Association of TLL1 gene polymorphism [rs1503298, T > C] with coronary heart disease in PREDICT, UDACS and ED cohorts

To determine the sequence variant of TLL1 gene [rs1503298, T > C] in three British cohorts [PREDICT, UDACS and ED] of patients with type-2 Diabetes mellitus [T2DM] in order to assess its association with coronary heart disease [CHD]. Analytical study. UCL, London, UK. Participants were genotyped in 2011-2012 for TLL1 SNP. Samples and related information were previously collected in 2001-2003 for PREDICT, and in 2001-2002 for UDACS and ED groups. Patients included in PREDICT [n=600], UDACS [n=1020] and ED [n=1240] had Diabetes. TLL1 SNP [rs1503298, T > C] was genotyped using TaqMan technology. Allele frequencies were compared using c2 test, and tested for Hardy-Weinberg equilibrium. The risk of disease was assessed from Odds ratios [OR] with 95% Confidence Intervals [95% CI]. Moreover, for the PREDICT cohort, the SNP association was tested with Coronary Artery Calcification [CAC] scores. No significant association was found for this SNP with CHD or CAC scores in these cohorts. This SNP could not be confirmed as a risk factor for CHD in T2DM patients. However, the low power of thesmall sample size available is a limitation to the modest effect on risk. Further studies in larger samples would be useful

Methods to reduce prescription errors in ophthalmic medication

The purpose of this audit was to determine the most common medication related prescription errors in ophthalmic practice, to determine avoidable prescription errors and evaluate the effect of preventative methods against these errors. The first audit was conducted prospectively over a four week period in Oct 2009 and a re-audit after 6 months on May 2010, to determine the effects of preventative measures suggested in the first audit. There were 4.7% [29/623] prescription errors during the initial four week audit period. A method of check and counter check of prescriptions was implemented and re-audit showed a reduction in incidence of errors to 0.77% [5/651] errors. The majority of prescribing errors occurred at the stage of writing the prescription and our findings suggest that the intervention of check and counter check can reduce the rate of error significantly.

Prevalence of microalbuminuria with relation to glycemic control in type-2 diabetic patients in Karachi

Diabetes is one of the most common endocrine disorders characterized by hyperglycaemia. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. The present study was conducted to determine the prevalence of microalbuminuria in relation to duration of diabetes, BMI, Serum Creatinine and HbA1c in an ethnic group of Type 2 diabetes mellitus residing in Karachi. This cross-sectional descriptive study was carried out in a community diabetic centre, located at Garden East Karachi from July to December 2007. One hundred known Type 2 diabetic patients with age 30- 70 years were included in the study. Informed consent and a structured questionnaire of each patient were recorded. Fasting venous blood and morning urine sample was collected for analysis of creatinine, HbA1c and microalbuminuria respectively. Statistical analysis was done using SPSS version 13.0. Pearson correlation was applied to observe association of microalbuminuria with different parameters. All p-values <0.05 were considered as statistically significant. Microalbuminuria had a highly significant correlation with duration of diabetes, serum creatinine [p<0.001], HbA1c [p<0.05] and BMI [p<0.024]. A strong correlation exists between age and serum creatinine [r=0.73]. The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control [high HbA1c>7%] or heredity factors. Screening for microalbuminuria and HbA1c test should be done in both newly and already diagnosed Type 2 diabetic patients as an early marker of renal dysfunction and glycaemic control

Predictors pf ischemic versus hemorrhagic strokes in hypertensive patients

To identify the factors that predispose to ischemic versus hemorrhagic stroke in hypertensive patients. Cohort study. The study was conducted at the Aga Khan University Hospital [AKUH], Karachi, from August 1999 to May 2001. All the hypertensive patients, who were registered in AKUH acute stroke outcome data base, over a period of 22 months, were identified and from this cohort the patients with first ever stroke were selected. The data regarding demographics, stroke type [ischemic vs. hemorrhagic], pre-existing medical problems, laboratory and radiological investigations was recorded and analyzed. Five hundred and nineteen patients with either ischemic stroke or parenchymal hemorrhage were registered over a period of 22 months. Three hundred and forty-eight patients [67%] had hypertension and of these, 250 had first ever stroke at the time of admission. Presence of diabetes mellitus [OR: 3.76; CI: 1.67-8.46] and ischemic heart disease [OR: 6.97; CI: 1.57-30.98] were found to be independent predictors of ischemic strokes. Presence of diabetes mellitus and ischemic heart disease predict ischemic stroke in a patient with hypertension

