Association of [hypovitaminosis v] with persistent non-specific musculoskeletal pains

Objective: The study was conducted in Pakistani population to find association of vitamin D deficiency with persistent non-specific musculoskeletal pains by comparing with pain free controls

Study Design: Case control study

Material and Methods: Patients aged 12 years or more presenting to Medical OPD with persistent nonspecific musculoskeletal pains for more than 3 months were selected as cases, while healthy individuals served as controls

Results: A total of 60 cases [patients with persistent non-specific pains] presenting to medical outpatients department at Military Hospital Rawalpindi and 60 controls were studied. Mean age of cases was 43.9 +/- 14.0 years and amongst controls were 33.2 +/- 17.8 years. Mean serum vitamin D level of 32.8 nmol/L was reported in cases whereas mean serum vitamin D level amongst controls was 26.7 +/- 17.8 nmol/L. Hypovitaminosis D amongst cases and controls was 86.6% and 95% respectively. The proportion of vitamin D deficiency did not differ significantly as compared to controls. There was non-significant difference in proportion of deficiency amongst cases and controls

Conclusion: Overall there was no association between persistent non-specific musculoskeletal pains and vitamin D deficiency

Comparison of short term mortality in ischemic stroke patients with or without stress hyperglycemia

Objective: To compare short term mortality in non-diabetic ischemic stroke patients with or without stress hyperglycemia

Study Design: Cohort study

Place and Duration of Study: This study was carried out at Neurology Department of Military Hospital, Rawalpindi from Jan 2010 to Jul 2012 for a total duration of six months

Material and Methods: Non-diabetic ischemic stroke patients were included in the study and they were divided in two groups. Each group had 75 patients. Group 'I' [Normoglycemic or control group] had normal blood glucose level while group 'II' [Hyperglycaemic or cohort] had hyperglycaemia on presentation or over next 72 hours. Prognosis in terms of patient either being dead or alive was determined within or at 4 weeks of admission in both groups. Data were entered and analysed using Statistical Package for Social Sciences SPSS version 10. Descriptive statistics were calculated for both qualitative and quantitative variables. For comparison of short term mortality in hyperglycaemic and normoglycemic stroke patients, chi-square test was applied. p-value <0.05 was considered statistically significant

Results: Short term mortality was higher in cohort [hyperglycemic] group as compared to control [normoglycemic] group [34.7% vs. 14.7%]. Relative risk was 2.36. The groups had a statistically significant difference in the short term mortality within four weeks with a Chi-Square 'p' value of 0.004 [p=0.004]

Conclusion: Short term mortality in non-diabetic ischemic stroke patients with stress hyperglycemia is higher than those patients who do not have stress hyperglycemia

Early diagnosis of Typhoid by PCR for FliC-d gene of Salmonella Typhi in patients taking antibiotics

To compare PCR [Polymerase Chain Reaction] with blood culture, typhi-dot and Widal test for the diagnosis of typhoid in patients taking antibiotics. Cross-sectional, comparative study. National University of Sciences and Technology, Islamabad, Pakistan, from April 2013 to August 2014. One hundred and five patients were included in the study. Blood was collected and inoculated into tryptone soya broth for culture. Any growth obtained was identified by API 20 E and confirmed by Salmonella anti-sera. Typhi-dot and Widal test were also done on all the samples. DNA extraction was done and PCR was carried out. Among the 105 patients, 79 [75.2%] were males and 26 [24.8%] were females, with mean age of 20.64 +/- 14 years. Typhi-dot was positive in 58 [55.2%] and negative in 47 [44.8%] patients. Blood widal test was positive in 27 [25.7%] and negative in 78 [74.3%] patients. Salmonella Typhi was positive on blood culture in only one [1%] patient. PCR for Salmonella Typhi was positive in 102 [97.1%] and negative in 3 [2.9%] patients. Positive cases detected by PCR were significantly higher as compared to Typhi-dot [p < 0.001], blood Widal test [p < 0.001] and blood culture [p < 0.001]. Positivity rate of PCR was significantly higher as compared to blood culture, Typhi-dot or Widal test for diagnosing typhoid in patients who were already taking antibiotics

Use of spirometry in detecting airway obstruction in asymptomatic smokers

To detect spirometric abnormalities in asymptomatic smokers in relation to duration of smoking. Cross sectional study. Place and Duration of Study: The study was carried out at PNS Shifa from Oct 2006 to June 2007. Subjects and Hundred individuals were included in this study who fulfilled the required criteria. Spirometry was done after briefing the patient about the procedure. Smokers were divided into two groups. Group I [5 to 9 pack years] and group II [? 10 pack years]. All relevant information were recorded on Performa [Annex-A]. The data was analyzed through SPSS-10, in terms of Mean +/- SD [Standard Deviation] for numeric response variables and independent sample T test was applied to compare significance of proportion for numeric response variables at p < 0.05. Categorical variables were compared by applying Chi-square test at p < 0.05 level of significance. Significant statistical difference was found between the mean age in the two groups with p-value of 0.011. This may be due to the longer duration of smoking history in Group II. Strong association was found between number of cigarette smoked and the pattern of airway obstruction as significant statistical difference of airway obstruction and early airflow limitation was found between the two groups of smokers at p value of 0.004. There is strong association between duration of smoking and development of airway obstruction even before the smoker become symptomatic

Hepatitis C; frequency of thrombocytopenia patients treated with interferon

To determine the frequency of thrombocytopenia and its manifestations in patients with Chronic Hepatitis C Virus infection treated with interferon and ribavirin. In door and out door patients. Case series. Department of Medicine PNS Shifa Hospital Karachi, from 1[st] August 2006 to 1[st] July 2007. A Proforma was designed to enter the data of 100 patients fulfilling the inclusion criteria included in the study. Adult patients between the ages of 18 and 50 years of both gender were selected. Presence of anti HCV antibodies, elevated serum alanine transaminase, a positive polymerase chain reaction for hepatitis C ribonucleic acid and compensated liver disease were prerequisites. All patients were treated with combination of interferon and ribavirin. Blood counts, alanine transaminase and prothrombin time were done at baseline and at 2, 4 and 8 weeks intervals after starting interferon. A drop in platelets count below 100,000/cmm was taken as interferon induced thrombocytopenia. In our study thrombocytopenia occurred in 1 1% patients. Grade 3 thrombocytopenia [platelet counts < 50,000] occurred in 01 patient out of hundred in which there was severe gum bleeding and purpura so antiviral treatment was discontinued. Grade 2 thrombocytopenia [platelet counts between 50,000-75,000] was observed in 03% patients but there were no bleeding episodes, 50% reduction dose was done in these patients. Grade 1 thrombocytopenia [platelet counts between 75,000- 100,000] was noticed in 07% patients but there were no bleeding manifestations and dose reduction was not done. Combination therapy is well tolerated, however, it can cause life threatening complications like bleeding episodes in a few patients. Bleeding complications and manifestations as a result of thrombocytopenia are uncommon