ABSTRACT
Objective: To evaluate and compare the antioxidant activity, total phenolic contents (TPCs) and in vitro antidiabetic activity of various pits extracts obtained from five Omani date cultivars. Methods: Sun-dried mature fruits of five Omani date varieties, namely, Fardh, Naghal, Khalas, Khinazi and Khasab were purchased from the local market in Muscat, Oman in the month of September 2014. Four seed extracts viz. water, ethanol, methanol and acetone were prepared for each date variety and their antioxidant activities were investigated by 1,1-diphenyl-2-picrylhydrazyl, hydrogen peroxide scavenging method and reducing power assay method, respectively. In vitro antidiabetic activity of the date pit extracts was evaluated by measuring their inhibitory effect on α-glucosidase and α-amylase level. TPCs were also quantified colorimetrically. Results: The results indicated that TPC of date seeds was solvent dependent. Acetone, ethanol and methanol were found to be significantly better solvents than water in extracting phenolic compounds from the date seeds. Pit extracts exhibited moderate to good in vitro antioxidant activity and increased reducing power. Among all date pit extracts, water extract exhibited significant in vitro antidiabetic activity in comparison to standard drug, acarbose. Conclusions: The present study confirms that disposed waste of Omani dates is a rich source of dietary antioxidant because of its high TPC. The pits due to their inhibitory effects on α-glucosidase and α-amylase level could be used as a monotherapy along with an appropriate diabetic diet and exercise or might be in conjunction with antidiabetic therapy to manage and prevent progression of diabetes.
ABSTRACT
Objective: To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country
Study Design: Cross-sectional, observational study
Place and Duration of Study: Medical Wards of Civil Hospital, Karachi, from January to June 2013
Methodology: Patients aged > 18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 [SPSS Inc., IL, Chicago, USA]
Results: A total of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 +/- 9.5 years. Among these, 61 [57.5%] were males and 45 [42.5%] females. Among all patients, 51.9% presented with loss of consciousness, 30.2% with slurred speech, 77.4% with limb weakness, and 9.4% with decrease vision. A total of 17 [16%] patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of < 60 years of age, 26% developed hyperthermia compared to 7.1% in patients of > 60 years of age [p=0.008]. On gender stratification, among male patients, 14.8% developed hyperthermia compared to 17.8% in female patients [p=0.43]
Conclusion: It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16% and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia
ABSTRACT
Objective: To determine the frequency of hepatic hydrothorax and its association with Child Pugh Class in patients with liver cirrhosis
Study Design: Descriptive, analytical study
Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-Ill, [Ward- 7], from June 2012 to May 2013
Methodology: All patients with established diagnosis of decompensated chronic liver disease were included. Detailed history, thorough physical examination, routine laboratory investigations, chest X-ray and abdominal ultrasound were carried out in all patients to find out the presence of pleural effusion and ascites, respectively. Fifty milliliters of pleural fluid was aspirated in all patients with pleural effusion using the transthoracic approach, taking ultrasound guidance, wherever required. Fluid was sent for microscopic, biochemical, and microbial analysis. SBEM defined if pleural fluid with polymorphonuclear [PMN] cell count > 500 cells/mm[3] or positive culture with PMN cell count > 250 cells/mm[3] with exclusion of a parapneumonic effusion
Results: Two hundred and six patients met the inclusion criteria, with mean age of 41.25 +/- 13.59 years. Among them, 149 [72.3%] were males and 57 [27.7%] females. Twenty-three [11.2%] had hydrothorax; right sided involvement was in 18 [78.3%] subjects, 3 [13%] had left sided while bilateral pleural effusion was found in 2 [8.7%] cases. SBEM was found in 07 [30.43%] cases. Mean serum albumin 3.125 +/- 0.71 gram/dl. There was association between serum albumin levels and hydrothorax. A significant association of hydrothorax with Child Pugh scoring system [p=0.018], but not with serum albumin [p=0.15]
