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Khan UR, Soomar SM, Ghazi SM, Naeem R, Kerai S, Jamali S. Epidemiological pattern and management of dog bite injuries in Karachi, Pakistan: A cross-sectional study. Injury 2023; 54 Suppl 4:110473. [PMID: 37573070 DOI: 10.1016/j.injury.2022.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 08/14/2023]
Abstract
BACKGROUND Dog bite injuries are a common problem globally; however, little is known about the epidemiology of dog bite injury from a low-and-middle-income country like Pakistan. This study aims to determine the epidemiology of dog bite injuries among children and adults from a tertiary care hospital in Karachi, Pakistan. METHODS We conducted a cross-sectional study on dog bite patients visiting the emergency department from November 2015 to August 2016 of a major public tertiary care hospital. Data was collected using a structured questionnaire on demographic details, bite history, and management of dog bite victims. Descriptive analysis was reported. Chi-square test was applied to check the associations between age-specific dog bite cases and independent variables. RESULTS 2178 participants were included in the analysis. 715 (38.8%) were children less than 18 years old, and 1463 (61.2%) were adults over 18 years. A majority of the patients were males (1909, 87.7%). Results show that most dog bite injuries (2052, 94.2%) tend to occur outside the house by stray dogs biting without provocation. People aged 18 years and above (61.2%) and males (children: 84.6%, adults: 89.1%) tend to be bitten more often. Lower limbs are most frequently bitten (children: 69.5%, adults: 85.8%). Free-roaming stray dogs (children: 73.4%, adults: 74.9%) were involved in reported biting cases. Many of the patients did not receive appropriate first aid and instead just washed the wound with soap and water (children: 45.1%, adults: 43.7%). 99% of the victims received Tetanus toxoid, Rabies vaccine, and immunoglobulins while in the emergency department. CONCLUSION There is a high burden of dog bite injuries from stray dogs in Karachi, Pakistan. Efforts should be made to create awareness among the general public on the risks of dog bites and on seeking appropriate first aid and medical attention for a dog bite injury.
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Affiliation(s)
- Uzma Rahim Khan
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Salman Muhammad Soomar
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan.
| | - Sanam Mir Ghazi
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Rubaba Naeem
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Salima Kerai
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Seemin Jamali
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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Naeem R, Ali A, Buksh AR, Quddusi A, Khan UR. Tip-over injuries among children: Data from an urban emergency department of Karachi, Pakistan. Injury 2023; 54 Suppl 4:110526. [PMID: 36481052 DOI: 10.1016/j.injury.2022.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Most unintentional injuries among children occur in the home environment. Tip-overs, defined as incidents where heavy objects fall on children due to some type of interaction, are one of the reasons for injuries inside the home. This study aims to determine injury patterns and outcomes for child injuries resulting from tip-overs in the home environment as reported in the emergency department. METHODS We performed a retrospective chart review of pediatric (under 18 years) tip-overs injuries occurred in years 2010 to 2015 at the Aga Khan University Hospital. Furthermore, parents of injured children participated in phone interviews to provide information about the injury scene. File review and telephonic interviews were conducted in the year 2015 and 2016. RESULTS A total of 75 children visited the emergency department with tip-over injuries, out of which 55 (73%) were boys. The majority of incidents (75.5%) happened inside the home, and the most common places were the living room and bedroom (32% and 21% respectively). More than half (53%) of the children were not under adult supervision at the time of the incident and less than half (47%) of the household took safety measures after the incident. Tip-over injuries were common among 3-year-old children with decreasing frequency as children grew older. The most common causes of tip-overs were TV/TV trolley (32%), followed by furniture (28%), and wall and roof (23%). The most common sites of injuries were head (n = 33, 44%) and extremities (n = 33, 44%). A majority of the cases (n = 66, 88%) were admitted to the hospital from the emergency department, under care of both general (n = 51, 68%) and critical care units (n = 15, 20%). More than a quarter (n = 27, 36%) required at least one surgical procedure during their hospital stay. The median length of hospital stay was one days (interquartile range, IQR 1-5 days). There were two cases of mortality (3%). CONCLUSION Most tip-over injuries among children were caused by TV, furniture, and TV trolleys. These injuries can be prevented with public education around home safety measures, such as mounting them on the wall.
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Affiliation(s)
- Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Asrar Ali
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Raheem Buksh
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.
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Salahuddin SM, Ayaz O, Jaffer M, Naeem R, Tikmani SS, Mian AI. Pediatric Appendicitis Score for Identifying Acute Appendicitis in Children Presenting With Acute Abdominal Pain to the Emergency Department. Indian Pediatr 2022; 59:774-777. [PMID: 35959758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of Pediatric Appendicitis Score (PAS) in predicting appendicitis in children presenting with acute abdominal pain to the Emergency Department (ED) of a private hospital in Pakistan. METHODS This validation study was through retrospective chart review of children between 4-18 years of age with clinical suspicion of acute appendicitis, presenting to the pediatric ED. Diagnostic accuracy was determined using sensitivity, specificity, predictive values, and area under the curve (AUC). RESULTS 104 children (76% boys) with mean (SD) age of 10.9 (3.5) years met the eligibility criteria. 91% (n=95) patients had moderate to high PAS (score ³4), and 95% (n=99) had biopsy-proven appendicitis. The likelihood ratio calculated for low, equivocal and high-risk PAS was 0.10, 2.17 and 2.53, respectively. An equivocal PAS (score 4-6) showed a sensitivity of 96.8%, specificity of 80%, positive predictive value of 98.9% and AUC of 0.84 for predicting acute appendicitis. CONCLUSION PAS showed good diagnostic accuracy in predicting acute appendicitis in children presenting to the ED.
