Social capital of Iranian patients living with acquired immune deficiency syndrome and associated factors

This study investigated the social capital of Iranian patients living with acquired immune deficiency syndrome [AIDS] and the associated factors. In a cross-sectional study the Integrated Social Capital Questionnaire was filled by a sequential sample of 300 patients visiting a referral counselling centre in Tehran. The patients' social capital scores were around 50% in the trust, social cohesion, collective action and cooperation and political empowerment domains. The groups and networks membership domain scored the lowest [27.1%]. In regression analysis, employment status was significantly associated with groups and networks membership; age, marital status and financial status were associated with collective action and cooperation; period of disease awareness and marital status affected social cohesion and inclusion; and having risky behaviour affected empowerment and political action. Efforts are needed to enhance the social capital of those patients living with AIDS who are younger, unemployed, divorced/widowed, with risky behaviours and shorter disease awareness

Carcinoma breast, late presentation: a big concern

To study the different presentation patterns and their treatment options in advanced carcinoma breast. A retrospective observational study North Surgical Ward, Mayo Hospital, Lahore, from November 2004 to April 2006. In total, 156 patients with carcinoma breast, confirmed histopathologically by biopsy and /or FNAC, were included in this study. Information was gathered from them using a structured questionnaire. The peak incidence of carcinoma breast was found to be between 31- 45 years of age. Majority of these patients presented in stage II [22%]. Maximum number of patients presented in stage III [56%]. However stage IV disease was also found in 12% of patients population. But stage I disease was least commonly presented disease [10%]. And infiltrative ductal carcinoma was the most prevalent [94%] histologic type. Modified radical mastectomy was the surgical treatment adopted in about 72% of cases with adjuvant or neoadjuvant chemotherapy. Advance stage breast lump with local or locoregional spread remained the commonest mode of presentation of carcinoma breast. And infiltrative ductal carcinoma is the commonest histologic variant. Majority of the of patients with carcinoma breast in Pakistan still present in advanced stages where almost no cosmetically more acceptable surgical procedure can be carried out

Pattern of coagulopathy in viperidae snake bite

The study was carried out in the Department of Physiology, Isra University, Hyderabad. Seventy three cases of viperidae snake bite were studied to observe the pattern of coagulopathy. All had prolonged clotting time at the time of admission. Prothrombin time was increased in 56 cases, activated partial thromboplastin time was increased in 63 cases, bleeding time was normal in all cases. Platelet count was decreased in 28 cases and fibrinogen levels were decreased in 36 cases. Disseminated intravascular coagulation was found to be the predominant pattern of coagulopathy in viperidae snake bite cases

Acute renal failure in viperidae snake bite victims

This study included 10 cases of viperidae snake bite that developed acute renal failure out of 73 cases admitted to various wards of Liaquat Medical College hospital during the last two years. All these patients reported to the hospital 3-5 days after the bite. All had signs of severe envenomation with incoagulable blood and prolonged PT and APTT. All has bleeding manifestations. Blood urea and serum creatinine were increased in all patients and four were anuric. Leucocytosis and thrombocytopenia were found in 7 cases, serum bilirubin was increased in 4 cases, 4 patients required dialysis and 4 out of 10 cases expired. Bad prognostic features included severe envenomation, leucocytosis, thrombocytopenia, and necessity for dialysis. We conclude that acute renal failure is a serious complication of viperidae snake bite with high mortality rate and it necessitates early and effective treatment

[Effects of depression on myocardial perfusion scintigraphy]

The relationship between depression and coronary artery disease is well established; however assessment of this relationship using functional and semi-quantitative imaging [myocardial perfusion scintigraphy] was lacking. The aim of this study was to assess the relationship between the severity of depression and the severity of myocardial perfusion abnormality. Patients were assessed with rest/stress 99mTc-MIBI myocardial perfusion scintigraphy using Single Photon Emission Computed Tomography [SPECT] and Beck Depression Inventory [BDI-II]. Visual and semi-quantitative assessment of myocardial perfusion score [MPS] in a five-scale measurement for standard 20-segment-model were used. When all patients [n=167] were evaluated, no correlation was found between MPS and BDI-score. Considering only those with significant perfusion abnormality [MPS<90, n=38], negative correlation was found between MPS and BDI score [r= -0.641, p=0.017]. Also higher BDI scores were recorded for patients with inferior wall infarction when compared with those with normal or near-normal MPS [MPS>95] [p=0.097], but other myocardial walls failed to show such association. In patients with significant perfusion abnormality, the greater is this abnormality the more severe is the depression. Also patients with inferior wall infarction, have a higher BDI-score as compared with normal subjects

