Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital

To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006.One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer [Precision Abbott] by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer [SYNCHRON CX7] by glucose oxidase method. We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L [60 mg/dl] and 16.7 [300 mg/dl]. A significant difference was observed for glucose values less than 3.3 mmol/L [p=0.002] and glucose values more than 16.67 mmol/l [p=0.049]. Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels

Does Ramadan fasting affect expiratory flow rates in healthy subjects?

To assess whether Ramadan fasting affects the expiratory flow rates in healthy subjects, and to know if these effects correlate to a change in other variables. This unmatched case-control longitudinal study includes 46 non-smoking healthy subjects who undertook lung function testing at the Aga Khan University, Pakistan. Expiratory flow rates and body mass were measured in 3 Islamic months, corresponding to November 2001 to January 2002. There was a significant reduction in body mass in Ramadan compared to pre and post Ramadan. No significant changes in expiratory flows were seen during Ramadan as compared to the pre Ramadan period. However, forced expiratory flow rates at 75% of vital capacity [FEF75] and between 75% and 85% of vital capacity [FEF75-85] showed a significant increase in the post Ramadan period compared to Ramadan. Changes in FEF75 were negatively correlated to changes in body mass between Ramadan and post Ramadan. This study shows that Ramadan fasting will not affect expiratory flow rates in healthy subjects. Post Ramadan values did show an increase in FEF75 and FEF75-85, possibly due to changes in body water and fat content. The reductions in body mass were most probably due to lack of nutrition and not dehydration as the fasts were performed in winter. Collection of reference values or early phase clinical trials measuring expiratory flow rates should not be affected by Ramadan fasting

Correlation of serum cortisol levels and stress among medical doctors working in emergency departments

To assess and correlate serum cortisol levels and self-perceived work-related stress among medical doctors working in emergency departments in different tertiary care hospitals of Karachi. Cohort study. The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology, AKUH, from December 2004 to August 2005. A total of 64 doctors participated from one private and two public tertiary care hospitals of Karachi. Thirtyfour doctors were from emergency departments and 30 from non-emergency departments. Serum cortisol levels were measured in the morning [between 8.00-8.30 am] and in the evening [between 8.00-8.30 pm]. Cortisol was measured by Florescence Polarization Immunoassay [FPIA] technique. Two questionnaires, modified mental Professional Stress Scale [PSS] and Aga Khan University Anxiety and Depression Scale [AKUADS] were used to assess stress levels. Emergency room physicians [ERP] were 1.2-year younger than non-emergency room physicians [NERP]. Mean evening cortisol of emergency physicians was 60.72nmol/L higher than non-emergency physicians. The difference between morning and evening cortisol was marginally significant [p = 0.051]. Morning diastolic blood pressure was 3mmHg higher in emergency physicians. Forty-one percent of emergency physicians and 20% of non-emergency physicians had AKUADS more than or equal to 20, the difference was borderline significant [p = 0.068]. Mean value of professional stress scale for emergency physicians was significantly higher than non-emergency physicians. Evening serum cortisol concentration was significantly associated with PSS [p = 0.011]. The sub-scales such as work-load [p = 0.007] and lack of resources were highly significant with evening cortisol [p = 0.005]. In this study, evening serum cortisol levels significantly correlated with work overload and lack of resources, however, there was marginally significant correlation between morning and evening serum cortisol difference. Study suggests that emergency physicians perceive more stress than non-emergency physicians. Work overload and lack of resources are major contributing factors for stress in these doctors

Comparison between tramadol and pethidine in patien controlled intravenous analgesia

To compare the efficacy and side effects related to Tramadol with Pethidine in patient controlled intravenous analgesia [PCIA] after total abdominal hysterectomies. A total of 60 patients were randomized to receive either Tramadol or Pethidine by PCIA [30 in each group] after total abdominal hysterectomy. Pain assessments were recorded one hour after starting the PCIA and then at 6, 12, and 24 hours by using visual analogue scale [VAS]. Nausea vomiting score and sedation score were also recorded. Good attempts, total attempts and total drug consumption was noted from PCIA pump at the end of the study period. The analgesia achieved in Tramadol group was comparable to Pethidine. The incidence of nausea and vomiting was similar in both groups. Tramadol causes significantly less sedation than Pethidine [p < 0.05]. Mean drug consumption, total attempts and good attempts were also significantly less in Tramadol group than Pethidine group [p < 0.05]. Tramadol produces equivalent analgesia and less sedation and can be used as an alternative to Pethidine in Patient Controlled Intravenous Analgesia for postoperative pain relief after Total Abdominal Hysterectomy [TAH]