Biomedical subjects

F A Khan

Publications and source records attributed to F A Khan.

At least 73 records · Page 4Linked to original sources

PubMed1999

Patients view of the anaesthetist in a developing country.

OBJECTIVE: The objective of this study was to assess patients regarding their knowledge and perception of the anaesthetists' role in patient care in a developing country. SETTING: The audit was conducted at the Aga Khan University Hospital, Karachi. METHODS: Two hundred surgical and 102 medical out-patients were included in the audit prospectively who filled a detailed questionnaire. RESULTS: Fifty-six percent of the patients knew that anaesthetists were medically qualified but only 20% and 27% had an idea about their role in the intraoperative and immediate postoperative period. 14.6% were aware of the anaesthetists role outside the operating room. No difference was observed between the two groups of patients except that a higher percentage of surgical patients were interested in having more information regarding anaesthesia and wanted to choose their anaesthetist if the need arose. Gender difference was observed in answer to two questions only. A higher percentage of males know the role of anaesthetist in the recovery room whereas a greater number of females who had surgery before remembered their anaesthetist postoperatively. CONCLUSION: The results of this audit show a poor perception of the anaesthetists role both inside and outside the operating room. Although public knowledge surveys have been carried out in developed countries there is a pressing need to repeat these in developing countries since the image as perceived by public may have a direct bearing on the recruitment of young doctors into an already shortage specialty in these less affluent countries.

Anesthesia↗

PubMed1999

Prevalence of macrovascular complications in diabetics of WAH, District Rawalpindi.

OBJECTIVE: To determine the prevalence of macrovascular complications in diabetic subjects with relation to age duration of diabetes and metabolic control. SETTING: Primary care centres of WAH, District Rawalpindi cross sectional population based study. METHODS: A total of 805 known diabetics (380 males and 425 females) were studied. Relevant history, detailed physician examination and ECG were done to assess the presence of ischaemic heart disease, stroke and diabetic foot complications. Their diabetic control was assessed by estimation of their plasma glucose and glycosylated haemoglobin. RESULTS: The prevalence of macrovascular complications was as follows: Ischaemic heart disease 19.8% (female 4.7%, males 7.8%), cerebrovascular disease 6.2% (females 4.7%, males 22.1%) and diabetic foot complications 2.1%. The macrovascular complications increased with age, duration of diabetes and were more prevalent in uncontrolled diabetics having glycosylated haemoglobin > 8.6%. CONCLUSION: Prevalence of macrovascular complication in our population is higher as compared to the West probably due to better management and diabetic care in those countries.

Adolescent↗

PubMed1999

Cultural barriers to successful communication during orthodontic care.

OBJECTIVE: To determine to what extent barriers related to culture and language, and how inappropriate expectations might impede orthodontic care, among Pakistani Muslims when compared to white Caucasians from similar socio-economic backgrounds in Bradford, UK. DESIGN: Semi-structured interviews. SETTING: Dentists were interviewed in the clinic. Parents and children were interviewed separately in the waiting room or in adjacent rooms depending on availability. PARTICIPANTS: Four dentists working in the Community and Hospital Dental Services, 30 children and 10 parents of white and Pakistani origin. RESULTS: Among the white Caucasian groups, three-way communication involving parents, children and dentist enhanced understanding, supported orthodontic treatment and reinforced the need for good home care. Among Pakistani families communication was primarily two-way, involving the dentist and the child. Parents and families had limited understanding of the process and were unable to offer a comparable level of support that would benefit their children most. This can place additional burdens on the Pakistani child patient and requires a very positive approach from the dental team. CONCLUSIONS: There is a clear need for chairside support, through patient advocates or interpreters, as well as the provision of appropriate educational material to match parents' educational needs on behalf of their children.

Adolescent↗

PubMed1998

FMRFamide-like immunoreactivity in the olfactory system responds to morphine treatment in the teleost Clarias batrachus: involvement of opiate receptors.

