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Biomedical subjects

S F Hussain

Publications and source records attributed to S F Hussain.

At least 19 recordsLinked to original sources
PubMed2005

Trends in hospital-based management of acute asthma from a teaching hospital in South Asia.

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved care included frequent use of pulse oximeter, preference of inhaled over systemic bronchodilators and increased use of systemic steroids. Significant deficiencies were identified in hospital-based management of acute asthma. Most aspects of asthma care continued to fall short of asthma guidelines.

Acute Disease↗
PubMed2005

Medical interns knowledge of TB in Pakistan.

Of 460 interns from five Pakistani teaching hospitals surveyed, only 22% correctly identified the estimated number of new TB cases in Pakistan. The majority (96%) knew that droplet infection was the usual mode of transmission. Only 38% considered sputum smears for acid-fast bacilli as the best test for diagnosis of pulmonary TB and 43.5% for follow-up during TB treatment. The recommended four-drug anti-TB regimen was prescribed by 56.5% in the initiation phase and the recommended two-drug combination in the continuation phase by 52%. Most interns (82%) were unable to identify a single component of directly observed treatment short course (DOTS) strategy. Our study reflects poor awareness of and low compliance to the World Health Organization/National Tuberculosis Programme guidelines among interns. For effective control of TB, immediate action to improve undergraduate and continuing medical education is essential, with special emphasis on national guidelines.

Clinical Competence↗
PubMed2004

Massive pleural effusion and marked increase of CA-125.

The tumour associated CA-125 antigen is widely used in monitoring ovarian carcinoma. In women with a massive pleural effusion and ascites, markedly increased CA-125 levels may lead to an erroneous diagnosis of ovarian cancer. Very high levels of tumour markers may be present in patients with benign pleural effusion, ascites, and chronic liver disease. Raised levels of tumour markers in serum or pleural fluid, in the absence of positive cytology, should be interpreted with caution.

Adult↗
PubMed2004

Asthma management by general practitioners in Pakistan.

SETTING: Teaching university hospital in Karachi, Pakistan. OBJECTIVES: Asthma management guidelines have been developed to assist practising physicians in treating asthma patients. The objective of this study was to evaluate if the prescribing habits of practitioners in Karachi were consistent with the published asthma guidelines. DESIGN: A questionnaire survey was conducted among practitioners attending a pulmonary continuing medical education (CME) programme. Three case scenarios of asthma were given, and the doctors were asked to write a prescription for each case. Doctors were asked about their views on inhaler therapy and dietary restrictions in asthma. RESULTS: Of 120 doctors, 100 (83%) responded. Thirty different regimens of short acting beta2-agonist and 16 regimens of steroid therapy were prescribed by the practitioners. Only 35% of the doctors prescribed corticosteroids for persistent asthma symptoms. The great majority of doctors were not aware of treatment options for persistent symptoms despite the use of preventive therapy (8% prescribed long-acting beta2-agonists, 6% high-dose inhaled corticosteroids and 13% theophyllines). Misconceptions about inhaler therapy and diet were found in 20 and 50 doctors, respectively. CONCLUSION: General practitioners in Pakistan did not follow asthma management guidelines. There was serious lack of knowledge about asthma medications coupled with misconceptions about inhaler therapy and dietary factors.

Administration, Inhalation↗
PubMed2004

Clinical characteristics of 110 miliary tuberculosis patients from a low HIV prevalence country.

SETTING: A university teaching hospital in Karachi, Pakistan. OBJECTIVE: To define the clinical characteristics and outcome of miliary tuberculosis (TB) patients from a low human immunodeficiency virus (HIV) prevalence country. DESIGN: Review of adult miliary TB patients admitted between 1994 and 2001. Clinical characteristics of those dying from miliary TB were compared with those of the survivors. RESULTS: Most of the 110 cases reviewed were middle aged or elderly, with a female preponderance. An underlying medical condition was present in 47%. Presenting symptoms were of several weeks' duration, and mostly constitutional (fever and weight loss). Common laboratory findings included anaemia (62%), lymphopaenia (71%), hyponatraemia (74%), elevated serum alkaline phosphatase (57%) and hypoalbuminaemia (92%). Typical miliary pattern was observed in 77% of radiographs. Sputum smear and culture were positive in respectively 36% and 52% of those tested. Biopsy was performed in selected patients. Mean hospital stay was 8.8 days, and mortality was 30%. Those who died were significantly older than survivors and had a more fulminant course. Presence of altered mental status, lung crackles, leucocytosis, thrombocytopaenia and the need for ventilation were associated with increased mortality. CONCLUSION: Miliary TB carries a high mortality. It should be considered in patients who present with prolonged systemic symptoms. A positive TB culture or biopsy is needed to establish a diagnosis.

