Difference in lipid levels; Among ischemic and hemorrhagic stroke patients at civil hospital Karachi

To determine the frequency of dyslipidemias in patients with stroke and to compare the lipid levels in ischemic and hemorrhagic stroke patients. An observational study. Medical wards of Civil Hospital Karachi. January 2010 to June 2011. A total of three hundred and fifty- five patients above the age of 18 years with clinical evidence of stroke. CT scan brain and fasting lipid levels were done in all patients. The lipid levels were compared between the ischemic and hemorrhagic stroke patients. Data was analyzed with SPSS version 16.0. Out of the 355 patients 161 [45.4%] had dyslipidemia. Among the dyslipidemic patients, there was not a statistically significant difference in serum cholesterol, triglycerides, and LDL and HDL levels between ischemic and hemorrhagic stroke. [p- value > 0.05]. There is a high frequency of dyslipidemia in stroke patients. While comparing ischemic and hemorrhagic strokes there was not a significant difference between the various lipid fractions.

Frequency of proteinuria in patients with older-onset diabetes mellitus attending civil hospital Karachi

To determine the frequency of proteinuria in patients with adult-onset diabetes mellitus. Descriptive study. This study was conducted at Medical Wards of Civil Hospital Karachi from 1[st] November 2010 to 30[th] April 2011. In this study 100 patients of adult onset diabetes mellitus were enrolled who were admitted in medical department at Civil Hospital Karachi. The duration of the study was 6 months. Diagnosed all patients with type 2 diabetes mellitus and > 40 years of age were included except for patients with urinary tract infection, haematuria, acute febrile illness, congestive cardiac failure, uncontrolled hypertension. A mid-stream urine sample was collected for the determination of UAE; Macroalbuminuria was tested first if it was found negative then urine was tested for Microalbuminuria. Out of 100 patients 55% patients had normal Albuminuria [<20 mg/liter] while 45% patients had evidence of increased proteinuria [>20 mg/liter]. Out of 45 proteinuric patients, 28[62.2%] patients had evidence of Microalbuminuria [cutoff; 20-200 mg/liter] and 17[37.8%] patients had Macroalbuminuria [cutoff; >200 mg/liter]. The concluded that the frequency of microalbuminuria is higher than macroalbuminuria in type 2 diabetic subjects

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]

Sphygmomanometers in clinical USE: are they reliable?

Hypertension affects approximately 1 billion individual worldwide. It is responsible for 7.1 million Premature deaths and 4.5% of disease burden. Higher the BP, the greater is the chance of heart attack, heart failure, stroke, and kidney disease. The management of Hypertension depends on stage of Hypertension which is determined by measurement of systolic and diastolic blood Pressure. Accurate assignment of blood pressure status is crucial from a public health standpoint. Overestimating or underestimating blood pressure by even 5 mm Hg can mislabel over 20 million persons as having high normal blood pressure rather than hypertension; conversely, another 20 to 30 million could be misclassified as hypertensive exposing these persons to the expense and adverse effects of treatment. Different type of Blood pressure instruments [sphygmomanometer] like mercury and aneroid type are generally used in our country. Whatever the type for accurate measurement of blood Pressure properly calibrated and validated instrument should be used. To determine the frequency of errors in Blood pressure instruments [sphygmomanometer] in use in different health care facilities All working BP apparatus used in different health facilities Damaged or out of order instruments Blood pressure instruments [sphygmomanometer] in use in different health care facilities were randomly tested on-site with ERKA Made In Germany Model No 83646 BAD Tötz Name of the facility where BP apparatus is used, designation of the user, the type of BP instrument, make of the instrument and error if any was recorded. Any difference of more than 5 mm mercury was taken as an error as recommended. 501 BP apparatuses were tested. All of them were in use. Out of these 252 [50.3%] were being used in teaching hospitals. 48.5% were mercury manometers most of the instrument were purchased six months earlier. Error was present in 30.1% of instruments in use. It was observed in 45.73% of aneroid type of BP apparatus and 13.58% of mercury type of BP apparatus. Difference range from 0 to 70 mm means 4.73 SD 8.313. Error was more in aneroid type of BP apparatus [p= .001] Error was significantly more in older instrument [p=.001] none of the instruments was calibrated. It is recommended that Blood pressure instruments should be regularly calibrated

Sick euthyroid syndrome: thyroid function abnormalities in patients with non-thyroid illness

