Platelet indices among subjects with and without diabetes mellitus and hypertension: a cross-sectional analysis at Karachi, Pakistan

Objective: to measure differences of platelet indices in subjects with and without diabetes mellitus and hypertension

Methodology: this was a cross-sectional analysis from Jan-11 to Feb-2012. From a target population of non-pregnant adult subjects being advised a fasting blood glucose or OGTT for confirming or excluding diabetes, we finally selected 820 individuals for inclusion into study. Fifty known diabetics were also included in the study. Subjects were formally interviewed and sampled for fasting blood glucose, and platelet indices [including platelet count, platecrit [PCT], mean platelet volume [MPV] and platelet distribution [PDW]. The results of platelet indices were compared between 4 groups based on OGTT. Platelet indices were also compared between groups based upon post-load glycemic status and hypertension

Results: age and MPV showed slight positive and significant correlations with fasting blood. [Age: r2=0.117 [p<0.001] and MPV: r2=0.116 [P=0.001]; other platelet indices did not show significant correlations. Out of the 4 platelet indices studied, MPV and PCT were found to significantly increase from normoglycemia to individuals with established diabetes mellitus in one way ANOVA analysis. Subjects demonstrating post load hyperglycemia [n=47] had higher mean platelet volumes than individuals having post load normoglycemia [n=30] [MPV: 9.63 + 1.51vs 8.90 + 0.98, p=0.012]. Hypertensive subjects did not demonstrate higher MPV results than normotensive subjects in our study

Conclusion: mean platelet volume and platecrit increases across various grades of hyperglycemia. However, the changes become quite prominent in subjects having established diabetes with marked hyperglycemia. Post load hyperglycemia was more predictive of rises in mean platelet volumes

Relationship between platelet indices and lipidemias: a cross-sectional study at Karachi

To compare platelet indices among patients with low and high levels of cholesterolemia and triglyceridemia. This cross-sectional study was conducted from January 2011to May 2012 at the departments of pathology, PNS Rahat and Baqai medical and dental university, Karachi. A total of 867 subjects presenting for estimation of fasting triglycerides and total cholesterol were selected after excluding patients receiving anti-platelet or lipid medication, pregnancy, acute in factious disorders. They were interviewed, examined and sampled for measurement of total cholesterol, triglycerides and platelet indices including total platelet count, mean platelet volume [MPV], platelet distribution width [PDW] and platecrit [PCT]. The results of platelet count and mean platelet volume were found to be significantly different among subjects with normal cholesterolemia [<5.2mmol/L], borderline raised cholesterol group [5.2-6.3 mmol/L] and hypercholesterolemia [>6.3 mmol/L]; however, post-hoc comparison did not show any significant difference between all groups. Using age as a variable and segregating total cholesterol results into 7 groups, starting from very low cholesterol values [<4.0 mmol/L] to highest [>6.5 mmol/L], in a univariate general linear model, higher mean platelet volume were observed at the extremes of cholesterolemia groups [p=0.039]. A similar trend was observed for platelet count after adjusting for age, where low levels of platelet levels were associated with hypocholesterolemia and hypercholesterolemia [p=0.021]. Higher MPV and low total platelet counts were associated with the observed extremes of cholesterol range. No significant differences were observed for platelet indices across various groups formulated based upon fasting triglycerides

Knowledge regarding the transmission of hepatitis-B, hepatitis-C virus infection and HIV among patients attending medical outpatient department at Nishtar hospital, Multan

To assess the level of knowledge regarding the transmission of hepatitis-B, hepatitis-C and HIV among the patients of medical outpatient department, Nishtar Hospital, Multan. Patients attending Medical outpatient department, Nishtar Hospital, Multan were interviewed in this cross-sectional study for the assessment of knowledge regarding the spread of Hepatitis B, Hepatitis C and .HIV. A total of 350 patients attending medical outpatient department were interviewed. Of these participants, 208 [59.4%] were males and 142 [40.6%] were females. Mean age of the participants was 35.15 +/- 6.57 years. Three [0.85%] were familiar with only hepatitis B, Three [0.85%] with only hepatitis C and 3 [0.85%] with only HIV and 290 [82.8%] were familiar with all three diseases while 51[14.5%] were unfamiliar with these diseases. Two hundred and sixty eight [16.6%] participants were knowing that these diseases could be transmitted by syringes while 265 [75.7%] by needles. Two hundred sixty one [74.6%] were knowing that these could be spread by the transfusion of contaminated blood, 217 [62%] knew that these could be spread by dental procedure with contaminated instruments, 233 [66.6%] reported that by unsafe sex, 169 [48.3%] by tattooing, 196 [56%] by ear/nose piercing, 261 [74.6%] by infected razors and 198 [56.6%] knew that these could be transmitted by mother to newborns. Knowledge regarding the spread of hepatitis B, C and HIV was found to be low in our study population which emphasizes the need for strong awareness campaigns and programs to address this issue

