ObjectiveRadiology as compared to other fields of medicine has lagged, in incorporating modern tr... more ObjectiveRadiology as compared to other fields of medicine has lagged, in incorporating modern training modalities such as gamification and simulation into its teaching curriculum. This study aims to evaluate effectiveness of simulation-based teaching (SBT) in collaboration with gamification. Albert Bandura's conception of self-efficacy was used to provide qualitative assessment of participants' learning process through training event. Modified competitive game-based teaching methodology was utilized. Workshop was divided into two sessions, first being three interactive didactic lectures followed by three competitive rounds. All participants were required to fill a self-administered pre- and post-self-efficacy questionnaire along with an activity evaluation form. ResultsSelf-efficacy scores for simulation-based stations for knowledge assessment and hands-on stations showed a significant p-value <0.05. Whereas significant association with respect to gender and knowledge as...
Objective: To determine the usefulness of the chest radiograph in reaching a clinical diagnosis i... more Objective: To determine the usefulness of the chest radiograph in reaching a clinical diagnosis in the pediatric inpatient population at a tertiary care centre in Karachi, Pakistan. Methodology: This was a retrospective chart review of pediatric inpatients (1 month -14 years) at Aga Khan Hospital, Karachi between April and June 2009. Radiographs ordered to assist diagnosis of disease, or as 'routine', were selected samples (n=326). For each radiograph, the clinical indication, the radiological diagnosis and the final clinical diagnosis were recorded and analyzed for frequencies and by cross-tabulation for concurrence. Results: The largest proportion of the clinical indications was the routine chest x-ray, at 39.3%. The most common diagnosis in radiology reports was 'no chest pathology' (39.9%). The second most common was 'pulmonary infection'. Almost 46.3% of the patients who had chest x-rays had no chest pathology in the clinical diagnosis. The greatest conc...
Introduction: Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultr... more Introduction: Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability. Methods: We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia.
Sir, Dedicated radiology teaching is an integral part of both undergraduate and postgraduate medi... more Sir, Dedicated radiology teaching is an integral part of both undergraduate and postgraduate medical training. Early exposure of good quality radiology instruction in medical school pays positively to the profession of radiology.1 There is a dearth of well-organized and structured radiology teaching programs in most institutions of Pakistan.2 We primarily aimed to determine the current status of teaching duties, and methodologies in radiology teaching departments in Pakistan.
Background: The use of cardiac computed tomography angiography (CCTA) as a complementary diagnost... more Background: The use of cardiac computed tomography angiography (CCTA) as a complementary diagnostic modality to echocardiography in patients with congenital heart diseases (CHDs) is expanding in low-and middle-income countries. The adoption of As Low As Reasonably Achievable techniques is not widespread, resulting in significant unintended radiation exposure, especially in children. Simple quality improvement measures geared toward reducing radiation dose can have a impact on patient safety in resource-limited centers in low-and middle-income countries. Objectives: To determine how a quality improvement initiative can reduce radiation exposure during CCTA in patients with CHD. Methods: We designed a key driver-based quality initiative to reduce radiation dose during CCTA for CHD using protocol optimization, communication, and training and implementation as the drivers for intervention. Preintervention variables (radiation exposure, scanning protocols, and image quality) were collected from September 2012 to July 2016 and compared with variables in the postimplementation phase (February 2017 to July 2017). We compared quantitative and categorical variables using the chi-square test. Linear regression analysis was used to evaluate the effect of various factors on radiation dose. Results: We documented a reduction in the effective dose in the postintervention versus preintervention phase (mean, 2.0 versus 21 mSv, P < 0.0001, respectively). Linear regression showed that the optimal organizational levels are associated with the same reduction in radiation. This finding shows that the time factor translates a combination of organizational and technical factors that contributed to the reduction in radiations. Conclusions: Our project showed a reduction in CCTA-associated radiation exposure.
To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to d... more To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to determine skeletal age in three defined age groups: less than one year, one to three years and three to 18 years. We also assessed the perceived confidence in skeletal age assessments made by respondents using their chosen bone age assessment technique, within each defined age group.
