Syed Sohail Ali

Publications of Syed Sohail Ali

• Clinical presentation and outcome of autosomal dominant polycystic kidney disease in Pakistan: a single center experience.

  Authors: Malik Anas Rabbani, Syed Sohail Ali, Ghulam Murtaza, Bushra Ahmad, Qamaruddin Maria, Bilal Karim Siddiqui, Syed Mansoor Ahmed Shah, Aasim Ahmad

  JPMA. The Journal of the Pakistan Medical Association. 07/2008; 58(6):305-9.

  OBJECTIVE: To delineate clinical presentation and outcome of Autosomal Dominant Polycystic Kidney Disease (ADPKD) in terms of need for renal replacement therapy of kidney transplantation in PakistaniOBJECTIVE: To delineate clinical presentation and outcome of Autosomal Dominant Polycystic Kidney Disease (ADPKD) in terms of need for renal replacement therapy of kidney transplantation in Pakistani patients. METHODS: Patients with ADPKD were identified using strict clinical criteria. Medical charts were evaluated retrospectively for initial presenting complaints, co-morbids, family history of ADPKD, any palpable mass on abdominal examination, cardiac examination for any abnormal finding and use of any anti-hypertensive drugs. Laboratory parameters were assessed. Chi square and Logistic regression analyses at 95% CI were used for statistical significance. A p value of less 0.05 was considered statistically significant. RESULTS: A total of 56 patients fulfilled our criteria of ADPKD. There were 40 (71.4%) males and 16 (28.6%) females in our study. The mean age at the time of diagnosis of ADPKD was 47.0 +/- 14.5 years. Mean follow up period for all patients was 7.6 +/- 4.2 years. Most common form of presentation was hypertension in 38 (67.9%) patients. Kidneys were palpable in 33 (58.9%), liver in 16 (28.6%) and spleen in 6 patients (10.7%). Microscopic haematuria was observed in 38 (67.8%) patients while gross haematuria was present in 10 (17.9%) patients. The murmur of mitral valve prolapse was found in 10 patients on clinical examination which was later confirmed on transthoracic echocardiography (TEE). On MRI/MRA 2 (3.6%) patients each had berry aneurysm and AV malformations. Three patients (5.4%) received renal transplant and 19 (33.9%) patients were dialysis dependent at the end of study. A total 11 (20%) were lost to follow up. Two patients (3.5%) died during six years follow up. Male sex and uncontrolled hypertension were most important predictors of poor prognosis (p < 0.03 and < 0.048 respectively). CONCLUSION: Pre-symptomatic patients with ADPKD should be monitored with blood pressure measurements and assessment of their renal function. The advantages of such monitoring include the ability to prevent or control infection and hypertension, to identify potential kidney donors from among the family, to offer advice on marriage and childbearing, and to provide prenatal diagnosis.

• Outcome of triple procedure in older children with developmental dysplasia of hip (DDH).

  Authors: Masood Umer, Haq Nawaz, Pashtoon Murtaza Kasi, Mahmood Ahmed, Syed Sohail Ali

  JPMA. The Journal of the Pakistan Medical Association. 12/2007; 57(12):591-5.

  OBJECTIVE: To evaluate the radiographic and functional results of the triple procedure (open reduction, femoral shortening and Salter's Osteotomy) in the treatment of Developmental Dysplasia of theOBJECTIVE: To evaluate the radiographic and functional results of the triple procedure (open reduction, femoral shortening and Salter's Osteotomy) in the treatment of Developmental Dysplasia of the Hip (DDH) disease in older children. METHODS: This case-series comprising 23 patients (29 hips) underwent the triple procedure of open reduction, femoral shortening and Salter osteotomy, at Aga Khan University Hospital between June 1995 and June 2005. Patients were classified pre-operatively according to the Tonnis class. Postoperative functional evaluation was performed using Modified MacKay's scoring system and radiographic assessment using Severin's scoring method. RESULTS: The mean age of patients at presentation was 6.84 years and the average follow-up was 19.6 months. The MacKay score was 'Good' to 'Excellent' in 25 hips; we had a failure in 1 hip joint. The Severin's class was I in 15 (51.7%) hips at the time of final evaluation as compared to none at the time of presentation. Patients younger than 5.6 years of age had a better radiological and clinical outcome as compared to older patients (p-value < 0.05). CONCLUSIONS: The triple procedure of open reduction, femoral shortening and Salter osteotomy gives best results in younger children. Early diagnosis and intervention is therefore imperative in the successful treatment of patients suffering from DDH.