Conclusion: The frequency of hepatic hydrothorax has a significant association with hepatic function as assessed by Child Pugh scoring system, but not with serum albumin
ABSTRACT
Objective: To determine and assess the common causes of conversion of laparoscopic cholecystectomy to conventional cholecystectomy
Methods: A cross sectional hospital based study was conducted in Surgical Unit-III, Abbasi Shaheed Hospital and Karachi Medical and Dental College. Overall 197 patients were selected through consecutive non probability sampling. Patients included were those with symptomatic cholelithiasis including acute cholecystitis, chronic cholecystitis and asymptomatic gall stones in which ultrasound abdomen demonstrated cholelithiasis with normal common bile duct. Written consent was taken from each admitted patients and assessed clinically androutine investigations [CBC, ESR, RBS, Urea, Creatinine, Liver Function test, Hepatitis Profile, X-ray chest, ECG and ultrasonography of abdomen] were done. Laparoscopic cholecystectomy was done under general anesthesia
Results: Laparoscopic cholecystectomy was successful in 188 patients [95.43%] while in 9 patients [4.59%] laparoscopic cholecystectomy was converted to open cholecystectomy
Conversion was because of haemorrhage in one patient [0.51%], Common bile duct injury inone patient [0.51%], non-visualization of gall bladder in one patient [0.51%], shortage of time for laparoscopic cholectectomy in two patients [.02%], cholecystoduodenalfistula in two patients [1.02%] while two patients [1.02%] were converted to open procedure due to carcinoma gall bladder
Conclusion: The conversion rate was five percent from laparoscopic cholecystectomy to open cholecystectomy hence laparoscopic cholecystectomy is a safe procedure
The knowledge of common reasons of conversion in our tertiary hospital will help to overcome these factors in future, which benefit in reducing cost and improve patients wellbeing
ABSTRACT
Objectives: To examine the association of central obesity [measured as waist-to-hip ratio] with glucose intolerance, and to compare the mean fasting blood sugar and the mean random blood sugar levels of centrally obese and non- obese adults
Study Design: Analytical case-control study
Place and Duration of Study: This study was carried out at the Medical Wards and OPDs of Civil Hospital Karachi from June 2015 to December 2015
Materials and Methods: The subjects were selected by non-probability convenience. Based on their waist-to-hip ratio they were divided into centrally obese [group A] and non-obese [group B]. The cut-off point for waist-to-hip ratio was 1.0 for males and 0.85 for females. One hundred non-diabetic, healthy adults were included in each group. All the subjects underwent a 2 hour 75-gm oral glucose tolerance test. Fasting blood sugar and random blood sugar at two hours post-glucose challenge were measured
Results: Five individuals had blood sugar levels in the diabetic range and were excluded from the study. Impaired glucose tolerance was observed in fifteen out of 98 subjects in the centrally obese group and six out of 97 subjects in the non-obese group. This difference was statistically significant [p=0.04]. Statistically significant difference was also observed between the mean fasting blood sugar and the mean random blood sugar of the two groups [p<0.001 in both cases]. The odds ratio for a person with central obesity to have impaired glucose tolerance was estimated to be 2.74
Conclusion: There is a significant association between central obesity [waist-to-hip ratio] and glucose intolerance
ABSTRACT
Objective: To determine frequency of hypomagnesemia in diabetic patients presenting at Civil Hospital Karachi
Study Design: Cross-sectional study
Place and Duration of Study: This study was conducted at a Diabetic Clinic in National Institute of Diabetes and Endocrinology [NIDE], Karachi from January to June 2016
Materials and Methods: All patients > 12 years of age of either sex, diagnosed cases of diabetes mellitus [either Type I or Type II] of > 5 years duration and have given consent for participation in the study were included. Patients with acute pancreatitis and have history of alcoholism [such conditions results in reallocation of the magnesium from extracellular to intracellular space], occurrences of diarrhea, regurgitating and nasogastric suction, ostomies and gastrointestinal fistulas [conditions which result gastrointestinal magnesium loss] and patients receiving diuretics, chemotherapeutic agents [cisplatin], antimicrobials [amphotericin B, aminoglycosides, pentamidine, capreomycin. vancomycin, and foscarnet], immunosuppressants [tacrulimus and cyclosporine], and proton-pump inhibitors, [as all these drugs results in renal loss of magnesium] were excluded