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Affiliation(s)
- Syed Maaz Salahuddin
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan. Correspondence to: Dr Syed Maaz Salahuddin, Instructor, Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Omair Ayaz
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Mehtab Jaffer
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Asad I Mian
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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Ahmed F, Khan UR, Soomar SM, Raheem A, Naeem R, Naveed A, Razzak JA, Khan NU. Acceptability of telephone-cardiopulmonary resuscitation (T-CPR) practice in a resource-limited country- a cross-sectional study. BMC Emerg Med 2022; 22:139. [PMID: 35918647 PMCID: PMC9347158 DOI: 10.1186/s12873-022-00690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND T-CPR has been shown to increase bystander CPR rates dramatically and is associated with improved patient survival. OBJECTIVE To evaluate the acceptability of T-CPR by the bystanders and identify baseline quality measures of T-CPR in Karachi, Pakistan. METHODS A cross-sectional study was conducted from January to December 2018 at the Aman foundation command and control center. Data was collected from audiotaped phone calls of patients who required assistance from the Aman ambulance and on whom the EMS telecommunicator recognized the need for CPR and provided instructions. Information was recorded using a structured questionnaire on demographics, the status of the patient, and different time variables involved in CPR performance. A One-way ANOVA was used to compare different time variables with recommended AHA guidelines. P-value ≤ 0.05 was considered significant. RESULTS There were 481 audiotaped calls in which CPR instruction was given, listened to, and recorded data. Out of which in 459(95.4%) of cases CPR was attempted Majority of the patients were males (n = 278; 57.8%) and most had witnessed cardiac arrest (n = 470; 97.7%) at home (n = 430; 89.3%). The mean time to recognize the need for CPR by an EMS telecommunicator was 4:59 ± 1:59(min), while the mean time to start CPR instruction by a bystander was 5:28 ± 2:24(min). The mean time to start chest compression was 6:04 ± 1:52(min.). CONCLUSION Our results show the high acceptability of T-CPR by bystanders. We also found considerable delays in recognizing cardiac arrest and initiation of CPR by telecommunicators. Further training of telecommunicators could reduce these delays.
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Affiliation(s)
- Fareed Ahmed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Abid Naveed
- Sindh Rescue & Medical Services, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.,Emergency Medicine, Weill Cornell Medicine, New York City, USA
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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Mansoor MA, Hamzah K, Naeem R, Zubir MNBM, Yahaya NA, Yusof FB, Rozali SB, Aspanut ZB, Ming HN. A Tri-Metallic (Mn–Co–Ti) Oxide Photoanode with Improved Photo-Conversion Efficiency. RUSS J INORG CHEM+ 2021. [DOI: 10.1134/s0036023621060139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Waheed S, Kapadia NN, Khan MF, Kerai SM, Raheem A, Naeem R. Randomised controlled trial to assess the effectiveness of apnoeic oxygenation in adults using low-flow or high-flow nasal cannula with head side elevation versus usual care to prevent desaturation during endotracheal intubation in the emergency department (ApOxED): study protocol. BMJ Open 2020; 10:e037964. [PMID: 33199418 PMCID: PMC7670939 DOI: 10.1136/bmjopen-2020-037964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Apnoeic oxygenation is a process of delivering continuous oxygen through nasal cannula during direct laryngoscopy. The oxygen that is delivered through these nasal cannulas is either low flow or high flow. Although the effectiveness of apnoeic oxygenation has been shown through systematic reviews and randomised controlled trials, a comparison of high-flow versus low-flow oxygen delivery has not been tested through a superiority study design. In this study we propose to assess the effectiveness of giving low-flow oxygen with head side elevation versus high-flow oxygen with head side elevation against the usual practice of care in which no oxygen is provided during direct laryngoscopy. METHODS AND ANALYSIS This will be a three-arm study instituting a block randomisation technique with a sample size of 46 in each arm (see table 1). Due to the nature of the intervention, no blinding will be introduced. The primary outcomes will be lowest non-invasive oxygen saturation measurement during direct laryngoscopy and during the 2 min after the placement of the tube and the first pass success rate. The intervention constitutes head side elevation up to 30° for improving glottis visualisation together with low-flow or high-flow oxygen delivery through nasal cannula to increase safe apnoea time for participants undergoing endotracheal intubation. Primary analysis will be intention to treat. ETHICS AND DISSEMINATION The study is approved by the Ethical Review Committee of Aga Khan University Hospital (2019-0726-2463). The project is an institution University Research Committee grant recipient 192 002ER-PK. The results of the study will be disseminated among participants, patient communities and healthcare professionals in the institution through seminars, presentations and emails. Further, the findings will be published in a highly accessed peer-reviewed medical journal and will be presented at both national and international conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04242537).
