Assessment of carotid artery wall in patients with OSA syndrome and the effect of CPAP on its thickness

In patients with Obstructive sleep apnea [OSA], the risks of fatal and nonfatal cardiovascular diseases and coronary artery disease are increased and measuring carotid intima-media thickness [CIMT] can assess these complications. Studying the effect of OSA syndrome in the carotid artery wall thickness as an indicator to cardiovascular complications, and the effect of CPAP on these changes. Polysomnography [PSG] was done for 45 patients; 29 patients of them proved to have OSA, and 10 obese subjects with normal PSG were included as a control group. All of them had ultrasonographic assessment of CIMT. 17 patients with OSA used CPAP overnight for 6 months and the CIMT was remeasured. 29 were diagnosed with OSA [12 severe, 9 moderate and 8 mild OSA]. There was a highly significant difference [p < 0.01] in CIMT between patient and control groups, and also between severe and mild OSA patients with non-significant difference [p > 0.05] between severe and moderate OSA. Regarding the different risk factors predispose to atherosclerosis, only factors related to OSA syndrome were correlated with CIMT. There was a highly significant reduction [p < 0.01] in CIMT after six months of CPAP usage. CIMT as a marker of atherosclerosis is significantly increased in patients with OSA and the use of CPAP in those patients is very important not only for improving sleep efficiency but also for reducing cardiovascular complications associated with OSAS

Role of fibulin-3 in the diagnosis of malignant mesothelioma

Early detection of malignant pleural mesothelioma [MPM] is critical to survival, the use of pleural or blood fibuin-3 might allow this early detection. Studying the validity of measuring serum and pleural fibulin-3 in the diagnosis of MPM. Fibulin-3 levels were measured in serum and pleural fluid by enzyme-linked immunosorbant assay [ELISA] in 45 patients with exudative pleural effusion. Patients with non-conclusive cytology or microbiological examination had undergone medical thoracosope for histopathological examination. Twenty five was diagnosed as MPM, 11 cases as pleural metastasis of carcinoma [Mets] and nine cases with benign pleural effusions. Patients with MPM had significantly higher pleural effusion and serum fibulin-3 levels than those with metastatic effusion of carcinoma or benign pleural effusion [p-value < 0.001]. Using a cut-off point of pleural fluid fibulin-3 [150 ng/ml] with AUC of 0.878 [sensitivity 72.3%, specificity 80] and at a cut-off point of serum fibulin-3 [66.5 ng/ml], with AUC of 0.776 [sensitivity 88%, specificity 81.8%], discrimination between MPM and Mets occurred. Also, using a cut-off point of pleural fluid fibulin-3 [127.5 ng/ml] with AUC of 0.909 [sensitivity 88%, specificity 77.8%], and at a cut-off point of serum fibulin-3 [18 ng/ml], with AUC of 0.931 [sensitivity 100%, specificity 77.8%], discrimination between MPM and benign pleural effusion could occur. Fibulin-3 in the serum and pleural fluid is a good biomarker in the diagnosis of MPM and in differentiation between MPM from malignant pleural metastasis other than mesothelioma and also from benign pleural effusions

Utility of quantitative analysis of urine lipoarabinomannan in the diagnosis of tuberculosis

Urinary lipoarabinomannan [LAM] detection is a promising approach for the rapid diagnosis of active tuberculosis [TB]. To assess the diagnostic accuracy of urine LAM among TB patients either pulmonary or extra pulmonary. This study was carried out on 85 cases [46 male and 39 female] with active tubercular infection divided into three groups; pulmonary [n = 40], extra pulmonary [n = 30] and disseminated tuberculosis [n = 15]. Twenty-five normal individuals were included as the control group. LAM level was measured in urine by enzyme-linked immunosorbant assay [ELISA]. TB Patients with disseminated disease had a higher urine LAM level [1.75 +/- 1.65 ng/ ml] than that for patients with pulmonary [0.58 +/- 0.53 ng/ml] or extra pulmonary TB [0.17 +/- 0.1 Ing/ml] [P < 0.001]. Patients with smear positive specimens had a higher urine LAM level [0.63 +/- 0.54 ng/ml] than that of smear negative [0.040 +/- 0.06 ng/ml] [P < 0.001]. Quantitative urine LAM test results positively correlate with the degree of bacillary burden. Advanced age, immunosuppressant state and advanced radiological lesion were significant factors that were associated with higher quantitative urine LAM [P < 0.05]. Urine LAM test is a simple, rapid, and reliable diagnostic modality for active pulmonary or extra pulmonary tuberculosis. Quantitative LAM detection results increasedprogressively with bacillary burden and immunosuppression. Patients with disseminated TB are target populations for urine LAM detection