Results: The average age of selected patients with diabetes mellitus was 46.81 +/- 6.8 years. Of 350 patients, 203 [58%] were female and 147 [42%] were male; 176 [50.3%] patients had diabetes for >/= 7years; 269 [76.9%] patients had type II diabetes and 275 [78.6%] had uncontrolled diabetes. The mean serum magnesium level was 1.48 +/- 0.36 mg/dl and the frequency of hypomagnesemia was 227 [64.9%] cases
Conclusion: It is concluded from this study that the frequency of hypomagnesemia was 64.9% among study population
ABSTRACT
It has been observed that exposure to cement dust has been found to be associated with impaired pulmonary function and lung diseases. Therefore, this study aims to determine the effects of chronic exposure to cement dust on the pulmonary function of cement mill workers [non smokers] and comparing it to non-exposed otherwise matched individuals. Cross sectional study. the study has been completed in duration of 4 months and the data was collected from a cement factory of Karachi. A cross sectional study was carried out on a sample size of 100 cement mill workers who were divided into two groups of non-smoker exposed [n=46] and non-smoker non-exposed [n=54] workers and matched for age, height, weight, BMI, duration of work and their PEFR and FEV[1] were observed using electronic peak flow meter. It has been found that there was no difference in the age, work experience, height, weight and BMI between the two groups while statistically significant difference was found in FEV1 between the two groups, while PEFR was found to be insignificant. Occupational cement dust exposure is associated with impaired pulmonary functions which may lead to chronic lung diseases in these workers. This justifies the need to take preventive measures
Subject(s)
Adult , Humans , Respiratory Function Tests , Cross-Sectional Studies , Lung Diseases , Occupational ExposureABSTRACT
Objective: To assess the efficacy of Sequential Organ Failure Assessment score [SOFA] as a determinant of outcome in critically ill medical patients
Study Design: Prospective observational cohort study
Place and Duration of Study: This study was conducted at Medical ICU of Civil Hospital Karachi from June 2014 to December 2014
Materials and Methods: The study was conducted on 152 patients admitted in the Medical ICU. The SOFA score was calculated on admission and thereafter daily until ICU discharge or death. The primary outcome measure was ICU mortality. The initial SOFA score, the SOFA scores at 48 and 72 hours, the mean and highest SOFA scores and the trend of SOFA score during the initial 48 hours were correlated with mortality
Results: The overall ICU mortality rate was 35.5 % [n=54]. Patients with an initial SOFA score of /= 10 had a mortality rate of 88.2 %. The SOFA scores at 48 and 72 hours also showed significant association with mortality. The mortality rates of patients having a score of /=10 at 48 and 72 hours were 91.3% and 93.8% respectively. A sharp rise in mortality was seen when the Highest SOFA score during the entire ICU stay exceeded 7. Patients having a mean SOFA score of greater than 5 had a mortality rate of 66.7% regardless of length of stay. Univariate Logistic Regression Analysis revealed that the Highest SOFA score had closest correlation with mortality followed by Mean SOFA score, SOFA at 48hours, and SOFA at 72 hours. The biggest area under the receiver operating characteristic curve [AUROCC] was seen for the Highest SOFA score followed by SOFA at 72 hours, Mean SOFA score and SOFA at 48hours. Analysis of the changes in SOFA score during the first 48 hours depicted a mortality rate of 54.9% when the score increased, 27.6% when the score decreased and 23.3% when it did not change
Conclusion: The serial evaluation of SOFA score proved to be a convenient and efficient tool to predict mortality in the critically ill ICU patients
ABSTRACT