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Affiliation(s)
- Shahan Waheed
- Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | | | | | - Ahmed Raheem
- Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Rubaba Naeem
- Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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Ahmed A, Afshan G, Irshad Khan R, Afzal B, Jamali S, Farooq N, Saleem S, Naeem R, Khan U. Managing acute pain in HIV+/AIDS patients: knowledge and practice trends among emergency physicians of major tertiary care centers of a developing country. BMC Res Notes 2020; 13:255. [PMID: 32456673 PMCID: PMC7249315 DOI: 10.1186/s13104-020-05095-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess knowledge and practice trends in managing acute pain in patients infected with human immunodeficiency virus (HIV+) or having acquired immunodeficiency syndrome (AIDS) among emergency physicians of four tertiary care hospitals. Acute pain management in such patients is complex because of multiple concomitant painful conditions related to their disease. After obtaining ethical approval and written informed consent, emergency physicians were requested to fill out a questionnaire. RESULTS Out of 84 physicians who participated, 49 had managed HIV+/AIDS patients during the preceding year. Out of the 49, 30 (61.2%) physicians stated that they used a combination of analgesics for acute pain in these patients. Forty-two (50%) out of the 84 participants believed that routine doses of opioids were adequate for pain relief, while 42 (50%) agreed that pain management was more complex in these patients mainly due to presence of multiple coexisting problems and psychological issues. Only 26 (31%) respondents considered that pain was under-reported and under-treated in these patients, mainly because physicians were more focused on patients' other disease related complications and issues. Formulation of guidelines are recommended for effective acute pain management in these patients encompassing associated issues, including concomitant painful conditions, opioid dependence, psychiatric problems, etc.
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Affiliation(s)
- Aliya Ahmed
- Department of Anaesthesiology, 2nd-Floor Private Wing, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Gauhar Afshan
- Department of Anaesthesiology, 2nd-Floor Private Wing, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Robyna Irshad Khan
- Department of Anaesthesiology, 2nd-Floor Private Wing, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Badar Afzal
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Seemin Jamali
- Accident and Emergency Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Nighat Farooq
- Accident and Emergency Department, Civil Hospital Karachi, Karachi, Pakistan
| | - Sarosh Saleem
- Paediatrics Department, Indus Hospital, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Uzma Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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Maul KM, Naeem R, Rahim Khan U, Mian AI, Yousafzai AK, Brown N. Child abuse in Pakistan: A qualitative study of knowledge, attitudes and practice amongst health professionals. Child Abuse Negl 2019; 88:51-57. [PMID: 30447502 DOI: 10.1016/j.chiabu.2018.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/13/2018] [Accepted: 10/14/2018] [Indexed: 06/09/2023]
Abstract
Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects can be profound and life altering for victims. There is substantial literature from high income countries about signs of abuse, but a dearth of data from low and middle income countries like Pakistan. Healthcare professionals (HCP) are ideally placed to detect abuse, but, to inform interventions, an understanding of their experiences, training needs and cultural beliefs is needed. This study aimed to: (1) Explore the challenges that HCP face when managing cases of abuse; (2) Explore cultural beliefs and understand how these shape practice and (3) Identify training needs. A qualitative study using a phenomenological design was conducted. In-depth interviews were conducted with doctors, nurses and security staff in the emergency department of a large private hospital in Pakistan (n = 15). Interviews were undertaken in Urdu, translated into English and analysed using an inductive thematic approach. Multiple challenges were identified. The process of referral to legal services was poorly understood and further training and guidelines was suggested by participants. As the legal system in Pakistan does not allow HCP to keep potentially abused patients in their custody, they felt restricted in their ability to advocate and concerned about the safety of both the identified children and themselves. HCP have potential to detect abuse early; however, in Pakistan there are numerous challenges. HCP require support through training, as well as clear institutional frameworks and legal support to undertake this role.
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Affiliation(s)
- Kayleigh M Maul
- Whiston Hospital, Warrington Road, Prescot, Liverpool, L35 5DR, UK.
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, P O Box 3500, Stadium Road, Karachi, Pakistan.
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, P O Box 3500, Stadium Road, Karachi, Pakistan.
| | - Asad I Mian
- Department of Emergency Medicine, Critical Creative Innovative Thinking (CCIT), Aga Khan University Hospital, Karachi, Pakistan.
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA.
| | - Nick Brown
- International Centre for Maternal and Child Health, Akademiska Sjukhuset, University of Uppsala, MTC-huset, Dag Hammarskjölds väg 14B, 752 37, Uppsala, Sweden; Department of Paediatrics, Länssjukhuset Gävle-Sandviken, 801 87, Gävle, Sweden; Department of Child Health, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.