In view of the close relationship between the FMRF-related peptides and the central opiate-sensitive system, we investigated the effects of morphine, alone and in combination with naloxone, on the FMRFamide-like immunoreactivity in the olfactory system of the teleost, Clarias batrachus. In the olfactory system of normal and untreated fish, FMRFamide-like immunoreactivity was confined to the ganglion cells and fibers of the terminal nerve; the cells in the olfactory epithelium per se or the olfactory nerve were not immunoreactive. Intensely immunoreactive cells appeared in the olfactory epithelium following 2 h of intracranial morphine administration. FMRFamide-like immunoreactivity also appeared in the olfactory nerve fibers as they ran caudally and arborized in the glomerular layer of the bulb. However, immunoreactivity in the ganglion cells of the terminal nerve and the ensuing fibers was abolished, suggesting the transport/release of the immunoreactive material. Pretreatment with naloxone, a potent opiate receptor antagonist, reversed the effects of morphine, suggesting the involvement of opiate receptors in the regulation of the ganglion cells of the terminal nerve. The results provide initial immunocytochemical evidence in favor of a relationship between the opiates and FMRFamide-containing systems within the framework of the olfactory system.

Amino Acid Sequence↗

PubMed1998

Comparative disposition kinetics of albendazole in sheep following oral and intraruminal administration.

The pharmacokinetics of albendazole was studied in sheep following single oral and intraruminal administration at nematocidal dose rates. The disposition curves of its metabolites indicated increased uptake of the drug in sheep following intraruminal as compared to oral dosing (p < 0.05). The increased bioavailability of benzimidazole anthelmintics given by the intraruminal route could be exploited for optimizing the use of anthelmintic for sustained parasite control in small ruminants.

Administration, Oral↗

PubMed1998

Truncated N-terminal fragments of huntingtin with expanded glutamine repeats form nuclear and cytoplasmic aggregates in cell culture.

Huntington's disease (HD) is a progressive neurodegenerative disorder caused by an expanding CAG repeat coding for polyglutamine in the huntingtin protein. Recent data have suggested the possibility that an N-terminal fragment of huntingtin may aggregate in neurons of patients with HD, both in the cytoplasm, forming dystrophic neurites, and in the nucleus, forming intranuclear neuronal inclusion bodies. An animal model of HD using the short N-terminal fragment of huntingtin has also been found to have intranuclear inclusions and this same fragment can aggregate in vitro . We have now developed a cell culture model demonstrating that N-terminal fragments of huntingtin with expanded glutamine repeats aggregate both in the cytoplasm and in the nucleus. Neuroblastoma cells transiently transfected with full-length huntingtin constructs with either a normal or expanded repeat had diffuse cytoplasmic localization of the protein. In contrast, cells transfected with truncated N-terminal fragments showed aggregation only if the glutamine repeat was expanded. The aggregates were often ubiquitinated. The shorter truncated product appeared to form more aggregates in the nucleus. Cells transfected with the expanded repeat construct but not the normal repeat construct showed enhanced toxicity to the apoptosis-inducing agent staurosporine. These data indicate that N-terminal truncated fragments of huntingtin with expanded glutamine repeats can aggregate in cells in culture and that this aggregation can be toxic to cells. This model will be useful for future experiments to test mechanisms of aggregation and toxicity and potentially for testing experimental therapeutic interventions.

Animals↗

PubMed1998

Renal involvement in the systemic inflammatory reaction syndrome.

Uncontrolled infection quite often leads to systemic inflammatory reaction syndrome (SIRS) and multiorgan dysfunction (MOD) syndrome. Thirty-five consecutive patients (19 males) fulfilling strict diagnostic criteria for SIRS were enrolled in two multicenter prospective double-blind trials involving new therapies for SIRS. The patients were followed prospectively up to day 28 after the enrollment. In the 35 patients with SIRS, males predominated in the age group below 40 (10/12, 83%) compared to the older group (nine males out of 23, 39%). Out of 16 females presenting with SIRS, only two were below the age of 40. This distribution was statistically different than our general MICU population. The serum albumin in these patients was uniformly low, with a mean of 22.5 gm/L. The bulk of SIRS patients (22/35; 63%) went on to develop acute renal failure (ARF). Although statistically not different, skin and peritoneal infections were more common in ARF group while pulmonary infections in non-ARF group. The majority of blood-cultures grew gram-positive organisms. Resolution of SIRS occurred within first 3 days in greater number of non-ARF survivors than ARF survivors (6/9, 66.7% vs. 6/16, 37.5%). Of the 22 ARF patients, 17 showed improvement in their renal function; the five who did not, died before day 28. The overall mortality (about 32%) was similar in both groups. Patients who developed both ARF and ARDS did not survive. In conclusion. SIRS occurs mostly in elderly patients, almost always in patients with low albumin levels. Premenopausal women seem to be protected. Blood cultures isolated a gram-positive organism in the majority of cases. Improvement in serum creatinine suggests good prognosis. The mortality in ARF and non-ARF groups is similar.

