To observe the effects of metformin hc1 on the carbohydrate metabolism in polycystic ovary syndrome

To observe the effects of metformin HC1 on the carbohydrate metabolism in polycystic ovary syndrome a clinical trial was carried out on fifty infertile females having polycystic ovary syndrome with ages between 20-40 years. They were enrolled from the infertility clinic of a private hospital in Karachi and were given tablet metformin HC1 500 mg thrice daily for a period of three months. Fasting serum glucose [FSG] and fasting serum insulin [FSI] were done twice during the study period [at day zero and day ninety] to assess the effects on the carbohydrate metabolism. Significant reduction was found in both the FSG and FSI levels at day ninety with P=0.001. It is concluded that metformin has produced beneficial effects on the carbohydrate metabolism in patients having polycystic ovary syndrome. This is because of increase peripheral uptake and utilization of glucose being done by metformin which in turn increases the insulin sensitivity and reduces the insulin resistance in these patients

Consequences of a medical emergency among emergency room patients

To study the consequences of a medical emergency among Emergency Room patients, at a teaching hospital in Karachi, Pakistan. Design: A questionnaire-based survey Settings: Emergency Room of Aga Khan University Hospital in Karachi, Pakistan. Main outcome measures: Consequences of a medical emergency in terms of impact on employment, financial position, family life, social life, recreational life, self-confidence and psyche. A hundred patients were surveyed. Emergency Room patients feel that they will not have a major impact on their job or employment, as a result of the medical emergency but it will have adverse financial consequences. The respondents in our study perceive the consequence of the medical emergency to have a variable impact on their family life, social life, recreation life and self-confidence. It is important to note with concern that a major impact on "Psyche" is expected by the emergency room patients, as a result of a medical emergency We have documented the consequences of a medical emergency among Emergency Room patients, with implications for medical practice and policy makers on health

Maximum tolerable dose of cyclophosphamide and azathioprine in Pakistani patients with primary renal disease

Objective: The immunosuppressive regimens, at present, mainly rely on western guidelines that were derived from studies conducted in western populations. No such study exists for South Asian population, which is home to almost two billion people different in both genetics and environment from west. Locally derived thresholds for side effects markedly different from western figures may warrant re-adjustment of current local immunosuppressive regimens that are at present based largely on western guidelines. In order to define optimum dose for Cyclophosphamide [CYC] and Azathioprine [AZA] based immunosuppressive therapy, we conducted this study to find out maximum tolerable doses of azathioprine [AZA] and cyclophosphamide [CYC] beyond which neutropenia and thrombocytepenia are most likely to occur in patients with primary renal pathology

Method: Patients with systemic vasculitis and idiopathic glomerulonephritis who were on CYC and AZA were identified through review of medical records at a tertiary care hospital in Pakistan [The Aga Khan University Hospital, Karachi]. Patients were categorized under three principal diagnosis i.e. systemic lupus erythematosus [SLE], primary [idiopathic] glomerulonephritis [GN] and Wegener's granulomatosis [WG]. The Receiver Operating Curve [ROC] was used to calculate the maximum tolerable dose for both CYC and AZA

Results: We identified 94 patients aged 6-82 years [median 44.5 years] with primary renal disease [Wegener's granulomatosis n=13, Systemic lupus erythematosis n=62 and idiopathic glomerulonephritis n=19] who received CYC or AZA. Of these 94 patients, 36.2% [n=34] received CYC and 63.8% [n=60] received AZA. The mean dose of CYC was 1.54 +/- 0.50 mg/kg of body weight [range: 0.77-2.93]. The mean dose of AZA was 1.64 +/- 0.59 mg/kg of body weight [range: 0.47-2.97]. The maximum tolerable doses calculated for CYC and AZA were 1.25 mg/kg and 1.30 mg/kg of body weight respectively. The maximum tolerable dose for CYC and AZA among males could not be calculated, because of insufficient number of patients who developed neutropenia and thrombocytopenia. The maximum tolerable doses for CYC and AZA among females were 1.34 mg/kg and 1.03 mg/kg of body weight respectively. Also we found out that AZA was relatively more likely to cause neutropenia and thrombocytopenia [p = 0.07]

Conclusion: We thereby recommend that CYC should be initiated at a dose no more than 1 mg/kg of body weight and AZA at an initial dose of 0.75-1.0 mg/kg of body weight. The dose may be adjusted later on the basis of clinical response and laboratory reports

Radiocontrast nephropathy: is it dose related or not?

