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Biomedical subjects

K Hameed

Publications and source records attributed to K Hameed.

At least 19 recordsLinked to original sources
PubMed2006

Trends in the management of inguinal hernia in Karachi, Pakistan: a survey of practice patterns.

INTRODUCTION: The study was conducted to identify and document the various aspects of elective inguinal hernia repair performed by general surgeons working in the different university hospitals of Karachi, Pakistan. METHODS: This questionnaire-based survey, carried out over a two-year period, involved 84 general surgeons of Karachi. The respondents were divided into groups and comparative analysis was carried out. RESULTS: 65 respondents (77.4 percent) were male and 19 (22.6 percent) were female. Mean years and standard deviation since post graduation were 7.7 and 7.3 years, respectively. 60 respondents (71.4 percent) reported the routine use of prophylactic antibiotics in all inguinal hernia repairs. 34 respondents (40.5 percent) quoted "spinal anaesthesia" as their preferred type of anaesthesia, 46 respondents (54.8 percent) chose to perform the procedure as a day case, and 49 respondents (58.3 percent) reported mesh repair as their preferred type of repair. 60 respondents (71.4 percent) did not recommend the laparoscopic approach to hernia repair. Surgeons associated with private hospitals were found more likely to choose mesh as their preferred method of inguinal hernia repair (p-value is 0.007), but less likely to use prophylactic antibiotics (p-value is 0.05) and respondents with more than ten years of postgraduate experience were found more likely to perform hernia repairs on an inpatient basis (p-value is 0.045). CONCLUSION: Various aspects of management of inguinal hernias are still determined by the preference of the operating surgeon. Day case management of hernia repairs, routine use of prophylactic antibiotics, use of mesh and open repair of hernias were the practice of the majority of surgeons, although differences were noted in specific groups of surgeons.

Elective Surgical Procedures↗
PubMed2004

Stevens Johnson syndrome in Pakistan: a ten-year survey.

OBJECTIVE: A pre-tested questionnaire-based, retrospective study to highlight the causative factors, mode of presentation, complications and outcome of patients with Stevens Johnson syndrome. SETTING: Aga Khan University Hospital over a 10 year period. METHODS: All case records with a diagnosis of Steven Johnson Syndrome in the period 1990 to 2000 were retrospectively reviewed. Data was retrieved on a comprehensive questionnaire. The demographic variatbles and drugs taken within the previous 21 days were noted. Date analysis was done by Epi-Info Version 6.0. RESULTS: Of the 101 studied patient files, the most common offender was found to be the Penicillins as a group and Sulfadoxine-Pyrimethamine (Fansidar) when considering all drugs individually. Most common complications included electrolyte disturbances (13.9%) and congestive heart failure (6.9%). Mortality rate was high at 10.1%. CONCLUSION: SJS was found to be a rare condition but having a mortality rate of 10.1%. As it can be induced by a large number of drugs, caution should be practiced while prescribing.

Adult↗
PubMed2003

Analysis of Fc gamma receptor II (CD32) polymorphism in populations of African and South Asian ancestry reveals east-west geographic gradients of allele frequencies.

Analysis of FcgammaRIIA alleles in Pakistanis and in Trinidadians of South Asian, African and mixed ancestry revealed no significant differences between Trinidadian South Asians and Pakistanis. H131 homozygotes were more common among Trinidadian South Asians than among Africans and those of mixed ancestry. Comparison with other populations revealed east-west geographic gradients of allele frequencies.

Africa↗
PubMed2002

Natural killer cell immunoglobulin-like receptor (KIR) locus profiles in African and South Asian populations.

Natural killer (NK) and some T cells express killer cell immunoglobulin-like receptors (KIRs), which interact with HLA class I expressed by target cells and consequently regulate cytolytic activity. The number of KIR loci can vary and so a range of genetic profiles is observed. We have determined the KIR genetic profiles from one African (n = 62) and two South Asian (n = 108, n = 78) populations. Several of the KIRs are present at significantly different frequencies between the two major ethnic groups (eg KIR2DS4 gene frequency 0.82 African, 0.47 S Asian. Pc < 1 x 10(-6)) and this is due to uneven distribution of two KIR haplotype families 'A' and 'B'. All three populations described here displayed a greater degree of diversity of KIR genetic profiles than other populations investigated, which indicates further complexity of underlying haplotypes; in this respect we describe two individuals who appear homozygous for a large deletion including the previously ubiquitous 2DL4. We have also reanalysed three populations that we studied previously, for the presence of a KIR which is now known to be an indicator of the 'B' haplotype. South Asians had the highest overall frequencies of all KIR loci characteristic of 'B' haplotypes (Pc < 0.0001 to < 0.004). Furthermore, gene frequency independent deviances in the linkage disequilibrium were apparent between populations.

Africa, Western↗
PubMed1997

The association of HLA-DRB genes and the shared epitope with rheumatoid arthritis in Pakistan.

