Neck pain-a problem with major effects

To study the prevalence of neck pain in patients and their effects on daily performance. Hospital based observational study. OPD of Mayo Hospital and private chamber of the consultant. Neck pain as a cause of morbidity in both genders with loss of work hours leading to economic and household pressures. A total of 100 patients were studied. Out of these 54% were males and 46% were females. Age range was 15-70 years with the mean of 37 +/- 15.12 years. Duration of pain was from range 1-10 years with the mean of 4 +/- 3.80 years. Sixty nine percent were married and 31% were unmarried, 74% had urban and 26% had rural background. Out of these 69% were working in sitting posture and 31% in standing posture with bent necks on their jobs. Pain was radiating to arms in 53%, dull localized in 34%, stabbing in 9% and of burning character in 4% of patients. No neurological deficit was noted except that movements of neck were painful with associated muscle spasm. These patients were put on muscle relaxants, analgesics, advised extension exercises and told to improve their working conditions by keeping high desks or soft cervical collar. 78% patients showed improvement in the pain and radiation whereas 22% did not get any relief who were referred to physiotherapy department. Neck pain and associated neck muscle pain is a common symptom. The muscle spasm can be overcome by good posture, proper position of neck during work, avoiding very long hours of bent neck. NSAIDs, muscle relaxants and light extension along with exercises of neck can overcome such problems

Is there need of specialized diabetes nurses in Pakistan?

To assess the knowledge of the staff nurses of diabetes mellitus working in the various wards of a teaching hospital of Lahore. Cross-sectional study. Hospital based, on the staff nurses working in medical, surgical, cardiology, emergency and psychiatry wards of Mayo Hospital, Lahore. Main outcome measures: Knowledge of diabetes mellitus of staff nurses. Fifty qualified nurses interviewed through questionnaire designed to assess their knowledge about various aspects of diabetes. Symptoms of disease known to the nurses were polyuria [86%], polydipsia [82%], delayed wound healing [74%] unexplained ill health [72%], whereas pruritus vulvae [62%], big sized babies at birth [42%], impotency [40%] were elicited in response to prompting. Sixty% of them were unaware of gastrointestinal symptoms. They were better aware of hypertension [90%], chronic renal failure [70%], ischaemic heart disease [50%] as associated diseases with diabetes mellitus and least aware of autoimmune diseases. Confusion/drowsiness [92%], profuse sweating [80%], heart sinking [72%], blurring of vision [68%] fatigability [68%] pallor [52%], irritability [34%], lack of concentration [26%], feeling of hunger [20%] were known as hypoglycaemic symptoms. They generally had the knowledge of the treatment and was quite adequate. Diet control [92%], diet and exercise [96%], oral and parenteral hypoglycaemic agents [100%] were known to them. However they were less knowledgeable about alteration in treatment. Majority were of the opinion that patients should be controlled on oral hypoglycaemic agents and avoid parenteral drugs. Although nurses knew the diet plays the role in management of diabetes mellitus, but were not aware of types of food given to the patients or how to make changes in the diet. Nurses working in emergency, medical as well as surgical units should undergo refresher courses for 1-2 weeks in nursing care of diabetics. Effort should also be made to train specialized diabetic nurses. This would reduce the burden on doctors besides improving diabetic care

Dyslipidemias in type II diabetes mellitus patients in a teaching hospital of Lahore, Pakistan