Background: Rib fractures are a major source of morbidity in patients with chest trauma. Computed... more Background: Rib fractures are a major source of morbidity in patients with chest trauma. Computed tomography (CT) scout film is a low-dose image that is obtained prior to a complete chest CT study for all patients undergoing a CT scan. In this study, we evaluated the diagnostic performance of CT scout film vis-Ã -vis that of chest X-ray for detection of rib fractures using chest CT scan as the reference standard. Methods: A cross-sectional study was performed at the radiology department of Aga Khan University Hospital (Karachi, Pakistan) from October 1, 2013 to September 31, 2014. Patients who underwent CT chest for evaluation of thoracic trauma were included in the study. Sensitivity and specificity of chest X-ray and CT scout film were calculated. Results: A total of 207 patients were included in the study (193 were male). Penetrating and blunt thoracic injuries affected 104 (50.2%) and 103 (49.8%) patients respectively. On CT chest, 75 (36.2%) patients had evidence of rib fractures. Sensitivity and specificity of CT scout film for detection of rib fractures were 56% and 87.9%, while those of chest X-ray were 61.3% and 98.5% respectively. The overall accuracy of CT scout film and chest X-ray for detection of rib fractures were 76.3% and 85% respectively. Conclusion: Diagnostic performance of CT scout film for detection of rib fractures was comparable to that of the plain chest radiograph. CT scout film does not provide any additional information or advantage over a plain chest radiograph. In patients with severe thoracic trauma, CT chest remains the modality of choice for accurate delineation of rib fractures and associated internal injuries.
The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational ag... more The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational age study is to develop and validate a programmatically feasible and simple approach to accurately assess gestational age of babies after they are born. The study will provide accurate, population-based rates of preterm birth in different settings and quantify the risks of neonatal mortality and morbidity by gestational age and birth weight in five South Asian and sub-Saharan African sites. This study used on-going population-based cohort studies to recruit pregnant women early in pregnancy (<20 weeks) for a dating ultrasound scan. Implementation is harmonised across sites in Ghana, Tanzania, Zambia, Bangladesh and Pakistan with uniform protocols and standard operating procedures. Women whose pregnancies are confirmed to be between 8 to 19 completed weeks of gestation are enrolled into the study. These women are followed up to collect socio-demographic and morbidity data during the preg...
Journal of Ayub Medical College, Abbottabad : JAMC
Omental infarction is a rare cause of acute abdomen in children. Typical findings on imaging esta... more Omental infarction is a rare cause of acute abdomen in children. Typical findings on imaging establish the diagnosis. We present case of a 7 years old boy who presented with acute right iliac fossa pain with diagnosis of omental infarction on imaging and findings confirmed on laparotomy. Sound knowledge regarding this infrequent cause of acute abdomen in children is necessary for timely diagnosis.
Journal of Ayub Medical College, Abbottabad : JAMC
Trauma remains one of the most frequent presentations in emergency departments. Imaging has estab... more Trauma remains one of the most frequent presentations in emergency departments. Imaging has established role in setting of acute trauma with ability to identify potentially fatal conditions. Adequate knowledge of health professionals regarding trauma imaging is vital for improved healthcare. In this work we try to assess knowledge of medical students regarding imaging in trauma as well as identify most effective way of imparting radiology education. This cross-sectional pilot study was conducted at Aga Khan University Medical College & Khyber Girls Medical College, to assess knowledge of medical students regarding imaging protocols practiced in initial management of trauma patients. Only 40 & 20% respectively were able to identify radiographs included in trauma series. Very few had knowledge of correct indication for Focused abdominal sonography in trauma. Clinical radiology rotation was reported as best way of learning radiology. Change in curricula & restructuring of clinical radi...
The Pediatric infectious disease journal, Jan 17, 2015
We evaluated the impact of the new pneumococcal Haemophilus influenzae protein D conjugate vaccin... more We evaluated the impact of the new pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10, GSK Vaccines) on tympanostomy tube placements (TTP). Finnish Invasive Pneumococcal (FinIP) disease vaccine trial was a nationwide phase III/IV cluster-randomized, double-blind trial. Children <19 months received PHiD-CV10 in two thirds of clusters (N=52) or hepatitis B or A vaccine as control in 26 clusters according to 3+1 or 2+1 schedules (infants <7 months) or catch-up schedules. A secondary objective of the trial was to assess vaccine effectiveness (VE) against TTPs in children who received at least one vaccine dose before or after 7 months of age. Blinded follow-up lasted from the date of first vaccination (from February 2009 through October 2010) to December 31, 2011. Outcome data were collected through the National Care register and Social Insurance Institution reimbursement register. Over 47000 children were enrolled. In 30527 infants <7 months of age at en...