Environmental stresses, especially extreme cold and hot weathers, have tendency to have more admissions for acute coronary syndromes. Due to scarcity of local data, we studied the variation in patient admission rates with acute coronary syndrome according to different seasons. Descriptive study. Coronary Care Unit, Civil Hospital and Pakistan Steel Hospital, Karachi, from January 2011 to December 2011. The study group comprised consecutive patients with acute coronary syndrome [unstable angina, Non STElevation Myocardial Infarction [NSTEMI], ST-Elevation Myocardial Infarction [STEMI] admitted to the coronary care unit. Patients with stable angina and valvular heart disease were excluded. Data was analyzed for admission according to different seasons, [winter, spring, summer and autumn]. The mean age of the 428 cases was 48.5 +/- 10.4 years [range 27 to 73 years]. Among the study group, 261 [61%] and 167 [39%] cases were male and female respectively. ST-elevation myocardial infarction, non ST-elevation myocardial infarction and unstable angina were present in 206 [48%], 128 [30%] and 94 [22%] respectively. Among the 428 patients, 184 [43%] cases had hypertension, 133 [31%] cases were smokers, 103 [24%] cases had dyslipidemia and diabetes mellitus and 08 [2%] cases had history of premature coronary artery disease. The number of patients admissions with acute coronary syndrome tended to change with sudden change in season. It increased in Winter 158 [36.9%] and Summer 130 [30.3%] in comparison to Spring 80 [18.69%] and Autumn 60 [14.02%] season. It was found variation in admission rates of acute coronary syndrome patients according to different seasons. The number of admissions not only increased in the cold season [winter] but also in hot season [summer] with sudden changes in temperature
ABSTRACT
To compare the angiographic findings in patients with acute myocardial infarction [AMI] and compare it with diabetic and non-diabetic patients admitted in the cardiology department of LUHMS. Descriptive analytical study. Department of cardiology at Liaquat University of Medical and Health Sciences [LUMHS] Hospital, Hyderabad. Periods of 1[st] June 2012 to 31[st] July 2013. All patients with AMI and had diabetes mellitus and age eighteen or more than eighteen years both male and female were included after taking informed consent. Out of 297 patients diagnosed as AMI, 195 [65.65%] patients had acute ST elevation Myocardial Infarction and 102 [34.35%] patients had acute non ST elevation myocardial infarction. Among 297 patients, 190 [64%] patients were non-diabetic and 107 [36%] patients were diabetic. Diabetic patients were older, more often males, but prevalence of smoking was less marked. Coronary angiographic findings among patients with AMI and diabetics revealed three vessels disease. Older patients with male predominance presented with AMI and had diabetes mellitus were found to have three vessels disease in coronary angiography
ABSTRACT
Objectives: To determine the frequency of common bacterial isolates cultured from diabetic foot infection in patients with type 2 diabetes mellitus [DM] falling in Wagner's grade-2 and grade-3 classification of diabetic foot [DF] infection
Study Design: Descriptive study
Period: A six months
Setting: Dow University of health sciences and civil hospital Karachi
Methods: Completed to examine the bacterial identification in cases admitted with the infection diabetic foot along with gave Wagner's evaluation 2 and 3 at tertiary care hospital Karachi. Bacteriological finding and anti-biotic affectability profiles were completed and analyzed with utilizing standard strategies
Results: Out of 115 cases, 82 [71%] were male and 23 [29%] were female. The mean age of patients was 51.7 +/- 9.45 years, mean duration of diabetes was 10.6 +/- 4.73 years, similarly mean length of time of diabetes foot wound was 46.15 +/- 23.75 days. 45 [39%] patients had Wegner's evaluation 2 and 70 [61%] patients had Wagner's evaluation 3. 99 cases indicated with culture growth, out of which 65 [65.65%] with gram negative microbes and 25 [25.25%] gram-positive microbes. The most successive bacteria's were Proteus [35.35%], Staph. Aureus [25.25%], Klebsiella [16.16%] and Pseudomonas [15.15%]. Both gram positive and gram negative showed frequent resistance to Cloxacillin, Amoxacillin, Levofloxacin, and Linezolid, gram negative life forms likewise indicated high resistance rate to Clindamycin, Vancomycin, and Cefotaxime. Tienam [Imipenem], Sulzone [salbactam in addition to cefoperazone] and Amikacin were the best effective against gram -ve and gram +vemicrobes. Staph. Aureus and Staph. Epidermidis were profoundly susceptible to Ciprofloxacin, Ceftriaxone, Clindamycin, and Vancomycin
