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Biomedical subjects

Z Nazir

Publications and source records attributed to Z Nazir.

15 recordsLinked to original sources
PubMed2004

Revisiting the accuracy of peak flow meters: a double-blind study using formal methods of agreement.

BACKGROUND: There is widespread use of peak flow meters in both hospitals and general practice. Previous studies to assess peak flow meter accuracy have shown significant differences in the values obtained from different meters. However, many of these studies did not use human subjects for peak flow measurements and did not compare meters of varying usage. In this study human subjects have been used with meters of varying usage. METHODS: Participants were tested using two new (meters A and C) and one old peak flow meter (meter B) in random order. The study was double-blinded. Participants were recruited from the university campus. RESULTS: Four hundred and nine individuals participated. The difference between peak flow means of A and B was -9.93 l/min (95% CI: -12.37 to -7.48, P<0.0001). The difference between peak flow means of B and C was 20.08 l/min (95% CI: 17.85-22.29, P<0.0001). The difference between peak flow means of A and C was 10.15 l/min (95% CI: 7.68-12.61, P<0.0001). CONCLUSION: There was a significant difference between the values obtained from the new and old peak flow meters and also between the two new peak flow meters. We conclude that there is need for caution in interchangeably using flow meters in clinical practice.

Adult↗
PubMed2004

Patent ductus arteriosus: an uncommon cause of tracheobronchial compression in infants.

Tracheobronchial compression is an important cause of respiratory distress in children, requiring precise diagnosis and early surgical management. Common causes of the compression are either intrinsic or extrinsic, the latter being usually due to vascular rings. We report a 10 weeks old boy in whom a dilated pulmonary artery due a large patent ductus arteriosus was the cause for extrinsic compression.

Journal Article↗
PubMed2004

Profile of children with congenital adrenal hyperplasia--a hospital study.

OBJECTIVE: To collect baseline information on congenital adrenal hyperplasia (CAH) and to identify relevant issues specific to this disease in Pakistan. METHODS: A retrospective analysis of medical records of pediatric patients registered for serum 17 hydroxyprogesterone (17-OHP) measurement and documented to have CAH in the period 1987 to 1998 was carried out at The Aga Khan University, Karachi (AKU). The clinical notes were reviewed for documentation of CAH as the diagnosis. RESULTS: Of the 152 children registered for 17-OHP testing, sixty-three were diagnosed with CAH. Salt wasting, simple virilization and non-classical CAH was found in 40 (63%), 18 (29.0%) and 5 (8.0%) patients respectively. Twenty-one (33.9%) patients were incorrectly assigned sex and of these, 20 (32.2%) patients were females who were either considered males or just not assigned gender. Parental consanguinity was found in 33 (52.3%) cases. No case had a history of similar features in either parent but in 19 (30.6%) cases similar features were present in siblings. Sixteen cases (25.4%) had a history of sibling death in the neonatal period and 7 had a history of sibling death in infancy. Maternal obstetric histories identified 3 (4.8%) cases with a history of still birth(s) and 4 (6.4%) with a history of abortion(s). CONCLUSION: Children with CAH should be diagnosed early as a rational and judicious choice of sex assignment is a critical aspect of treatment. The high rate of consanguinity emphasized the need to establish the true incidence of the defect in Pakistani population.

17-alpha-Hydroxyprogesterone↗
PubMed2000

Clinicopathological profile of Wilms' tumor.

