Risk factors and outcome in 114 young stroke patients

Incidence of young stroke is increasing world wide and it is important to identify the precipitating factors for prevention of stroke. This study was conducted to identify the risk factors and outcome of stroke in young patients who were admitted to Civil Hospital Karachi. It is a descriptive correlational study. The young stroke patients who were admitted in neurology and all medical units of Civil Hospital Karachi from 2003 to 2005 were evaluated for the factors responsible for stroke and their outcome. 114 young stroke patients were included in this study who were clinically diagnosed as a case of stroke and their lesions were confirmed through CT/MRI of brain .Non-stroke lesions presented as motor neurological deficit were excluded. Detailed clinical history, comprehensive neurological examination, CT/MRI of brain and in certain cases conventional cerebral angiography was done. The sample contained 79 males and 35 females. Hypertension was the most common risk factor: The other risk factors were smoking, hyperlipidemia and family history of stroke. Cerebral infarction was diagnosed in 78[68.4%] patients and intracerebral hemorrhage/sub-arachnoid hemorrhage was seen in 36 [31.6%]. Small vessel occlusion was common than large artery atherosclerosis. Hypertensive intracerebral hemorrhage was the most common sub-type of intra cerebral hemorrhage. 47.3% patients were discharged as independent, 31.6% as dependent and 21.1% died. The frequency of hypertension and hypertensive intracerebral hemorrhage suggests accelerated hypertensive arteriolar damage, possibly due to poor control of hypertension. The causes of stroke among young adults are more diverse than in the elderly and require a thorough diagnostic work up for further prevention of stroke

Effects of Captopril on cirrhotic patients with refractory ascites: a preliminary report

To determine the effect of Captopril on cirrhotic patients with refractory ascites. A prospective study of effect of Captopril on twelve patients with biopsy proven liver cirrhosis with refractory ascites over a period of two weeks. Setting: Medical Unit IV, Civil Hospital Karachi. Twelve patients, eight males and four females, between the ages of 23 to 59 years with biopsy proven liver cirrhosis and ascites not responding to intense diuretic therapy. All patients had serum albumin > 2.5 gm/dl. None of the patient had SBP or electrolyte imbalance. All patients were given 12.5 mg/day to 25 mg/day Captopril along with Spironolactone and Furosemide. Reduction of body weight and increase in 24 hours urine output after two weeks of Captopril therapy along with diuretics. After starting of Captopril at a dose of 12.5 mg/day and then increases to 25 mg/day after one week along with Spironolactone and Furosemide, the body weight reduced to 1.2 kg [mean] from the initial pre-treatment weight at the end of first week, and 2.3 kg at the end of second week. The 24 hours urine output increased from 1.4 L to 1.6 L and 1.8 L after the first and second weeks of treatment respectively, which is an increase of 0.4 L in 24 hours. The blood pressure and serum electrolytes showed no significant variation. There were no major adverse effects apart from a non-significant dry cough in six patients. Captopril along with diuretics has a beneficial effect on cirrhotic patients with refractory ascites