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
Vascular Ehlers-Danlos Syndrome (VEDS), previously called Ehlers-Danlos syndrome type-IV, is a he... more Vascular Ehlers-Danlos Syndrome (VEDS), previously called Ehlers-Danlos syndrome type-IV, is a heterogeneous group of heritable connective tissue disorders characterized by thin, translucent skin, easy bruising, arterial, intestinal, and/or uterine fragility. There is large vessel involvement that leads to arterial rupture often preceded by aneurysm, arteriovenous fistulae, or dissection. Noninvasive imaging studies such as CT angiography and MR angiography are preferred as diagnostic studies for this condition. We are reporting a 4 years old girl who was presented with right sided unilateral convulsions and hypertension. CT angiogram showed stenosis with post-stenotic dilatation of coeliac and superior mesenteric arteries. There were extensive calcified plaques with atherosclerotic changes in the segment of right common iliac artery with aneurysmal dilatation of celiac, superior mesenteric and common iliac artery. Radiological findings were consistent with vascular Ehlers-Danlos sy...
JPMA. The Journal of the Pakistan Medical Association, 2005
To determine the role of emergency ultrasound examination in the diagnosis and management of ecto... more To determine the role of emergency ultrasound examination in the diagnosis and management of ectopic pregnancy. A descriptive study done at the Radiology Department, Aga Khan University Hospital, Karachi from January 1999 to December 2000 using observational facts by non-probability convenient sampling method. Seventy one patients who presented with acute symptoms in early pregnancy, were subjected to emergency pelvic ultrasound. Both transabdominal and transvaginal ultrasound were done in 52 patients while in 19 patients only transabdominal ultrasound was performed. Serum Beta hCG levels, of all patients were greater than 1500 iu/ml. Ultrasound correctly identified ectopic pregnancy in 71 patients. Ultrasound diagnosis included live embryo in six patients, adnexal mass with pelvic fluid in 54 patients, extrauterine gestational sac in 4 patients and pelvic fluid without adnexal mass in 7 patients. There was no indeterminate ultrasound scan, resulting in 100% specificity and sensitiv...
JPMA. The Journal of the Pakistan Medical Association, 2005
A middle-aged lady presented with pain, tenderness and swelling in the left hypochondrium since o... more A middle-aged lady presented with pain, tenderness and swelling in the left hypochondrium since one month. She had a history of contact with dogs and grazing animals. Sonography and computed tomography showed the pathognomonic signs of hydatid disease. The patient refused surgical treatment. She was discharged on Albendazole therapy and did not return for a follow up.
JPMA. The Journal of the Pakistan Medical Association, 2011
To evaluate the focused abdominal CT scan [FACT] in clinically equivocal cases of acute appendici... more To evaluate the focused abdominal CT scan [FACT] in clinically equivocal cases of acute appendicitis in paediatric population. A cross-sectional study was conducted at the Radiology Department of Aga Khan Hospital, from August 2007 to November 2008. A total of 84 patients (42 males & 42 females) with clinically equivocal signs and symptoms of acute appendicitis referred to radiology department for CT evaluation were studied. CT findings were compared with histopathology and clinical follow-up. The sensitivity of focused CT for acute appendicitis was 91%; specificity was 69% and accuracy of 76% while PPV and NPV were 58%, 94% respectively. Focused unenhanced CT is a quick, accurate and non invasive modality for the assessment of clinically equivocal cases of acute appendicitis for ruling out patients and reducing negative appendectomies.