The profile of renal tumors in children less than 15 years of age during the period 1991-1997 is presented. Among the 37 children with kidney tumors, 29 (78.4%) had Wilms' tumor. There was also a 20-year-old female with Wilms' tumor. The median age at presentation was 2.6 years (range 2.5 months to 20 years). 66.7% of the cases diagnosed were < or = 3 years and 90% were < or = 6 years. Five cases were under one year of age. The male to female ratio was 2:1. Twenty-two cases (73.3%) were triphasic and 7 (23.3%) were biphasic. Only one case was monophasic with blastemal component. Five cases (16.7%) showed nephrogenic rests in the uninvolved renal parenchyma and one case had nephroblastomatosis. The tumor was favorable in 26 cases (86.7%) and unfavorable in 4. Fourteen cases were in-patients while 16 were outside referrals. The pathological (10 cases whose specimens were sent from other centers) and clinicopathological (13 hospitalized patients) staging showed 10 cases (43.5%) with stage 1, 4 cases (17.4%) with stage 2, and 7 cases (30.4%) with stage 3. In two cases (8.7%), there was stage 4 disease. The length of the follow-up period in the 13 hospitalized patients ranged from 7 days to 5 years 5 months (median 14 months). There was one recurrence and one death after 2 years of diagnosis.

Adolescent↗
PubMed1998

Amebic liver abscess: spare the knife but save the child.

BACKGROUND/PURPOSE: Amebic liver abscess (ALA), the most common extraintestinal manifestation of infection with Entameba histolytica, carries significant morbidity and mortality in the pediatric age group. The efficacy of metronidazole in the treatment of ALA is well established, but the role of surgical intervention remains controversial. Many investigators still advocate aggressive surgical therapy for complicated and ruptured ALA. Reports regarding management of ALA in children are sparse and deal with small numbers of patients. The objective of this study was to assess the effectiveness of parenteral metronidazole combined with judicious aspiration of ALA in obviating the need for surgical intervention. METHODS: The medical records of all children admitted with the diagnosis of ALA between 1986 and 1997 to the Aga Khan University Hospital were reviewed retrospectively. The diagnosis of ALA was confirmed in 48 patients by an ultrasound scan together with elevated indirect hemagglutination (IHA) titres (>250). Ages ranged from 3 weeks to 14.5 years. RESULTS: Thirty-seven (75%) children were below the fifth percentile for height and weight, and 45 (93.7%) presented with a hemoglobin level of less than 10.0 g/dL. Comorbid factors included pulmonary tuberculosis (n = 2, chicken pox (n = 1), tetralogy of Fallot (n = 1), and thalassemia major (n = 2). There was a mean delay of 13 days before presentation to the hospital. All patients were treated with parenteral metronidazole and broad-spectrum antibiotics. The latter were discontinued on confirmation of the diagnosis. The duration of treatment with metronidazole ranged from 2 to 5 weeks. Percutaneous aspiration of the ALA was performed under ultrasound guidance using sedation in 28 patients for one or more of the following indications; ALA greater than 7.0 cms (n = 20), left lobe involvement (n = 8), and no response after 48 hours of medical therapy (n = 6). Nine patients required more than one aspiration. One patient with peritoneal rupture of the ALA additionally underwent percutaneous aspiration of the peritoneal cavity under ultrasound guidance. One patient required insertion of a chest tube after rupture of the ALA into the right pleural cavity, and another underwent urgent bronchoscopy after rupture of the abscess into the tracheobronchial tree. The hepatobronchial fistula closed spontaneously with medical therapy. No patient required open surgical drainage, and all recovered without relapse. The mean duration of hospitalization was 12 days. CONCLUSION: Our experience suggests that parenteral metronidazole combined with timely aspiration of the abscess can obviate the need for surgical intervention in large and complicated ALA even in malnourished children who present late for treatment.

Adolescent↗
PubMed1998

Persistent Müllerian duct syndrome.

Persistent müllerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism. We present 5 cases with PMDS (2 cases associated with testicular malignancy) and discuss the diagnosis and management. Management strategies of PMDS have changed. Whereas in the past, removal of the müllerian remnants was targeted together with orchidopexy or -ectomy, this is no longer recommended. However, testicles that cannot be descended at an early stage are at a high risk of malignancy and should, therefore, be removed. If this is necessary on both sides, there is the additional problem of lifelong testosterone substitution which requires efficient patient monitoring and good patient compliance. In cases where this cannot be achieved, compromises, such as temporarily delayed orchidectomy, may be considered.