To know the pattern of dyslipidemias amongst type II diabetic patients. Design: Observational study. Setting: Hospital based study on type II diabetic patients, who were either admitted or reported to outpatient department/diabetic clinic on take days of Unit-I of Sir Ganga Ram Hospital, Lahore, Pakistan. Subjects: One hundred consecutive type II diabetics between the age of 40-70 years. Those who had hyperlipidemia due to other causes e.g. nephrotic syndrome, hypothyroidism and type-I diabetes mellitus were excluded. Main Outcome Measures: Dyslipidemias One hundred patients suffering from type II diabetes mellitus were included in the study. Out of these 64% were females and 36% were males. The age range was 41-70 years with mean of 56.1 +/- 9.38. Out of these 100 patients, duration of diabetes mellitus of less than 10 years was noted in 43% of patients and more than 10 years in 57%. Random blood sugar was 229.34 +/- 6.23 and fasting blood sugar was 153.5 +/- 4.45 when it was seen in the total study subjects, random blood sugar 210.51 +/- 7.68 and fasting blood sugar 143.83 +/- 5.35 in sub group whose duration of illness was less than 10 years. In sub group whose DM was for more than 10 years random blood sugar was 257.91 +/- 12.81 and fasting blood sugar was 171.21 +/- 8.14. Serum cholesterol was 226.88 +/- 18.48 in the patients as one group, in illness of less than 10 years, it was 191.72 +/- 5.72 and in illness of more than 10 years duration it was 213.11 +/- 6.70. Serum triglyceride in illness of less than 10 years duration was 191.83 +/- 8.05 and where it was more than 10 years, it was 210.04 +/- 8.90. Serum HDL-C was 36.25 +/- 0.45 in patients illness of less than 10 years and 35.57 +/- 0.60 in more than 10 years. Serum LDL - C was 127.1 +/- 3.99 in patients with less than 10 years of diabetes mellitus and 147.5 +/- 5.20 in patients with more than 10 years of illness. Fifty-eight patients were hypertensive, 43% of the male patients were smokers. Conclusions: Diabetic dyslipidemia is an important cause of morbidity. Duration of diabetes is associated with higher incidence of dyslipidemia. Type II DM is associated with a marked increase in the risk of CHD. Dyslipidemia is believed to be a major cause of increased risk. In this study we found elevated total serum cholesterol, LDL-C but normal HDL-C. Patients should be educated to get checked regularly for lipid abnormalities and if found to be abnormal, should control blood sugar and lipids very effectively

Patients with postpartum complications admitted in a medical ward of Mayo Hospital, Lahore

To evaluate the postpartum complications and their outcome in patients who were admitted between the periods of 1st July 1999 to 30th June 2000 in a medical ward following delivery. A prospective study of patients who were admitted in a medical ward with various postpartum complications following delivery at home or hospital. Department of Medicine, Mayo Hospital/K.E. Medical College, Lahore, Pakistan. Sixty-four patients who were admitted through emergency or referred/shifted from obstetrical wards attached to the hospital. Out of 64 patients, septicemia was detected in 26 [40.5%], renal failure in 8 [12%], Disseminated Intravascular Coagulation [DIC] in 6 [10%], jaundice in 6 [10%], eclampsia/fits in 8 [12%], tuberculosis in 4 [6%], tetanus in 3 [5%], postpartum cardiomyopathy in 2 [3%], stroke in 1 [1.5%]. Fifty-two [81.24%] were discharged home, 6 [9.38%] died in the hospital and 6 [9.38%] left against medical advice [L.A.M.A.] in moribund condition. Only serious postpartum complications present in medical wards. Physician, obstetrician and other specialties should act as one team to prevent maternal mortality and morbidity

Skin manifestations amongst diabetic patients admitted in a general medical ward for various other medical problems

To calculate prevalence of incidental skin manifestations in patients with diabetes mellitus admitted for treatment of various other medical problems in a general medical ward of a teaching hospital, Lahore, Pakistan. Design: Cross-sectional study. Setting: Hospital based study on admitted patients in a medical ward, Mayo Hospital, Lahore. Subjects: One hundred consecutive adult diabetic patients of any age and either sex admitted for various other diseases/problems. Main Outcome Measures: Skin manifestations. Out of 100 patients, 60% were males, and 40% females. Skin manifestations were seen in 90% of patients. Diabetic neuropathy was seen in 65.6%, cutaneous infections in 62.2%, pruritus in 46.7%, Diabetic dermopathy in 33.3%, skin tags in 21.1%, acanthosis nigricans in 16.7%, eruptive xanthomas in 8.9%, vitiligo in 6.7%, diabetic bullae in 5.6%, diabetic rubeosis in 5.6%, lichen planus in 4.4%, erysipelas like erythema in 4.4%, trophic ulcers in [3.3%], wet gangrene foot in 2.2% and necrobiosis lipodica, granuloma annulare and reacting perforating collagenosis in 1.1% each. Conclusions: There are many skin manifestations amongst diabetics who are also suffering from various other medical problems. Patients in routine do not give much importance to these lesions because they appear harmless to them. They do not seek advice of physician/surgeon/dermatologist unless they develop serious skin and soft tissue infections like carbuncles, trophic ulcers or gangrene