• Pre-operative renal function and selective renal vein renin levels as markers of favourable outcome in renovascular hypertension.

  Authors: Malik Anas Rabbani, Alia Zaidi, Bushra Ahmad, Syed Sohail Ali, Asmooni Younus, Zaid Soofi, Syed Mansoor Ahmad Shah

  JPMA. The Journal of the Pakistan Medical Association. 04/2007; 57(4):178-81.

  OBJECTIVE: To evaluate factors that affect outcome following revascularization in patients with renovascular hypertension. METHODS: This study was conducted at the Aga Khan University Hospital. ItOBJECTIVE: To evaluate factors that affect outcome following revascularization in patients with renovascular hypertension. METHODS: This study was conducted at the Aga Khan University Hospital. It included all the patients diagnosed to have Renovascular hypertension confirmed by renal angiography between July 1996 to September 2000. Using ANOVA (Analysis of variance) and paired-sample t-test, several preoperative factors were evaluated for their ability to predict postoperative improvement of blood pressure and renal function. For descriptive purpose patients were divided into cured, improved and failure groups. RESULTS: Of the total 15 patients, 9 were males and 6 were females. Before the surgical procedure, 13 patients were on 3 or more antihypertensive drugs. Eleven patients received vein grafts, three patients had PTFE (polytetraflouroethyline) grafts while one patient underwent angioplasty and stenting. The patients had a median follow-up period of nine months with a range of 2 to 84 months. Five were completely cured, as they became normotensive without antihypertensive therapy after operation, whereas four showed marked improvement in BP control postoperatively, requiring two antihypertensive drugs. Six patients showed no improvement requiring 3 or more drugs. Extended cure or improvement of renovascular hypertension was achieved in nine patients. Normal preoperative serum creatinine level, high preoperative unstimulated peripheral renin levels and renal vein renin ratio of at least 1.75:1 were the most significant predictive factors for favorable outcome. CONCLUSION: This study confirms the long term effectiveness and safety of renovascular reconstruction in the relief of severe hypertension. The results further suggest that normal preoperative renal function, high renal vein renin ratio and high preoperative unstimulated peripheral renin levels are associated with the most favourable postoperative outcome (p <0.01). Preoperative severity and duration of hypertension and degree of disparity in kidney sizes do not affect the overall results in terms of postoperative improvement in renal function and blood pressure control (p=0.734).

• Do clinical manifestations of Systemic Lupus Erythematosus in Pakistan correlate with rest of Asia?

  Authors: Malik Anas Rabbani, Bilal Karim Siddiqui, Muhammad Hammad Tahir, Bushra Ahmad, A Shamim, Shahid Majid, Syed Sohail Ali, Syed Mansoor Ahmed Shah, Aasim Ahmad

  JPMA. The Journal of the Pakistan Medical Association. 06/2006; 56(5):222-7.

  OBJECTIVE: Systemic Lupus Erythematosus (SLE) is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly,OBJECTIVE: Systemic Lupus Erythematosus (SLE) is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data. METHODS: Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University Hospital between 1986 and 2001 were studied by means of a retrospective review of their records. The results were compared with various studies in different regions of Asia. RESULTS: Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is generally consistent with Asian data. There was less cutaneous manifestations, arthritis, serositis, haematological and renal involvement compared to various regions in Asia. The neurological manifestations of SLE, however, place Pakistani patients in the middle of a spectrum between South Asians and other Asian races. CONCLUSION: This study has shown that the clinical characteristics of SLE patients in our country may be different to those of other Asian races. Although our population is similar to South Asians, but clinical manifestations of our SLE patients are considerably different, suggesting some unknown etiology. Further studies are required to confirm the above results and to find statistically sounder associations.

• Bilateral breast enlargement due to Trichophyton rubrum.

  Authors: Syed Sohail Ali, Afia Zafar, Suhail Muzaffar, Fawad Aslam, Javaid A Khan

  Breast (Edinburgh, Scotland). 05/2006; 15(2):263-5.

  Gynecomastia is the most common cause of breast enlargement in males. Trichophyton rubrum is a common dermatophyte, is responsible for a variety of infections, and may rarely manifest as aGynecomastia is the most common cause of breast enlargement in males. Trichophyton rubrum is a common dermatophyte, is responsible for a variety of infections, and may rarely manifest as a dermatophytic pseudomycetoma. We report the case of a 52-year-old man who presented with progressive bilateral breast enlargement. This is the first reported case of bilateral breast pseudomycetoma due to T. rubrum. Long-term antifungal therapy with itraconazole was successful.