To assess the safety of high dose non-ionic contrast media during a single radiological procedure in patients with pre-existing renal impairment. One hundred eighteen patients, with serum Creatinine greater than 1.3 mg/dl who were undergoing coronary angiography or percutaneous transluminal coronary angiography [PTCA] were included in the study. All patients received the nonionic dye ULTRAVIST [Iopromide]. Serum creatinine were measured before, 48 hours and 1 week after the administration of contrast agent. An acute contrast induced reduction in renal function was defined as an increase in Serum Creatinine concentration of >=0.5mg/dl, 48 hours after the administration of contrast agent. All patients with end stage renal disease or patients undergoing coronary bypass surgery within a week after coronary angiography or had any concomitant factors that could cause acute renal failure e.g., sepsis, hypotention, etc., were excluded. Patients receiving a dose of upto100 ml of contrast agent [low dose group] were separated from those who received greater than 100 ml of contrast agent [high dose group]. Patients in both groups had similar characteristics in terms of sex, age, weight and underlying disease. Student's t-test was used for statistical analysis. The mean age of our patients was 62.3 + 8.83 [range 40 - 84 years]. There were 93 [78.8%] males and 25 [21.2%] females. The mean pre-contrast creatinine in the low contrast group was 1.97+0.92 and high dose group was 2.16+1.90 [p=0.48]. The post-contrast Creatinine at 48 hours was 2.11+1.11 and 2.06+1.39 in the groups receiving low and high dose contrast agents respectively [p=0.830], while at 7 days post-contrast it was 2.17+1.28 and 1.95+1.43 respectively in the two groups [p=0.391]. The contrast-induced reduction in renal function [rise in serum Cr >=0.5 mg/dl above base line] occurred in 14% [n=8] of patients in low dose and in 11% [n=7] in high dose contrast group [p=0.830, insignificant]. The results of our study confirm that high dose non-ionic contrast is not associated with increased risk of contrast-mediated nephrotoxicity in patients with pre-existing renal insufficiency undergoing cardiac angiography [p=0.830, insignificant]

Bidirectional cavopulomanry shunt for cyanotic heart disease: Surgical experience from a developing country

The importance of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic congenital heart disease is widely recognized. This study was conducted to highlight our surgical experience with this procedure in a developing country. A retrospective study was conducted using medical records at the Aga Khan University Hospital, Karachi, Pakistan. Clinical findings at presentation, anatomical defects seen on transthoracic echocardiography, pre-operative McGoon index, cardiopulmonary bypass time, use of cardioplegia, post-procedure oxygen saturations and complications were evaluated. A total of 8 patients underwent bidirectional cavopulmonary anastomosis. There were 6 males [75%] and 2 females [25%]. Ages and weights at operation averaged 5.7 +/- 3.7 years [range 2-14 years] and 18.6 +/- 10.4 kg [range 8.5-35.5 kg] respectively. The most common symptoms were the presence of cyanosis in all [100%] patients followed by recurrent respiratory tract infections in 3 [37.5%] patients. Transthoracic echocardiography revealed 6 [75%] patients with atrial septal defects, 5 [62.5%] with tricuspid atresia, 3 [37.5%] with ventricular septal defects, 3 [37.5%] with malposition of great vessels, 2 [25%] with pulmonary stenosis and 2 [25%] with double inlet left ventricles. The mean pre-procedure McGoon index was 2.1 +/- 0.5 [range 1.37-2.80]. All patients received cardioplegia. Cardiopulmonary bypass was used in all patients for a mean time of 154.1 +/- 83.6 minutes [range 60-298 minutes]. All patients were ventilated for a mean period of 1.5 +/- 0.7 days [range 1-3 days]. The ICU stay was 3.0 +/- 0.6 days [range 2-5 days] with a total hospital stay of 9.8 +/- 3.8 days [range 7-18 days]. The mean post-procedure oxygen saturation was 82.6 +/- 3.5% [range 76-86%]. The most common post-operative complication was supraventricular arrhythmia in 2 [25.0%] patients. There were no intra-operative or early [within 7 days of procedure] deaths. One patient developed pulmonary artery hypertension and died 23 months later due to cardiac arrest. Patients tolerated the procedure well. After a mean follow-up of 10 months, 6 patients were assessed to be in New York Heart Association [NYHA] functional class I and one patient in NYHA class II. Clinical and post-procedural data gathered from our experience confirms the safety of bidirectional cavopulmonary anastomosis