Oesophageal varices - what is the cause? Cirrhotic or non-cirrhotic portal hypertension

To investigate the cause of oesophageal varices in a teaching hospital. Design: A prospective study of 100 patients with portal hypertension. Setting: East Medical Ward, Mayo Hospital Lahore attached with K.E. Medical College, Lahore. Subjects: One hundred consecutive patients of portal hypertension admitted or referred to G/E section of East Medical Ward. Main Outcome Measures: Patients who presented with upper G.I. bleed, oesophageal varices being the cause, effort was made to prove whether it is CPH or NCPH. 10% patients had oesophageal varices due to non-cirrhotic aetiology. 90% were suffering from cirrhotic portal hypertension. Upper GI bleed is a common emergency, which is due to various causes. Portal hypertension being one of them, it is common to think that all patients with varices are cirrhotic. Non-cirrhotic patients have long history of haematemesis and melaena or only melaena, normal or near normal liver functions, moderate to massive splenomegaly and no hepatic encephalopathy. Role of surgery in such patients is beneficial and mortality is not high as in cirrhotics

Prevalence of hypertension amongst young, students at the time of entry in a medical college of Punjab

White coat hypertension is a well-known entity, many are declared hypertensive only taking one reading of B.P Hypertension being a silent killer should be diagnosed and managed as early as possible. Unfortunately our general public is not in the habit of annual check up. One hundred and seventy nine medical students were examined at the time of entry to a medical college, out of these 52[29.05%] were hypertensive. These students were followed up for one year and only 4[2.24%] were hypertensive. At the time of first examination majority 69.25% were in stage I, whereas 19.25% were in stage II and 11.5% were in stage III. Male were 39 [75%] and females 13 [25%] with an average age 18.5 years. Students in stage III had higher BMI. Four students who were picked up as hypertensive, had one or= both parents hypertensive. All these students were told about the complications of hypertension and hypertensives were counseled and pursued for control of B.P.

Tetanus in adult population: uncommon modes of transmission

To document and evaluate various injuries leading to tetanus in adults. Retrospective study involving indoor patients with tetanus. Tetanus section of medical Ward of Mayo Hospital, /K.E.Medical College, Lahore. Ninety one patients admitted in the ward in the year 1997. Main outcome measures: Some unreported wounds possibly leading to tetanus in adults. There was male preponderance [M:F = 1.5:1] Majority [93.4%] were be low the age of 60 years and 75 patients [82.4%] were below the age of 50 years. Fifty six [61.5%] patients were from urban slums and 35 [38.5%] were from rural areas and none from posh localities. Eighty six [94.5%] were not vaccinated and 5 [5.5%] were not sure of having vaccination against tetanus. Commonest site of the wound was on foot and leg [46.1%] followed by uterus and vagina [26.4%], other sites being arm [12.1%] hand, [11%] nose, head, thigh and back 1.1% each. Commonest type of wound was roadside accident [37.3%], illegally induced abortions, delivery and post delivery handling [26.4%]. Other unusual wounds were nail injuries [7.7%] elective surgery [5.5%] firearms and crackers [4.4%]. I/M. injections [4.4%] thorn [3.3%] electiricshock [2.2%] scratch of hen paw [2.2%], dog bite [1.1%]. No cause found in 5 [5.5%] patients. Mean stay in the ward was 33.6 +/- 19.2 days. Fifty [55%] patients recovered completely and were discharged home. The mortality was 42.8% and 2.2% left the ward against medical advice. Besides common injuries, that can lead to tetanus, uncommon wounds of firearms and crackers, illegally induced abortions [dai] mis-handling, tubal ligation, IUCD etc. have not been reported in the past to cause tetanus, and should not be overlooked. Most of the survivors had longer incubation period. Severe and fatal tetanus was noted in patients with shorter incubation period