Adolescent↗
PubMed2003

Overnight home oximetry: can it identify patients with obstructive sleep apnea-hypopnea who have minimal daytime sleepiness?

BACKGROUND: Overnight home oximetry is being widely used as a case selection technique for patients with suspected obstructive sleep apnea-hypopnea (OSAH). In the absence of excessive daytime sleepiness (EDS), patients with snoring and/or witnessed apnea are considered to have low probability of OSAH. METHODS: Patients suspected to have OSAH, who denied EDS, and had a normal overnight home oximetry were studied by polysomnography for presence of significant OSAH (apnea/hypopnea index (AHI) > 15/h). RESULTS: Twelve (40%) of the 30 patients studied had significant OSAH. All had a 2% oxygen desaturation index of less than 10/h. The sensitivity of oximetry increased at lower desaturation indices butthis was associated with decreased specificity. Review of oximetry waveform pattern, by experienced physicians, did not improve the diagnostic accuracy. Combining oximetry with a clinical prediction rule would have reduced the need for polysomnography by 30%. CONCLUSION: Many patients, who present with snoring and/or witnessed apnea and are referred to a sleep disorder clinic for suspected OSAH, may have significant OSAH even if they deny EDS. Overnight home oximetry did not help discriminate between those patients with or without OSAH.

Adult↗
PubMed2003

Tuberculosis diagnosis and treatment practices of private physicians in Karachi, Pakistan.

In a densely populated urban area of Karachi, Pakistan, a questionnaire survey was made of the knowledge and practices of 120 private general practitioners about the diagnosis and treatment of tuberculosis (TB). The majority knew that cough, fever and weight loss were the main symptoms of TB, but less than half knew that blood in sputum, poor appetite and chest pain were associated with the disease. Only 58.3% of physicians used sputum microscopy for diagnosing TB and 35.0% used it as a follow-up test. Only 41.7% treated TB patients themselves, the remaining referring their patients to specialists. Around 73.3% of the doctors were aware of the 4 first-line anti-TB drugs. Efforts to improve the knowledge of private practitioners, and strategies to enhance public-private collaboration forTB control in urban areas are urgently required.

Anorexia↗
PubMed2002

Is there a value of mantoux test and erythrocyte sedimentation rate in pre-employment screening of health care workers for tuberculosis in a high prevalence country?

SETTING: Pre-employment screening of health care workers (HCWs) is practiced widely. Research needs to be carried out to evaluate the screening procedure in developing countries. OBJECTIVE: To evaluate the efficacy of Mantoux test and erythrocyte sedimentation rate (ESR) for the diagnosis of active tuberculosis (TB), in pre-employment screening of HCWs, in a high prevalence country. DESIGN: Pre-employment screening of all new employees was reviewed from June to September 2000. The screening consisted of history, physical examination, blood and urine tests, Mantoux test and a chest radiograph. Patients with clinical, laboratory or radiological features suggestive of active TB were referred to a specialist. RESULTS: Out of 207 employees, a Mantoux reaction of > or = 10 mm and ESR of > or = 25 mm/first hour was noted in 90 (43.5%) and 21 (10.1%), respectively. One person had symptoms suggestive of TB and was already on anti-tuberculosis therapy at the time of screening. All other employees were asymptomatic. Based on radiographic findings, four (2%) cases were referred and one was given anti-tuberculosis therapy. An additional 48 (23.1%) employees were referred on the basis of positive Mantoux or elevated ESR; none were found to have active TB. CONCLUSION: In high prevalence countries use of Mantoux test and ESR in pre-employment screening of HCWs is not recommended for detection of active TB.

Adolescent↗
PubMed2001

Heterogeneity of the memory CD4 T cell response: persisting effectors and resting memory T cells.

