Eczema; frequency of different types in a tertiary care hospital

Objectives: To determine the frequency of different types of eczema in patients presenting in a tertiary care hospital. Study Design: Cross sectional descriptive type of study. Setting: Hamdard University Hospital Karachi. Period: January 2013 till December 2013

Patients and Methods: All new cases of any type of eczema were registered by nonprobability convenient sampling. Total 192 patients of both genders and all ages were enrolled after taking informed consent. Diagnosis was made on detailed history and clinical examination by consultant dermatologist. All specific and relevant investigations were done according to requirement. Patients were divided in two groups, exogenous eczema and endogenous eczema, for convenience. Data was analyzed by the latest version of SPSS

Results: There were 192 patients, out of which 52.08% were males and 47.91% females. Out of the total presented patients 50% had endogenous eczema, 43.37% had exogenous eczema and 25.62% had unspecified eczema. In endogenous group 11.45% had hand dermatitis followed by seborrhoeic dermatitis, atopic dermatitis and asteatotic eczema in descending frequency of presentation. Pityriasis alba, discoid eczema and pompholyx were seen less frequent. In exogenous eczema allergic contact dermatitis was seen in 14.06% patients, while irritant contact dermatitis in 11.45% patients. Infective eczema and photo-allergic eczema were seen in small number of patients

Conclusion: It was found in this study that allergic contact dermatitis was most common type of eczema followed by other types. Whatever the type is, eczema can be treated, symptoms can be relieved and recurrences can be prevented by appropriate therapy. All types of eczema affect patient's quality of life adversely. However, they can be prevented by educating patients and their relatives to take adequate safety measures like using good quality emollients prophylactically

Radiological risk analysis of sediment from Kutubdia Island, Bangladesh due to natural and anthropogenic radionuclides

To assess the environmental radioactivity levels and hence to determine the population exposure in Kutubdia Island, Bangladesh the sediment samples were analyzed by using gamma ray spectrometry. In those sediment samples the average activity concentration of natural radionuclides [238]U, [232]Th and [40]K were found 15.39+/-1.67, 38.35+/-0.76 and 475.51+/-21.15 Bq/kg respectively. The activity concentration of [238]U and [232]Th were less than the world average. But the activity concentration of 40K was higher than the world average values. These results were used to calculate the radiological hazard parameters like radium equivalent activities [Ra[eq]], representative level index [I[gammar]]. Due to natural radionuclides in sediment, the effective annual outdoor dose in the study area was 0.07 mSv; which is within the accepted range of 0.07 mSv. The average value of radium equivalent activities [Ra[eq]] and representative level index [Igr] were found to be 128.03+/-12.08 Bq/Kg and 0.96+/-0.09 Bq/Kg which were greater than the world average. The anthropogenic radionuclide [137]Cs was also found in few samples. The average activity concentration of [137]Cs was 1.64+/-0.20 Bq/kg which is lower than the world average. The obtained experimental data of this research work would be useful to assess the population exposure from radionuclides in sediment as well as base line data of natural radioactivity in this island