Role of surgery in portal hypertension

To evaluate and compare the benefits of surgical shunts/procedures in cirrhotic and non-cirrhotic portal hypertension. Department of Cardiovascular Surgery and Clinical Medicine, K.E. and FJ. Medical Colleges/Mayo Hospital, Lahore, Pakistan. A retrospective study of patients with portal hypertension who underwent various surgical procedures. The results were statistically analysed and significance of distribution of age and sex was tested by using chi square test with one degree of freedom. One hundred and eighty one [181] patients with portal hypertension referred from various teaching hospitals of Lahore and other major cities of Punjab for surgical intervention between 1977-1994. Effectiveness of various surgical shunts in different subgroups of portal hypertension [CPH and NCPH] in recurrent variceal bleeding and ascites. There was a male preponderance among patients undergoing shunt operations. The mean age of noncirrhotics was significantly less as comapred to cirrhotics. Thirty days postoperative mortality was 11.6%. Role of various shunt operations in patients with portal hypertension is mainly palliative. It is of some help in patients with cirrhotic portal hypertension but it is certainly much more beneficial in NCPH for prevention of recurrent oesophageal bleeding with improved survival

Antigenemia in chronic liver disease

To investigate the prevalence of HBsAg and Anti HCV antibodies in chronic liver disease [CLD] in a teaching hospital of Lahore. Design: A prospective study of 90 patients with cirrhosis and portal hypertension. This was a part of research for MD thesis. Setting: East Medical Ward, Department of Medicine, Mayo Hospital Lahore attached with King Edward Medical College, Lahore-Pakistan. Subjects: Ninety consecutive patients of cirrhosis with portal hypertension admitted to East Medical Ward from 1993-1994. Main Outcome Measures: Prevalence of viral markers as possible aetiological agents leading to hepatitis and cirrhosis. Fifty-nine patients [65.5%] had positive anti HCV antibodies, 22 patients [24.4%] had positive HBsAg whereas 22 patients [24.4%] were positive for both. The remaining 9 patients were negative for both HBsAg and anti HCV antibodies. All the patients with antigenemia had either history of injections or blood transfusions in the past, which might have led to viral transmission causing hepatitis and cirrhosis. Cirrhosis is on the rise in Pakistan and a very common health problem challenging the medical profession. Screening of blood donors and other preventive measures can help reduce the magnitude of the menace

experience of fulminant hepatic failure in Lahore

To critically evaluate the prevalence, clinical presentation, associated factors, diagnosis and prognosis of Fulminant Hepatic Failure in a hospital setting. Design: A prospective study of patients with fulminant hepatic failure and hepatocellular jaundice. Setting: Department of Medicine, Mayo Hospital/K.E. Medical College, Lahore-Pakistan. Subjects: Nine hundred ninety eight consecutive patients with hepatocellular jaundice admitted to Mayo Hospital from 1989-92. Out of a total of 998, 30 patients [3%] had acute fulminant hepatic failure. Majority of these patients were young females [24/30] with F: M ratio 4: 1 and most of these were pregnant in their third trimester common cause was viral hepatitis followed by drug induced hepatic injury. Twenty five [83.33%] of the patients died within one week of admission and 5 [16.67%] who survived were those who had relatively prolonged incubation period. Acute Fulminant Hepatic Failure [FHF] is rare but very serious complication of Acute Viral hepatitis [AVH]. Liver transplantation is the treatment of choice. Future treatment possibilities are discussed