Biomedical subjects
Publications and source records attributed to Nawal Salahuddin.
Tracheopulmonary artery fistula is an extremely rare condition. We report the case of an 80-year-old man who presented with massive hemoptysis. He was found to have tuberculous mediastinal lymph nodes that had eroded into the pulmonary artery and anterior tracheal wall, leading to a pseudoaneurysm of the right pulmonary artery and a tracheopulmonary artery fistula.
OBJECTIVE: To determine the outcome of patients discharged home on portable ventilator. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi from January 2000 to December 2004. PATIENTS AND METHODS: All ventilator-dependent patients discharged home were contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. SPSS version 13 was used to analyze data. RESULTS: Eleven patients were discharged home on invasive ventilation. Mean age was 49 years (range 10-98 years). Cause of ventilatory failure were cervical spine trauma in 36%, primary neurological disease in 27%, critical illness neuropathy and respiratory failure in 18% each. Survival rate was 73%, with three deaths. Mean duration of ventilation was 9.45 months (95% CI 3.24, 15.67). Rate of successful weaning after discharge was 36%, with 4 patients off all forms of ventilatory support and 2 on only nocturnal support. A 2.8 (95% CI 0.5, 16.6) relative risk towards successful weaning was associated with the presence of a family member as the primary care giver. Mean scores on the EQ-5D descriptive tool were; mobility 2 (-/+0.82), self-care 2 (-/+0.82), usual activities 1.86 (-/+0.69), pain/discomfort 1.43(-/+0.79), anxiety/depression 1.29 (-/+0.76). Mean score on the EQ-VAS was 48.2(-/+ 27.3). CONCLUSION: In carefully selected patients, home ventilation is a viable option with the expectation of successful weaning and survival. Patients discharged home on ventilation reported a reasonably good quality of life with proportionately more problems related to independence compared to overall well-being.
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OBJECTIVE: To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia. DESIGN: Cohort study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. PATIENTS AND METHODS: This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitating cardiac, pulmonary or rheumatologic disease were categorized as 0 stairs climbed. Outcome variables were postoperative cardiopulmonary complications or mortality. Period of follow-up was until hospital discharge. RESULTS: Seventy-eight patients were enrolled, 59 (75.6%) climbed 1 flight of stairs, 19 (24.3%) climbed < 1 flight. All-cause cardiopulmonary complications rate was 26 %. The most frequent complication was lobar atelectasis, followed by bronchospasm and acute MI. The complication rate was 22.8% in those able to climb 1 flight and 40% in those patients who climbed < 1 flight. The group that climbed < 1 flight tended to have complications associated with poor reserves of the cardiopulmonary systems, i.e. pulmonary edema, exacerbation of underlying lung disease. The relative risk of developing complications, if unable to climb at least 1 flight of stairs, was calculated to be 1.8 (95% CI 0.7 - 4.6). CONCLUSION: Stair climbing can be a useful pre-operative tool to predict the risk of postoperative cardiopulmonary complications.
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Boerhaave's syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations. All clinicians need to be aware of this lethal disease, its frequent unusual presentations and the importance of early diagnosis.