Conclusion: Gram negative microbes were more common than gram positive living beings. Proteus, Staph Aureus, Klebsiella and Pseudomonas aeruginosa were the most widely recognized microorganisms of DF infection. Tienam [Imipenem], Sulzone [salbactam in addition to cefoperazone], and Amikacin were best effective agents
ABSTRACT
To determine the frequency of various clinical presentations of snake bitten admitted patients. Study design: Descriptive case series study. This study was carried out in General Medicine ward, at Medical department of Peoples Medical University and Hospital Nawabshah, from September 2011 to March 2012. This study consisted of 55 patients admitted through the outpatient department, as well as from casualty department of Peoples Medical University and Hospital Nawabshah. Detailed History was taken from all the patients with special regard to type of snake, age, sex, site, time of bite, time lapsed between bite and reaching to hospital. Detailed clinical examination of local features were fang marks, swelling, bleeding from wound, pain and systemic features like nausea, vomiting, echymosis, drowsiness, discharge from wound, hematuria, ptosis, respiratory failure of envenomation. Systemic review was also done to see any co-morbidity. All patients underwent for base line and specific investigations especially clotting time [CT]. Inclusion criteria were that all diagnosed patients of snake bite, aged > 12 year of either sex admitted with the history of snake bite with irrespective of toxicity were included. Patients with history of thorn prick, insect bite were excluded criteria. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Out of 55 patients included in this study, 39 were men [70.9%] and 16 patients were female [29%]; with male to female ratio of 2.4:1. There was wide variation of age ranging from a minimum of >12 year to 60 year. The mean age was 39 +/- 5.8 years. In our study mostly patients 35[63.63%] reached hospital within 60 minutes followed by 12[21.88%] patients within 30 minutes. 5[9%] patients reached within 90 minutes and one patients reported more than 120 minutes. Symptoms of patients were pain at the bite side in 55[100%], ecchymosis in 18[32.72%], discharge from wound in 9[16.36%], bleeding from gum in 8[4.4%] Nausea and vomiting in 7[12.72%], hematuria in 11[20%], ptosis in 8[14.54%], drowsiness in 5[9%] and respiratory failure in 5[9%]. We conclude that males are commonly affected than females and the farmers and labourers are the most vulnerable section of the population for snake bites. In this study age, presence signs and treatment by faith healers is independent predictors of death in case of snake bite. This may provide important evidence to formulate preventive strategies especially health education
ABSTRACT
To determine the frequency and factors associated with hypomagnesaemia in hypokalemic type-2 diabetic patients presenting at Civil Hospital, Karachi. A cross-sectional study. Department of Medicine and Diabetic Clinic of Civil Hospital and Dow Medical College, Karachi, from November 2010 to May 2011. A total of 358 adult type-2 diabetics with hypokalemia were selected for this study. With aseptic measures, venous blood was collected for serum magnesium, potassium, HDLc, LDLc Triglyceride [TGs] and glycosylated hemoglobin [HbA1c] from each subject after an overnight fasting and was analyzed on Roche Hitachi 820 Photo Spectrometry. The data was analyzed on SPSS version 17 to determine the factors associated with hypomagnesaemia like duration of diabetes, Body Mass Index [BMI], diabetic nephropathy, HDLc, LDLc Triglyceride [TGs] and glycosylated hemoglobin [HbA1c] level. Mean age of study population was 55.62 +/- 9.9 years. Most of them [n=228, 63.7%] were males. Out of the 358 subjects, 198 [55.3%] had hypomagnesaemia. There was significant association between hypomagnesaemia with duration of diabetes, Body Mass Index [BMI], diabetic nephropathy, HDLc, LDLc Triglyceride [TGs] and glycosylated hemoglobin [HbA1c] level. Hypomagnesaemia is very common in type-2 diabetic hypokalemic patients. Therefore, it should be routinely sought by the clinicians. Early recognition and subsequent treatment of hypomagnesaemia may help in better glycemic control, may delay the chronic complications and decrease the mortality in diabetic hypokalemic patients
ABSTRACT
