Publications by Year: 2011

Warraich HJ, Shahul S, Matyal R, Mahmood F. Bench to bedside: dynamic mitral valve assessment. J Cardiothorac Vasc Anesth. 2011;25 :863-6.Abstract
PURPOSE: The authors analyze a commercially available software package capable of geometrically reconstructing the mitral valve (MV) dynamically throughout systole. DESCRIPTION: Three-dimensional echocardiography has revolutionized the understanding of MV geometry. Advanced quantification software can be used to assess geometric changes in the MV, which have been shown to have important implications for MV surgery. EVALUATION: The authors performed geometric analysis on 24 patients, with both anatomically normal and abnormal MVs to assess the feasibility of this new software. The application of this new software is briefly reviewed. CONCLUSION: This new software, despite its limitations, allows an improved perspective on MV geometry with implications for MV repair and surgical decision making.
Mir F, Tikmani SS, Shakoor S, Warraich HJ, Sultana S, Ali SA, Zaidi AK. Incidence and etiology of omphalitis in Pakistan: a community-based cohort study. J Infect Dev Ctries. 2011;5 :828-33.Abstract
INTRODUCTION: Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. METHODOLOGY: Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. RESULTS: Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10 %); Pseudomonas spp., 52 (8.9 %); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%). CONCLUSIONS: A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented.
Warraich HJ, Bhatti UA, Shahul S, Pinto D, Liu D, Matyal R, Mahmood F. Unilateral pulmonary edema secondary to mitral valve perforation. Circulation. 2011;124 :1994-5.
Matyal R, Bose R, Warraich H, et al. Transthoracic echocardiographic simulator: normal and the abnormal. Journal of Cardiothoracic and Vascular Anesthesia. 2011;25(1):177-81.
Bose R, Matyal R, Warraich H, et al. Utility of a transesophageal echocardiographic simulator as a teaching tool. Journal of Cardiothoracic and Vascular Anesthesia. 2011; 25(2):212-5.
Warraich H. Pakistan: the final frontier for a polio-free world. Lancet. 2011;15; 377(9761):207-8.
Warraich H, Matyal R, Shahul S. Giant saphenous vein graft pseudoaneurysm causing tricuspid valve stenosis. Journal of Cardiac Surgery. 2011;26(2):177-80.
Matyal R, Warraich H, Karthik S, et al. Anterior myocardial infarction with dynamic left ventricular outflow tract obstruction. Annals of Thoracic Surgery. 2011; 91(3):e39-40.
Warraich H, Zaidi A, Patel K. Floods in Pakistan: a public health crisis. Bulletin of the World Health Organization. 2011;89(3):236-7.