Clinical probability of pulmonary embolism: comparison of different scoring systems

Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine and clinical probability assessment is a fundamental step in its diagnosis. To evaluate the role of estimating clinical probability of pulmonary embolism and to compare between different pre-test probability scoring systems as regards their sensitivity and specificity. We used seven scoring systems [original Geneva score, revised Geneva score, simplified Geneva score, Wells score, simplified Wells score, simplified Charlotte rule, Pisa model] to assess the clinical probability of PE in 41 patients with suspected pulmonary embolism for whom the final diagnosis was based on multislice CT pulmonary angiography [CTPA]. Twenty-four patients [58.5%] had pulmonary embolism. The scores with the strongest correlation with the result of CTPA were the Pisa model [P 6

Transition towards health promoting hospitals: adapting a global framework to Pakistan

The World Health Organization encourages hospitals to become Health Promoting Hospitals [HPH] but adapting this concept to Pakistan has not been investigated. We explore perceptions of healthcare stakeholders about strategies and a priority action-plan to encourage HPHs in Pakistan. We conducted a qualitative study in 2007 where key-informant interviews and focus group discussions were held with healthcare stakeholders in Karachi. Thematic analysis was done and emerging themes were categorized. The HPH core components were perceived as the [standard framework]; however more emphasis was placed on priority actions as to satisfy [basic needs] of patients, staff and the community. This included basic facilities of comfort, health, hygiene, safety, security and emotional support. A change in the traditional mindset from cure to care and identification of key personnel, awareness-raising and cooperation would strengthen advocacy efforts for HPH in Pakistan

[Effect of lecithin on blood lipid profiles in hypercholesterolemic patients]

Hypercholesterolemia is a risk factor for atherosclerosis that responded variably to dietary modification of fat and cholesterol. Previous studies in humans have shown that ingestion of lecithin can alter plasma cholesterol and triglyceride but results were different. The current study was designed to investigate the hypocholesterolemic properties of lecithin on patient with hypocholesterolemia. Sixty one subjects [27 Male, 34 Female] with mean ages 44 +/- 14 years old with hypercholesterolemia, was admitted to Mottahari Health Center[Shiraz], randomly assigned to the case [n=31] and control [n=30] groups. Case group received three lecithin capsules [1200 mg] which contain 420 mg Phosphatidylecoline, daily for six weeks. Subject's weight, Body Mass Index [BMI] and serum lipid concentration were measured at the beginning and the end of six weeks. No significant difference were found in mean weight in case group when compared to control group. Also no significant difference were found in mean BMI in case group when compared to control group. Significantly lower mean serum Total Cholesterol, LDL cholesterol, and triglyceride and significantly higher HDL cholesterol were found in case group. In addition mean serum total cholesterol [P<0.05], LDL cholesterol [P<0.05] and TG [P<0.05] decreased and mean serum HDL-Cholesterol [P<0.05] increases significantly in case group vs. control group. This study showed that lecithin could be considered as effective nutrient useful in dietary treatment of hypercholesterolemia

Induced sputum versus fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Tuberculosis still constitutes a major health problem despite advances in diagnosis and treatment. The diagnosis of TB is difficult in patients who cannot produce sputum spontaneously. This study aimed to compare between sputum induction using nebulized hypertonic saline, and fiberoptic bronchoscopy in the diagnosis of pulmonary TB, in clinically and radiologically suspected cases. Thirty suspected pulmonary tuberculosis cases were subjected to: 1-Tuberculin skin test. 2-Sample collection: a. Three successive spontaneous morning sputum samples, b. Sputum induction for 3 successive mornings c. Fiberoptic bronchoscopy with bronchial washing, brushing and Post-bronchoscopic sputum collection. All samples were stained with Ziehl-Neelsen stain. Induced sputum [SI] and bronchial wash were also cultured on Lowenstein-Jensen [L.J] medium. According to L J cultures there were 25[83.3%] positive bronchial wash samples VS 22[73.3%] induced sputum samples. The diagnostic yields of sputum induction and post-bronchoscopic sputum were similarly significant. Also, the yields of bronchial washing and bronchial brushing were similarly highly significant .The differences between all these procedures was non significant. The third SI sample was the most sensitive in the detection of AFB There was no significant difference between SI and Bronchial washing whether by using Z-N stain or L-J culture. Sensitivity, specificity and predictive values of different methods of specimen collection in diagnosing pulmonary TB gave non-significantly different results. Sputum induction is an easy, cheap and non invasive procedure that has a significantly high diagnostic yield for clinically and radiologically suspected cases of pulmonary tuberculosis who have dry cough or whose sputum for three successive days are negative. The third SI sample is the most significant one. There is no significant difference between SI and FOB using any of its procedures