To determine the frequency of Pott's disease in patients of paraparesis presenting to medical wards of Civil Hospital Karachi. Cross sectional study. This study was conducted in all Medical Wards of Civil Hospital, Karachi, from 1[st] January 2012 to 31 Dec 2012. A total of 133 patients of spastic paraparesis and meeting inclusion criteria were included in this study. Inquiry was carried out regarding age, gender, presenting complaints, duration of illness, past history of TB and site of involvement of spine. Diagnosis of Pott's diasease was made on Magnetic Resonance Imaging [MRI] findings of soft tissue edema, disc space narrowing, paraspinal mass or vertebral collapse. Out of 133 patients, mean age was 47.7 [ +/- 15.6] years with male: Female = 1.6: 1. Out of 133 patients of spastic paraparesis, Pott's disease was diagnosed in 53 [39.8%] cases. Frequency of pott's disease was high in male [M: F = 2.1: 1], 36 [43.9%]. Average age of patients with pott's disease was 49 +/- 13.2 years [Min - Max = 22 - 80 years]. In this study Pott's disease was diagnosed in 39.8% patients of spastic paraparesis. Frequency of pott's disease was high in male gender and older [Age: 31 - 50 years] patients
ABSTRACT
To detect the frequency of Obesity in type 2 diabetic patients. It was a Cross Sectional study carried out at Diabetes Clinic, Medical Unit III, Jinnah Postgraduate Medical Centre Karachi from 1[st] Jan 2012 to 30[th] June 2012. Three hundred and eighty seven [387] type II diabetic patients of either sex and any age were included in the study. Non-purposive convenience sampling technique was used to enroll patients in the study. History regarding diabetes, hypertension [HTN], Cerebrovascular Accidents [CVA], smoking and other tobacco exposure was taken. Physical examination was carried out and height, weight, body mass index [BMI], blood pressure, peripheral pulses and anklebrachial index [ABI] was calculated. Categorical variables such as Gender, Age groups, BMI groups, HTN, smoking, hyperlipidemia and ABI were expressed as frequencies and proportions. Means with standard deviations were calculated for continuous variables such as age, duration of diabetes, BMI, duration of HTN and duration dyslipidemia. For categorical variables, differences between patients were tested using the chi-square test. P value of
ABSTRACT
Currently in acute coronary syndrome, PCI is most common strategy. No-reflow phenomenon [NR] is one of serious complication. Aim of this study was to evaluate role of intracoronary bolus administration of tiroflban in acute coronary syndrome patients with no-reflow during PCI. It is prospective and observational study. It is multicenter study, conducted in Karachi, Pakistan from August 2011 to July 2013. Total of 62 patients of acute coronary syndrome underwent for PCI and developed no-reflow, received intracoronary bolus tiroflban were included. The angiographic definition of successful reperfusion should include both TIMI 3 flow as well as MBG 2 or 3. No-reflow, assesed by thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade [MBG] during treatment. Data were entered and analyzed using SPSS-16 software. Statistical significance was defined as p-value <0.05. Out of 62 patients, 43 were males .The mean age was 51 +/- 13, range from 37 to 70 years. TIMI flow 1 and 11 seen in 17, 37 patients while MBG 1 and 11 seen in 20 and 33 patients before intracoronary bolus administration of tiroflban. After bolus administration of tiroflban, TIMI flow 111 was seen in 61[98.387 %] out of 62 patients while MBG 11 and 111 was also noted in 61[98.387 %] out of 62 patients. It showed better Thrombolysis In Myocardial Infarction flow grades and TIMI myocardial perfusion grades [OR 0. 22, 95% CI 0 .12 -0 .39, p-value <0.001] immediately after intracoronary bolus administration of tiroflban in-reflow phenomenon patients during PCI. In patients with ACS, Intracoronary bolus adminstration of tiroflban is effective drug to improve no-reflow during percutaneous coronary intervention especially when patient blood pressure is at lower-side
ABSTRACT