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Nayani K, Naeem R, Munir O, Naseer N, Feroze A, Brown N, Mian AI. The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department. BMC Pediatr 2018; 18:339. [PMID: 30376827 PMCID: PMC6208017 DOI: 10.1186/s12887-018-1317-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/22/2018] [Indexed: 01/03/2023] Open
Abstract
Background Respiratory distress is a common presenting complaint in children brought to the Emergency Department (ED). The Clinical Respiratory Score (CRS) has shown promise as a screen for severe illness in High Income Countries. We aimed to validate the admission CRS in children presenting to the ED of a Low-to Middle Income Country. Methods Children (1 month to 16 years) presenting with respiratory distress to the ED of the Aga Khan University Hospital, Karachi, Pakistan, between November 2015 to March 2016, were enrolled. The CRS was measured at initial presentation, prior to any management and 2 h after treatment was started. The predictive value for admission to the paediatric critical care units for a variety of cut offs for CRS at presentation were derived. Results A total of 112 children (70% male) of median age 12 months (IQR 2, 34.5 months) were enrolled. Patients with severe CRS (score 8–12) at presentation were more likely to be admitted to paediatric critical care (90% vs. 23% with mild-moderate CRS; OR: 5.7; 95% CI: 2.2–15.3, p < 0.001). The sensitivity and specificity of CRS > 3 in predicting outcome were 94% (95% CI 79.8–99.3) and 40% (95% CI 35–45), respectively, with a positive likelihood ratio of 1.6 (95% CI 1.31–1.98) and negative predictive value of 94% (95% CI 81–98). Conclusion An admission CRS of > 3 in the ED of a Low-to Middle Income Country had excellent predictive value for disease severity, and it should be considered for incorporation into ED triage protocols.
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Affiliation(s)
- Kanwal Nayani
- Department of Paediatrics and Child Health, AKU, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Owais Munir
- Department of Emergency Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Naureen Naseer
- Department of Emergency Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Asher Feroze
- Department of Emergency Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Nick Brown
- Department of Paediatrics and Child Health, AKU, Karachi, Pakistan.,International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Paediatrics, Länssjukhuset Gävle-Sandviken, 801 87, Gävle, Sweden
| | - Asad I Mian
- Department of Emergency Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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Ismail S, Awan S, Naeem R, Siddiqui S, Afzal B, Jamil B, Khan UR. Occupational exposure to HIV in a developing country: assessing knowledge and attitude of healthcare professional before and after an awareness symposium. BMC Res Notes 2018; 11:131. [PMID: 29448948 PMCID: PMC5815206 DOI: 10.1186/s13104-018-3231-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Health care providers (HCPs) are at risk of occupational exposure to HIV infection. In developing world these exposure occur due to general lack of awareness, education and structured training of HCPs. The objective of the study was to asses if continuing medical education symposium can be used as an effective educational tool to improve attitude, awareness and knowledge regarding occupational exposure to HIV infection. This quasi-experimental study was conducted among HCPs from Karachi, Pakistan. After assessing the baseline knowledge, awareness, and attitude by means of pretest; HCPs were reassessed with posttest after an education symposium on occupational exposure to HIV infection. RESULTS Among 364 participating HCPs, 14.2% had previous training on post exposure prophylaxis. There was an overall statistically significant (P value < 0.001) improvement in the attitude of the participants. A statistically positive improvement in the number of participants giving correct answer was observed in 9 out of 11 questions (P value < 0.001). The mean score of participants' knowledge before intervention was 6.44 ± 1.84, which improved to 8.82 ± 2.17. Along with the increase in knowledge, a positive change in the attitude regarding safety against HIV was observed after the education symposium.
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Affiliation(s)
- Samina Ismail
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Safia Awan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Sarfraz Siddiqui
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Badar Afzal
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Bushra Jamil
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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Ahmad H, Naeem R, Feroze A, Zia N, Shakoor A, Khan UR, Mian AI. Teaching children road safety through storybooks: an approach to child health literacy in Pakistan. BMC Pediatr 2018; 18:31. [PMID: 29415675 PMCID: PMC5804052 DOI: 10.1186/s12887-018-0982-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/04/2018] [Indexed: 12/04/2022] Open
Abstract
Background Road traffic injuries (RTIs) commonly affect the younger population in low- and-middle-income countries. School children may be educated about road safety using storybooks with colorful pictures, which tends to increase the child’s interest in the text. Therefore, this study assessed the use of bilingual pictorial storybooks to improve RTI prevention knowledge among school children. Methods This pretest-posttest study was conducted in eight public and nine private schools of Karachi, Pakistan, between February to May 2015. Children in grades four and five were enrolled at baseline (n = 410). The intervention was an interactive discussion about RTI prevention using a bilingual (Urdu and English) pictorial storybook. A baseline test was conducted to assess children’s pre-existing knowledge about RTI prevention followed by administration of the intervention. Two posttests were conducted: first immediately after the intervention, and second after 2 months. Test scores were analyzed using McNemar test and paired sample t-test. Results There were 57% girls and 55% public school students; age range 8–16 years. Compared to the overall baseline score (5.1 ± 1.4), the number of correct answers increased in both subsequent tests (5.9 ± 1.2 and 6.1 ± 1.1 respectively, p-value < 0.001). Statistically significant improvement in mean scores was observed based on gender, grades and school type over time (p-value < 0.001). Conclusion Discussions using bilingual pictorial storybooks helped primary school children in Pakistan grasp knowledge of RTI prevention. RTI education sessions may be incorporated into school curricula using storybooks as teaching tools. Potential exists to create similar models for other developing countries by translating the storybooks into local languages. Electronic supplementary material The online version of this article (10.1186/s12887-018-0982-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haris Ahmad
- Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Nukhba Zia
- Aga Khan University Hospital, Karachi, Pakistan
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Siddiqui E, Afzal B, Kazi G, Feroz A, Naeem R, Mansoor T, Allana A, Siddiqui S, Siddiqui Z. Factors behind not using child restrain(t) among hospital employees and general population: A case control study. World J Emerg Med 2017; 8:269-275. [PMID: 29123604 PMCID: PMC5675967 DOI: 10.5847/wjem.j.1920-8642.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/15/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Motor vehicle crash (MVC) related injury has been identified as a major public health concern. Child restrain (CR) seat belts can minimize the mortality and morbidity from MVC. The use for seat belts is substantially low in developing countries like Pakistan even though its use has been shown to decrease morbidity and mortality by a significant extent. METHODS This was a case control study with cases from the general population (GP) and controls from the Aga Khan University (AKU) employees in a 3:1 ratio. The study questionnaire was based on parameters like gender, education level, awareness and presence of CR and also assessed the frequency of usage, reasons for not using CR and the source of knowledge regarding CR use. RESULTS Out of 848 respondents, 212 were from AKU and 636 were from the GP. 96.7% from AKU had at least a bachelor's degree while less than half (42.6%) of those from the GP were graduate or above (P<0.001). A statistically significant difference was found between the two groups with drivers from AKU being generally more aware about CR and its use. 81.1% of the group from AKU compared to 59.7% from the general population were found to be aware of child restraint use (P<0.001). Media (40.6%) was found to be the most common source of information amongst the AKU employees. CONCLUSION Most motor vehicle related injuries in children can be prevented or their severity may be reduced by the use of appropriate child restraint seat belts.