Introduction: Non-thyroid illness is accompanied with many severe illnesses like septicemia, renal failure, cirrhosis of liver, Pulmonary Tuberculosis, chronic heart failure, after major surgical trauma, etc. This study was undertaken on first four illnesses, which are common medical problems, and admitted in medical wards in advanced stages. This is to bring awareness amongst clinicians while interpreting TFT abnormalities in severe illnesses

Objective: To assess the thyroid function status in patients with severe illnesses, which are commonly encountered in Medical wards. Interpretation of Thyroid hormones should be cautiously made in such conditions. Design: Descriptive/Observational, Non-interventional study Place and Duration of Study: Medical unit III, Civil Hospital, Karachi. From 1[st] March 2001 to 1[st] April 2002. The cases were recorded as and when received, keeping exclusion criteria as mentioned below

Material and Methods: 50 adult patients of either sex, admitted in the hospital for nonthyroidal illness were tested for the thyroid function status by means of T3, T4 and TSH analysis. Results were evaluated for the presence of Sick Euthyroid Syndrome

Results: Of the 50 patients, 24 [48%] had a low T3, low T4 or both but with normal TSH

Conclusion: Sick Euthyroid Syndrome should be considered while managing the patients with serious and debilitating illnesses

Measuring the blood pressure, do we really need sleeves rolled up?

Technical issues and techniques are very important while measuring the Blood Pressure. It has been recommended that blood pressure should be measured on bare arm. In Pakistani society especially in females, this procedure becomes difficult to practice due to social and cultural issues. This study is carried out to check that measuring the Blood Pressure with cuff placed over the sleeve or without sleeve [bare arm] makes any difference

Method: two hundred subjects admitted in Civil Hospital Karachi, attending the OPD of CHK and their attendants were examined under standard conditions and Blood Pressure was measured by mercury sphygmomanometer. Three readings were recorded first with cuff placed over sleeves and with cuff placed on bare arm. Mean of systolic and diastolic blood pressure with and without sleeve were analysis on SPSS Version 11.5

Result: difference in means of systolic blood pressure between clothed and unclothed arm was 0.94 mmHg with a standard deviation of 4.32 and difference of means of diastolic blood pressure for the same was 0.58 mmHg with a standard deviation of 3.80. This was clinically insignificant

Conclusion: the difference found in blood pressure with and without sleeve was not significant clinically

Frequency of impaired glucose tolerance in hypertensive patients

Objective: To determine the frequency of impaired glucose tolerance [IGT] in hypertensive patients

Design: Descriptive cross-sectional study

Place: Civil Hospital Karachi

Sample Size: Eighty patients

Duration: July 2001 to July 2002

Patients and Methods: All the hypertensive patients above 30 years of age of both sexes were included in this study. A detailed relevant history, physical examination including BP was carried out and all the base line investigations and Glucose Tolerance Test [GTT] were performed. Data of each patient were entered on a separate perfoma

Results: Eighty hypertensive patients were studied, out of these 46 [57.5%] were females and 34 [42.5%] were males. The ages of patients were between 32-80 years, mean age + SD was 55.725 + 13.364. The maximum patients were in 41-60 years of age [56.25%]. Results of this study showing that the frequency of IGT was 46.2%, prevalence of impaired fasting glucose [IFG] was 8.7% and prevalence of diabetes was 5% in these hypertensive patients

Conclusion: It is concluded hat impaired glucose tolerance is related to hypertension and other clinical and metabolic abnormalities such as obesity, smoking, hyperlipidemia and family history of DM and positive history of intake of diabetogenic antihypertensive drugs such as diuretics and beta-blockers. Hypertensive patients should be screened for glucose tolerance by OGTT on mass level for the prevention of diabetes. It is an easy and cost effective approach

Clinical profile of 100 cases of liver abscess

One hundred patients with liver abscess were studied for clinical features and complications. They were diagnosed by radiography, ultrasonography, serology and by needle aspiration. A variety of interesting clinical, haematological and ultrasonographic findings were observed. Literature on liver abscess was reviewed and results compared

Serodiagnosis of amoebic liver abscess by IHA method

Serological test based on IHA [Indirect Haemagglutination Method] was performed in 100 cases of hepatic abscess. The test was 100% sensitive and 94% specific. The cut off point of antibody titer between normal population and patients with invasive amoebiasis was 1:128. Antibody titer in amoebic liver abscess was 1:5242 +/- 2795. A significant [P<0.001] correlation was found between total leucocyte count and antibody titer