Nadeem Aslam

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Berry syndrome: One stage surgical repair in a neonate

International Journal of Case Reports and Images

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, mont... more International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.

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Combatting with challenges in medical education during COVID-19 pandemic: A mixed-methods study on the effectiveness of e-learning in pediatric clinical clerkship of a university hospital, Pakistan

E-Learning and Digital Media

The purpose of this research is to ascertain the effectiveness of using the e-learning method for... more The purpose of this research is to ascertain the effectiveness of using the e-learning method for a module in pediatric clerkship at the [redacted name] University Hospital, Karachi. The fourth-year undergraduate medical students, who rotates for eight weeks in Pediatric clerkship, participated in this study. It was a sequential (Quantitative-Qualitative) mixed-method study, which was conducted from May-August 2020. Students were divided according to their status of in-person rotation (Novice, Semi-expert, Expert). The quantitative component of the study consisted of pre and post-tests and pre-validated post-session feedback., while focused-group discussions were done to explore students’ experiences. SPSS version 20.0 was used for quantitative data while qualitative data underwent content analysis. Fifty-nine participants (68.8%) were female. The intervention batch comprised of 102 students (41 Novice (40.2%), 21 Semi-expert (19.6%), and 40 Expert (39.2%)). Using paired t-test anal...

683: Multisystem Inflammatory Syndrome in Pakistani Children: A Description of the Phenotypes

Critical Care Medicine, 2021

Cardiovascular Dysfunction in Children Exposed to Preeclampsia During Fetal Life

Journal of the American Society of Echocardiography, 2021

OBJECTIVE Keeping in view the Developmental Origin of Health and Disease hypothesis, this study a... more OBJECTIVE Keeping in view the Developmental Origin of Health and Disease hypothesis, this study aimed to assess differences in cardiac and vascular structure and function in children exposed to preeclampsia in-utero as compared to those of normotensive mothers. We hypothesized that children exposed to preeclampsia had altered cardiac and vascular structure and function as compared to the unexposed group. METHODS This was a retrospective cohort study which included children between 2-10 years of age born to mothers with and without exposure to preeclampsia in-utero (n= 80 in each group). Myocardial morphology and function using echocardiogram and carotid intima-media thickness and pulse wave velocity were performed. Multivariable linear regression was used to compare preeclampsia exposed and non-exposed groups. Subgroup analysis to assess differences between early vs late onset preeclampsia was also performed. RESULTS Forty one percent (n=33) mothers had early onset preeclampsia. Children in the exposed group had significantly higher prevalence of Stage 1 systolic and diastolic hypertension (22%, n=18 and 35%, n=18 respectively) as compared to the unexposed group (9%, n=7 and 19% n =15 respectively, p=0.01). Children in the exposed group also had higher pulse wave velocity as compared to unexposed group (0.42 +/- 0.1 vs 0.39 +/- 0.1, p=0.03). Subgroup analysis revealed that blood pressure and pulse wave velocity changes were primarily determined by early onset preeclampsia. There was no significant difference in cardiac morphology or systolic and diastolic function between the exposed and unexposed groups. CONCLUSION In-utero exposure to preeclampsia has an effect on the vascular function in children aged 2-10 years, primarily related to early onset disease. Routine blood pressure screening should be recommended for such children.

Multisystem inflammatory syndrome (MIS-C) in Pakistani children: A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis

PLOS ONE, 2021

Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Sy... more Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods All children (1 month– 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C. Results Thirty children with median age of 24 (interquartile range (IQR)1–192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respecti...

Combatting with Challenges in Medical Education During COVID-19 Pandemic: A Mixed-Methods Study Identifying the Effectiveness of Using E-Learning in Pediatric Clinical Clerkship of A University Hospital, Pakistan

Background The emergence of COVID-19 raises the opportunity to reimagine medical education. One w... more Background The emergence of COVID-19 raises the opportunity to reimagine medical education. One way of attempting this is online classes, also known as e-learning, through recordings and or live streaming. The purpose of this research is to ascertain the effectiveness of using the e-learning instructional methodology for a Pediatric module with the fourth year MBBS students at the Aga Khan University Hospital, Karachi. Methods It was a sequential (Quantitative-Qualitative) mixed-method study. The quantitative component of the study consisted of pre and post-tests, as well as feedback on each session. The qualitative component was composed of focused-group discussions to explore students' experiences. Statistical analysis was performed using SPSS 20.0. Mean ±SD was reported for quantitative variables, and frequency and percentages were calculated for nominal variables. The pre and post-test scores were compared using a paired t-test. Pre and post mean test scores were analyzed in...