• Healing during physician-patient consultation.

  Authors: Waris Qidwai, Syed Sohail Ali, Semi Ayub, Salma Ayub

  Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 12/2005; 15(11):689-92.

  OBJECTIVE: To determine the patient perceptions regarding healing during a physician-patient consultation. DESIGN: A questionnaire-based survey. PLACE AND DURATION OF STUDY: Family Practice Center ofOBJECTIVE: To determine the patient perceptions regarding healing during a physician-patient consultation. DESIGN: A questionnaire-based survey. PLACE AND DURATION OF STUDY: Family Practice Center of the Aga Khan University Hospital, Karachi, Pakistan, in June 2004. PATIENTS AND METHODS: A questionnaire was designed that included the demographic profile of patients comprising age, gender, education and occupation as well as questions in line with the study objective. It was administered to 111 patients, visiting outpatient department of the hospital. Participants were explained the study objective, a written consent was taken and full confidentiality was assured. RESULTS: The mean age of the study population was 27.86 years. Majority of the subjects were males with 68% having graduate or more education. A physician-patient consultation has healing properties for patients and physicians, according to 99 (89%) and 67 (65%) respondents respectively, with 65 (58%) having had experienced healing during the consultation process. The competence of a physician, individual attention given by a physician and a cool and calm attitude of a physician, were reported to increase healing in a physician-patient consultation according to 34 (30%), 32 (29%) and 13 (11%) respondents respectively. The unhelpful physician behavior, incorrect diagnosis and physician's rude and arrogant attitude were reported to decrease healing according to 42 (37%), 15 (14%) and 14 (13%) respondents respectively. CONCLUSION: The study shows that a majority of the patients believe a physician-patient consultation has healing properties on its own, based on healing potential in the consultation process itself. Physicians must try to find ways to improve their ability to act as healers during consultation with patients.

• Clinico-laboratory findings in male lupus patients from a tertiary care hospital, Pakistan.

  Authors: Malik Anas Rabbani, Bushra Ahmad, Syed Mansoor Ahmed Shah, Sabeen Fatima Mekan, Syed Sohail Ali, Aasim Ahmed

  JPMA. The Journal of the Pakistan Medical Association. 05/2005; 55(4):165-6.

  This study was conducted to delineate the clinical pattern of a cohort of Pakistani male patients with systemic lupus erythematosus (SLE). Clinical and laboratory data were collected of 24 maleThis study was conducted to delineate the clinical pattern of a cohort of Pakistani male patients with systemic lupus erythematosus (SLE). Clinical and laboratory data were collected of 24 male patients who were diagnosed with SLE and admitted to a tertiary care hospital between 1986 and 2001. Imaging and invasive studies (including aspirations and biopsies) were also recorded. Fourteen patients (58%) had renal involvement, with WHO class 4 and 5 comprising 89% of the cases. Eight patients (33%) had neurological involvement. Out of these 8 patients, 3 presented with psychosis (12.5%) and 4 (17%) with seizures. Twenty three patients (96%) had hematological involvement, 6 (25%) had serosal and 10 (41%) had articular involvement. Cutaneous lesions were noted in 10 (41%) patients. A majority of the patients were noncompliant and were lost to follow-up; therefore, ultimate outcome could not be clearly delineated. A high index of suspicion for SLE in males may permit early diagnosis and dictate the need for more aggressive therapy.

• Systemic lupus erythematosus presenting as hemolytic uremic syndrome: a case report.

  Authors: Malik Anas Rabbani, Bushra Ahmad, Sabeen Fatima Mekan, Suhail Muzaffar, Syed Sohail Ali

  JPMA. The Journal of the Pakistan Medical Association. 03/2005; 55(2):84-7.

  Associating systemic lupus erythematosus (SLE), with an initial presentation of hemolytic uremic syndrome (HUS) is rare. We report a case of 21-year old Afghani female admitted to our hospital withAssociating systemic lupus erythematosus (SLE), with an initial presentation of hemolytic uremic syndrome (HUS) is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general condition improved. Unfortunately she was lost to follow up as she decided to return back to Afghanistan.

• Paediatric stool cultures: seasonal variation in bacterial pathogens isolated in Karachi, Pakistan.

  Authors: Mahboob Alam, Muna Ahmed, Syed Sohail Ali, Muslim Atiq, Yasir Naeem Akhtar, Aamir Ansari, Fahd Abdullah Chaudhry, Hamid Bashir, Syed Farid-ul-Husnain, Afia Zafar

  Tropical doctor. 02/2005; 35(1):21-3.