European Journal of Trauma and Emergency Surgery, 2014
Purpose To assess the utility of trauma series radiographs in the management of alert pediatric p... more Purpose To assess the utility of trauma series radiographs in the management of alert pediatric patients with traumatic injury and to ascertain whether it is necessary to acquire the entire trauma series in these children. Methods A total of 176 consecutive children below the age of 15 years and having Glasgow Coma Scale score greater than 12, who presented to the emergency department of a tertiary care hospital with a history of recent trauma, were retrospectively reviewed. All the children had undergone a thorough clinical examination followed by complete trauma series radiographs, according to the American College of Surgery guidelines. Results A total of 558 radiographs were reviewed by a consultant pediatric radiologist including 528 trauma series radiographs and 30 additional radiographs. Among the trauma series radiographs, 35 (6.63 %) had evidence of injury; 24 (4.54 %) and 11 (2.08 %) involving the chest and pelvic regions, respectively. All children with normal physical examination had normal cervical spine and chest radiographs. Among the 11 positive pelvic X-rays, only two had radiological signs of injury in the absence of localizing physical signs, and all these children were less than 3 years of age. In all the remaining cases, children had localizing signs on physical examination. Out of the 30 additional X-rays, 27 (90 %) had radiological evidence of injury. Conclusions The routine use of entire radiological trauma series in alert pediatric patients with a normal physical examination has a very low yield. In these children, the localizing signs and symptoms can help us in determining the specific radiological examination to be utilized.
Journal of Ayub Medical College, Abbottabad : JAMC
Gaucher's disease is an inherited lysosomal storage disorder with a deficiency of the enzyme ... more Gaucher's disease is an inherited lysosomal storage disorder with a deficiency of the enzyme glucocerbrosidase that manifests with clinical features of anemia, hepato-splenomegaly, skeletal destruction and organ dysfunction due to the accumulation of glucocerbrosides. There are several types of Gaucher's disease with varying prognosis and clinical progression of disease. We describe two cases followed at the Aga Khan University, Karachi, Pakistan, with different forms of the disorder. The enzyme Imiglucerase (Cerezyme, Genzyme) has been used to treat Type 1 Gaucher disease while the neuronopathic type has been resistant to therapy. We used Imiglucerase 60 microg/kg every 2 weeks in one patient with Type 1 Gaucher disease and followed hepatic, splenic volumes and blood counts. Treatment with Imiglucerase resulted in a decrease in splenic size, reduced requirements for transfusions and an improvement in cardiopulmonary symptoms.
ObjectiveRadiology as compared to other fields of medicine has lagged, in incorporating modern tr... more ObjectiveRadiology as compared to other fields of medicine has lagged, in incorporating modern training modalities such as gamification and simulation into its teaching curriculum. This study aims to evaluate effectiveness of simulation-based teaching (SBT) in collaboration with gamification. Albert Bandura's conception of self-efficacy was used to provide qualitative assessment of participants' learning process through training event. Modified competitive game-based teaching methodology was utilized. Workshop was divided into two sessions, first being three interactive didactic lectures followed by three competitive rounds. All participants were required to fill a self-administered pre- and post-self-efficacy questionnaire along with an activity evaluation form. ResultsSelf-efficacy scores for simulation-based stations for knowledge assessment and hands-on stations showed a significant p-value <0.05. Whereas significant association with respect to gender and knowledge as...
Objective: To determine the usefulness of the chest radiograph in reaching a clinical diagnosis i... more Objective: To determine the usefulness of the chest radiograph in reaching a clinical diagnosis in the pediatric inpatient population at a tertiary care centre in Karachi, Pakistan. Methodology: This was a retrospective chart review of pediatric inpatients (1 month -14 years) at Aga Khan Hospital, Karachi between April and June 2009. Radiographs ordered to assist diagnosis of disease, or as 'routine', were selected samples (n=326). For each radiograph, the clinical indication, the radiological diagnosis and the final clinical diagnosis were recorded and analyzed for frequencies and by cross-tabulation for concurrence. Results: The largest proportion of the clinical indications was the routine chest x-ray, at 39.3%. The most common diagnosis in radiology reports was 'no chest pathology' (39.9%). The second most common was 'pulmonary infection'. Almost 46.3% of the patients who had chest x-rays had no chest pathology in the clinical diagnosis. The greatest conc...
Introduction: Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultr... more Introduction: Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability. Methods: We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia.
Sir, Dedicated radiology teaching is an integral part of both undergraduate and postgraduate medi... more Sir, Dedicated radiology teaching is an integral part of both undergraduate and postgraduate medical training. Early exposure of good quality radiology instruction in medical school pays positively to the profession of radiology.1 There is a dearth of well-organized and structured radiology teaching programs in most institutions of Pakistan.2 We primarily aimed to determine the current status of teaching duties, and methodologies in radiology teaching departments in Pakistan.
