. It needs to be adequately addressed, and expert help from qualified psychologist and/or a psychiatrist may be required in selected patients to incorporate body-mind techniques in the pain management.

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