Induced sputum versus fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Tuberculosis still constitutes a major health problem despite advances in diagnosis and treatment. To compare between sputum induction using nebulized hypertonic saline, and fibreoptic bronchoscopy in the diagnosis of pulmonary TB, in clinically and radiologically suspected cases. 30 patients were subjected to: 1-Tuberculin skin test. 2-Microbiological examination of: a. Three successive spontaneous morning samples, b. Sputum induction for 3 successive mornings c. Fibreoptic bronchoscopy with Bronchial washing, brushing and post-bronchoscopic sputum collection. All samples were stained with Ziehl-Neelsen stain. Induced sputum [SI] and bronchial wash were also cultured on L.J medium. The diagnostic yields of sputum induction and post-bronchoscopic sputum were similarly significant. Also, the yields of bronchial washing and bronchial brushing were similarly highly significant. The differences between all these procedures was non significant. The third SI sample was the most sensitive in the detection of AFB. There was no significant difference between SI and Bronchial washing whether by using Z-N stain or L-J culture. Sensitivity, specificity and predictive values of different methods of specimen collection in diagnosing pulmonary TB gave non-significantly different results. Sputum induction is an easy, cheap and non invasive procedure that has a significantly high diagnostic yield for clinically and radiologically suspected cases of pulmonary tuberculosis who have dry cough or whose sputum for three successive days are negative. The third SI sample is the most significant one. There is no significant difference between SI and FOB using any of its procedures

Socio-economic and demographic factors associated with injecting drug use among drug users in Karachi, Pakistan

To identify the socio-economic and demographic factors associated with injecting drug users [IDUs] in Karachi. We recruited 242 IDUs [taking drugs through sub-dermal routes] and 231 non-IDUs [taking drugs other than sub-dermal routes] from February through June 1996. IDUs were interviewed regarding socio-demographic factors, economic condition, and social network [marital status, living with spouse]. In addition, information regarding location of drug users within the city [districts of Karachi] and current history of sexually transmitted diseases [STDs] were gathered. Moreover, blood samples were also obtained for HIV testing. Multivariate analysis showed that the income generation via illegal modes [AOR 1.6, 95% CI 1.0-2.6], non-sharing of income with family [AOR 1.7, 95% CI 1.1-2.7] and presence of suicidal thoughts [AOR 2.0, 95% CI 1.1-3.8] were associated with the use of drugs through injections. Further, drug users from districts West, East and Central were more likely to use drug through injection as compared to drug users from district South. The history of genital herpes was also found to be associated with injecting drug use. One IDU was found seropositive for HIV.The high-risk behaviors, such as illegal modes of earning and presence of suicidal thoughts, among IDUs suggest that the group needs rehabilitation programme. Moreover, non-sharing of income suggest that IDUs are isolated from social network, therefore primary prevention activities with focus on improving socio-economic conditions and social networking can reduce drug use through injections. Focused interventions on target districts would be helpful in reducing IDU

Knowledge and misconceptions about sexually transmitted infections in married women-perspective from Islamabad

To study the knowledge of married women regarding existence of sexually transmitted infection [STI] their complications, treatment seeking, ways of preventing STI acquisition and opinion about sex education in schools/colleges and media. Setting: The Mother and Child Health Center, a tertiary care hospital in Islamabad. A cross-sectional survey based on sample of convenience was conducted, using a structured questionnaire with both close and open-ended questions. Trained women physician interviewers conducted the interviews after obtaining verbal consent. Out of 218 women approached for interviewing, only two refused to participate in the study. The mean age of the respondents was 28.5 years [range 18 - 53 years]. One hundred and sixty-eight [77.8 percent] respondents had heard/knew about sexually transmitted infections STIs. Two hundred and ten [97.2 percent] respondents had heard/knew about AIDS and out of these 162 [77.1 percent] knew that it is also transmitted through sexual contact. One hundred and eighty two [84.2 percent] felt a need for sex education in the media, both print and electronic and 204 [94.4 percent] respondents said that they would like to learn more about sexually transmitted infections. One hundred ninety four [98.8 percent] respondents had heard the Latin term Luekorrhoea. Of these 158 [81.5 percent] thought it was a gynecological disease. Majority thought it caused weakness. Widespread misperceptions were found to exist, which does not augur well for the effective prevention of STls in the country. Population based studies are required to study the knowledge and epidemiology of STIs, as well as a need for a health education campaign in the country