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Affiliation(s)
- Emad Siddiqui
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Badar Afzal
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ghazala Kazi
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Asher Feroz
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Tarab Mansoor
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahreen Allana
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Saif Siddiqui
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Zain Siddiqui
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
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13
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Jordan RW, Naeem R, Jadoon S, Srinivas K, Shyamalan G. The value of manipulation of displaced distal radius fractures in the emergency department. Acta Orthop Belg 2016; 82:203-209. [PMID: 27682281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to report the success of maintaining reduced distal radius fractures with cast immobilisation and analyse risk factors for redisplacement. A retrospective analysis of distal radius fracture manipulated between April 2011 and 2013 was conducted. Age, gender, fracture classification, ulna fracture, dorsal comminution and volar alignment were recorded. Reduction and redisplacement were measured using Sarmiento's modification of Lidstrom's system. 110 patients were included ; mean age 62.8 years and 83.4% female. The AO classification was used to grade initial fractures A2 (44%), A3 (25%), C1 (20%) and C2 (10%). 86.4% of cases were improved following manipulation, although 48.4% redisplaced and 27.4% required surgical intervention. The radial length (60%) was harder to maintain than dorsal alignment (44%) in cases of redisplacement. Successful alignment of the volar cortices was associated with a statistically significant reduction in redisplacement (p = 0.024). Manipulation of distal -radius fractures is initially beneficial but half of cases redisplace.
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14
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Khan IQ, Khan NU, Naeem R, Kerai S, Allen K, Zia N, Shahbaz S, Afridi SQ, Siddiqui E, Khan UR, Hyder AA, Razzak JA. Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data. BMC Emerg Med 2015; 15 Suppl 2:S7. [PMID: 26692453 PMCID: PMC4682416 DOI: 10.1186/1471-227x-15-s2-s7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. METHODS Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. RESULTS A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. CONCLUSION Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging.
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Affiliation(s)
- Irum Qamar Khan
- Department of Emergency Medicine, Aga Khan Hospital, Karachi, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan Hospital, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan Hospital, Karachi, Pakistan
| | - Salima Kerai
- Department of Emergency Medicine, Aga Khan Hospital, Karachi, Pakistan
| | - Kate Allen
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nukhba Zia
- Department of Emergency Medicine, Aga Khan Hospital, Karachi, Pakistan
| | - Sana Shahbaz
- Department of Emergency Medicine, Aga Khan Hospital, Karachi, Pakistan
| | | | | | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan Hospital, Karachi, Pakistan
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Junaid A Razzak
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The author was affiliated with the Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan at the time when study was conducted
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15
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Jordan RW, Naeem R, Srinivas K, Shyamalan G. A comparison of magnetic resonance arthrography and arthroscopic findings in the assessment of anterior shoulder dislocations. Skeletal Radiol 2015; 44:653-7. [PMID: 25532474 DOI: 10.1007/s00256-014-2080-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study is to establish the sensitivity and specificity of MRA in the investigation of patients with traumatic anterior shoulder dislocations. MATERIALS AND METHODS A retrospective analysis of consecutive patients undergoing both magnetic resonance arthrography and arthroscopic assessment after a traumatic anterior shoulder dislocation between January 2011 and 2014 was performed. Demographic data were collected from electronic records. Images were interpreted by 8 musculoskeletal radiologists and patients were treated by 8 consultant orthopaedic surgeons. Arthroscopic findings were obtained from surgical notes and these findings were used as a reference for MRA. The sensitivity, specificity, and positive predictive value were calculated for the different injuries. RESULTS Sixty-nine patients underwent both an MRA and shoulder arthroscopy during the study period; however, clinical notes were unavailable in 9 patients. Fifty-three patients (88 %) were male, the mean age was 28 years (range 18 to 50) and 16 subjects (27 %) had suffered a primary dislocation. The overall sensitivity and specificity of MRA to all associated injuries was 0.9 (CI 0.83-0.95) and 0.94 (CI 0.9-0.96) retrospectively. The lowest sensitivity was seen in osseous Bankart 0.8 (CI 0.44-0.96) and superior labral tear (SLAP) lesions 0.5 (CI 0.14-0.86). The overall positive predictive value was 0.88 (CI 0.76-0.91) with the lowest values found in rotator cuff 0.4 (CI 0.07-0.83) and glenohumeral ligament (GHL) lesions 0.29 (CI 0.05-0.7). CONCLUSION Magnetic resonance angiography has a high sensitivity when used to identify associated injuries in shoulder dislocation, although in 8 patients (13 %) arthroscopy identified an additional injury. The overall agreement between MRA and arthroscopic findings was good, but the identification of GHL and rotator cuff injuries was poor.