To Determine the frequency of chronic backache in the nursing staff of a tertiary care hospital. Cross sectional study. This study was carried out at Civil Hospital Karachi from 1[st] November 2011 to 30[th] April 2012. Two hundred seventy two patients were included who fulfilled the inclusion criteria after taking the informed consent. The SPSS version 14 was applied to the data. Data was analyzed through SPSS software. 49 [18%] males and 223 [82%] females. The mean age of study population was 43 +/- 7.5 years and mean duration of job was 19.3 +/- 7.6 years. 10 [3.7%] subjects had history of daily duration of work of less than 6 hours and only 06 [2.2%] work for more than 12 hours daily as compared to this 256 [94.1%] study subjects work for 6-12 hours daily. 05 [1.8%] had history of posture of sitting at most of their working hours, followed by 10 [3.7%] standing, 85 [31.3%] mobile and 172 [63.2%] subjects had non-specific posture. 197 [72.4%] had backache as compared to this 75 [27.6%] did not had backache. Out of 197, 05 [1.8%] had backache at thoracic area, another 05 [1.8%] had backache at cervical and lumbar areas followed by 20 [7.4%] had backache at cervical area and 167 [61.4%] had backache at lumbar area. 77 [28.3%] had the history of radiation of backache. 7 [2.6%] had backache for <6 weeks, 32[11.8%] had backache for 6 weeks to 3 months and 158 [58.1%] had back ache for >3 months. The findings of this study suggest that backache is a common problem in the population of nurses in Pakistan. LBP is a widespread disease affecting nurses but not a major cause of sickness absence in the workplace. Poor knowledge of back care ergonomics and unavailability of lifting equipment are major predisposing factors to LBP among nurses [occupation hazard oriented]
ABSTRACT
To know the frequency of right ventricular infarction in patients with acute inferior wall myocardial infarction. Retrospective study. This study was carried out in Department of Medicine at Civil Hospital Karachi from 1[st] November 2011 to 30[th] April 2012. In this study 65 adult patients of either sex with ECG evidence of inferior wall infarction were enrolled who were admitted in medical department at Civil Hospital Karachi. The duration of the study was 6 months. Inclusion criteria were age > 12 years of either sex or acute inferior wall myocardial infarction on electrocardiography [ST- segment elevation of more than or equal to 1 mm in at least two or three leads i.e. II, III, and aVF]. Exclusions criteria were age less than 12 years and evidence of either right or left bundle branch block on ECG. Data was analyzed through SPSS software. Out of these 65 patients, 45 [69%] were male and 20 [31 %] were female. All patients with acute inferior wall myocardial infarction were divided into three age groups i.e. 3[4%]cases were < 40 years, 44[58.66%] cases between 40-60years , and 18[24%] cases in > 60 years. From a total of 65 patients presented with acute inferior wall myocardial infarction, 40 [62%] were not associated with right ventricular infarction [Group-I], whereas 25 [38%] were associated with right ventricular infarction [Group-II], On ECG, ST-segment elevation in leads V 3R and V 4R was present in 1 out of 40 [2.5%] patients in Group-I, and 23 out of 25 [92%] in Group-II [p=<0.001]. The sensitivity, specificity, positive and negative predictive value of raised JVP was 72%, 82.5%, 78.2% and 82.5% respectively. The sensitivity, specificity, positive and negative predictive value of clear lung fields in the presence of raised JVP was 84%, 87.5%, 80.7% and 89.7% respectively. ST-segment elevation in leads V3R and V4R was 92% sensitive, 97.5% specific, having 95.8% positive and 95.12% negative predictive value. On echocardiography right ventricular dilatation was 96% sensitive, 97.5% specific, having 96% positive and 97.5% negative predictive value. In conclusion, frequency of right ventricular infarction is 38.46% in association with inferior infarction in our clinical settings
ABSTRACT
To evaluate the frequency of culture positive tuberculosis and to determine the sensitivity of drugs in exudative pericardial fluid. Descriptive observational study. This study was conducted on patients admitted in cardiology and Medical wards of Civil Hospital Karachi from 1[st] November 2010 to 30[th] April 2011. In this study 50 patients of pericardial effusion diagnosed on the basis of history, physical examination, electrocardiography, chest x-ray PA view and echocardiography underwent pericardiocentesis under fluoroscopy. Pericardial fluid D/R was done and all the patients having exudative pericardial fluid [protein] 3 gm% and LDH > 200 IU were selected. All the exudative pericardial effusion were sent for AFB culture and sensitivity on L.J. medium. Inclusion criteria were all patients with the diagnosis of exudative pericardial effusion above 12 years of age of either sex. Exclusion criteria were all patients with transudative pericardial effusion and below 12 years of age. 3 [6%] patients had culture positive for mycobacterium tuberculosis on L.J medium. 