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Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs

Heart Asia, 2019

BackgroundThe importance of registries for collaborative quality improvement has been overlooked ... more BackgroundThe importance of registries for collaborative quality improvement has been overlooked in low/middle-income countries (LMIC). Aga Khan University Hospital (AKUH) in Pakistan joined the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in March 2017 with the goal of leveraging international collaboration to improve patient care and institutional standards.MethodsThe C3PO-QI key driver-based approach was used, with certain modifications, for process re-engineering in AKUH’s congenital cardiac catheterisation laboratory (CCL) to reduce radiation exposure during cardiac catheterisation procedures (the primary outcome of C3PO- QI). Educating staff and standardising procedural documentation were the principal goals of the process re-engineering. Data survey was used to assess staff knowledge, attitude and practice before and after the initiative. Additionally, case demographics and outcomes were compared between AKUH and C3PO-QI centres.Results...

Is the child at risk? Cardiovascular remodelling in children born to diabetic mothers

Cardiology in the Young, 2019

Objective:The objective of this study was to assess differences in myocardial systolic and diasto... more Objective:The objective of this study was to assess differences in myocardial systolic and diastolic function and vascular function in children 2−5 years of age born to diabetic as compared to non-diabetic mothers.Methods:This study was a retrospective cohort conducted in 2016 at The Aga Khan University Hospital, Karachi, Pakistan. It included children between 2 and 5 years of age born to mothers with and without exposure to diabetes in utero (n = 68 in each group) and who were appropriate for gestational age. Myocardial morphology and function using echocardiogram and carotid intima media thickness (cIMT) and pulse wave velocity was performed to evaluate cardiac function as well as macrovascular remodelling in these children. Multiple linear regression was used to compare the groups.Results:There was no significant difference in cardiac morphology, myocardial systolic and diastolic function, and macrovascular assessment between the exposed and unexposed groups of AGA children. Subg...

Atrial Thrombus in a Premature Newborn Following Cardio-Pulmonary Resuscitation

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, Jun 1, 2016

Critically ill newborns, whether term or preterm, are at great risk for developing symptomatic th... more Critically ill newborns, whether term or preterm, are at great risk for developing symptomatic thromboembolic disease. Comorbidities like inflammation, DIC, fluctuations in cardiac output, congenital heart disease, as well as central venous or arterial catheters, are the predisposing risk factors. Clinically symptomatic or asymptomatic cases are usually picked up by echocardiography, usually done for other indications. Management usually comprises of observation, heparin therapy, thrombo-embolectomy, and catheter directed revascularization. We present a case of premature neonate who developed thrombus at inter-atrial septum as a possible consequence of cardiopulmonary resuscitation, detected by echocardiography. Conversely, there is always a possibility of paradoxical emboli in neonates with patent foramen ovale (PFO). Subsequent clinical course remained asymptomatic and baby was discharged home after 6 weeks with cardiac follow-up. Atrial septal findings of organized clot/thrombus ...

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Distinctive Hemodynamics in the Immediate Postoperative Period of Patients with a Longer Cardiac Intensive Care Stay Post-Tetralogy of Fallot Repair

Congenital Heart Disease, 2015

After complete surgical repair the majority of tetralogy of Fallot (ToF), patients stay ≤2 days i... more After complete surgical repair the majority of tetralogy of Fallot (ToF), patients stay ≤2 days in the Cardiac Intensive Care Unit (CICU) while some may stay longer. We undertook this study to investigate the factors associated with shorter vs. longer length of stay in the CICU to help manage resources effectively. Patients who underwent ToF repair at Aga Khan University, Pakistan, between July 2006 and December 2011 were studied in a case-control design. Clinical parameters were compared between short stay group (SSG) (≤2 days) and long stay group (LSG) (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2 days). Odds ratios were calculated, and regression was performed. Ninety-eight patients (LSG 65, SSG 33) were included. Patients with lower preoperative saturation were 2.67 times more likely to be in the LSG group (P = .02). At 4 hours postoperatively, patients with a higher inotropic score (odds ratio [OR] = 3.03, confidence interval [CI] = 1.19-7.7, P = .02), higher central venous pressure (OR = 3.04, CI = 1.27-7.32, P = .013), and significant tachycardia at 4 hours (OR = 3.5, CI = 1.19-10.3. P = .02) were at risk for having a prolonged CICU stay. On multivariate analysis, significant postoperative tachycardia at 4 hours (z-score ≥3) was highly specific (sensitivity = 38.5%, specificity = 84.9%) for predicting the chances of being in the LSG. Other predictors included preop O2 saturation ≤82.5% (sensitivity = 61.1%, specificity = 63.0%) and CVP ≥10 mm Hg at 4 hours (sensitivity = 55.4%, specificity = 71.9%). Patients who end up staying longer in the CICU have features that are distinctive in the immediate postoperative period, and this can help clinicians in identifying patients who may need more support.