Background: The use of cardiac computed tomography angiography (CCTA) as a complementary diagnost... more Background: The use of cardiac computed tomography angiography (CCTA) as a complementary diagnostic modality to echocardiography in patients with congenital heart diseases (CHDs) is expanding in low-and middle-income countries. The adoption of As Low As Reasonably Achievable techniques is not widespread, resulting in significant unintended radiation exposure, especially in children. Simple quality improvement measures geared toward reducing radiation dose can have a impact on patient safety in resource-limited centers in low-and middle-income countries. Objectives: To determine how a quality improvement initiative can reduce radiation exposure during CCTA in patients with CHD. Methods: We designed a key driver-based quality initiative to reduce radiation dose during CCTA for CHD using protocol optimization, communication, and training and implementation as the drivers for intervention. Preintervention variables (radiation exposure, scanning protocols, and image quality) were collected from September 2012 to July 2016 and compared with variables in the postimplementation phase (February 2017 to July 2017). We compared quantitative and categorical variables using the chi-square test. Linear regression analysis was used to evaluate the effect of various factors on radiation dose. Results: We documented a reduction in the effective dose in the postintervention versus preintervention phase (mean, 2.0 versus 21 mSv, P < 0.0001, respectively). Linear regression showed that the optimal organizational levels are associated with the same reduction in radiation. This finding shows that the time factor translates a combination of organizational and technical factors that contributed to the reduction in radiations. Conclusions: Our project showed a reduction in CCTA-associated radiation exposure.
To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to d... more To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to determine skeletal age in three defined age groups: less than one year, one to three years and three to 18 years. We also assessed the perceived confidence in skeletal age assessments made by respondents using their chosen bone age assessment technique, within each defined age group.
Background: Rib fractures are a major source of morbidity in patients with chest trauma. Computed... more Background: Rib fractures are a major source of morbidity in patients with chest trauma. Computed tomography (CT) scout film is a low-dose image that is obtained prior to a complete chest CT study for all patients undergoing a CT scan. In this study, we evaluated the diagnostic performance of CT scout film vis-Ã -vis that of chest X-ray for detection of rib fractures using chest CT scan as the reference standard. Methods: A cross-sectional study was performed at the radiology department of Aga Khan University Hospital (Karachi, Pakistan) from October 1, 2013 to September 31, 2014. Patients who underwent CT chest for evaluation of thoracic trauma were included in the study. Sensitivity and specificity of chest X-ray and CT scout film were calculated. Results: A total of 207 patients were included in the study (193 were male). Penetrating and blunt thoracic injuries affected 104 (50.2%) and 103 (49.8%) patients respectively. On CT chest, 75 (36.2%) patients had evidence of rib fractures. Sensitivity and specificity of CT scout film for detection of rib fractures were 56% and 87.9%, while those of chest X-ray were 61.3% and 98.5% respectively. The overall accuracy of CT scout film and chest X-ray for detection of rib fractures were 76.3% and 85% respectively. Conclusion: Diagnostic performance of CT scout film for detection of rib fractures was comparable to that of the plain chest radiograph. CT scout film does not provide any additional information or advantage over a plain chest radiograph. In patients with severe thoracic trauma, CT chest remains the modality of choice for accurate delineation of rib fractures and associated internal injuries.
The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational ag... more The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational age study is to develop and validate a programmatically feasible and simple approach to accurately assess gestational age of babies after they are born. The study will provide accurate, population-based rates of preterm birth in different settings and quantify the risks of neonatal mortality and morbidity by gestational age and birth weight in five South Asian and sub-Saharan African sites. This study used on-going population-based cohort studies to recruit pregnant women early in pregnancy (<20 weeks) for a dating ultrasound scan. Implementation is harmonised across sites in Ghana, Tanzania, Zambia, Bangladesh and Pakistan with uniform protocols and standard operating procedures. Women whose pregnancies are confirmed to be between 8 to 19 completed weeks of gestation are enrolled into the study. These women are followed up to collect socio-demographic and morbidity data during the preg...