APACHE↗

PubMed1998

Staphylococcus capitis causing aortic valve endocarditis.

Coagulase-negative staphylococci have been implicated in certain human infections but are generally considered to be contaminants. Although their clinical significance has been questioned, rare species of coagulase-negative staphylococci such as Staphylococcus capitis and Staphylococcus ludgunensis have recently emerged which cause endocarditis with high morbidity and mortality rates. We report a case of severe aortic valve endocarditis with conduction delays due to S. capitis infection which was treated successfully with antibiotics.

Aged↗

PubMed1997

Comparative evaluation of therapeutic approaches in stage III and IV squamous cell carcinoma of the thoracic esophagus with conventional radiotherapy and endoscopic treatment in combination and endoscopic treatment alone: a randomized prospective trial.

PURPOSE: To define the role of endoscopic dilatation/intubation and radiotherapy in squamous cell carcinoma of esophagus patients to improve their quality of life. METHODS AND MATERIALS: One hundred and four patients with squamous cell carcinoma of the thoracic esophagus having Stage III and IV disease were enrolled in the present study, with 90 patients in Group 1 (nonesophagorespiratory fistula group) and 14 patients in Group 2 (esophagorespiratory fistula group). From Group 1 patients, 47 were subjected to radiotherapy (conventional) and had endoscopic dilatation and/or intubation whenever and wherever required (Group 1a), and 43 patients were allowed to follow the natural course of the disease except palliation with endoscopic dilatation and/or intubation whenever and wherever required (Group 1b). From Group 2, 4 patients received radiotherapy in addition to endoscopic intubation, while 10 patients received only endoscopic intubation. RESULTS: The median survival for Group 1a was 7 months, for Group 1b--3 months, for Group 2a--4.25 months, and Group 2b--3.6 months. Only three patients from Group 1a survived more than 18 months, while no patient from Groups 1b, 2a, or 2b survived for more than 1 year. The difference in survival between Group 1a and 1b was statistically significant. CONCLUSION: The addition of radiotherapy to endoscopic treatment definitely prolongs survival as well as improves the quality of life of these patients. We recommend both for the adequate palliation of patients with this disease.

Adult↗

PubMed1997

Calcitonin-like immunoreactivity in the subcommissural organ and Reissner's fiber in the teleost Clarias batrachus, frog Rana tigrina and lizard Calotes versicolor.

In the CNS of vertebrates, although the subcommissural organ (SCO) has been identified as an ependymal brain gland and Reissner's fiber (RF) as a condensed product of its secretion, the exact nature of the secretory substances has remained elusive. In the present study, immunocytochemical application of polyclonal antibodies against calcitonin revealed intense immunoreactivity in the cells, cell processes and cerebrospinal spinal fluid (CSF)-contacting apical terminals of the columnar ependymal cells of the SCO in the teleost, Clarias batrachus. Intense immunoreactivity was also seen throughout the length of the RF as it extended along the Sylvian aqueduct, fourth ventricle and central canal of the spinal cord. Control procedures were employed to confirm the specificity of the immunoreaction. The results for the first time suggest that calcitonin-like substance may be the synthetic and secretory product of the SCO that may be released into the CSF or stored in the RF. Presence of calcitonin-like immunoreactivity in the SCO-RF complex of the frog Rana tigrina and the lizard Calotes versicolor underscores wider significance of the phenomenon. In view of the potentials of these findings, it is felt that investigations aimed at establishing the precise nature of calcitonin-like immunoreactive material in the SCO-RF complex may be rewarding.

Animals↗

PubMed1997

Human islet allografts in patients with type 2 diabetes undergoing liver transplantation.

BACKGROUND: Most patients with cirrhosis have insulin resistance and impaired glucose tolerance, and 20% eventually develop diabetes. Although diabetes in this setting may be reversible after orthotopic liver transplantation (OLTx), immunosuppressive agents administered after transplantation could exacerbate this disease. We report the results of the first pilot trial of islet cell transplantation (ICTx) in patients with diabetes undergoing OLTx. METHODS: Five patients with diabetes and liver cirrhosis underwent OLTx and ICTx. Donor bone marrow cells were also infused to enhance the acceptance of the graft. We identified seven patients who received only OLTx and donor bone marrow cells as historical controls. RESULTS: Preliminary results suggest that ICTx in conjunction with OLTx may improve glucose metabolism (insulin requirement, hemoglobin A1c) in patients with liver cirrhosis. However, there was virtually no change in pre- and posttransplant basal C-peptide levels in the recipients of OLTx + ICTx. CONCLUSIONS: We are planning to further evaluate the effect of OLTx with or without ICTx in a randomized prospective trial, using euglycemic insulin clamp studies.

