Frequency of impaired glucose tolerance test in patients with active tuberculosis

Objective: To determine the frequency of impaired glucose tolerance in patients presenting with active pulmonary tuberculosis in tertiary care hospital, Karachi

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Dow University Hospital [Dow University Health Sciences Karachi] from 1stJune 2014to 30thNovember 2014

Materials and Methods: A total of 110 diagnosed adult cases of active pulmonary tuberculosis on the basis of sputum smear positivity were included in this study. Blood samples were drawn for investigations and sent to the same reference laboratory to minimize bias.Data was collected on a pre-tested self administered Performa

Results: There were 59.1% were male and 40.9% were female. Frequency of impaired glucose tolerance in patients presenting with active pulmonary tuberculosis was observed in 20.9%. Rate of impaired glucose tolerance was highly associated with above 40 years of age patients and with family history of diabetes

Conclusion: In Pakistan DM is on the rise and TB has one of the highest incidence in the world. There is emerging evidence that one disease is fuelling the other. The interest in diabetes and TB is mounting rapidly, so the clinician and researchers should prepare themselves to meet the challenges of the two diseasecombined

Frequency of subclinical hypothyroidism in patients with proliferative diabetic retinopathy

To determine the frequency of subclinical hypothyroidism in patients with proliferative diabetic retinopathy. Cross Sectional Study. This study was conducted in Dow University Hospital, Dow University of Health Sciences, Karachi from 1[st] January 2012 to 31[st] December 2012. One hundred and nineteen patients attending the medicalOPD Dow University of Health Sciences were included in study. 119 patients were enrolled in study .47.1% were male and 52.9% were female patients mean age was 55.75 +/- 7.85 years, Mean HbA1[c] value was 8.02 +/- 1.46%, Subclinical hypothyroidism was identified in 26.9% the patients. Subclinical hypothyroidism is associated with the development of proliferative diabetic retinopathy in the patients suffering from type 2 diabetics

Serum magnesium level in migraineurs versus non migraineurs

The objective is to observe relationship between low serum magnesium level and Migraine. Prospective Observational. This study was conducted in Dow University Hospital, Dow University of Health Sciences, Karachi from 1[st] January 2013 to 31[st] December 2014. One hundred and fifty patients attending the medical and Neurology OPD at Dow University Hospital were included in study. They were diagnosed according to International Headache Society [HIS] criteria for migraine headache. 150 patients were enrolled in study 49 [32.7%] were male and 101 [67.3%] were female patients mean age was 28 [ +/- 6.2] years, After excluding other causes migraine was diagnosed in 102 [68%] patients. Out of 102 patients 71 [69.7%] were have low serum magnesium level. In the remaining patients with non migrainous headache, only 6 patients [12.5%] have low serum magnesium level because of some other causes for example medications. Migraine is frequently associated with Serum low level of Magnesium compare to patient with nonmigrainous headache

Cardiovascular and renal protection in type 2 diabetic hypertensive patients. the role of calcium channel blockers

To study the effects of Calcium Channel Blocker [Amlodipine] as monotherapy in diagnosed hypertensive, non-insulin dependent diabetes mellitus [NIDDM] patients. Prospective study. This study was conducted at Jinnah post graduate medical centre [JPMC] Karachi, in collaboration with the department of medicine JPMC, Karachi from July 2010 to January 2011. This study is to examine the effects of Amlodipine in type 2 diabetic hypertensive patients with base line proteinuria. 20 normal subjects were also selected as a control group with CCB [Amlodipine] baseline to final change for SBP as well as DBP was significantly reduced i.e.24.70 % [p<0.001] and 16.20% [p<0.001] respectively. CCB showed 44% [p<0.001] reduction in FBS, creatinine clearance reduced by 8.10% [p<0.5], serum potassium reduced by 4.50%, non significant increase in serum urea i.e.3.70% and serum creatinine i.e. 3.8% was observed. Aim of treating hypertension is to control or limit its cardiovascular complications; CCB and are the drug of choice in controlling blood pressure and to prevent the progress of cardiovascular events in patients without diabetic nephropathy as well as reserves for add-on therapy in hypertensive patients complicated with diabetic nephropathy

Repetitive nerve stimulation test, an investigation that helps in confirming diagnosis in seronegative myasthenia gravis

To assess the effectiveness of Repetitive Nerve Stimulation Test in the diagnosis of Seronegative Myasthenia Gravis. Descriptive Observational. This study was conducted at Dow University of Health Sciences and Jinnah Postgraduate Medical Centre during the period of three years from 2010 to 2013. A total 129 cases, both out patients as well as inpatients, who were diagnosed as a case of Myasthenia Gravis clinically and by other investigations including, Edrophonium Test, Chest Radiology, and Acetylcholine Receptor antibodies were studied. Out of 129 cases, of Myasthenia Gravis, who were admitted or came in outpatient department, 55 subjects are male. On Repetitive Nerve Stimulation study at 3Hz, significant decrement was found in trapezius in 16 [88%] patients who are Seronegative and in 90 [81%] seropositive patients. Repetitive Nerve Stimulation Test is a promising tool in the diagnosis of Myasthenia Gravis and should be a part of investigations used to diagnose this neuromuscular junction disorder especially in Seronegative cases, for confirming the diagnosis