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Affiliation(s)
- R W Jordan
- Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK,
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16
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Affiliation(s)
- R. Naeem
- Department of Plastic Surgery, Sandwell Hospital, West Bromwich, West Midlands, UK
| | - A. Soueid
- Department of Plastic Surgery, Sandwell Hospital, West Bromwich, West Midlands, UK
| | - A. Lahiri
- Department of Plastic Surgery, Sandwell Hospital, West Bromwich, West Midlands, UK
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17
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Vejabhuti C, Dishop M, Hicks J, Naeem R, Reed J, Lopez-Terrada D. Clear Cell Sarcoma of Soft Tissue with Cytogenetic and Molecular Analyses. J Cutan Pathol 2008. [DOI: 10.1111/j.0303-6987.2006.0511k.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Bhargava R, Naeem R, Marconi S, Luszcz J, Garb J, Gasparini R, Otis CN. Tyrosine kinase activation in breast carcinoma with correlation to HER-2/neu gene amplification and receptor overexpression. Hum Pathol 2001; 32:1344-50. [PMID: 11774167 DOI: 10.1053/hupa.2001.29668] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The HER-2/neu oncogene encodes a transmembrane receptor with intrinsic tyrosine kinase activity. A pilot study was performed to investigate downstream effects of HER-2/neu (or related growth factor receptor) activation by identifying phosphorylated tyrosine. Fifty-four breast carcinomas were evaluated for HER-2/neu overexpression by the HercepTest (Dako, Carpinteria, CA) and the monoclonal CB11 antibody (Ventana, Tucson, AZ). Phosphotyrosine (an indication of tyrosine kinase activity) was detected by an antiphosphotyrosine mouse monoclonal antibody (Upstate Biotechnology, Lake Placid, NY). The gene amplification status was evaluated in 50 of the 54 cases by fluorescence in situ hybridization (FISH) using the Ventana gene probe. The HER-2/neu oncogene amplification was detected in 28% (14 of 50) of cases. Of the 14 cases showing oncogene amplification, tyrosine kinase activity was detected in 9 (64.2%) cases. There was moderate agreement between HER-2/neu gene amplification and tyrosine kinase activity (kappa = 0.43). Immunohistochemical staining of 3+ (with both HercepTest and CB11) showed better agreement with HER-2/neu oncogene amplification and increased tyrosine kinase activity than 2+ immunohistochemical staining. Overall, oncogene amplification and overexpression correlated with increased tyrosine kinase activity, supporting the mechanism of tyrosine kinase activation by HER-2/neu amplification and overexpression. However, 7 cases showing increased tyrosine kinase activity did not show gene amplification or 3+ receptor expression (by either HercepTest or CB11), raising the possibility of other growth factor receptors operating via the tyrosine kinase pathway. There was no apparent correlation between tyrosine kinase activity and hormone receptor status (estrogen or progesterone). Increased tyrosine kinase activity is more commonly associated with higher-grade tumors and thus may correlate with aggressive biologic behavior in breast carcinoma. The results of this pilot study suggest that a larger-scale investigation into downstream activation of tyrosine kinase and correlation to clinical outcome or response to Herceptin therapy may identify subsets of patients whose clinical response or outcome may be predicted by tyrosine kinase activation.
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Affiliation(s)
- R Bhargava
- Department of Pathology, Baystate Medical Center, Springfield, MA 01199, USA
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19
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Yusuf RZ, Naeem R. Cytogenetic studies of spontaneous miscarriages: a seven year study to compare significance of primary vs. secondary culture methods for assessment of fetal karyotype yield and maternal cell contamination. Early Pregnancy (Cherry Hill) 2001; 5:121-31. [PMID: 11753525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Primary in-situ culture (PIC) and secondary trypsinized culture (STC) are the two currently used methods for culturing chorionic villi in order to cytogenetically evaluate products of conception (POC) from spontaneous miscarriages. We compare these culture techniques in our laboratory over a period of seven years to evaluate fetal karyotype yield and maternal cell contamination. Data from a total of 2077 cases from 1992-1999 was entered into a data entry program created in Epi Info version 6. Analysis, using the chi square test of significance, was performed in the same program. Our data demonstrated a statistically significant excess of normal female karyotype detected by the STC method and a statistically significant excess of abnormal karyotypes detected by the PIC method. We attribute these findings to the greater risk of maternal cell contamination with the STC method. We conclude that the PIC method is more accurate in detecting the fetal karyotype and the STC method has a higher risk of maternal cell contamination. We suggest that the PIC method should be adopted as the method of choice when evaluating POC by culturing chorionic villi.