Journal of Ayub Medical College, Abbottabad : JAMC
Omental infarction is a rare cause of acute abdomen in children. Typical findings on imaging esta... more Omental infarction is a rare cause of acute abdomen in children. Typical findings on imaging establish the diagnosis. We present case of a 7 years old boy who presented with acute right iliac fossa pain with diagnosis of omental infarction on imaging and findings confirmed on laparotomy. Sound knowledge regarding this infrequent cause of acute abdomen in children is necessary for timely diagnosis.
Journal of Ayub Medical College, Abbottabad : JAMC
Trauma remains one of the most frequent presentations in emergency departments. Imaging has estab... more Trauma remains one of the most frequent presentations in emergency departments. Imaging has established role in setting of acute trauma with ability to identify potentially fatal conditions. Adequate knowledge of health professionals regarding trauma imaging is vital for improved healthcare. In this work we try to assess knowledge of medical students regarding imaging in trauma as well as identify most effective way of imparting radiology education. This cross-sectional pilot study was conducted at Aga Khan University Medical College & Khyber Girls Medical College, to assess knowledge of medical students regarding imaging protocols practiced in initial management of trauma patients. Only 40 & 20% respectively were able to identify radiographs included in trauma series. Very few had knowledge of correct indication for Focused abdominal sonography in trauma. Clinical radiology rotation was reported as best way of learning radiology. Change in curricula & restructuring of clinical radi...
The Pediatric infectious disease journal, Jan 17, 2015
We evaluated the impact of the new pneumococcal Haemophilus influenzae protein D conjugate vaccin... more We evaluated the impact of the new pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10, GSK Vaccines) on tympanostomy tube placements (TTP). Finnish Invasive Pneumococcal (FinIP) disease vaccine trial was a nationwide phase III/IV cluster-randomized, double-blind trial. Children <19 months received PHiD-CV10 in two thirds of clusters (N=52) or hepatitis B or A vaccine as control in 26 clusters according to 3+1 or 2+1 schedules (infants <7 months) or catch-up schedules. A secondary objective of the trial was to assess vaccine effectiveness (VE) against TTPs in children who received at least one vaccine dose before or after 7 months of age. Blinded follow-up lasted from the date of first vaccination (from February 2009 through October 2010) to December 31, 2011. Outcome data were collected through the National Care register and Social Insurance Institution reimbursement register. Over 47000 children were enrolled. In 30527 infants <7 months of age at en...
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
Vascular Ehlers-Danlos Syndrome (VEDS), previously called Ehlers-Danlos syndrome type-IV, is a he... more Vascular Ehlers-Danlos Syndrome (VEDS), previously called Ehlers-Danlos syndrome type-IV, is a heterogeneous group of heritable connective tissue disorders characterized by thin, translucent skin, easy bruising, arterial, intestinal, and/or uterine fragility. There is large vessel involvement that leads to arterial rupture often preceded by aneurysm, arteriovenous fistulae, or dissection. Noninvasive imaging studies such as CT angiography and MR angiography are preferred as diagnostic studies for this condition. We are reporting a 4 years old girl who was presented with right sided unilateral convulsions and hypertension. CT angiogram showed stenosis with post-stenotic dilatation of coeliac and superior mesenteric arteries. There were extensive calcified plaques with atherosclerotic changes in the segment of right common iliac artery with aneurysmal dilatation of celiac, superior mesenteric and common iliac artery. Radiological findings were consistent with vascular Ehlers-Danlos sy...
JPMA. The Journal of the Pakistan Medical Association, 2005
To determine the role of emergency ultrasound examination in the diagnosis and management of ecto... more To determine the role of emergency ultrasound examination in the diagnosis and management of ectopic pregnancy. A descriptive study done at the Radiology Department, Aga Khan University Hospital, Karachi from January 1999 to December 2000 using observational facts by non-probability convenient sampling method. Seventy one patients who presented with acute symptoms in early pregnancy, were subjected to emergency pelvic ultrasound. Both transabdominal and transvaginal ultrasound were done in 52 patients while in 19 patients only transabdominal ultrasound was performed. Serum Beta hCG levels, of all patients were greater than 1500 iu/ml. Ultrasound correctly identified ectopic pregnancy in 71 patients. Ultrasound diagnosis included live embryo in six patients, adnexal mass with pelvic fluid in 54 patients, extrauterine gestational sac in 4 patients and pelvic fluid without adnexal mass in 7 patients. There was no indeterminate ultrasound scan, resulting in 100% specificity and sensitiv...