• Level of preparedness of patients for medical emergency.

  Authors: Waris Qidwai, Syed Sohail Ali, Muhammad Baqir, Semi Ayub

  Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 04/2004; 14(3):193.

• Is routine histological evaluation of pediatric hernial sac necessary?

  Authors: Khurram Siddiqui, Zafar Nazir, Syed Sohail Ali, Shahid Pervaiz

  Pediatric surgery international. 03/2004; 20(2):133-5.

  Advocates of routine histological examination of hernial sac recommend it for surgical quality assurance, to report injuries to the vas deferens, and to detect occult malignant and benign diseasesAdvocates of routine histological examination of hernial sac recommend it for surgical quality assurance, to report injuries to the vas deferens, and to detect occult malignant and benign diseases such as tuberculosis. However, the value of this routine examination is debated in this era of cost containment in health care. We conducted a retrospective study of our practice and reviewed the relevant literature to find any justification to continue this practice. Only 2.2% of hernial sacs submitted for histopathology showed unusual findings, and none of these findings were clinically important. In conclusion, the findings of our study and our review of the current literature do not support the routine histological examination of hernial sac in the pediatric age group.

• Capillary haemangioma of the uterus: a rare cause of menorrhagia.

  Authors: Syed Sohail Ali, Suhail Muzaffar, Naila Kayani, Faridoon Setna

  The Australian & New Zealand journal of obstetrics & gynaecology. 03/2003; 43(1):85-6.

• Fallopian tube carcinoma presenting as cervical growth: the dilemma of skip metastasis.

  Authors: Syed Sohail Ali, Omar Saeed, Suhail Muzaffar, Tehmina Riaz, Faridoon Setna, Semi Ayub

  The Australian & New Zealand journal of obstetrics & gynaecology. 03/2003; 43(1):82-4.

• Necrotizing fasciitis of head & neck: the Pakistani experience.

  Authors: Mubasher Ikram, Omar Saeed, Syed Sohail Ali, Iftikhar Salahuddin

  Asian journal of surgery / Asian Surgical Association. 02/2002; 25(1):13-7.

  Necrotizing fasciitis is a potentially life threatening, rapidly spreading polymicrobial infection rarely seen in the head and neck region. We present our experience of managing five patients withNecrotizing fasciitis is a potentially life threatening, rapidly spreading polymicrobial infection rarely seen in the head and neck region. We present our experience of managing five patients with necrotizing fasciitis of head and neck at the Aga Khan University Hospital, Karachi, Pakistan. One patient had necrotizing fasciitis of the facial region only; three had necrotizing fasciitis of the neck region; and one patient had necrotizing fasciitis of the neck with extension to the chest. None of these patients was immunocompromised. Dental foci of infection was the root cause in three of the patients. Imaging was not only diagnostic but also helped to identify the extent of the disease. All five patients had early extensive multiple debridments, and received multiple antibiotic therapy and intensive care support. Four patients survived. We conclude that necrotizing fasciitis is a very aggressive infection, which may be misdiagnosed unless imaging examination is performed early. Aggressive medical and surgical treatment results in good survival but extension of disease beyond the neck into the chest carries a poor prognosis.

• Patient expectations from an emergency medical service.

  Authors: Waris Qidwai, Syed Sohail Ali, Muhammad Baqir, Semi Ayub

  Journal of Ayub Medical College, Abbottabad : JAMC. 17(3):3-6.

  BACKGROUND: Patient expectation survey at the Emergency Medical Services can improve patient satisfaction. A need was established to conduct such a survey in order to recommend its use as a qualityBACKGROUND: Patient expectation survey at the Emergency Medical Services can improve patient satisfaction. A need was established to conduct such a survey in order to recommend its use as a quality improvement tool. METHODS: The study was conducted on patients visiting the Emergency Medical Services, Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and expectations of patients. The ethical requirements for conducting the study were met. RESULTS: A hundred patients were surveyed. The majority was relatively young, married men and women, well educated and better socio-economically placed. The majority of the patients expected a waiting time and a consultation time of less than 30 minutes and 20 minutes, respectively. The majority of respondents expected and agreed to be examined by a trainee but there were reluctant to be examined by the students. There was an expectation that the consultant will examine patients and not advice the attending team over the phone. The majority of the patients expected intravenous fluid therapy. There was a desire to have patient attendant present during the consultation process. The majority of the patients expected to pay less than three thousand rupees for the visit. An expectation exists for investigations and hospitalization. Involvement of patients in decisions concerning their treatment and written feedback on their visit was expected. CONCLUSIONS: We have documented the need and value of patient expectation survey at the Emergency Medical Services department. The use of such a tool is recommended in order to improve the satisfaction levels of patients visiting such facilities.