Private practitioner survey in pakistan regarding their knowledge, attitude and practice of diseases reporting

A quick survey of the knowledge, attitude and practice [KAP] of disease reporting among private practitioners was undertaken in July 1997 to serve as a basis for discussion about the role of the private practitioners in the Early Warning System being developed by WHO, NIH and the Ministry of Health of Pakistan. One hundred and twenty one [121] physicians were interviewed from busy areas of Islamabad and Rawalpindi. Of the doctors interviewed, 85% claimed to have learned about disease reporting, either in medical college or through other avenues. Of recent medical graduates, 88% had learned information about surveillance while those who graduated before 1970 only 76.5% had studied surveillance. However, 97% over all indicated that disease surveillance would have a positive effect on public health in Pakistan. While only 19% of these private practitioners answered that they had been reporting disease. Almost all of them had useful suggestions for developing a disease surveillance system in which they could become involved

Prevalence of hypertension in punjab

To determine the prevalence of hypertension amongst the people of Punjab. Sampling design: a two stage stratified sample design was adopted for the survey, primary sampling Units [PSUs] and Secondary Sampling Units [SSUs]. Setting: Urban and Rural, Punjab 1990-1993. Subjects: Stratified systematic sample of 3991 males and females aged 18 years and above. Out of sample population 18.9% were smoker, 1.6% diabetics, 15% had high serum cholesterol level, 18.9% overweight and 4.7% were obese The prevalence of hypertension was 17.7% in adult population of Punjab. Among hypertensive 96.2% have mild hypertension 1.6% moderate hypertension and 2.2% have severe hypertension and among them 18.2% had isolated systolic hypertension, 42.3% isolated diastolic hypertension and 36.5% had combine hypertension The statistically significant association was found between hypertension and its risk factors [Blood glucose, serum cholesterol and body mass index.] No statistically significant association was detected between hypertension and smoking The prevalence of hypertension increased significantly according to increase in age. Hypertension was more prevalent among male as compare to female. The prevalence of hypertension was more in urban population than rural but this is due to high body mass index, high blood glucose and high serum cholesterol level of urban population. Among hypertensive 18.6% were aware about their hypertensive condition and only 12.5% were using antihypertensive drugs. Among antihypertensive drug user 37.9% have controlled hypertension

Gender issue neglected aspect of health promotion in Pakistan

OBJECTIVE: To identify neglected aspects of primary health care activities and propose effective strategies for better health promotion in Pakistan. METHOD: An observation study was carried out from March-July, 1998 in a low-medium income group in Karachi West in a primary health care set-up. Seventy-three% of female clients were influenced by the advice of male members of the family, 22% followed the directions of elderly female member, 5% availed health services on their own will. The Pakistani female community is influenced strongly by the male members of the family in almost all health related activities

Herpesvirus-Specific IgM antibodies in thalassaemic children

Thirty thalassemic children [22 males and 8 females] were included in this study. Thorough history and clinical examination, enzyme immunoassay [EIA] were used for detection of IgM antibodies against herpes simplex virus [HSV] types 1 and 2, cytomegalovirus [CMV] and Epstein Barr virus [EBV]. IgM antibodies for HSVI, HSVII, CMV and EBV were positive in 10%, 40%, 6.6% and 20% of the thalassemic patients studied, respectively. The prevalence was significantly higher in thalassemic patients compared with a control group of 20 children with matched age and sex [53% versus 10%] [p <0.001], and also among splenectomized compared with non-splenectomized thalassemics [60% versus 40%] [p <0.05]. Furthermore, among serologically positive patients, the incidence of symptomatic herpes infections was 33%, 42%, 50% and 50% for HSVI, HSVII, CMV and EBV, respectively. It might be concluded that patients with thalassemia are at high risk for symptomatic as well as subclinical herpesvirus infections. Reactivation of these infections may constitute an important cause of morbidity and mortality, particularly among splenectomized patients. Identification of herpesvirus infections is recommended, especially among these patients in order to institute specific antiviral therapy for serologically positive thalassemics