JPMA. The Journal of the Pakistan Medical Association, 2005
A middle-aged lady presented with pain, tenderness and swelling in the left hypochondrium since o... more A middle-aged lady presented with pain, tenderness and swelling in the left hypochondrium since one month. She had a history of contact with dogs and grazing animals. Sonography and computed tomography showed the pathognomonic signs of hydatid disease. The patient refused surgical treatment. She was discharged on Albendazole therapy and did not return for a follow up.
JPMA. The Journal of the Pakistan Medical Association, 2011
To evaluate the focused abdominal CT scan [FACT] in clinically equivocal cases of acute appendici... more To evaluate the focused abdominal CT scan [FACT] in clinically equivocal cases of acute appendicitis in paediatric population. A cross-sectional study was conducted at the Radiology Department of Aga Khan Hospital, from August 2007 to November 2008. A total of 84 patients (42 males & 42 females) with clinically equivocal signs and symptoms of acute appendicitis referred to radiology department for CT evaluation were studied. CT findings were compared with histopathology and clinical follow-up. The sensitivity of focused CT for acute appendicitis was 91%; specificity was 69% and accuracy of 76% while PPV and NPV were 58%, 94% respectively. Focused unenhanced CT is a quick, accurate and non invasive modality for the assessment of clinically equivocal cases of acute appendicitis for ruling out patients and reducing negative appendectomies.
European Journal of Trauma and Emergency Surgery, 2014
Purpose To assess the utility of trauma series radiographs in the management of alert pediatric p... more Purpose To assess the utility of trauma series radiographs in the management of alert pediatric patients with traumatic injury and to ascertain whether it is necessary to acquire the entire trauma series in these children. Methods A total of 176 consecutive children below the age of 15 years and having Glasgow Coma Scale score greater than 12, who presented to the emergency department of a tertiary care hospital with a history of recent trauma, were retrospectively reviewed. All the children had undergone a thorough clinical examination followed by complete trauma series radiographs, according to the American College of Surgery guidelines. Results A total of 558 radiographs were reviewed by a consultant pediatric radiologist including 528 trauma series radiographs and 30 additional radiographs. Among the trauma series radiographs, 35 (6.63 %) had evidence of injury; 24 (4.54 %) and 11 (2.08 %) involving the chest and pelvic regions, respectively. All children with normal physical examination had normal cervical spine and chest radiographs. Among the 11 positive pelvic X-rays, only two had radiological signs of injury in the absence of localizing physical signs, and all these children were less than 3 years of age. In all the remaining cases, children had localizing signs on physical examination. Out of the 30 additional X-rays, 27 (90 %) had radiological evidence of injury. Conclusions The routine use of entire radiological trauma series in alert pediatric patients with a normal physical examination has a very low yield. In these children, the localizing signs and symptoms can help us in determining the specific radiological examination to be utilized.
Journal of Ayub Medical College, Abbottabad : JAMC
Gaucher's disease is an inherited lysosomal storage disorder with a deficiency of the enzyme ... more Gaucher's disease is an inherited lysosomal storage disorder with a deficiency of the enzyme glucocerbrosidase that manifests with clinical features of anemia, hepato-splenomegaly, skeletal destruction and organ dysfunction due to the accumulation of glucocerbrosides. There are several types of Gaucher's disease with varying prognosis and clinical progression of disease. We describe two cases followed at the Aga Khan University, Karachi, Pakistan, with different forms of the disorder. The enzyme Imiglucerase (Cerezyme, Genzyme) has been used to treat Type 1 Gaucher disease while the neuronopathic type has been resistant to therapy. We used Imiglucerase 60 microg/kg every 2 weeks in one patient with Type 1 Gaucher disease and followed hepatic, splenic volumes and blood counts. Treatment with Imiglucerase resulted in a decrease in splenic size, reduced requirements for transfusions and an improvement in cardiopulmonary symptoms.
Uploads
Papers by Naila Nadeem