The association of particular HLA-DR alleles and the shared epitope with rheumatoid arthritis (RA) is now well established. The strength of these links varies between races. Furthermore, the proposition that the presence of the shared epitope is indicative of severe disease has been more difficult to sustain in non-Europeans. This study examines the frequency of HLA-DR and HLA-DRB1 amongst Pakistanis for the first time. Using the polymerase chain reaction (PCR) and sequence-specific oligonucleotide probes (PCR-SSOP) and primers (PCR-SSP), HLA-DR phenotype and genotype frequencies were ascertained in 86 RA hospital out-patients and 79 healthy controls matched for age, gender and ethnicity. HLA-DR1 and HLA-DR4 frequency was similar in patients and controls. HLA-DR10 occurred in 26 instances (15%) in RA and in eight (5%) controls (Pcorr = 0.048). HLA-DR2 was also increased in patients (P = 0.053) and its major subtype DR15 was significantly increased (Pcorr = 0.03). HLA-DR5 frequency was 5% in patients and 19% in controls (Pcorr = 0.002). The HLA-DR4 alleles possessing the shared epitope were more common in RA (Pcorr = 0.03) and this difference was enhanced by inclusion of other alleles possessing the shared epitope (Pcorr = 0.002). Shared epitope alleles were observed in 43 (50%) patients and 17 (22%) controls (Pcorr = 0.003). The shared epitope did not distinguish patients with more severe disease, as reflected by pain, joint deformities, disability, rheumatoid factor or X-ray damage. The distribution of HLA-DR alleles in Pakistanis with RA supports the shared epitope hypothesis. In common with other non-European racial groups, HLA-DR4 was not associated with RA. Unlike other groups, there was a weak link of RA with HLA-DR2. A protective effect of HLA-DR5 was apparent. In accord with some other studies, the shared epitope in this hospital out-patient population was not a marker for more severe disease.

Adolescent↗
PubMed1997

A comparison of the prevalence of rheumatoid arthritis and other rheumatic diseases amongst Pakistanis living in England and Pakistan.

The impact of environmental factors on the causation of rheumatoid arthritis (RA) is thought to be considerable. We explored this by comparing the prevalence of RA amongst Pakistanis living in England, where it is relatively high amongst ethnic English, and in Pakistan. The frequency of other rheumatic diseases was also compared. Information on 2056 adult Pakistanis in England and 4232 in Pakistan was obtained by house-to-house surveys using identical protocols. Positive respondents were examined by the same two clinicians in both countries. Rheumatic complaints increased with age and were more common in females in both communities. The standardized morbidity ratio (SMR) (95% CI) of RA in England was 2.1 (1.1-3.1) compared with Pakistan, a difference that was entirely attributable to females. The SMR (95% CI) for women was 3.0 (0.4-5.6) and for men 0.86 (-0.84 to 2.56). In Pakistan, there was a trend to more reporting of some but not all rheumatic complaints amongst the affluent segment of the population. This was increasingly apparent amongst those resident in England and the possibility of an impact of easier ascertainment amongst the more educated cannot be discounted. Low back pain was significantly more common in England. Furthermore, the colder climate was frequently invoked as a cause of more symptoms in England. Thus, several factors may have influenced the observation that RA is more common amongst Pakistanis in England compared with Pakistan. An environmental factor cannot be excluded. However, the frequency of non-specific musculoskeletal pain was similar. The regions of Pakistan from which the two populations were derived were also different and immunogenetic heterogeneity might also have contributed to the difference in RA prevalence.

Adolescent↗
PubMed1996

A comparison of the clinical features of hospital out-patients with rheumatoid disease and osteoarthritis in Pakistan and England.

Several studies have demonstrated differences between ethnic groups in the severity and pattern of rheumatoid arthritis (RA) and osteoarthritis (OA). The current investigation compared RA and OA in Pakistani and British White Caucasian out-patients in two teaching hospitals. There were 88 RA patients in each setting, matched for age, gender and disease duration. The pattern of OA was sought by recording the details of 44 consecutive new referrals to each clinic. Amongst the RA patients, joint deformity and tenderness were similar, but disability was more severe, ESR higher, anaemia more pronounced and RA latex more often positive amongst the Pakistani patients. X-ray damage was more pronounced amongst the British patients, especially in the feet. The British were also more likely to have rheumatoid nodules and to have undergone disease-modifying treatment or joint surgery. The paradox of more severe indices of disease activity and disability with less X-ray erosion in hands and feet might be explained by the impact of treatment on joint inflammation and the beneficial influence of surgery on disability in the British. The worse X-ray scores in the White Caucasians might indicate a genetic predisposition to radiologically more severe disease. The age of the British OA patients was significantly higher, but this is unlikely to have influenced the striking disparity in the frequency of isolated knee OA, which was significantly greater in the Pakistani patients. Comparison with age- and sex-matched healthy Pakistani subjects suggested that susceptibility to knee OA was strongly associated with body weight, but not with knee bending at prayer or with joint laxity. Amongst the Pakistanis, Heberden nodes, hip involvement and evidence of generalized OA were significantly less, but these observations may have been due to their younger age. The study confirmed differences in the clinical presentation of both RA and OA amongst patients in Pakistan compared with White Caucasians in Britain. Several confounding factors, such as patient recruitment, culture, treatment and age, may have influenced the results, but it remains likely that genetic factors are important.