Pattern of skin diseases in a tertiary care private hospital, Karachi

To determine the pattern of skin diseases in a tertiary care hospital in Karachi and to compare the results with local and international literature. The current study was carried out in the Dermatology Department, Hamdard University Hospital, Karachi from 1[st] September 2011 to 31[st] August 2012 over a period of 1 year. All the freshly registered patients presenting in the outpatient were enrolled irrespective of gender and age, after an informed consent. Clinical diagnosis was made on the basis of detailed history and clinical examination. Laboratory investigations were performed where required e.g. routine investigations and biochemical profile. Skin biopsy and histopathology were performed in doubtful cases. All the findings were recorded, compiled, tabulated and analyzed. 1733 patients comprising 936 [54%] females and 797 [46%] males were enrolled. There were 728 [42%] children and 1005 [58%] adults. Infections and infestations were the most common skin conditions constituting 37.4% of all the enrolled patients of which 399 [23%] were children and 250 [14.4%] adults. Eczema was next in frequency comprising 313 [18%] patients including 150 [8.6%] children and 163 [9.4%] adults. Acne was seen in 229 [13%] patients, urticaria in 97 [5.5%] while hair disorders were recorded in 66 [4%] patients. Papulosquamous disorders and pigmentary dermatoses were observed in less than 3% of the patients studied. Scabies presented with the highest frequency [18%] and among pyodermas [10%], furunculosis [4%] and impetigo 59 [3%], being the most frequent. Fungal infections [3%] had a frequency more then viral infections [2%]. Atopic dermatitis was the most frequently seen eczema [6%] followed by seborrhoeic dermatitis [5%] and contact dermatitis [4.5%]. The pattern of skin diseases is same in various cities of Pakistan with minor differences. Scabies and infections remain the most common diseases while eczema also constitutes an important group of dermatoses in our part of the world

Diabetes mellitus prediction; Serum lipids, ALT and fasting blood glucose: using serum lipids and ALT

The rapid change in lifestyles and dietary has led to a pandemic of diabetes mellitus. The diagnosis of diabetes mellitus sometimes requires 2 hr OGTT sampling. Recent evidence has shown that there are lipid related abnormalities associated with diabetes mellitus, so a consideration comes in fortheir utilization as a marker to support diabetes mellitus. [1] To correlate serum total cholesterol, triglycerides and ALT with fasting blood glucose [2]. To predict diagnosis of diabetes mellitus using above serum markers. Cross-sectional analysis, descriptive study. This study was carried out between Mar-2010 to Jan-2011 at the department of pathology, PNS RAHAT in collaboration with PNS SHIFA. A total of 251 subjects were screened for presence of glucose dysregulation. Based upon the results of fasting blood glucose, subjects were grouped as having normal glucose tolerance [NGT], impaired fasting glucose [IFG], and newly diagnosed diabetes mellitus [NDDM]. A comparison of lipids including triglycerides, total cholesterol and alanine aminotransferase [ALT] were made in the above groups to measure the differences between the above mentioned three groups. ALT, triglyceride and total cholesterol were correlated with results of fasting blood glucose through pearson's correlation. Later the performance of different cut-offs of triglycerides, total cholesterol and two mathematical models [[Factor-l=FBG [mmol/L] + triglycerides [mmol/L]] and [Factor-ll=FBG [mmol/L] + triglycerides [mmol/L] + total cholesterol [mmol/L]]] were evaluated for detecting diabetes mellitus against the gold standard 2 hr OGTT in 71 subjects. The results of triglycerides, total cholesterol and serum ALT between the three groups were as: [[Triglycerides: NGT =1.91, IFG =2, 10, NDDM= 2.75, p=0.003] [total cholesterol: NGT=5.03, IFG=5.19, NDDM=5.74, p=0.056] [ALT:NGT=28.47, IFG=27.95, NDDM=25.78, p=0.846]]. Most correlation was found between serum triglycerides and fasting blood glucose [r2=0.235, p<0.001]; while serum total cholesterol and ALT showed lesser correlations [[total cholesterol:r2= 0.172, P=0.007], [ALT:r2= 0.010, p= 0.877]]. While triglycerides demonstrated superiority in terms of sensitivity to total cholesterol for detection of diabetes mellitus, the factors incorporating lipids and glucose had the highest overall diagnostic efficiency. Triglycerides and total cholesterol levels rise from normoglycemic individuals to subjects having impaired fasting glucose and newly diagnosed diabetics. The inclusion of triglycerides and total cholesterol for diagnosis of diabetes mellitus improves the chances of for detection of diabetes mellitus

Ethnic differences in metabolic syndrome among South Asians of Pakistan

To determine the prevalence of metabolic syndrome in different ethnic subgroups of urban population of Karachi, Pakistan. This cross sectional study was conducted in Lyari Town. Data of 856 adults >25 years old was available in terms of ethnic subgroups for analysis; 363 of these subjects gave blood samples. Their anthropometric, demographic and biochemical data was collected. Distinct ethnic subgroups- Muhajir, Punjabi, Sindhi, Baluchi and Pushtun were defined on the basis of mother tongue. Out of 856 subjects, 73% were females. Mean age of the subjects was 40.7 +/- 14.1 years. Metabolic syndrome was found in 34.8% subjects according to the IDF criteria. In terms of ethnic groups the highest prevalence of metabolic syndrome was seen in Pushtuns [41.3%] and the lowest in Muhajirs [32.5%]. Statistically significant differences were seen in the age adjusted waist circumference, waist-hip ratio, fasting triglycerides, insulin and HOMA levels among ethnic subgroups. Prevalence of metabolic syndrome in the studied population was found to be significantly high but there was no statistical difference seen among various ethnic subgroups. Further large scale studies are needed to confirm these findings

Incidence of mitral regurgitation following first episode of myocardial infarction at 1[st] week

Frequency of mitral regurgitation [MR] after active MI in the first week. This comparative study, was carried out at the Department of Medicine, Unit-II, Services Hospital, Lahore from August 2000 to August 2001. A total of 50 patients were included in the study resented to emergency and admitted to CCU or other wards of the Services Hospital, Lahore. At presentation patients were examined fully and then daily at least for a period of 5 days. Patient underwent complete M mode and two dimensional echocardiography including plus wave, continuous wave and color flow maping. Incidence of MR at 1[st] week of post-MI was 24%. Higher incidence of mortality among MR patients [10%- as compared to non-MR patients [4%]. Mitral regurgitation is frequently seen after MI. It carries a bad prognosis. Every patient should undergo echocardiography for risk stratification and prognosis

autopsy study of asphyxial deaths

The study includes autopsy examination of 132 cases of asphyxial deaths, brought by the police at Department of Forensic Medicine, K.E.M.U., Lahore during the year 2002, 2003 and 2004. The study revealed that the female to male ratio was 2:3 and individuals in the third decade of life are maximally involved. The ligature was a single loop in 77.7% of the cases and multiple in 22.3% of the cases. The most frequent non-specific asphyxial signs were congestion [72.7% of the cases] and petecheal haemorrhages [78%] cases. The hyoid bone was fractured in 22.7% cases. The associated injuries found were, physical and sexual in nature in 65% of the cases examined

Endoscopic evalution of acute dysphagia due to mechanical obstruction

To find out the common causes of mechanical dysphagia in South Punjab and determine the endoscopic features of benign and malignant stricture to decide for either therapeutic intervention [endoscopic dilatation/stunting] or biopsy. This descriptive study was conducted in Medical Unit-1, Gastroenterlogy Nishtar Hospital Multan Pakistan during the period from September 2004 to December 2005. A total 50 patients were included in the study. Foreign body in esophagus, was seen in 3 patients [6%] 2 female and one male. Two patients [4%] had esophageal web, both patients were female and upper part of oesophagus was involved in both of them. Benign stricture was the commonest abnormality. Lower third of oesophagus was the commonest site of involvement [62.5%], middle one third was involved in 31.25% of cases while upper third was involved in only 1 patient [6.25%]. Carcinoma oesophagus was predominantly found in males and lower one third was the commonest site [71.4%]. No patient had involvement of upper third while middle third was involved in 28.6%. Mean age of the patients was 42; age range was 14 to 63. Duration of dysphagia ranged from one day to 35 days; mean duration was 18 days. Upper gastrointestinal endoscopy is a safe and valuable procedure in individuals of all age groups with dysphagia and often leads to positive therapeutic intervention even in quite frail subjects. Benign esophageal stricture, esophagitis and esophageal carcinoma, are the commonest causes of dysphagia in South Punjab

Effect of simvastatin on insulin sensitivity in type 2 diabetic subjects

To study the effect of Simvastatin therapy on insulin sensitivity in type 2 Diabetes mellitus subjects. This is a randomized case control study, conducted at Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan. The study was conducted in 100 type 2 diabetes subjects of both sexes. Patients were randomized into two groups. Fifty patients were given Simvastatin 40mg/day for three months while 50 patients were used as controls. Both groups had similar anthropometric [age, duration of diabetes, BMI and Blood pressure] and biochemical [serum creatinine, fasting plasma glucose, fasting insulin level and lipid profile] characteristics. Insulin resistance was assessed by calculating homeostasis model assessment for insulin resistance [HOMA-IR] before and after 3 months of simvastatin treatment [40mg/day]. Simvastatin [40mg/day] markedly decreased cholesterol, triglycerides and LDL levels but did not significantly affect insulin sensitivity as determined by HOMA-IR. However it improved insulin sensitivity in subjects having insulin resistance.[HOMA IR reduction 1.92; p=0.001] Short term simvastatin therapy [3 months] had no effect on insulin sensitivity, but had a significant lipid lowering effect in all the subjects

Relationship among fatness, blood lipids, and insulin resistance in Pakistani children.

Observations on associations between fatness and metabolic risks among South-East Asian adults have resulted in devising lower thresholds of body mass index (BMI) for them. Metabolic abnormalities, including type 2 diabetes, are now also appearing in children and are associated with obesity. There has not been much work done to identify indicators of metabolic risks among South Asian children. This study was undertaken to observe the relationship among fatness, blood lipids, and insulin resistance in Pakistani children. Fatness, lipids, and insulin resistance were assessed in 92 middle-class Pakistani school children aged 8-10 years. Height, weight, waist, hips, mid-arm circumference, and triceps skin-fold, measured in school, were used for calculating various indicators of fatness, i.e. BMI, waist hip ratio (WHR), and arm-fat percentage. Fasting blood samples were analyzed for total lipids, triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), glucose and insulin levels. Homeostasis model assessment (HOMA) index was calculated to assess insulin resistance. Two separate multiple regression models of various risk indicators (family history, sex, BMI, WHR, arm-fat percentage) showed that only arm-fat percentage had a significant positive association both with insulin levels (b = 2.04, p = 0.044) and LDL (b = 2.11, p = 0.037). Only five children were overweight (BMI-for-age > 85th percentile according to National Center for Health Statistics 2000 reference). Neither overweight children nor those who were in the uppermost tercile of BMI-for-age differed significantly from other children in terms of presence of higher-than-desirable values of lipids or insulin. However, compared to those in the lowest tercile, children who were in the uppermost tercile of armfat percentage had a significantly higher frequency of high blood cholesterol (40% vs 67%, p = 0.027), high LDL (33.3% vs 61.3%, p = 0.026), and markedly higher proportion above average insulin levels (16.7% vs 35.5%, p = 0.083). Arm-fat percentage could be developed as a practical tool for determining the risk status of children. However, further cross-sectional assessments are needed to ascertain accurate relationships among arm-fat percentage, lipid profiles, and insulin resistance in larger and varied groups of children.

Mesenteric panniculitis

A 68 years old female was referred from the clinic for ultrasound pelvis on 03-02-2003. She had pain in the hypogastrium for the last 2 months. On clinical examination no significant abnormality was detected. Her laboratory investigations were within normal limits. Ultrasound pelvis was normal but incidentally, a hyperechoeic mass was noted anterior to abdominal aorta and inferior to the pancreas. The size of the mass was 7.4 x 6 cm and vessels were traversing through the mass. CT scan was advised for further evaluation. CT scan was performed after 2 weeks which showed soft tissue stranding in the mesenteric fat, anterior to aorta, at the same level described in the ultrasound report. Superior mesenteric vessels were traversing the mass. No abdominal or pelvic lymphadenopathy was noted. These features were consistent with mesenteric panniculitis [Figure 2]. The case was managed conservatively and follow-up was planned. The patient had a follow-up ultrasound examination performed 6 months later which showed resolution of the earlier findings. The patient was asymptomatic at the time of follow-up