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

Seasonal variation in bacterial pathogens isolated from stool samples in Karachi, Pakistan

To determine the seasonal variation of the commonly isolated bacterial pathogens in stool samples. A retrospective descriptive study was undertaken of all the stool samples submitted from within Karachi to the Aga Khan University Hospital Laboratory over a period of five years [January 1997- December 2001] in order to determine the commonly isolated bacterial pathogens and to predict their seasonal variation. A total of 16379 stool samples were included in this review. Bacterial isolates were found in 6670 stool samples [culture detection rate=40.7%]. The mean age at the time of culture of each sub-group was <1 year group [6.58 +/- 3.1 months], 1-5 years [2.13 +/- 0.94 years], 5-14 years [8.3 +/- 2.6 yrs] and adults [43.2 +/- 18.5 years]. Male: Female ratio was 1.2:1. Vibrio cholera 01 Ogawa [32.8%], Campylobacter jejuni [17.3%], Enteropathogenic Escherichia coli [9.9%], Salmonella paratyphi b [6.6%] and Shigella flexneri [6.2%] were the most common organisms isolated. These organisms show a distinct seasonal variation with summer predilection. In contrast to the previous studies from South Asia, which have identified E. coli, followed by Vibrio cholerae as the most common enteric isolates, we found Vibrio cholera 01 Ogawa followed by Campylobacter jejuni as the most common enteric pathogens isolated in an urban setting. It is important to consider seasonal variation when empirically treating diarrheal diseases in our region

Comparison between allergic and non-allergic rhinitis patients as regards clinical and allergic aspects in Riyadh

Hundred patients with nasal symptoms of sneezing runny nose nasal itching and nasal blockage were investigated. The patients were divided using skin prick test into two groups i.e. allergic group and non-allergic group according to negative or positive skin reactions to a list of variable allergens. Medical history and clinical examination alone seemed to be inadequate in differentiating the two groups, although alternating nasal blockage and sneezing were more prominent in the allergic group. In the allergic group, sensitivities to indoor allergens, i.e. house dust mixture, cat, cockroaches as well as pollens of some grasses weeds and trees, were very important. Among the non-specific precipitating factors, dust, smokes, strong smells and stress seem to be important

Effect of pancreatectomy on blood sugar and lipid levels in various tissues of a lizard [Uromastix Hardwickii]

1. The effect of pancreatectomy on blood sugar and lipid levels was studied in a lizard, Uromastix hardwickii. 2. The blood sugar decreased gradually till 72 hours after pancreatectomy. 3. Glyceride level of plasma and adipose tissue was decreased in depancreatized animals, while liver glyceride level was slightly increased. 4. The plasma and adipose tissue cholesterol was elevated in depancreatized animals while liver cholesterol level was not changed. 5. Elevated level of plasma phospholipid was maintained 24 hours after pancreatectomy. The liver phospholipid was first increased, and returned to normal level after 24 hours. 6. The major fatty acids of adipose tissue were palmitic, stearic, oleic and linoleic. 7. The stearic acid was reduced during 16-48 hours after pancreatectomy with the concomitant increase in oleic acid. 8. The long chain fatty acids were eliminated after 24 hrs. of pancreatectomy, while the short chain fatty acids were accumulated