Background and Objectives-Identification of STRK1 locus by the deCODE group followed by the discovery of phosphodiesterase 4D (PDE4D) gene in strong association with ischemic stroke patients has provided useful insights toward understanding the genetic etiology of the disease. In this study, we aimed at investigating the association between 3 polymorphisms of the PDE4D gene and ischemic stroke in the Pakistani population. Methods-Three polymorphisms in PDE4D gene were analyzed in 200 patients of ischemic stroke and 250 controls of Pakistani origin using polymerase chain reaction-restriction fragment length polymorphism method. Data were coded and entered in SPSS Windows (version 12.0). Odds ratios and 95% CIs were calculated using multivariate logistic regression analysis. Although the past 3 decades have seen a decline in the incidence of the disease in the Western population, 1 the burden of the disease in South Asian countries (India, Pakistan, Bangladesh, and Sirilanka) has inclined and is expected to rise. 3 Several epidemiologic studies in families and in twins have indicated a distinctive genetic component predisposing to stroke. 4 However, identification of these factors remained elusive until the discovery of STRK1 locus by deCODE group, 5 followed by association of the phosphodiesterase 4D (PDE4D) with ischemic stroke in the Icelandic population. 6 In this study, we investigated the association between 3 polymorphisms of the PDE4D gene and ischemic stroke in the Pakistani population. Results-Marker MethodsThe study was conducted at the Liaqat National Hospital and Aga Khan University Hospital Karachi in 2001 to 2002. The study population consisted of 200 patients of ischemic stroke and 250 controls. Ischemic stroke was defined as a sudden loss of global or focal cerebral function persisting for Ͼ24 hours with corresponding infarction on brain imaging with a probable vascular cause. All patients underwent a complete neurological examination. Data were collected with the help of a pretested and coded data extraction sheet. Controls were free of stroke and were from local population sharing the same environment. The study was approved by the ethics committee of both hospitals.An individual was classified as having arterial hypertension with a previous diagnosis of hypertension or if systolic or diastolic blood pressure was Ͼ140 mm Hg or Ͼ90 mm Hg, respectively, on Ն2 different occasions. Subjects were classified as having diabetes mellitus if he or she already had the diagnosis of diabetes mellitus or if his or her fasting plasma glucose was Ͼ126 mg/dL. Ischemic heart disease was established on past medical history, review of ECGs, and other relevant clinical information. Sample size of 200 cases and 250 controls based on allele frequencies was calculated for a power of 80% using the software Quanto. 7 Laboratory Measurement and TechniquesA total of 10 mL of venous blood was collected in an EDTA tube and plain tubes separately for DNA extraction from white blood cells and serum analysis. DNA was extracted...

BackgroundMistreatment or belittlement of medical students either by faculty or fellow students has often been reported. Perception of mistreatment has also been associated with increased degree of psychological morbidity. There is a lack of such studies being conducted amongst the medical students of Pakistan. The aim of this study was to determine the prevalence and forms of perceived mistreatment and presence of mental health morbidity in a private medical school in Pakistan. Also, any association between mental health morbidity and mistreatment was to be identified.MethodsA cross sectional study was carried out on medical students from Aga Khan University Hospital, Karachi, Pakistan during the period of June–September 2007. A self administered questionnaire, adapted from Frank et al and Baldwin et al was distributed to a total of 350 students. The questionnaire consisted of three parts: the first dealing with the demographics of the population, the second concerning the various forms of mistreatment, while the third assessed the mental health of students using the General Health Questionnaire 12(GHQ12). Descriptive statistics were performed. The Chi-square test and Fisher's exact tests were applied.ResultsA total of 350 students were approached out of which 232 completed the questionnaire giving a response rate of 66.2%. Mistreatment was reported by 62.5% (145/232) of the respondents. Of these, 69.7% (83/145) were males and 54.9% (62/145) were females. There was a significant relationship between gender, year division, stress at medical school and possible use of drugs/alcohol and reported mistreatment but no statistical relationship was seen with psychiatric morbidity. The overall prevalence of psychological morbidity was 34.8% (77/221).ConclusionThis study suggests high prevalence of perceived mistreatment and psychological morbidity among Pakistani medical students. However, no association was found between these two aspects of medical student education. There is a need to bring about changes to make the medical education environment conducive to learning. Increased student feedback, support systems and guidance about progress throughout the year and the provision of adequate learning resources may provide help with resolving both of these issues.

Our study compares the risk factors, clinical presentations and outcomes of pulmonary infections caused by Nocardia asteroides and non-asteroides species. We performed a retrospective cohort study comparing pulmonary infections by both species in patients presenting to a tertiary care hospital in Karachi, Pakistan. Forty-one patients were identified with pulmonary nocardiosis, with 58.5% belonging to the N. asteroids complex. The most common clinical findings were fever and a cough for both groups, with lobar infiltrates being the most common finding on chest radiographs. In vitro testing showed a sensitivity of all species to trimethoprim-sulfamethoxazole (TMP-SMZ), aminoglycosides, ceftriaxone and imipenem. The majority of the patients were treated with TMP-SMZ in combination with other drugs. The results of our study suggest that there is no significant difference in the risk factors, presentations and outcomes of pulmonary infections by N. asteroides and non-asteroides species. Immunocompromised patients are more likely to have unfavorable outcomes.

INTRODUCTION: HeRO graft provides upper extremity access as a last resort. Catheter related thrombosis of a central vein or the right atrium leading to pulmonary embolism (PE) is a rare but potentially fatal complication. We describe a case of positional syncope and dyspnea as a complication of a malpositioned HeRO graft.