Spetrum of complications and mortality of bacterial meningitis: an experience from a developing country

The aim of this study was to obtain data on predisposing factors, causative organisms and their associated mortality and complications related to acute bacterial meningitis. The chart review of all patients in whom acute bacterial meningitis was diagnosed at The Aga Khan University Hospital from January 1995 through December 2001. One hundred ninety-four patients were included in study. There were 146 males and 48 females. The mean age of our study population was 41 +/- 12.3 years. One hundred and ninety [97.9%] patients had communityacquired meningitis-, only 4 [2.0%] patients developed meningitis nosocomially. The two most common predisposing factors were diabetes mellitus [13.9%] and otitis media [7.7%] among all 194 patients. A significant proportion of patients with complications had diabetes mellitus [24.6%, p<0.001]. CSF and blood cultures were positive in 53 [27.3%] and 42 [21.6%] patients respectively-, there was no statistical difference found. The most common organisms isolated were Streptococcus pneumoniae in 35 [36.8%] patients followed by Neisseria meningitides in -30 [31.5%] -patients. Approximately 68% of -positive cultures -yielded S. pneumoniae and N. meningitides [p<0.0001]. The overall mortality rate was 22.1%. The mortality rate for Streptococcus pneumoniae was 17.1%. The highest mortality was observed in patients with Pseudomonal meningitis where all four patients expired followed by mortality rate of 85.7% in Escherichia coli afflicted patients [p<0.001]. Complications occurred in 73 [37.6%] patients with persistent complications in 31 [42.4%] patients. Complications resolved in 34 [46.5%] patients. The most common complications were seizures [12.8%] and cranial nerve palsies [11.3%]. Seizures were more likely to occur in older patients [p<0.05] whereas hydrocephalus was more common in younger patients [p<0.05]. Bacterial Meningitis remains a serious disease associated with substantial morbidity and mortality. Most cases are community acquired with S. Pneumoniae being the most common pathogen. Old age, diabetes mellitus, a positive culture, seizures as a complication and late stage in the disease are the important predictors of a poor outcome

Ischemic stroke subtypes in Pakistan: the Age Khan University stroke data bank

Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital. We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi. A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 [42.7%]; large artery atherosclerosis 106/393 [26.9%]; cardioembolic 24/393 [6.1%]; undetermined 80/393 [20.3%]; and other determined types 15/393 [3.8%]. The high proportion of lacunar strokes in our population may be due to high burden of inadequately treated hypertension and diabetes. Clear cut cardioembolic stroke was relatively infrequent in our population. Lacunar stroke is the most common subtype of stroke in our patient population. This is most likely secondary to uncontrolled hypertension

Should carotid endarterectomy be performed for symptomatic carotid stenosis in Pakistan?

The risk of stroke and death associated with carotid endarterctomy is operator dependant. Data regarding risks of this procedure are not available in Pakistan and therefore it is difficult to make accurate risk benefit analysis for individual patients. Our objective was to determine safety of carotid endarterectomy at an academic tertiary care center in Pakistan. Patients who underwent carotid endarterectomy [CEA] at our hospital during a ten-year period were identified through ICD-9 coding system of the hospital medical records. Demographic features, associated medical problems and immediate postoperative complications were recorded and analyzed. Sixty-three carotid endarterectomies were performed on 59 patients. Ages range from 43 to 80 [mean 61 +/- 8] years; 53 were male and 10 were female. Common associated diseases among these patients were hypertension; 38 [64.4%], ischemic heart disease; 26 [44%], diabetes mellitus; 24 [40.7%], dyslipidemia; 19 [32.2%] and renal insufficiency; 13 [22%]. Most common complication was neuropraxia [transient neuropathy]; 5 [7.9%], followed by pneumonia and stroke; each in 3 [4.8%] patients. None of the strokes related to the surgical procedure were disabling. Two of the patients who had stroke, recovered fully within 17 weeks and one recovered partly but was independent in all daily activities of living [ADLs]. One patient died following simultaneous coronary artery bypass graft [CABG] and CEA. The risk of stroke or death for patients undergoing CEA was high with simultaneous CABG [3/11, 27%] and low for patients undergoing CEA alone [1/52, 2%]. Carotid endarterectomy is a safe procedure in patients with symptomatic carotid stenosis at our hospital and should be performed, when indicated

