Risk factors in various subtypes of ischemic stroke according to TOAST criteria

To identify the frequency of risk factors in various subtypes of acute ischemic stroke according to TOAST criteria. Cross-sectional, observational study. Ziauddin Hospital, Karachi, from January to December 2007. Ziauddin Hospital, Karachi, from January to December 2007. Patients with acute ischemic stroke were enrolled. Studied variables included demographic profile, history of risk factors, physical and neurological examination, and investigations relevant with the objectives of the study. Findings were described as frequency percentages. Proportions of risk factors against subtypes was compared using chi-square test with significance at p< 0.05. Out of the 100 patients with acute ischemic stroke, mean age at presentation was 63.5 years. Risk factor distribution was hypertension in 85%, Diabetes mellitus in 49%, ischemic heart disease in 30%, dyslipedemia in 22%, smoking in 9%, atrial fibrillation in 5%, and previous history of stroke in 29%. The various subtypes of acute ischemic stroke were lacunar infarct in 43%, large artery atherosclerosis in 31%, acridoembolic type 8%, stroke of other determined etiology in 1% and stroke of undetermined etiology in 18%. Hypertension and Diabetes were the most association was found with ischemic heart disease [p=0.01]. Importance and relevance of risk factors evaluated for subtypes rather than ischemic stroke as a whole should be reflected in preventive efforts against the burden of ischemic stroke

Risk factors for stroke: a hospital based study

Stroke is the commonest neurological cause of morbidity and mortality all over the world being the third leading cause of death. The goal of this study was to ascertain the frequency of risk factors for first ever stroke in our patients. This prospective study included all patients of either sex, 20 to 70 years and above admitted in Dr. Ziauddin Medical University Hospital, North Nazimabad Campus, Karachi, with first ever stroke verified by CT scan brain during a period of one year. Data analysis showed that 70.1% had cerebral infarction and 29.9% cerebral hemorrhage. The mean age at presentation was 62 years and male to female ratio 1.05:1.The most frequent risk factors included hypertension 65.8%, smoking 43%, diabetes mellitus 41.3%, underlying cardiac diseases 29.1%, family history of stroke/transient ischemic attack in the first-degree relatives 26.7%, high cholesterol 25.5%, history of past transient ischemic attack 24.9% and significant extracranial carotid atherosclerosis in 18.18%. In-hospital mortality was 11.7%. At 30-day follow up 22.27% of all stroke survivors were functionally independent. This study suggested that diabetes mellitus was more and underlying cardiac diseases less frequent in our patients than in the western reported series. Cerebral hemorrhage was relatively morecommon and the mean age at presentation was lesser compared to those in the developed countries. Stroke patients consume a large part of health resources all over the world so accurate information about the incidence, risk factors, management and outcome is needed for planning medico-social services besides primary and secondary stroke prevention in the community

Esophageal motility disorders in diabetics with and without neuropathy

To detect the presence of esophageal motor disorders in diabetic patients, and to establish whether there is any difference between patients with and without neuropathy. Fifty-six diabetic patients admitted at Department of Medicine at Ziauddin Medical University Hospital, Karachi were selected to observe if manometeric findings were different in diabetic patients with and without diabetic neuropathy. Poor glycemic control was observed amongst patients with diabetic neuropathy as compared to those without neuropathy. Double peaked peristalsis and failure of peristalsis was more common in patients with diabetic neuropathy as compared to those without neuropathy. High amplitude and broader wave peristalsis and hypertensive lower esophageal sphincter was found in patients without neuropathy. Aperistalsis and multiple peaked waves were equally prevalent in patients with and without neuropathy. Poor glycemic control was found in patients with diabetic neuropathy, double peaked and failed peristalsis was the most common manometric abnormality among them

Evaluation the outcome of stroke: a prospective hospital based study

This study was aimed to determine the functional outcome after stroke and to assess the influence of various factors on acute in-hospital stroke mortality. This prospective study included 281 stroke patients of either sex, 20 to 70 years and above admitted in Dr. Ziauddin Medical University Hospital, North Nazimabad Campus, Karachi, during a period of one year. Main outcome measures used were Glasgow Coma Scale [GCS] and Modified Rankin Scale [mRS]. Data analysis showed that in-hospital mortality was 11.74% [n=33/281]. Age and gender had no adverse effect on acute mortality in this study while poor initial GCS; hemorrhagic stroke and all the studied risk factors were bad prognostic factors. At the end of one month, 32 patients were lost to follow-up and mortality was 13.5% [n=5/216] while excellent outcome was observed in 22.27% [n=47/216] and poor outcome in 77.72% [n=164/216] of patients. This study confirms the significant morbidity and mortality associated with stroke and shows the need in preventing and controlling the risk factors for early death

Factors determining outcome of acute renal failure patients

Acute Renal Failure [ARF] is a common medical problem. Delay in diagnosis is associated with increased mortality. Variety of conditions can lead to ARF. Many factors can influence the outcome of ARF. This study was done to find the predictive factors related to outcome of ARF. One hundred adult patients of acute renal failure admitted to Ziauddin Hospital were studied. Certain factors related to outcome of ARF were identified and analyzed. Among such factors oliguria, levels of urea, creatinine and potassium were found significant poor prognostic predictors on univariate analysis as far as outcome of treatment modality is concerned. The multivariate analysis revealed that the presence of oliguria is the only significant independent predictor [P<0.001] for good outcome with dialysis. Oliguria was found to be the major predictor of non recovery of renal function

Esophageal motility disorders in diabetics

To see the presence of esophageal motor disorders in diabetic patients and compare it with controls at the Department of Medicine Ziauddin Medical University Hospital, Karachi. Diabetic patients admitted at Ziauddin Medical University Hospital, Karachi were taken as study subjects, whereas age and sex matched healthy volunteers not suffering from any disease neither taking any medication for dyspepsia were taken as controls Esophageal manometry was done to see the motility disorders in diabetic patients and controls. Resting pressure of the lower esophageal sphincter in diabetics was similar to controls. Percentage of relaxation of the lower esophageal sphincter was low in diabetics. Amplitude of esophageal peristalsis and duration of contraction was similar in both the groups. Propulsive velocity of peristalsis was slower in diabetics. Parameters of upper esophageal sphincter were similar in diabetics and controls. Abnormal peristaltic waves like aperistalsis of the esophageal body, high amplitude and broader waves, absent contraction and hypertensive lower esophageal sphincter were seen in diabetics only. Poor relaxation of the lower esophageal sphincter and slow propulsive velocity were noted in diabetics. Abnormal peristaltic waves like aperistalsis of the esophageal body, high amplitude and broader waves, absent contraction and hypertensive lower esophageal sphincter were seen in diabetics only