Adult↗
PubMed1994

Pediatric urolithiasis: to cut or not to cut.

Urolithiasis is a major source of morbidity in children of the third world. Since its advent in 1982 and despite uncertainties about the long-term effects on the kidney, extracorporeal shock wave lithotripsy (ESWL) has rapidly replaced traditional surgery in the management of this condition. A retrospective study was conducted to compare the outcome of ESWL with that of open surgery in the management of paediatric urolithiasis in a single institution between November 1988 and December 1991. Emphasis was placed on the rate of stone clearance, complications, duration of follow-up, and cost of treatment of each modality. A total of 83 patients under 14 years of age underwent management of 101 stones; the stones were located in the kidneys (63), ureters (13), or bladder (25). Thirty-one patients who enrolled directly through the Lithotripsy Clinic underwent a total of 65 ESWL sessions for 44 calculi (mean, 2.1 sessions per patient). The overall stone clearance rate was 82%, with an 83% clearance rate for renal stones. There were three failures. Nine patients did not return after the first ESWL session, and by the end of 6 months, 93.5% were lost to follow-up. The cost of ESWL ranged from $600 to $1,000 (mean, $780). Fifty-two children were managed through the Pediatric Surgery Clinic and underwent open surgery (57 stones). The overall stone clearance rate was 96%, with a clearance of 88% for renal calculi. There were two wound infections and no deaths. All patients returned for the first follow-up visit, but by the end of 6 months, only 34.5% were available for follow-up. The total cost of treatment ranged from $520 to $900 (mean, $580). The authors believe that with the present level of knowledge, use of the lithotriptor should be restricted to children with small stones and/or those for whom long-term follow-up is possible.

Adolescent↗
PubMed1993

The abdominal cocoon--an unusual cause of intestinal obstruction in adolescents.

The abdominal cocoon is a rare cause of intestinal obstruction in adolescent girls caused by encasement of the small intestine in fibrous tissue. Only 15 cases have been reported in the English literature so far. This is a report of another two patients managed at the Aga Khan University Hospital. The correct diagnosis is often not suspected, resulting in delays in the treatment of this condition. Following simple surgical release of the entrapped bowel, these patients do well.

Adolescent↗
PubMed1993

Amebic liver abscess in children.

Although amebic liver abscess can be a cause of significant morbidity and mortality in all ages, there are few reports dealing with this entity in children. Twenty-four children with amebic liver abscess, ages ranging between 3 weeks and 14.5 years, were managed at the Aga Khan University Hospital, Karachi, Pakistan, between November, 1987, and October, 1992. The most frequent presentation was high grade fever and right upper quadrant pain, associated with tender hepatomegaly, leukocytosis and an elevated erythrocyte sedimentation rate. The diagnosis was confirmed by elevated indirect hemagglutination titers and ultrasonography of the liver. Unlike the experience in adult patients none of the patients had concomitant jaundice, and significant derangement of liver enzymes was unusual. The abscesses were likely to be solitary (22 of 24 patients). There were no deaths despite a mean delay of 15 days before presentation to our hospital. A high index of suspicion, early institution of metronidazole therapy and aspiration of abscesses with potential to rupture are believed to have contributed to the better outcome in these children when compared with results in previous reports.

Adolescent↗
PubMed1993

Penile constrictive band injury.

Penile strangulation caused by a thread or human hair is an uncommon cause of urethral injury described in paediatric practice. Five children presented with this entity to the Aga Khan University Hospital, Karachi between August, 1991 and August, 1992. Three children had uneventful recoveries after removal of the constricting agent. Two patients developed urethrocutaneous fistulae and partial amputation of the penis because of late presentation. Early recognition and removal of the constricting agent is necessary to prevent serious complications.

Child↗