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Affiliation(s)
- R Z Yusuf
- Baystate Medical Center, Tufts University School of Medicine, Department of Pathology, 759 Chestnut Street, Springfield, MA 01119, USA
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20
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Abstract
We describe a newborn boy one of triplets, whose karyotype was 46,XY, t(8;12)(q22;q21). Prenatal diagnosis of multiple craniofacial anomalies had been made. Following delivery, the patient was thought to exhibit findings consistent with a diagnosis of frontofacionasal dysostosis. We hypothesize that one of the break points of this translocation may involve a gene essential to craniofacial development.
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Affiliation(s)
- J Habecker-Green
- Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts 01199, USA
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21
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Habecker-Green JG, Naeem R, Gold H, O'Grady JP, Kanaan C, Bayer-Zwirello L, Murray MS, Cohn GM. Prenatal diagnosis and clinical features of an individual with tetrasomy 18p and trisomy 18q mosaicism. J Perinatol 1998; 18:395-8. [PMID: 9766419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Prenatal diagnosis and clinical follow up of a patient with mosaicism for anomalies of chromosome 18 are reported. The fetus appeared on ultrasound to have multiple anomalies, including clubbed feet, abnormal hand positioning, edema of the scalp, cleft palate, and polyhydramnios. The karyotype on amniocytes was 47,XY,+i(18p). Postnatally, the peripheral blood karyotype was 46,XY,+i(18q), whereas the skin fibroblast karyotype was 47,XY,+i(18p). The infant had many features consistent with those previously described in cases of tetrasomy 18p and some that were consistent with trisomy 18q.
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Affiliation(s)
- J G Habecker-Green
- Department of OB/GYN, Baystate Medical Center, Springfield, MA 01199, USA
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22
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Habecker-Green J, Naeem R, Goh W, Pflueger S, Murray M, Cohn G. Reproduction in a patient with trisomy 8 mosaicism: case report and literature review. Am J Med Genet 1998; 75:382-5. [PMID: 9482643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We describe a patient with trisomy 8 mosaicism followed through a sixth pregnancy and discuss issues in phenotypic and genotypic variability, the risk for neoplasia, and reproductive risks.
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Affiliation(s)
- J Habecker-Green
- Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts 01109, USA
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Marini T, Pflueger S, Jackson A, Naber S, Karpells S, Naeem R. A five-year experience with fragile X testing. Setting laboratory standards of practice and a cost-effective protocol. Diagn Mol Pathol 1997; 6:161-6. [PMID: 9276188 DOI: 10.1097/00019606-199706000-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
During the years 1990-1994, our center tested 652 patients, with a broad range of referral indications, for fragile X syndrome using either cytogenetic analysis alone (Protocol 1) or more recently, a combination of DNA analysis and routine karyotyping (protocol 2). The overall positive rate for fragile X was 3.1% with an incidence of other chromosomal abnormalities (OCAs) of 3.2%. Breakdown of cases using each testing protocol along with percent positives is: [table: see text] Use of Protocol 2 yielded only definitive fragile X results, while more than half of the "positives" using Protocol 1 were equivocal. Historically this has been problematic for both the laboratory and physician since interpretation is often dependent on an equally equivocal clinical picture. Protocol 2 eliminates these diagnostic dilemmas without compromising detection of other chromosomal abnormalities, the incidence of which appears to be unaffected by testing method used. The overall incidence of OCA of 3.2% underscores the value of routine karyotyping in this referral group and likely reflects the phenotypic variability of fragile X and its clinical overlap with other chromosomal abnormalities. We believe that a fragile X testing protocol combining routine karyotyping with definitive molecular technology represents the most cost-effective diagnostic approach to this clinically challenging patient population.
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Affiliation(s)
- T Marini
- Baystate Medical Center, Springfield, MA 01199, USA
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24
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Naeem R, Lux ML, Huang SF, Naber SP, Corson JM, Fletcher JA. Ring chromosomes in dermatofibrosarcoma protuberans are composed of interspersed sequences from chromosomes 17 and 22. Am J Pathol 1995; 147:1553-8. [PMID: 7495279 PMCID: PMC1869963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ring chromosomes are found in most dermatofibrosarcoma protuberans (DFSPs), and recent reports demonstrate that portions of the DFSP ring chromosomes derive from chromosome 17. In this study we characterized ring chromosomes in three DFSPs using a combined approach of karyotyping, chromosome painting, and comparative genomic hybridization. Chromosome painting demonstrated that the ring chromosomes in each DFSP were composed of discontinuous, interwoven sequences from chromosomes 17 and 22. Amplification of chromosomes 17 and 22 sequences was confirmed in each of these cases by comparative genomic hybridization, and over-representation of chromosomes 17 and 22 sequences was also demonstrated by comparative genomic hybridization in 1 of 2 cytogenetically unremarkable DFSPs. We conclude that amplification of chromosomes 17 and 22 sequences, in ring form, is a characteristic aberration in DFSP.