[Agreement of two methods of planar and SPECT scintigraphy with 99mTc- RBC in detection of liver Hemangioma]

Hemangiomas are the most frequent benign tumors of the liver and detecting them from metastasis or other malignant hepatic tumors is of outmost importance. 99mTc- RBC scan is highly specific and is the method of choice for this differentiation. This scintigraphy is performed in Planar and SPECT modes. These two procedures are in agreement most of the times, however since SPECT is more expensive and time consuming we planned a study to evaluate the agreement of these two methods. Sixty two patients [age range 20-80 yr, mean age 42 yr], 41 female [67%] and 20 male [33%], who were under evaluation for liver mass detected on abdominal ultrasound or CT scan, underwent 99mTc- RBC scan with both Planar and SPECT methods. The data was processed by computer and SPSS software [11.5]. Planar scan was positive in 42% and negative in 59% of cases, while for SPECT study these values were 68.9% and 31.1%, respectively. The Kappa value for planar and SPECT scan results was 48%, and there were 17 lesions [27%] which were detected only by SPECT. SPECT scan defined 35% of the posteriorly located hemangiomas, and 58.3% of hemangiomas smaller than 3 cm, which were not detected by planar scans. Also 75% of patients with multiple hepatic lesions showed more lesions by SPECT as compared to planar scan. Since there is a weak agreement between SPECT and Planar scan, SPECT is considered the more reliable method in diagnosis of liver hemangioma and this is especially true when the hemangioma is of small size, has a posterior location or in cases of multiple lesions

Study on the sources of nosocomial fungal infections at intensive care unit and transplant wards at a teaching hospital in Tehran

The incidence of nosocomial fungal infections has increased dramatically during the past two decades as the consequence of continuous increase in the number of severely immunocompromised patients. This study was done to determine the presumptive sources of nosocomial fungal infections at the intensive care unit and transplant wards [in a university- based teaching hospital in Tehran] during a 10-month period. Totally 583 samples were obtained from the air, surfaces, health care workers and also from the patients at those wards. Mycological culture of the samples yielded growth of 25 different genus and species of fungi and the most common isolated fungi were Candida albicans, Penicillium spp., Aspergillus niger, and Cladosporium spp., respectively. It was noted that health care workers were carrying fungi on their hands [50%], nasal mu-cosa [57.6%], in oral cavity [38.6%] and also by their shoes [92.3%] and uniforms [92.7%]. Environmental fungal contamination was shown and it was more prominent at the intensive care unit. Hospitalization also had more significant effect on colonization of fungi in the patients at the latter ward. Therefore, the highly susceptible patients in present study were at the greatest risk of developing fungal infections and preventive measures were critical for prevention and control of these life-threatening fatal infections

Outbreak of dengue haemorrhagic fever in Karachi

In 1994, there occurred two separate outbreaks of febrile illness in Karachi. These were characterized mainly by thrombocytopenia. Haemorrhages were observed in number of cases. This prospective study included 120 cases who dropped their platelet count below 100,000/cmm. All were adult males with the mean age of 27.1 years. Duration of fever was 3.14 days [mean 7.5]. Vomiting and nausea were seen in 77.5% and 59.1% cases. Myalgias, headache and backache were other common symptoms. Haemorrhages were found in 53.3% cases with epistaxis in 17% and bleeding gums in 14.1%. Platelets were between 90,000 to 100,000 in 23.3%, in 42.6% cases count was between - 50,000 - 90,000 and below 50,000 in 34.1% with the mean count of 58000/cmm. In 1994, six out of seven sample processed were positive for antibodies against dengue type II. In 1995, 15 out of 34 samples tested were positive for the same dengue type. One patient died of myocariditis. Rest of patients recovered. Occurrence of dengue fever in Karachi has been documented and this should now be considered in the differential diagnosis of undiagnosed cases of fever. Myocarditis as cause of death in dengue fever has also been documented inviting further research and discussion