Correlation between clinical severity and eosinophillic count in asthmatic patients

To determine the correlation between the blood eosinophil count and the severity of symptoms in asthmatic patients. Prospective observational study. This study was carried out in Dow General Hospital, Dow University of Heath Sciences from l[st] January 201 1 to 31[st] December 2011. Asthmatic patients who were admitted in Dow General Hospital, Dow University of Heath Sciences, and those who fulfilled the inclusion criteria were enrolled in the study. Physical examination was carried out and the severity of the symptoms was gauged by using Peak Expiratory flow meter and absolute eosinophil count. The data thus collected was analyzed using SPSS Version 15. Among 56 patients who were enrolled in the study 29[51.8%] were male and 27[48.2%] were female. Ages were between 13 and 70 years. The absolute eosinophil count ranged between 70/mm[3] and 1400/mm[3]. Based on the definition of asthma severity, 20 patients [35.7%] had mild asthma, 17[30.4%] had moderate and 19[33.9%] patients had severe asthma. Statistical analysis showed that no relationship exist between blood eosinophil count and the severity of asthma, [p < 0.003]

To assess vitamin d levels in patients diagnosed as fibromyalgia in patients attending dow university hospital

To assess the Vitamin D levels in patients diagnosed as fibromyalgia in patients attending Dow University Hospital Karachi. Descriptive study. This study was conducted at Dow University Hospital, Karachi from 21[st] January 2013 to 30[th] December 2013. 83 patients were selected from the outpatient department of medicine OPD. among 83 patients who were enrolled in the study 60 [72.71%] were male and 23were [27.71] were females ages were between 7 and 70 years, the vitamin D levels ranged between 2 and 58with mean vitamin D level found to be 12,58 which is counted as moderate deficiency. 83 patients with fibromyalgia were included in study. Among them who were enrolled in the study 60 [72.28%] were male and 23 [27.71%] were females .The subjects included in study age between 17 and 70 with mean age of 39.69 years. The fibromyalgia was gauged on clinical assessment. Vitamin D levels were classified. Vitamin D levels ranged between 2 and 58 with mean 12.58. As objective of study to assess vit D levels in diagnosed fibromyalgia patients in our population it was found that relationship between two parameters in significant. Vitamin D deficiency is frequently diagnosed in patients with fibromyalgia and nonspecific musculoskeletal pain in study population

Prevalence of metabolic syndrome in patients present with unstable angina

The main objective of this study was to determine the frequencyof metabolic syndrome in patients presesnting with unstable angina at DUHS. Cross-sectional observational study. This study was carried out at all medical wards of a DUHS from January 2012 to July 2012. 81 patients with Unstable Angina [UA] presented in medical ward that fulfilled the inclusion and exclusion criteria and gave informed consent were enrolled for the study. Metabolic syndrome was defined according to ATPIII criteria. Patients were evaluated for obesity, diabetes, hypertension, hypertriglyceridemia and low HDL. Total 81 patients with unstable angina were included in this study Out of them 43 [53.1%] were male and 38 [46.9%] were female. Mean age was 60.23 +/- 8.7. Majority of patients [49.4%] were lying in 51 to 60 years age group. The frequency of metabolic syndrome was thirty nine [48.1%]. Among them twenty three [53.5%] were male and sixteen [42.1%] were females, hence it shows insignificant p value of 0.018. Metabolic syndrome is common with high frequency in our population. This study provides a quantitative estimate of the frequency of metabolic syndrome and suggests Diabetes, low HDL, hypertension, hypertriglyceridaemia and obesity strongly correlates with unstable angina

Radiographic patterns in HIV associated pulmonary tuberculosis

To compare the radiologic patterns in HIV positive patients with pulmonary tuberculosis with non-HIV positive patients of pulmonary tuberculosis. Descriptive study. The study is a carried out in the Department of Medicine at Dow University Hospital from July, 2010 to July, 2011. The admission records of 54 HIV-positive patients were analyzed. A total of 30 patients out of 54 presented with pulmonary symptoms, which were further evaluated by sputum smear for acid-fast bacilli and chest radiographs. These 30 patients were compared with 30 non-HIV, smear positive for acid-fast bacilli patients. Out of 30 HIV seropositive patients, 29 were male and 1 was female with the mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 10 patients [33.3 %]. Frequent radiographic patterns included normal 12[40%] and apical infiltrates 5[16.6%]. Cavitatory lesion was observed in 1 patient. Dominant symptoms were weight loss 29[93.3%] and fever 24[80%]. Out of the 30 non-HIV seropositive pulmonary tuberculosis patients, 20 were male and 10 were female of mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 30 patients [100%]. