Association of sensory polyneuropathy with restless legs syndrome

Objective: To determine the prevalence of restless legs syndrome [RLS] in elderly patients with pure sensory polyneuropathy and correlate the findings with other clinical features

Study Design: Observational / cross sectional study.Place and Duration of Study: This study was conducted at the Dow University Hospital and Civil Hospital Karachi from 2013 to 2015

Materials and Methods: 48 patients with Restless leg syndrome were evaluated in our multicenter, prospective study in 2 years for evidence of pure sensory neuropathy either they have demyelinating or axonal type. Patients were evaluated according age at which symptomsstarted, the severity of symptoms, typical clinical findings and laboratory investigations

Results: In 21 of the 48 [43.7%] patients, peripheral neuropathy was detected. Ten patients had pure sensory polyneuropathy and remaining have mixed sensory motor polyneuropathy. The pure sensory neuropathy group had comparatively intense and frequent symptoms of Restless leg syndrome. Some of them have family history of Restless leg syndrome. Patients with Mixed sensory motor polyneuropathy did not have similar strong symptoms of Restless leg syndrome and pain in legs

Conclusion: The result suggests that Restless leg syndrome is triggered by painful paresthesias is primarilyrelated with pure sensory neuropathy. Patients with mixed sensory motor neuropathy have less intense feature of restless leg syndrome. So the treatment options should be focused on medicines used for neuropathic pain

MRI features of spinal fluorosis: results of an endemic community screening

Fluorosis is endemic in many parts of the world. However community studies on MRI features of fluorosis are lacking. The aim of this study was to determine MRI features of spinal changes in a community with endemic fluorosis in the Thar Desert Pakistan. Randomly selected adults from the Village Samorindh, district Thar parker, Sindh, Pakistan, with spinal fluorosis diagnosed on plain x-rays and raised serum fluoride levels were studied from June 2008 to January 2009. MRI was carried out on 0.5 T open magnet MRI system. Features of vertebral body, spinal ligaments, intervertebral disc, facet joints, iliac wings and other incidental findings were noted. Sclerosis was defined as low signal intensity on both T1 and T2 weighted images. Results were described as mean and percentage values. All the studied 27 subjects complained of back ache without neurological signs. The average age was 43.33 +/- 10.45 years; 21 being male [77.8%]. The most frequent findings included generalized vertebral sclerosis [24, 88.8%], ligamentum flavum hypertrophy [23, 85%], anterior [20, 74%] and lateral [17, 62.9%] disc herniation, thickened longitudinal ligaments, and narrowing of spinal foramina. Hemangioma was seen in 04[14.8%]. The most commonly involved level was L1-2, L4-5 and lower dorsal spine. Vertebral sclerosis, a combination of premature degeneration with anterior disc herniation and an unusually high frequency of vertebral hemangioma formed the spectrum of MRI findings in subjects with spinal fluorosis having back ache but no neurological findings

Type 2 diabetes; effects of socio-demographic factors among patients

To determine the effects of various socio-demographic factors upon the prevalence of diabetes mellitus. Type 2 Diabetes is growing at an epidemic scale. Besides genetic predisposition, numerous environmental factors elicit the development of diabetes. An estimated 246 million people are suffering from diabetes worldwide. Majority of diabetics [80%] live in very poor countries of the world, where even the least expensive lifesaving diabetes drugs are not available. Pakistan ranks number seven in terms of global diabetes burden and is projected to reach number five in 2025. Approximately half of the diabetics are aware of their disease status, and most of them are diagnosed with complications and poor metabolic control. This study determines the effects of various socio-demographic factors upon the prevalence of diabetes mellitus. Cross-sectional. National Institute of Diabetes and Endocrinology, DUHS, Karachi, Pakistan. March 2008 to December 2009. 1029. The mean age of the study sample was 50.5 +/- 12.1 years. Fifty two percent study participants were males and 48% females. They were from various occupations, educational levels and socio-economic strata. Among these diabetics, 73% had family history of diabetes; 20% were doing exercise, 20% knew self monitoring blood glucose and 6% had knowledge to inject insulin. Only 29% followed diabetes diet. A vast majority of diabetic patients was not doing exercise; had least knowledge of self monitoring blood glucose and did not follow diabetes diet. Various environmental factors, lack of related information and peoples' reluctant attitude played important role in the high prevalence of diabetes

Effects of Ramadan fasting and physical activity on glucose levels and serum lipid profile among type 2 diabetic patients

To assess the effect of fasting and physical activity on blood pressure, fasting glucose, cholesterol, triglyceride, high density and low density lipoproteins among diabetic type 2 patients. Seventy five patients who had three visits [last ten days of Shabann [visit 1], Ramadan [visit 2] and Shawwal [visit 3]] were included in the study. Physical measurements, clinical measurements and 12 hours fasting blood sample were taken, along with an interview for demographic information and physical activity on each visit. The samples were analyzed for 1] Glucose, 2] Cholesterol, 3] Triglyceride, 4] Uric Acid, 5] HDL-C, and 6] LDL-C. The mean weight of the patients decreased significantly from 71.43 kg to 69.41 kg from visit 1 to visit 2. Mean systolic blood pressure also decreased significantly from 124.25 mm/Hg to 119.86 mm/Hg while. Mean triglyceride level decreased from 239.095mg/L to 207.07 mg/L from visit 1 to visit 2 and it kept decreasing to 159.25 mg/L till third visit. Mean LDL value increased from 104.12 mg/L to 112.64 mg/L from visit one to visit two and then further increased to 119.0 mg/L on the third visit. Ramadan fasting is safe for diabetes type II patients and is associated with weight loss and improvement in the overall diabetic control. Furthermore, the physical activities could reduce the body weight, waist measurement, systolic blood pressure, triglyceride and HDL

survey to assess the female sexual harassment in the higher educational institutes of Karachi

To determine the nature and frequency of the exposure of female students to sexual harassment at higher educational institutes; and explore the adverse effects of sexual harassment on the victims and coping strategies implied by them. Sexual harassment, whether at workplace, educational institution, street or leisure is a problem gaining increasing recognition in every society. Despite the widespread nature of the problem, there are still considerable misunderstandings as well as differences of opinion concerning whether particular situations or behaviours are sexually harassing in nature or not. The victim may feel threatened, humiliated, harassed, and would interfere with the performance, satisfaction, commitment, and undermine security, or create an intimidating environment. This study was conducted in ten institutes which included six medical, three engineering and one general colleges/universities of Karachi from January 6 to September 30, 2009. A total 480 female students were conveniently selected from ten different educational institutes, and were provided a self administered questionnaire with their consent. The identify of all the study subjects was kept secret. Out of total 480 female students, 460 i.e. 96% returned the filled questionnaire. Among them, 65% reported of sexual harassment of various degrees / levels irrespective of their residential area, appearance and attire. These females were harassed by the fellow students [37%], faculty [32%], and strangers [64%] who included patients, attendants, visitors and passerby. Although almost all of the participants [98%] wanted a punishment for the harassers, yet they [78%] were reluctant to disclose the name/ identity of those perpetrators because of the fear of exploitation, social taboo, further embarrassment, adverse consequences, and career obstacles. Many females were the victim of sexual harassment in various forms. There is a need to sensitize the society; and mass awareness programs should be carried out through variety of media

Treatment profile of hepatitis C patients - a comparison of interferon alpha 2a and 2b treatment regimes

To compare the side effects, cost, end treatment response [ETR] and Sustained viral response [SVR] with combination therapy of either interferon alpha 2a or 2b in combination with Ribavarin. Randomized Control Clinical Trial [RCCT]. The study was conducted at Sarwar Zuberi Liver Centre [SZLC], Civil Hospital Karachi [CHK], from May 2004 to July 2009. Patients positive for qualitative HCV ribonucleic acid [RNA] by Polymerase chain reaction [PCA] and genotype 3 were included. Patients with decompensated cirrhosis, severe depressive illness, autoimmune hepatitis, hyperthyroidism, pregnancy, heart failure, uncontrolled diabetes, obstructive pulmonary disease, children less than three years and patients who had previously received treatment were excluded. Single blind randomization using computerized randomization list was done and patients divided into groups A and B, those requiring treatment were given injection Interferon 3 million units [MU] subcutaneously [SC] three times/week and Ribavarin 1000 mg per day [weight 75kg] orally with either interferon alpha 2a [group A; FDA approved products] or alpha 2b [group B; non FDA approved product]. Demographics, side effects, ETR and SVR were noted. ETR was defined as absence of virus at the end of treatment and SVR was taken as absence of HCV RNA at 6 months after completion of treatment. There were a total 310 patients with mean age of 34.07 +/- 9.38 years including 52.4% males, [n=162]. Majority of the patients were from North Pakistan. There were 155 patients each in group A and group B respectively. The cost of treatment for interferon alpha for a single patient for 6 months was Rs 60,000, while for Interferon alpha 2b was Rs 30,000. Side effects [fever initially, followed by fatigue, headache, musculoskeletal pain, depression, alopecia, insomnia, and anorexia] were more prominent in group B when compared with group A. In group A, ETR was 83.8% [130/155] while in group B was 83.2% [129/155]. While SVR available in group A was 61/70 [87.1%] and in group B was 60/72 [83.3%]. Response to combination therapy for HCV was 83%. ETR and SVR were similar for both interferon alpha 2a and 2b. Side effects though minor are more with alpha 2b [non FDA approved products]

Frequency of rectal varices in patients with cirrhosis

To document the frequency of rectal varices in patients with cirrhosis of liver and compare it with that of oesophageal varices in liver and to compare the frequency of rectal varices with non-cirrhotic controls. Design: A cross-sectional analytical survey. Place and Duration of Study: The study was conducted in the medical wards of Civil Hospital, Karachi from August 2000 to July 2001. Patients and All patients of confirmed cirrhosis of liver, presenting during the study period, were selected for initial workup. On the basis of upper gastrointestinal [GI] endoscopy, patients were segregated into those with oesophageal varices [Group-A] and those without them [Group-B]. A matched control group [Group-C] was added, which consisted of patients of irritable bowel syndrome [IBS] who underwent sigmoidoscopic/colonoscopic examination during the study period. Fiberoptic sigmoidoscopy was done in all selected patients. Statistical analysis for continuous variables was done by student's 't' test while non-continuous variables were analyzed by Mann-Whitney-U test. A total of 104 patients [males 61; females 43] were included. Hepatic encephalopathy grade was significantly lower in Group-B [p < 0.0001]. Grade-I varices were seen in 13 patients, Grade-II in 38 and Grade-III in 33 patients of Group-A. Rectal varices were present in 59.9% of patients in Group-A as compared to Group-B in which no one had them [p<0.0001]. Rectal varices are common in patients of portal hypertention

Pharmacokinetic difference of some generic tablet gliclazide 80 mg on Pakistani population

The goal of rational drug therapy is to produce a desired pharmacological response in an acceptable and predictable manner while minimizing the occurrence of undesired events. The Pharmacokinetics of different generics of tablet gliclazide 80 mg was investigated on healthy [10 x 2], Pakistani subjects. For this exploration an open-label, randomized, two-period crossover [Balanced in Complete Block Design] study, was conducted The out come of the said study suggests that all generics were found analogous regarding pharmacokinetic behavior in-spite of having different excipients, concentration of excipients, sources of raw material, manufacturing process, machinery, resources and also inter individual variation of the study. Results of the study also undoubtedly advocate that generics manufactured in different manufacturing units of Pakistan are near to the standard formulation and produce comparable results. No significant differences in pharmacokinetics parameters were observed, however, minor differences might narrate with inter individual variation in human volunteers and in different generic as well as different pharmaceutical unit