Fatness, Lipids, Insulin sensitvity, and life style of children from high and low risk families

Children show variation in certain diabetes related risk factors according to the family history. Early detection of high risk groups could prevent or delay the onset of diabetes. Insulin level and fatness of Pakistani children has never been compared according to family history. This study was designed to observe the differences in insulin sensitivity, lipids and fatness in children from high and low risk families. Two groups of 8-10 year old school children were assessed for the differences in insulin sensitivity, lipids, fatness, food and activity habits. The first group had no family history for diabetes [low risk group, n=40] in any first or second degree relative. The second group had positive family history of diabetes [high risk group n=40] Data were collected through questionnaire sent to parents and children's interview. Blood test and anthropometric assessments were done at the schools by a physician. The two groups of children had similar level of insulin sensitivity. Children having positive family history for diabetes had markedly higher mean values for BMI, and arm fat% as compared to the controls. Though the low risk group had markedly higher level of total lipids and triglycerides the high risk group had markedly lower HDL and significantly higher LDL [p=0.008] and HDL-LDL [p=0.009] ratio than the low risk group. There was no significant difference in food and activity habits of the two groups. Marked variations in lipid profile of children from high and low risk families are evident at an early age. Presence of these differences in the absence of differences in food and activity habits and insulin sensitivity suggests that variation in lipid storage and metabolism could precede the appearance of reduced insulin sensitivity in children from high-risk families. Measures to control excessive fat deposition in childhood could be an initial step towards the prevention of diabetes and heart disease in adult life

Giardia lamblia in patients undergoing upper gastrointestinal endoscopy

To determine the frequency of giardiasis in patients undergoing upper G.I. endoscopy for dyspepsia and other upper G.I. disorders, duodenal aspirates were collected in 200 patients and simultaneous duodenal biopsies in 163 patients. Nine percent aspirates and 1.8% duodenal biopsies showed Giardia lamblia trophozoites. Giardia as a cause of dyspepsia should be considered in patients with negative endoscopy and in those who remain symptomatic inspite of adequate treatment for known upper G.I. disorders

Progesterone: an alternative long term therapy for bloc bloaters with cor pulmonale

Efficacy of depo-provera [medroxyprogestrone] as a long acting respiratory stimulant was evaluated in fine patients of established chronic obstructive airway disease. All patients reported improvements in subjective feeling and reduction in intensity of productive cough. Effort in tolerance improved considerably but dyspnoea did not get better

Specificity of radionuclide scanning in chronic obstructive pulmonary disease

Seventy one middle aged patients, 10 females, 61 males, with chronic obstructive pulmonary disease were studied prospective by to determine the relationship between perfusion lung scan, radiographic appearance and clinical category of the obstructive airway disease. None of these patients had any previous history or fresh clinical evidence of pulmonary emboli. Fifty four patients [76%] were chronic smokers [mean duration of smoking 28.5 years] while 17 patients [24%] were non-smokers. All patients had a perfusion lung scan and a chest radiograph. Thirteen patients [18.3%] did not show any perfusion defect. Among those who showed perfusion defects, 57% had radiographs consistant with bronchitis and 4.3 with emphysema. None of the radiographs showed any opacity consistant with an area of reduced perfusion. Average incidence of perfusion defects among Blue Bloaters, simple chronic bronchitis and corpulmonale was 74%, whereas, for clinical emphysema [Pink Puffers] this ec as 100%. Radionuclide perfusion scan is a non-specific test which is of no help in deterntining diagnosis and severity of the pathological process in patients with chronic obstructive pulmonary disease