Efficacy and Complication of misoprostal for second tremester pregnancy termination among primigravida versus multigravida

To compare the efficacy and complications of Misoprostol for Second Trimester Pregnancy termination among primigravida and multigravida. It was a prospective study conducted at Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital, Bahawalpur. The study was done in the period from June 2008 to February 2009. One hundred and twenty pregnant women at 14-24 weeks of gestation divided into two groups viz. Group 1: Primigravida and group 2: Multigravida. Patients needing terminations of pregnancy were 10%. The data was collected on a specially designed proforma. It was analyze on SPSS version 13.0.0. Chi-square test was applied to determine the statistical significance. The mean age of primigravida was 22.57 years as compared to that [27.37 years] of multigravida. The mean gestational age was comparable in both groups. The mean induction expulsion interval found in primigravida was 15.59 hours and in multigravida 9.13 hours. The complications like dead fetus, pelvic infection, coagulopathy, rupture, incomplete abortion were less among multigravida as compared to primigravida. Our study concludes that use of Misoprostal for second trimester pregnancy termination is cost effective and easy to administer among primigravida and multigravida. The complications like pelvic infection are less common among the multigravida

Frequency of hyperuricemia in patients with ischemic heart disease

To determine the frequency of hyperuricemia, as a risk factor, in patients with ischemic heart disease in our setup. This prospective and observational study was carried out in the Departments of cardiology, medical unit III and pathology, Peoples Medical College and Hospital, Nawabshah from 15[th] January 2007 to 15[th] July 2007. Fifty patients, of any age and of either sex, diagnosed on ECG as ischemic heart disease [IHD] were selected and compared with serum uric acid [SUA] levels and age, sex, approximately body mass index [BMI] matched healthy controls. SUA was measured on 3[rd] day of admission by using enzyme uricase method on CLINIKON photometer 5010. Hyperuricemia was found in 27 out of 50 IHD patients and in 5 out of 50 controls; therefore a highly significant association was observed. Mean SUA level was 7.21 +/- 2.14 in patients with ischemic heart disease and 5.38 +/- 1.26 was found in healthy control subject. The difference between these two means was highly significant [P<0.0001]. Hyperuncemia significantly associates with IHD. It does not cause t IHD, neither is an independent risk factor but it only accelerates the process of atherosclerosis which can worsen the preexisting IHD

Profound swim stress-induced analgesia with Ketamine

The potential of ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, in preventing central sensitization has led to numerous studies. Ketamine is increasingly used in the clinical setting to provide analgesia and prevent the development of central sensitization at subanaesthetic doses. However, few studies have looked into the potential of ketamine in combination with stress-induced analgesia. This study looks at the effects of swim stress, which is mediated by opioid receptor, on ketamine analgesia using formalin test. Morphine is used as the standard analgesic for comparison. Adult male Sprague-Dawley rats were assigned to 6 groups: 3 groups (stressed groups) were given saline 1ml/kg intraperitoneally (ip), morphine 10mg/kg ip or ketamine 5mg/kg ip and subjected to swim stress; 3 more groups (non-stressed groups) were given the same drugs without swim stress. Formalin test, which involved formalin injection as the pain stimulus and the pain score recorded over time, was performed on all rats ten minutes after cessation of swimming or 30 minutes after injection of drugs. Combination of swim stress and ketamine resulted in complete analgesia in the formalin test which was significantly different from ketamine alone (p<0.05) and saline with stress (p<0.01). There is no significant difference between ketamine stressed and morphine stressed. These results indicate that ketamine and swim stress act synergistically to produce profound analgesia in the formalin test. This suggests that in the clinical setting, under stressful situations such as operative stress, ketamine is capable of producing profound analgesia at a subanaesthetic dose.