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Affiliation(s)
- R Naeem
- Department of Pathology, Baystate Medical Center, Springfield, Massachusetts, USA
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25
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Naeem R, Singer S, Fletcher JA. Translocation t(8;13)(p11;q11-12) in stem cell leukemia/lymphoma of T-cell and myeloid lineages. Genes Chromosomes Cancer 1995; 12:148-51. [PMID: 7535088 DOI: 10.1002/gcc.2870120210] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
An unusual hematologic neoplasia has been described recently in which the predominant clinical features include T-cell lymphoma, myeloid hyperplasia, and eosinophilia. The multilineage involvement in this disorder suggests transformation of a primitive stem cell. Abnormal karyotypes have been described in three such cases, including one case with t(8;13)(p11.2;q12) and a second case with t(8;13)(p23;q14). We report translocation of chromosomes 8 and 13 in lymph node karyotypes from two patients with this syndrome. Fluorescence in situ hybridization confirmed an identical translocation, t(8;13)(p11;q11-12), in lymphoma cells from each patient. The translocation breakpoints are of particular interest because the FLT3 receptor tyrosine kinase gene has been mapped 13q12. FLT3 is expressed highly in hematopoietic progenitor cells and in myeloid and lymphoid acute leukemias.
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Affiliation(s)
- R Naeem
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115
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26
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Abstract
Cytogenetic analyses of short-term cultures revealed clonal chromosome aberrations in 6 of 13 desmoid tumors. These aberrations included two consistent events, trisomy 8 (n = 4) and trisomy 20 (n = 3), which have not been reported previously in desmoid tumors. Because trisomy 8 was found in two recurrent desmoid tumors, we used fluorescent in situ hybridization (FISH) methodology to evaluate chromosome 8 in 25 paraffin-embedded and frozen desmoid specimens. The FISH studies demonstrated that both patients with cytogenetic trisomy 8 at the time of recurrence also had had trisomy 8 in primary tumors 4 years earlier. The proportion of trisomy 8 cells in these cases did not change substantially between original diagnosis and recurrence. The FISH studies also revealed trisomy 8 in one recurrent desmoid tumor which had been cytogenetically unremarkable and revealed trisomy 8 in one recurrent desmoid that had not been karyotyped. Four of six patients with trisomy 8 had been followed for more than 1 year, and the desmoid tumors in each of these 4 patients recurred. By contrast, recurrence was noted in only 2 of 17 patients whose desmoid tumors lacked trisomy 8. Our findings demonstrate that trisomy 8 and trisomy 20 are nonrandom aberrations in desmoid tumors. Trisomy 8 appears to be associated with an increased risk of recurrence.
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Affiliation(s)
- J A Fletcher
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115
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27
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Naeem R, Donovan K, Corson JM, Fletcher JA. Fluorescent in situ hybridization assessment of chromosome 7 copy number in uncultured lung and kidney cells. Cancer Genet Cytogenet 1993; 66:100-2. [PMID: 8500094 DOI: 10.1016/0165-4608(93)90235-e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Trisomy 7 is common in cells cultured from nonneoplastic lung and kidney tissues, but the frequency of trisomy 7 in uncultured lung and kidney has not been determined. In this study, we used fluorescent in situ hybridization (FISH) to assess chromosome 7 copy number in uncultured interphase nuclei from lung and kidney specimens. All specimens had low level mosaicism for trisomy 7(1.5-5.25%), but control experiments indicated a potential wide margin of error in quantifying these events.
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Affiliation(s)
- R Naeem
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115
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28
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Fletcher JA, Pinkus GS, Donovan K, Naeem R, Sugarbaker DJ, Mentzer S, Pinkus JL, Longtine J. Clonal rearrangement of chromosome band 6p21 in the mesenchymal component of pulmonary chondroid hamartoma. Cancer Res 1992; 52:6224-8. [PMID: 1423265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pulmonary chondroid hamartomas (PCH) are biphasic benign tumors that contain both mesenchymal and epithelial populations. In this report we describe two PCH in which clonal translocations at chromosome band 6p21 were demonstrated in mesenchymal cells. One of these had a unique translocation, t(6;14)(p21;q24), that was also found in one of two PCH karyotyped previously. The t(6;14) has not been described in other varieties of benign or malignant neoplasia. The 6p21 aberrations are of particular interest because break points in this chromosomal region appear to be characteristic of endometrial polyps. Endometrial polyps, like PCH, are biphasic benign tumors in which mesenchymal clonality has been demonstrated.
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MESH Headings
- Adult
- Aged
- Chromosome Aberrations/physiology
- Chromosomes, Human, Pair 11/physiology
- Chromosomes, Human, Pair 12/physiology
- Chromosomes, Human, Pair 14/physiology
- Chromosomes, Human, Pair 18/physiology
- Chromosomes, Human, Pair 6/physiology
- Female
- Gene Rearrangement/genetics
- Hamartoma/genetics
- Humans
- Immunohistochemistry
- Karyotyping
- Lung Neoplasms/genetics
- Male
- Mesoderm/pathology
- Mesoderm/physiology
- Translocation, Genetic/genetics
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Affiliation(s)
- J A Fletcher
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115
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