Defining the cellular composition of the memory T cell pool has been complicated by an inability to distinguish effector and memory T cells. We present here an activation profile assay, using anti-CD3 and antigenic stimuli, that clearly distinguishes effector and memory CD4 T cells and defines subsets of long-lived memory CD4 T cells based on CD62 ligand (CD62L) expression. The CD62L(low) memory subset functionally resembles effector cells, exhibiting hyper-responsiveness to antigenic and anti-CD3 mediated stimuli, high proliferative capacity, and rapid activation kinetics. The CD62L(high) memory subset functionally resembles resting memory cells, exhibiting hyporesponsiveness to anti-CD3 stimuli, lower proliferative capacity, and slower activation kinetics. Our results indicate that the memory CD4 T cell pool is heterogeneous, consisting of persisting effectors and resting memory T cells.

Adoptive Transfer↗
PubMed2000

[Atypical endometrial hyperplasia. Prognosis and course].

The treatment of patients with the diagnosis atypical endometrial hyperplasia has been disputed during the last decades. The aim of the study was to evaluate the treatment of these patients and analyse the progression rate to invasive carcinoma of the endometrium. Fifty-seven patients with atypical hyperplasia were examined and treated from 1976 through 1991. The medical records were examined retrospectively and the pathology slides were revised by one pathologist in accordance with the 1975 WHO recommendations. Thirty-one (54%) patients were on oestrogen treatment as monotherapy at the time of diagnosis. Forty-two patients had a hysterectomy performed within five months, and five patients had a hysterectomy performed 10 to 61 months after diagnosis. A total of 18 out of 57 patients (31.6%) had or developed endometrial carcinoma all with myometrial invasion: 14 stage I with < or = 50% myometrial invasion, three stage I with > 50% myometrial invasion, and one stage IV. There was no significant difference in age, body mass index, parity or hormone replacement treatment between the group with endometrial carcinoma and the group without endometrial carcinoma. We conclude that unopposed oestrogen treatment and nulliparity are the main risk factors for atypical hyperplasia and that hysterectomy is the appropriate treatment for patients with atypical hyperplasia of the endometrium.

Adult↗
PubMed1999

Effector CD4 T cells are biochemically distinct from the memory subset: evidence for long-term persistence of effectors in vivo.

Memory T cell responses are believed to be mediated by long-lived memory T cells that arise directly from a subset of short-lived, activated effector T cells that have reverted to the resting state. Although widely accepted, definitive proof that memory T cells arise from effectors is lacking because of the inability to reliably distinguish these subsets based on known phenotypic or functional parameters. We have used a biochemical approach to distinguish effector and memory CD4 T cell subsets and follow the differentiative fate of effector cells in vivo. When examined biochemically, effector and memory CD4 T cells are strikingly distinct and exhibit qualitative and quantitative differences in tyrosine phosphorylation. These effector-specific patterns were identical in effectors derived either from naive CD4 T cells (primary effectors) or memory CD4 T cells (memory effectors). To monitor the fate of effector cells in vivo, Ag-activated CD4+ TCR-transgenic T cells were transferred into irradiated BALB/c mice. These TCR-transgenic CD4 T cells persisted in adoptive hosts for several months, gave a recall response to Ag, yet exhibited effector-specific biochemical profiles. These results suggest that a subset of effector CD4 T cells can persist in vivo and contribute to long-term immunity by mediating secondary immune responses.

Adoptive Transfer↗
PubMed1999

Pneumothorax: a review of 146 adult cases admitted at a university teaching hospital in Pakistan.

OBJECTIVE: There is a lack of data on the etiology and outcome of pneumothorax among the Pakistani population. Our aim was to review the etiology, clinical course, management and outcome of patients presenting with pneumothorax. PATIENTS AND METHODS: All adult cases with pneumothorax admitted to a University Teaching Hospital in Karachi, between January 1992 and June 1996, were reviewed and analyzed. RESULTS: A total of 146 patients were reviewed. Their mean age was 46.3 years (SD +/- 17.8 years) with a male to female ratio of 3.7:1. Secondary pneumothorax was the commonest type seen (45%), followed by traumatic (21%), iatrogenic (18%) and primary (16%). Tuberculosis (47%) and COPD (45%) were most common lung diseases associated with secondary pneumothorax. Pneumothorax secondary to TB presented at an earlier age than that with COPD (49.6 vs. 60.1 years). Similarly, patients with primary pneumothorax were significantly younger than patients with secondary pneumothorax (42.3 vs. 51.7 years). Rib fracture was the most common cause of traumatic pneumothorax. Coronary artery bypass grafting, transthoracic fine needle aspiration and neck vein cannulations were the leading iatrogenic causes. The commonest symptoms of pneumothorax were dyspnea (68%) and chest pain (40%). Most cases (81%) were successfully managed by intercostal tube drainage. CONCLUSION: In our study population, secondary pneumothorax was the commonest variety seen. TB was the commonest cause of secondary pneumothorax, closely followed by COPD. Nearly 40% of pneumothorax were either traumatic or iatrogenic. Intercostal tube drainage remains the treatment of choice for pneumothorax.