Transcatheter closure of small-to-large patent ductus arteriosus with different devices: queries and challenges

The Journal of invasive cardiology, 2007

Transcatheter closure of patent ductus arteriosus (PDA) has been in place for more than three dec... more Transcatheter closure of patent ductus arteriosus (PDA) has been in place for more than three decades. We share our experience with the newer devices. Ninety-eight patients, with a mean age of 64 +/- 11 months (range 7 months to 54 years), underwent attempted transcatheter closure of PDA. Thirty-seven patients were infants and 10 were adults. Two patients had residual PDA after surgical ligation. There were 66 females and 32 males. Sixty-six patients were symptomatic and 32 were asymptomatic. Cardiac catheterization showed significant pulmonary hypertension in 18. The mean size of the PDA on aortogram was 3.1 +/- 1.4 mm (range 1.1 to 11 mm). Seven patients were referred for surgical ligation. The PDAs of 37 patients were closed using coil devices, 52 with Amplatzer duct occluders (ADO) and two with Amplatzer muscular VSD devices. One patient had a very large PDA which was embolized and retrieved surgically. One patient required occlusion with two coils. The occlusion rate in the cat...

Solitary infantile myofibromatosis of the skull

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2007

This is the report of a 6 months old boy presenting with a firm, solitary mass on the temporal re... more

Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: A single center experience in a developing economy

Annals of cardiac anaesthesia

The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Develo... more The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection. The 1702 patients included ...

Congenital bilateral choanal atresi

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate ... more Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This is a case report of a full-term, healthy newborn baby presenting with intermittent attacks of cyanosis and respiratory distress soon after birth.

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Effect of intravenous gamma globulin on short- and mid-term clinical outcome in acute viral myocarditis in children

World Journal of Cardiovascular Diseases, 2014

Acute viral myocarditis is an extremely diverse disease with a predictable good outcome with supp... more Acute viral myocarditis is an extremely diverse disease with a predictable good outcome with supportive therapy. The objective of this study was to look at the clinical outcome of patients receiving additional intravenous gamma globulin compared to those receiving conventional anti-congestive therapy alone. Patients and methods: This is a retrospective review of charts of children admitted with acute myocarditis. Group 1 was children who received intravenous gamma globulin (IVIG) along with conventional anti-congestive therapy. Group 2 were patients who received the conventional anticongestive therapy alone. Short-term outcome was survival to hospital discharge, and midterm outcome was improvement of left ventricular ejection fraction at 6 months and one year follow-up. Results: A total of 36 patients were enrolled and 18 were males. The mean age of all patients was 2.3 ± 2.6 years and the mean duration of illness for the whole group was 6.7 ± 3.8 days. Group 1 comprised of 16 patients. There was no difference in short-term outcome with mortality of 2 patients in Group1 (12.5%) and 3(15%) in Group 2 (p = 0.2). At intermediate term follow up, recovery of ejection fraction in Group 1 was in 4/14 (28%) and in Group 2 it was 9/17 (55%) and at 12 months it was 10/13 (77%) in Group 1 and 15/16 (94%) in Group 2 (p = 0.02 and 0.19 respectively). Conclusion: Acute myocarditis has a high spontaneous cure rate. Our study did not show any significant difference in the short-term or midterm outcome between children receiving IVIG compared to those who did not. KEYWORDS Acute Myocarditis; Intravenous Gamma Globulins; Congestive Heart failure Charts of children admitted with acute myocarditis during the last five years were reviewed. A proforma addressing the symptoms, duration, hemodynamic status, cardiac enzymes, electrocardiographic tracings, radiological abnormalities, echocardiographic findings, medical treatment, mechanical ventilation, complications and shortterm and mid-term outcome was made. The diagnosis of acute viral myocarditis was made

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Murmur and Doppler Alternans in Critical Pulmonary Stenosis

Pediatric Cardiology, 2011

Pulsus alternans is a well-recognized clinical entity in which alternating strong and weak pulses... more Pulsus alternans is a well-recognized clinical entity in which alternating strong and weak pulses are detected. It usually is secondary to underlying myocardial failure. Murmur alternans (alternation in murmur intensity) has been described in aortic stenosis and a few right-sided lesions such as pulmonary hypertension and embolism. This report describes a case of murmur alternans in critical pulmonary stenosis that also showed Doppler alternans on echocardiography. The underlying cause was right ventricular systolic dysfunction.

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Congenital Bilateral Choanal Atresia

Archives of Otolaryngology - Head and Neck Surgery, 1956

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