Recurrent ethmoidal polypi; a prospective study

OBJECTIVE: To evaluate the various aspects of recurrent ethmoidal polypi and to ascertain the treatment modality for them with the least recurrence. DATA SOURCE AND PERIOD: The study is conducted in 110 patients over two years period [Feb 1995 to Jan 1997], presented in the OPD of the Holy Family Hospital Rawalpindi with Recurrent Ethmoidal Polypi. METHODS: A performa was allocated to every patient to record, present and past history of the disease. H/O allergy, upper respiratory tract infections and family history. Previous treatment modalities either medical or surgical and number of recurrences were noted. Through ENT examination and relevant investigations were carried out. There is predominance of male [68%], adult patients [70%]. Most of the patients presented in winter season, with nasal obstruction 87%, Rhinorrhoea 81%, PND 49%, Sneezing 43% and Headache 42% etc. Previously the patients had conservative treatment 25% and simple polypectomies 64%. Recurrence was treated with medical treatment [anti histamines and topical steroids etc], with about 52.7% success. Repeated polypectomy followed by topical steroids is 60% successful 4 patients required external ethmoidectomy followed by antihistamines with 100% results. in most of the patients recurrence of polypi can be treated by medicinal and meticulously performed simple polypectomy followed by antihistamines and or local steroids. About 5 to 10% patients require extensive surgical operations. External ethmoidectomy is the final court of appeal with 100% results

Asymmetrical tonsils: Clinical, microbiological and histopathological evaluation

In this study, the different causes of the asymmetrical tonsils are ascertained with histopathological examination. Tonsillar surface bacteriological examination and histopathological picture are also compared. There is no correlation between tonsillar surface bacteriology and histopathological examination done after tonsillectomy. While the chronic tonsillitis [non-specific] is the commonest cause, tuberculosis of the tonsils is not uncommon, presenting as asymmetrical tonsils, in Pakistan

Serum tocopheral levels in brucellosis

The levels of various isomers of Tocopherol, a known effecter molecule influencing immune response of host to infectious agents, in sera of patients with brucellosis were measured by utilising high pressure liquid chromatographic techniques and compared with matched controls. Analysis of the results obtained revealed that in patients with brucellosis, serum levels of tocopherol were either markedly reduced or totally absent. These results suggest that the observed decrease or total lack of tocopherol in patients with brucellosis may result in an increase in the invasive disease causing ability of infecting organism, consequently promoting its survival in the host

Normal values for serum alpha-fetoprotein in a regional Arab population

By employing methodology based on enzyme linked immunosorbent assay [ELISA], normal reference values for serum alpha fetoprotein [AFP] in healthy males and non-pregnant females were determined. AFP levels in serum ranged from 0 to 11.5ng/ml for healthy males and from 0 to 12.78ng/ml for healthy non pregnant females.these values covered 95 percentile confidence limit and were similar to those reported for the population of Western Hemishere

Endoscopic management of posterior urethral disruption associated with fracture pelvis

We managed 4 cases of posterior urethral disruption following fracture pelvis, by endoscopic realignment, 11 to 14 days after injury. We used rigid endoscopes through suprapubic tract and distal urethra, for the procedure. A guide wire was passed through suprapubic cystoscope into the urinary bladder and across the disrupted posterior urethra into the distal urethra. Silicone Foleys type catheter was passed per urethra over guide wire into the bladder for 4 weeks. Intermittent self catheterisation was advised for 6 months after removal of urethral and suprapubic catheters. Good results were achieved in 3 cases, who are stricture free, continent and potent. One patient is stricture free, potent but is incontinent of urine. This technique has reduced morbidity rate and does not adversely affect subsequent ureqthroplasty, if so required

normal range reference for peripheral blood lymphocyte subsets in regional Arab population

By utilising monoclonal antibodies, relative proportion of peripheral blood B and T lymphocytes subsets found in healthy regional Arab population were analysed and normal reference ranges within 2.5 to 97.5 percentile were established. The reference ranges for the B-lymphocytes, total T-lymphocyles [CD 3], T-helper/ind ucer cells [CD 4] and T-suppressor/ cytotoxic cells [CD 8] were 2.84 - 11.65, 64.50 - 86.87, 38.50 - 56.44 and 19.11 - 33.72 percent respectively. These values are similar to those reported for western populations