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Biomedical subjects

A R Sarwari

Publications and source records attributed to A R Sarwari.

14 recordsLinked to original sources
PubMed2002

Predictors of mortality in brain abscess.

OBJECTIVE: Brain abscess carries significant morbidity and mortality. Our objective was to elucidate the clinical presentation of brain abscess and to assess predictors of mortality in these patients. METHODS: All patients with a brain abscess presenting to the Aga Khan University Hospital, a tertiary care referral center in Karachi, Pakistan, were studied retrospectively. Statistical analysis involved univariate analysis and a logistic regression model. RESULTS: Among the 66 patients analyzed, a distant metastatic focus of infection was the most commonly identified predisposing factor (29%). Otogenic infection was the commonest contiguous source and sinusitis was noticeably absent. Multiple abscesses were frequent (35%). Streptococci were the most common isolates (39%). Lumbar puncture was performed in 44% and steroids administered in 33%. Treatment was surgical in 58%. Most comatose patients were treated conservatively. Overall mortality was 29%. Univariate analysis identified comatose presentation and identification of a distant focus of infection as predictors of mortality. The logistic regression model, however, identified a distant focus of infection as the only independent predictor. CONCLUSION: Age greater than 30 years, corticosteroid use, multiple abscesses, performance of lumbar puncture and conservative management had no affect on outcome.

Adolescent↗
PubMed2002

Predictors of inpatient mortality in 190 adult patients with tuberculous meningitis.

INTRODUCTION: Tuberculous meningitis (TBM), a tuberculous infection of the leptomeninges, carries significant morbidity and mortality. To date, little literature is available regarding TBM in Pakistan. METHODS: All adult patients with TBM admitted to a tertiary care teaching hospital in Karachi, were reviewed retrospectively. AIMS: To describe the demographic profile, clinical features, laboratory and radiological picture of these patients and to identify predictors of mortality. RESULTS: Among the 190 patients analyzed, majority (28%) were between 21-30 years of age. Fever (90%), impaired consciousness (63%) and nausea/vomiting (50%) were the most common presenting symptoms. Thirty four percent were categorized as clinical stage III. CSF cultures were positive in only 5%. Thirty seven percent had an associated lung pathology on a chest X-ray. Neuroimaging revealed meningeal enhancement in 27% and hydrocephalus in 23%. All patients were treated with antituberculous therapy; 79% received concomitant steroid therapy. Neurosurgical intervention was required in 13% and mechanical ventilation support in 12%. Overall mortality was 20% and neurological sequelae were seen in 42% of the survivors. Univariate analysis showed age greater than sixty years, clinical stage III and mechanical ventilation as predictors of mortality. The logistic regression model, however, revealed that stage III presentation was not an independent predictor. CONCLUSION: We continue to see late presentations of TBM in our setting. The current study has shown that age greater than sixty years and the need for mechanical ventilation are significant independent predictors of mortality.

Adolescent↗
PubMed2001

Serotype distribution of Salmonella isolates from food animals after slaughter differs from that of isolates found in humans.

If raw meat and poultry are the primary point of entry for Salmonella species into human populations, a correlation might be expected between the serotype distribution of Salmonella species isolated from animals at the time of slaughter and that of isolates found in humans. For 1990-1996, sufficient national data were available to permit such a comparison. A mathematical model was developed to predict serotype distributions of Salmonella isolates among humans on the basis of animal data. There was a significant mismatch between the serotype distributions among humans predicted by the model and those actually observed. This mismatch raises questions about the validity of the "standard" assumptions about Salmonella transmission on which the model was based-namely, that raw animal products are the primary source for human salmonellosis, that the risk of transmission to humans is equal for all food product categories, and that all Salmonella serotypes have an equal ability to cause human illness.

Abattoirs↗
PubMed2000

Infective endocarditis and septic embolization with Ochrobactrum anthropi: case report and review of literature.