Stroke in young adults: identification of risk factors and prognosis

The present study was undertaken to identify stroke risk factors in young adults and prognosis of stroke. The subjects included eighty six stroke patients at or below the age of 45 years. Most important risk factors prevalent in young adults were found to be hypertension [37%], diabetes mellitus [20%], smoking [22%], obesity [14%], heart disease [10.5%], hypercholestraemia [11.6%], psychogenic stress [23.2%] drug addiction [7%], and peurperium [3.5%]. In about 35% cases, no definite risk factor was found. Features predicting poor prognosis included haemorrhagic stroke, severe hypertension, uncontrolled diabetes mellitus, papillary abnormalities and post stroke seizures. Over all mortality rate was 12%

Inadequate postprandial compensatory tachycardia in elderly people

The effects of aging on cardiovascular and autonomic systems were evaluated through postprandial baroreceptor activity comparison between a group of young adults [n=20] and a group of elderly subjects [n=50.] through measurements of pulse rate, which is an indicator of baroreceptor activity. Significant rise of pulse rate was observed in the young adults at 15, 30, 45 and 60 minutes after meal, while similar postprandial compensatory tachycardia was not found in the elderly group. The mean differences in pulse rate in young adult group at 15, 30, 45 and 60 minutes after meal were 2.05 +/- 0.28, 5.90 +/- 0.37, 5.95 +/- 0.37 and 3.60 +/- 0.42 beats/minute respectively, while the same values at the same time intervals in elderly subjects were 0.48 +/- 0.31, 1.14 +/- 0.54, 0.06 +/- 0.34 and -0.36 +/- 0.26 beats/minute respectively. Highly significant differences [p< 0.001] were observed in the values at all postprandial time intervals between the two groups

Ventilatory lung functions and total serum IgE in bronchial asthma

Ventilatory lung functions offer a useful tool in the diagnosis of pulmonary diseases, assessment of their severity and response to therapy. Whereas, total serum IgE levels can be used to differentiate the allergic individuals from the non-allergic patients. Present study was planned to ascertain the levels of total serum IgE and ventilatory lung functions in the healthy control and asthmatic subjects attending the Out-Patient Department of Thoracic Medicine at J.P.M.C. Fifty healthy controls and an equal number of asthmatics were investigated for the ventilatory lung functions using Autospiro [model AS-500] spirometer. The estimation of total serum IgE was carried out by the enzyme immunoassay. The current data revealed the higher levels of total serum IgE; 195.26 26.21 IU/ml [Mean + SEM] in the native healthy adults as compared to the data available in the European population. The level of total serum IgE in 72% of asthmatic patients was found to be 1383.83. 338.00 IU/ml [Mean +/- sem] which was significantly higher as compared to those obtained from the controls in the similar age and sex group. Such asthmatics exhibited a significant decline [P < 0.01] in ventilatory lung functions [FVC, FEV1, FEF 25-75% and PEF]. The present data suggest that IgE is related to the environmental, geographical and allergic conditions. Furthermore, the impairment of ventilatory functions is associated with the raised levels of total serum IgE in large number of asthmatics which indicates the fundamental role of the immunoglobulin

Maximum mid expiratory flow rate: a better index of detection of early small airway obstuction than FEV1 in healthy smokers

Expiratory spirometry was performed on forty Male asymptomatic smokers of different age groups. Maximum Mid expiratory flow rate [MMFR] and forced expiratory volume first second [FEV1] were recorded. It was found that MMFR shows a significant decrease in smokers as compared to the control subjects; FEVI was found to be within normal predicted values in most of the cases. These results suggest that MMFR is a more sensitive and better test in detecting early changes in the small airways of healthy smokers than FEVI