Adolescent↗
PubMed1998

Role of fibreoptic bronchoscopy in the management of immunocompromised patients with pulmonary infiltrates.

Immunocompromised patients are prone to develop various pulmonary complications. The range of diagnostic possibilities is wide, infection being the commonest cause. Non-invasive diagnostic tests are often unrewarding. In this study, we have evaluated the diagnostic efficacy and safety of fibreoptic bronchoscopy in immunocompromised patients with pulmonary infiltrates. Patients tolerated the procedure well. This technique identified the etiology in up tp 75% of cases. After treatment based on the result of bronchoscopy, 63% patients improved and were discharged.

Adult↗
PubMed1998

Prevalence of pulmonary tuberculosis on the roof of the world.

SETTING: The Shimshal Valley, a remote village in Northern Pakistan, is one of the seven Pamirs of Central Asia, widely known as the roof of the world. OBJECTIVE: To investigate the prevalence of pulmonary tuberculosis (TB) in the Shimshal Valley. DESIGN: The Rapid Village Survey Method (RVS) was used to investigate the prevalence of pulmonary tuberculosis. The selection criteria were chronic cough, hemoptysis, past history of TB and close contact with a tuberculous patient. After clinical examination, a chest radiograph was done and a single spot sputum sample was obtained for smear examination. RESULTS: The total population of the village was 1077, of whom 231 cases were studied. Overcrowding affected 75% of the study population. The prevalence of smear positive pulmonary TB in the village studied was 554 per 100000 population, and the prevalence of active smear-negative TB was estimated at 1949/100 000. The prevalence of active pulmonary TB increased with age and the only risk factor for active TB was age over 45 years. Of the 21 cases with a past history of pulmonary TB, only 38% had completed a full course of chemotherapy. CONCLUSION: Pulmonary TB is a very serious health issue in the rural community (Shimshal Valley) of Pakistan. This study highlights the lack of efficacy of national tuberculosis control programs in the country.

Adolescent↗
PubMed1995

Hot flushes in men with pituitary adenoma.

BACKGROUND: Hot flushes are common in menopausal women and also in men made acutely hypogonadal after orchiectomy or testicular injury. It is, however, an unusual symptom in patients with hypogonadism secondary to pituitary tumors. METHODS: In evaluating the histories of men with hypogonadal state associated with nonfunctioning pituitary macroadenoma we were struck by the presence of hot flushes in four of them. RESULTS: All four of the patients were hypogonadal with sexual dysfunction preoperatively. All had low gonadotropins and low testosterone levels with varying degrees of panhypopituitarism. All had successful transsphenoidal removal of tumors. None had endocrine improvement following surgery. All patients had improvement in sexual function and the hot flushes with administration of testosterone postoperatively. CONCLUSIONS: Hot flushes are an uncommon presentation in men with pituitary adenoma. Perhaps the symptom will become more prominent if it is specifically questioned. We postulate that the cause of the flushing is related to nonsuppressed pulsatile secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus.

Adenoma↗
PubMed1995

Attitudes of Asian medical students towards smoking.

BACKGROUND: There have been numerous studies on smoking habits among young adults in developed countries. Similar data from developing countries are scanty. METHODS: A survey of medical students from one of the medical colleges in Pakistan assessed their smoking habits and attitudes towards smoking. In June 1993 a coded survey questionnaire was sent to each medical student at The Aga Khan Medical University in Karachi requesting data on their smoking habits, their attitudes towards smoking in various areas of the hospital, and their views about passive smoking and tobacco publicity. RESULTS: Of 324 medical students, 89% responded of whom 11% were current smokers. The incidence of smoking was greater among male students than females (17% versus 4%). The average age of initiation of smoking was 17 years and the major influence was friends. There was an increased awareness of harmful effects of smoking among medical students. Almost all felt that passive smoking was injurious to health. CONCLUSION: The prevalence of current smokers among Asian medical students was found to be 11%. Females smoked less than their male counterparts. There has been an increased awareness of the hazards of passive smoking among the medical students and most were in favour of legislative actions to discourage tobacco advertising.

Adult↗