5 [10%] had culture positive of other bacteria of which 2 [4%] had culture positive for resistant Staphylococcus aureus, 2 [4%] had culture positive for Streptococcus pneumonia and 1 [2%] had culture positive for Streptococcus viridans and 42 [84%] patients had culture negative for AFB and other bacteria. Out of 50 patients, 16 [32%] were in age group between 20-40 years, 22 [44%] were in age group between 41-60 years and 12 [24%] were in age group> 60 years. Out of 16 patients having age between 20-40 years, 1 [6.25%] had culture positive for AFB, 3 [18.75%] had culture positive for other bacteria and 12 [75%] had culture -ve for all organism. Out of 22 patient having age between 41-60 years, 2 [9.09%] had culture +ve for AFB, 2 [9.09%] had culture for other bacteria and 18 [81.81%] had culture negative for all organisms. Out of 12 patients having age >60 years, none [0%] had culture +ve for AFB, none [0%] had culture +ve for other bacteria and all 12 [100%] had culture negative for all organisms. All 3 patients having culture positive for AFB were found to be sensitive to all antituberculous drugs. The concluded that frequency of culture positivity is only 6% for Mycobacterium Tuberculosis, so this should not be the investigation of choice to confirm tuberculous pericardial effusion. However, other parameters should also be looked for in establishing the diagnosis of pericardial effusion like clinical parameters, the prevalence of tuberculosis in relative area, ESR, MT, Mycobacterium tuberculosis DNA PCR and Mycobacterium tuberculosis culture on BACTEC
Subject(s)
Humans , Female , Tuberculosis/diagnosis , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents , Microbial Sensitivity TestsABSTRACT
To determine the frequency of various neurological and psychiatric symptoms associated with B12 deficiency. Observational and descriptive study. The study was conducted on patients presenting to the neurology clinics and inpatients who were admitted through the emergency department at Aga khan University Hospital Karachi, from 1 st July 2011 to March 2012. 150 patients of either gender and age more than 18 years. Detailed history was taken from all the patients with special regard to anemia. Inclusion criteria were that patients above 18 years of age of either sex with low serum B12 levels. Patients having any type of neurological tumors, major ischemic stroke, major intracranial haemorrhage, patients on neuroleptic medications and any evidence of toxin induced neuropathy were excluded. All patients underwent for specific investigation complete blood count, serum B12 levels [derived by Radio Assay method [RIA]. Further investigations Nerve Conduction Studies / Electromyography and CT Scan / Magnetic resonance Imaging of the Brain / spinal cord were carried out as and when required, depending on the clinical scenario. There were 69 [46%] males and 81 [54%] females. Female to male ratio was 1:0.8. The age ranged between 18 to 90 years with the mean age of 45.7+ 5.6. Out of 150 patients 107 patients [71.3%] had severe vitamin B 12 deficiency while 43 [28.7%] had mild to moderate deficiency. Neurological manifestations which were observed included; Memory was impaired in 13 [8.7%] of the patients. Dysarthia, along with other cerebellar signs [Nystagmus and dysdiadochokinesia] was present in 9 patients [6%]. 4 patients [2.7%] sought medical attention regarding their abnormal gait and their neurological examination revealed extensor planter responses and hyperreflexia. Cranial nerve examination revealed Anosmia in 2 [1.3%] and upper motor neuron facial weakness in 1 [0.66%] patients. Motor weakness was found in 2 patients [1.3%], and spasticity in 2 [1.3%] patients. 5 patients [3.3%] had sensory complains and were found to have impaired pain and touch perception. Proximal muscle weakness in one patient while another patient had asymmetric muscle weakness and rest of the patients had normal muscle power. None of the patient had autonomic dysfunction. In six neuropsychiatric problems were commonly seen in vitamin B12 deficient people. In these patients depression was observed in 16%, agitation 12.7%, memory impairment 8.7%, cerebellar signs and dysarthria 6%, sensory symptoms 3.3% and gait abnormality and hyperreflexia and extensor planters 2.7%. Various Neuropsychiatric problems are associated with vitamin B12 deficiency and the most common Neuropsychiatric illness found in these patients were depression, agitation, and memory impairment