Ochrobactrum anthropi, previously known as CDC group Vd, is an aerobic, Gram-negative bacillus of low virulence that occasionally causes human infection. We describe a case of infective endocarditis with O. anthropi complicated by septic embolization. A review of all the literature reported cases of O. anthropi infection is presented and categorized into 'Central line related', 'Transplant related' and "Other pyogenic infections". Mortality appears to be related to the underlying disease state, rather than the organism.

Adult↗
PubMed1999

Parasite density and malaria morbidity in the Pakistani Punjab.

The relationship between quantitative Plasmodiumfalciparum or P. vivax parasitemia and clinical illness has not been defined in Pakistan or in other areas where malaria transmission is not highly endemic. Standardized questionnaires were given to and physical examinations and parasitologic tests were performed in 8,941 subjects seen in outpatient clinics in 4 villages for 13 consecutive months in the Punjab region of Pakistan. The results, based on multivariable analysis, showed that a clinical diagnosis of malaria, a history of fever, rigors, headache, myalgia, elevated temperature, and a palpable spleen among children were all strongly associated with the presence and density of P. falciparum or P. vivax malaria in a monotonic dose-response fashion. The malaria attributable fraction of a clinical diagnosis of malaria, and the same symptoms and signs also increased with increasing P. falciparum and, to a lesser extent, P. vivax, parasitemia. Unlike in sub-Saharan Africa, clinical illness due to malaria often occurs in the Punjab among adolescents and adults and in patients with parasite densities less than 1,000/microl. Clinical guidelines based upon parasitemia and symptomatology must be adjusted according to the intensity of transmission and be specific for each geographic area.

Adolescent↗
PubMed1998

Prospective study on the relation between living arrangement and change in functional health status of elderly women.

Limited prospective data exist on how living arrangements are associated with change in functional health. This study evaluated whether elderly women living alone were less likely to experience functional decline when compared with women who lived with others. A total of 619 community-dwelling, white women from Baltimore, Maryland, aged 65-99 years at baseline were questioned annually from 1984 to 1986. Functional health was measured as the sum of limitations in seven physical and seven instrumental activities of daily living (Instrumental ADL). A total of 148 women experienced functional decline over the 2 years, primarily as a deterioration in Instrumental ADL. The association between living arrangement and change in Instrumental ADL depended on the level of physical impairment. Among women without severe impairment, Instrumental ADL deterioration was significantly less for those living alone compared with those living with spouses (odds ratio (OR) = 0.60, 95% confidence interval (CI) 0.45-0.92) or nonspouse others (OR = 0.62, 95% CI 0.45-0.96). For women with severe impairment, however, those living alone had a greater decline in Instrumental ADL, especially when compared with those living with nonspouse others (OR = 5.13, 95% CI 1.23-21.28). These results suggest that, unless severely physically impaired, women living independently have less deterioration in functional health when compared with peers in alternate living arrangements.

Activities of Daily Living↗
PubMed1996

The pharmacologic consequences of fever.

Despite its potential importance to the management of patients with febrile illnesses, the effect of fever on pharmacokinetics and pharmacodynamics has received little attention in the clinical literature. This article considers literature published in this potentially important area.

Animals↗
PubMedDate not supplied

Malaria in West Virginia: forty cases seen at West Virginia University Hospital.

In the U.S., malaria predominately occurs in travelers and immigrants. We report a series of 40 cases at West Virginia University Hospital, and 24 of whom were students who had visited areas of East Africa, West Africa and Asia usually in either December, January, August or September. Most patients (79%) reported a previous episode of malaria, and P. falciparum was identified in 60%. Fever, chills and rigors were the most common symptoms. Correct use of malaria prophylaxis was recorded in five patients, and only two of these were students. Successful outcomes were recorded in all but one patient. Our series suggests that international students would benefit from the proper use of chemoprophylaxis, thus decreasing the number of cases of malaria seen in university settings.

Adolescent↗