• Renal cortical necrosis: a case series of nine patients & review of literature.

  Authors: Syed Sohail Ali, Syed Zulfiqar Rizvi, Suhail Muzaffar, Aasim Ahmad, Akhtar Ali, Sheema H Hassan

  Journal of Ayub Medical College, Abbottabad : JAMC. 15(2):41-4.

  BACKGROUND: The purpose of this study is to review cases of renal cortical necrosis (RCN) which we came across during a period of five years, confirmed on needle biopsy specimens, with literatureBACKGROUND: The purpose of this study is to review cases of renal cortical necrosis (RCN) which we came across during a period of five years, confirmed on needle biopsy specimens, with literature available so far. METHODS: All renal biopsy records between January 1996 to December 2001 at the Aga Khan University Hospital, Karachi, Pakistan were reviewed to identify patients with histologically proven renal cortical necrosis. Seven patients were also referred by the department of Nephrology, Lady Reading Hospital, Peshawar, Pakistan. Patients' medical records were reviewed for demographic, clinical, and follow up data. RESULTS: There were total of nine patients identified with renal cortical necrosis. The mean age was 26.21 +/- 13.01 year. Five cases (55.5%) were caused by obstetric complications. The most common histology type of RCN was patchy cortical necrosis in seven patients (77.8%). Three patients were alive at last follow up; remaining patients were lost to follow up. CONCLUSION: Obstetric complications remain the leading cause of renal cortical necrosis in our setting. The recognition of this entity and value of renal biopsy in cases of acute renal failure needs to be emphasized as this helps in establishing diagnosis, to assess prognosis and to aid in selection of a rational approach to therapy.

• Renovascular hypertension: factors affecting the outcome following surgical revascularisation.

  Authors: Malik Anas Rabbani, Alia Zaidi, Syed Sohail Ali, Bushra Anas, Asmooni Younus, Syed Mansoor Ahmad Shah

  Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 14(4):469-74.

  This study was conducted at the Aga Khan University Hospital, Karachi, Pakistan to evaluate factors that affect outcome following revascularisation in patients with renovascular hypertension. WeThis study was conducted at the Aga Khan University Hospital, Karachi, Pakistan to evaluate factors that affect outcome following revascularisation in patients with renovascular hypertension. We included all the patients diagnosed to have renovascular hypertension, confirmed by renal angiography, between July 1997 and September 2000. Of the total 15 patients, nine were males and six were females. Eleven patients received venous grafts, three received polytetraflouroethyline (PTFE) grafts while one patient underwent angioplasty and stenting. All were followed-up for a period of nine months (median) with the range from 2 to 84 months. A total of 33.3% of the study patients were completely cured, as they became normotensive without anti-hypertensive therapy after operation, while 27% showed marked improvement in blood pressure control post-operatively. Thus, extended cure or improvement of renovascular hypertension was achieved in 60% of patients. Normal pre-operative serum creatinine level, high pre-operative unstimulated peripheral renin levels and renal vein renin ratio of at least 1.75:1 were the most significant predictive factors for favorable outcome (p < 0.012). The pre-operative severity and duration of hypertension as well as degree of disparity in kidney sizes did not predict the post-operative improvement in renal function and blood pressure control.

• Ischemic monomelic neuropathy: a complication of vascular access procedure.

  Authors: Malik Anas Rabbani, Aasim Ahmad, Syed Mansoor Ahmed Shah, Tahseen Mozzaffar, Mahesh Moolani, Syed Sohail Ali

  Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 13(1):60-2.

  Ischemic monomelic neuropathy (IMN) is an infrequently recognized type of ischemic neuropathy produced by shunting blood or acute occlusion of a major proximal artery in the extremities. IMNIschemic monomelic neuropathy (IMN) is an infrequently recognized type of ischemic neuropathy produced by shunting blood or acute occlusion of a major proximal artery in the extremities. IMN predominantly occurs in diabetic patients with evidence of peripheral atherosclerotic vascular disease and neuropathy. We report a case of ischemic monomelic neuropathy occurring in a diabetic patient with end-stage renal disease following the placement of polytetrafluoroethylene (PTFE) graft as a vascular access in the proximal upper arm for chronic hemodialysis.