Adolescent↗

PubMed1997

High-dose donor bone marrow infusions to enhance allograft survival: the effect of timing.

BACKGROUND: The development of strategies to enhance survival of transplanted organs and to potentially lower or even discontinue immunosuppressive therapy would represent a significant advance in posttransplant patient care. The aim of this clinical trial was to determine the effect of timing and dose of peripheral donor bone marrow cell (DBMC) infusion on graft and patient survival after liver transplantation. METHODS: DBMC, obtained from vertebral bodies, were administered in 101 recipients of liver allografts (OLTX). There were 107 patients for whom DBMC could not be obtained; they received OLTX alone (controls). A total of 5 x 10(8)/kg DBMC were infused at day 0 (group 1; n=9); at days 0 and 11 (group 2; n=26); or at days 5 and 11 (group 3; n=26). In group 4 (n=40), patients received up to five infusions of 2 x 10(8)/kg DBMC at days 5, 14, 21, 28, and 90 after OLTX. RESULTS: When the results from patients receiving two or more DBMC infusions (groups 2, 3, and 4) are considered, both patient and graft survival were significantly improved compared with the control group (P=0.02 and P=0.01, respectively). In groups 3 and 4, 88.5% and 95% of patients were alive with mean follow-up of 536 and 265 days, respectively, compared with 77.6% of patients in the control group (average follow-up of 452 days) (P=0.02). Graft survival was also significantly improved in groups 3 (88.5%) and 4 (92.5%), compared with the controls (72%) (P=0.007). CONCLUSIONS: The results suggest that dose and timing of DBMC infusions may be important variables affecting allograft survival. A randomized prospective trial is now in progress to compare group 3 DBMC infusion protocol with controls receiving OLTX alone.

Adult↗

PubMed1997

Glucagon-like peptide-1 (GLP-1): a trial of treatment in non-insulin-dependent diabetes mellitus.

Glucagon-like peptide-1 (7-36) amide (GLP-1) is released from the gut into the circulation after meals and is the most potent physiological insulinotropic hormone in man. In contrast to presently available therapeutic agents for non-insulin-dependent diabetes mellitus (NIDDM), GLP-1 has the advantages of both suppressing glucagon secretion and delaying gastric emptying. We report the first chronic study of subcutaneous (s/c) GLP-1 treatment in NIDDM. Five patients with poorly controlled NIDDM were entered into a six-week, double-blind crossover trial. Each received three weeks treatment with s/c GLP-1 40 nmol or saline, given three times a day immediately before meals. A standardized test meal was given at the beginning and end of each treatment period. GLP-1 reduced plasma glucose area under the curve (AUC) following the standard test meal by 25% (AUC, 0-180 mins, GLP-1 start of treatment 482.2 +/- 38.2 vs. saline start of treatment 635.7 +/- 45.4 mmol min L-1, F = 16.4, P < 0.02). The beneficial effect of GLP-1 on plasma glucose concentration was fully maintained for the three-week treatment period. Plasma glucagon levels were significantly lower for 60 min postprandially after GLP-1 treatment. In this group of patients there was no significant increase in postprandial insulin levels with GLP-1. We have demonstrated a significant improvement in postprandial glycaemic control with s/c GLP-1 treatment that was fully maintained over a three-week treatment period. GLP-1 improves glycaemic control even in the absence of an insulinotropic effect and is a potential treatment for NIDDM.

Blood Glucose↗

PubMed1997

Comparison of nalbuphine and buprenorphine in total intravenous anaesthesia.

Nalbuphine (0.3 mg.kg-1) and buprenorphine (2.5 micrograms.kg-1) were compared as part of a total intravenous anaesthesia regimen using a propofol infusion in 60 patients undergoing laparoscopic cholecystectomy in a randomised double-blind study. Changes in haemodynamic variables greater than 20% from the baseline were noted. No difference was observed in blood pressure but the heart rate was significantly lower in the buprenorphine group. Intra-operative bradycardia (heart rate < 60 beat.min-1) occurred more often in the buprenorphine group. Recovery was fast and comparable with both drugs and no patient reported awareness. Quality of analgesia was similar in both groups. Both drugs provide suitable analgesic supplementation to total intravenous anaesthesia.