Adult↗
PubMed1996

Knee pain amongst the poor and affluent in Pakistan.

The frequency of joint symptoms was determined amongst 2022 affluent and 2210 poor adults in Karachi, Pakistan. Joint pain was significantly (P = 0.025) more common amongst the affluent (6.6%) compared with the poor (5%) and this was due to a significantly greater frequency of knee pain in the richer community (3% vs 1.8%; P = 0.008). The prevalence increased with age and was more common in females. Almost half were associated with varus deformity, suggesting the presence of associated OA in a high proportion. The overall frequency of knee pain seemed no greater than in series reported from the West. Compared with age- and sex-matched controls, body weight was significantly greater amongst those with knee pain, both amongst the affluent (P = 0.005) and the poor (P = 0.02). Control subjects were heavier in the affluent population, suggesting that the greater frequency of knee symptoms in this community was due to their relative obesity. Knee bending at prayer was most common amongst the affluent controls and may indicate that religious observance also contributed to the problem in the richer population. Squatting was a characteristic of the poor who had less knee pain than the affluent. Knee flexing could not therefore be confidently implicated. No relationship could be demonstrated between knee pain and joint laxity.

Adolescent↗
PubMed1995

The prevalence of rheumatoid arthritis in affluent and poor urban communities of Pakistan.

Using previously applied methods a survey of joint symptoms was undertaken among 4232 adults, evenly distributed between affluent and poor areas of Karachi, Pakistan. Only six cases of definite rheumatoid arthritis (RA) (1958 ARA criteria) were identified in the 245 persons who complained of joint problems of at least 4 weeks duration. The prevalence was 0.9 [confidence interval (CI) 0.21-3.61] and 1.98 (CI 0.55-5.1) per thousand in the poor and affluent districts, respectively. These were substantially less than prevalence rates reported in the West but were similar to figures derived from other developing countries. There was no obvious impact of current living standards on the findings. The relative paucity of older female subjects in both the affluent and poor communities may account at least in part for the low rates observed. The infrequency of rheumatoid nodules in Southern Asians with RA illustrates the difficulty of applying existing diagnostic criteria to this community.

Adolescent↗
PubMed1995

The frequency of known diabetes, hypertension and ischaemic heart disease in affluent and poor urban populations of Karachi, Pakistan.

The high frequency of diabetes mellitus and coronary artery disease among people of South Asian extraction living in the West is well established. The prevalence of these disorders in Southern Asia is less certain. No previous attempt has been made to estimate their occurrence in Pakistan. In order to compare the prevalence of known diabetes mellitus, hypertension and ischaemic heart disease between affluent and poor urban communities in Pakistan, a survey of consecutive households was undertaken in a relatively prosperous and a poor area in Karachi. Information was obtained on 4232 adults evenly distributed between the two areas. Body weight and height were measured in 199 healthy subjects at the two sites. The prevalence of known diabetes in the affluent population was 4.5%, significantly higher than 1.8% in the poor area (p < 0.001). A maximal prevalence of 25% was seen in the affluent community aged 55-64. Diabetes was more common in females in both populations. The overall prevalence of hypertension was similar in the two areas although significantly more frequent in the middle aged and affluent. A history of ischaemic heart disease occurred in 1.9% of the affluent and 0.6% of the poor (p = 0.003). Healthy subjects were heavier and more obese in the richer community. Thus the susceptibility of South Asian populations to diabetes and ischaemic heart disease is also apparent in an affluent segment of Pakistani society. The phenomenon is not attributable simply to urbanization. Obesity is probably an important contributory factor. The economic implications for developing South Asian countries are serious.

Adolescent↗
PubMed1993

The diagnosis of Poncet's disease.

Two cases of polyarthritis in young people with extra-articular tuberculosis are described. The clinical features were consistent with the concept of Poncet's disease. After synovial biopsy one patient proved to have tuberculous peripheral arthritis. This observation raised doubts about the diagnosis in the other patient. Multiple joints may be simultaneously infected with Mycobacterium tuberculosis and Poncet's disease, if it exists, should not be entertained in the absence of synovial biopsy.

Adolescent↗
PubMed1993

Spontaneous sternal fractures in four patients with chronic airflow obstruction taking corticosteroids.

Four patients with chronic airflow obstruction developed spontaneous sternal fractures. All had received repeated courses of high dose corticosteroids and three were receiving long term treatment with low dose corticosteroids. It is important to consider sternal fracture in the differential diagnosis when patients with chronic airflow obstruction present with chest pain.

Adrenal Cortex Hormones↗
PubMed1993

Retained stones in the common bile duct: results of management.

Seventeen patients underwent treatment for retained common bile duct stones. In 7 patients the stones were removed via a T-tube tract using steerable catheters while 5 patients underwent ERCP and sphincterotomy and 5 underwent surgical re-exploration. Considering morbidity, mortality, success rate and patients' stay in the hospital, non-operative modalities should be the treatment of choice for retained common bile duct stones.

Cholangiopancreatography, Endoscopic Retrograde↗