Prioritizing investment in medical education.
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Biomedical subjects
Publications and source records attributed to Fawad Aslam.
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An 11-month-old infant presented with acute urinary retention. He had presented 3 months earlier with complaints of an enlarging abdominal mass that was initially diagnosed as a mesenteric cyst on ultrasonography. Voiding cystourethrogram revealed a large bladder diverticulum. Bladder diverticulum should be a differential diagnosis in children, especially male, presenting with urinary retention, fever and an abdominal mass.
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Tuberculosis (TB) of the scapula is an extremely rare presentation of osteoarticular tuberculosis. In a tuberculosis endemic setting with a rising burden of acquired immunodeficiency syndrome, this rare presentation may become more frequent. The common presentation is with longstanding Complaints of pain and swelling in the shoulder region, typically in young adults. Classic radiographic features include a well defined radiolucent lesion with minimal sequesteration. The erythrocyte sedimentation rate is usually elevated and initially these patients are frequently mis-diagnosed and thus a high index of clinical suspicion is required. Medical therapy with antituberculous drugs is the standard modality of treatment. This case serves to higlight the salient features of scapular TB.
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BACKGROUND: Knowledge about coronary heart disease (CHD) and its risk factors is an important pre-requisite for an individual to implement behavioral changes leading towards CHD prevention. There is scant data on the status of knowledge about CHD in the general population of Pakistan. The objective of this study was to assess knowledge of CHD in a broad Pakistani population and identify the factors associated with knowledge. METHODS: Cross sectional study was carried out at four tertiary care hospitals in Pakistan using convenience sampling. Standard questionnaire was used to interview 792 patient attendants (persons accompanying patients). Knowledge was computed as a continuous variable based on correct answers to fifteen questions. Multivariable linear regression was conducted to determine the factors independently associated with knowledge. RESULTS: The mean age was 38.1 (+/- 13) years. 27.1% had received no formal education. The median knowledge score was 3.0 out of a possible maximum of 15. Only 14% were able to correctly describe CHD as a condition involving limitation in blood flow to the heart. Majority of respondents could identify only up to two risk factors for CHD. Most commonly identified risk factors were stress (43.4%), dietary fat (39.1%), smoking (31.9%) and lack of exercise (17.4%). About 20% were not able to identify even a single risk factor for CHD. Factors significantly associated with knowledge included age (p = 0.023), income (p < 0.001), education level (p < 0.001), residence (p < 0.001), a family history of CHD (p < 0.001) and a past history of diabetes (p = 0.004). Preventive practices were significantly lacking; 35%, 65.3% and 84.6% had never undergone assessment of blood pressure, glucose or cholesterol respectively. Only a minority felt that they would modify their diet, stop smoking or start exercising if a family member was to develop CHD. CONCLUSION: This is the first study assessing the state of CHD knowledge in a relatively diverse non-patient population in Pakistan. There are striking gaps in knowledge about CHD, its risk factors and symptoms. These translate to inadequate preventive behavior patterns. Educational programs are urgently required to improve the level of understanding of CHD in the Pakistani population.
Gynecomastia is the most common cause of breast enlargement in males. Trichophyton rubrum is a common dermatophyte, is responsible for a variety of infections, and may rarely manifest as a dermatophytic pseudomycetoma. We report the case of a 52-year-old man who presented with progressive bilateral breast enlargement. This is the first reported case of bilateral breast pseudomycetoma due to T. rubrum. Long-term antifungal therapy with itraconazole was successful.
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A 12-year-old girl presented with hemoptysis, fever and weight loss. She was initially diagnosed and treated for presumed tuberculosis and a lung abscess. Salmonella typhi was isolated from the abscess. Hydatid cyst was diagnosed at surgery. This is the first reported case of a pulmonary hydatid cyst infected with S. typhi.
Sarcoidosis is a chronic granulomatous multi-system disease with a clinical picture often mimicking tuberculosis. We present a case of a patient who presented with a clinical picture akin to both of these granulomatous disorders and was started on anti-tuberculous regimen despite the lack of any solid evidence pointing towards tuberculosis. As a result her clinical condition continued to deteriorate for months until finally a bronchoscopic biopsy established her disease process as sarcoidosis. She was then started on systemic corticosteroid therapy for sarcoidosis and during the ensuing period has shown marked improvement in her clinical picture with near normalization of the biochemical and radiographic parameters of her pathology. This case illustrates the need for vigilant interpretation of the clinical scenario in patients such as these where a misdiagnosis may lead to significant patient distress as well as weighing down on the economic and health resources.
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.
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OBJECTIVE: To analyze the pattern of the first author's institutional affiliation and the distribution of different article types published in the students' corner of the Journal of Pakistan Medical Association. METHODS: This cross-sectional study was carried out in July 2005 and analyzed the students' corner (whenever present) of the Journal of Pakistan Medical Association from January 1998 to June 2005. RESULTS: For the 90 issues of the journal in the stipulated period, 96 articles were published in the students' corner. Original studies 46 (47.9%) were the most commonly published article category followed by personal opinion/review category (43.8%) and case-reports 8 (8.3%). The number of personal opinion/review articles has been steadily decreasing. Students from Aga Khan University contributed 74 (77.1%) articles followed by students from Ziauddin Medical University 10 (10.4%). Almost 95% of the authors were from private medical colleges. Sindh was the location of the first authors institution in 90 (93.8%) cases. CONCLUSION: A major chunk of all articles published in the students' corner of the Journal of Pakistan Medical Association originates from two private medical colleges in Sindh. Efforts must be made to increase student participation across the country. This may be done by asking students to begin scientific writing by submitting personal opinion articles. Further research is needed to assess the status of student research in terms of published output in Pakistan.
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