Adult↗

PubMed1997

Incidence of intra-operative bradycardia. Comparison of atracurium and vecuronium in gynaecological surgery.

Intra-operative bradycardia is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice and can lead to a potentially dangerous outcome. In a randomised double-blind trial, 50 female patients undergoing elective abdominal hysterectomy were divided into two groups. Group I received atracurium and group II received vecuronium as a neuromuscular blocking agent in a balanced anaesthetic technique. The incidence of bradycardia was compared among the two groups. Bradycardia was defined as a heart rate of less than 60 beat.min-1. A heart rate of less than 45 beat.min-1 was labelled as severe bradycardia and symptomatic bradycardia was defined as bradycardia associated with hypotension. The two groups were similar in their demographic characteristics. The results showed that there was no statistically significant difference among the two groups regarding the incidence of simple bradycardia. However, the incidence of severe bradycardia or symptomatic bradycardia requiring treatment was significantly higher in the vecuronium group.

Adult↗

PubMed1997

Outcome of abruptio placentae in normotensive and hypertensive patients in Aga Khan University Hospital, Pakistan.

The aim of our study was to compare the perinatal and maternal outcome in hypertensive women experiencing abruptio placentae with that of normotensive women. We hypothesized that hypertensive women experiencing abruptio had a less favorable outcome than the normotensive women. Ours was a retrospective cohort study, in which the outcome of 33 hypertensive women with abruptio was compared with 138 normotensive women experiencing abruptio placentae. Our results indicate that although higher number of hypertensive women with abruptio had a past history of hypertension and were more likely to have diabetes (p = 0.05) there was no difference found in the grades of abruption or in any other antenatal complications between the 2 groups. The hypertensive women were also more likely to undergo cesarean section. We did not find any difference in the neonatal outcome. Therefore, we conclude that there is no difference in the maternal and perinatal outcome between the hypertensive and normotensive women experiencing abruptio.

Abruptio Placentae↗

PubMed1997

A profile of 100 complicated cases of chronic suppurative otitis media.

A two year study of cases of chronic suppurative otitis media admitted in the Ear, Nose and Throat (ENT) Department of Sir Salimullah Medical College and Mitford Hospital from January 1991 to December 1992 was done. 112 patients of chronic suppurative otitis media (CSOM) were admitted during this two year period, out of which 100 patients (89.3%) presented with different types of complications and only 12 patients (10.7%) presented with no complications. Factors associated with the late presentation of the disorder, including poor socioeconomic conditions and lack of hospital facilities, are identified. Measures to prevent the rate of complications and hearing loss in children are suggested.

Adolescent↗

PubMed1997

Reference values of common blood chemistry analytes in healthy population of Rawalpindi-Islamabad area.

The reference values of common blood chemistry analytes in healthy population, aged newborn to 80 years, of Rawalpindi Islamabad area were determined at AFIP, Rawalpindi. A total of 2115 healthy subjects, 1206 males and 909 females, were included in the study. Plasma glucose was analysed by GOD/POD, serum cholesterol by CHOD/PAP, triglycerides by GPO/PAP, urea by urease/GLDH, creatinine by Jaffe' rate reaction, uric acid by uricase, total bilirubin by Jendrassik and Grof, total protein by biuret, alanine transaminase (ALT) by optimized IFCC and alkaline phosphatase (AP) by optimized DGKC method. The between batch CVs of all the parameters were within acceptable quality goals. The reference values were calculated using 2.5 and 97.5 percentiles as lower and upper limits (95% CI). In healthy adult males the reference values were: fasting plasma glucose, 3.6-6.0 mmol/l; serum cholesterol; 3.2-6.6 mmol/l; triglycerides, 0.6-2.3 mmol/l; urea, 2.8-6.4 mmol/l; creatinine, 65-132 umol/l; uric acid, 164-430 umol/l; total bilirubin, 5-18 umol/l; total protein, 57-83 g/l; ALT, 15-45 U/l and AP, 185-620 U/l. The values in adult females, children and elderly subjects were slightly different than adult males. The reference values of our population show mild to moderate differences from the other Asian, European and American populations. It is recommended that reference values of different biochemical investigations should be established in various areas of Pakistan to make appropriate use of such investigations.

Adolescent↗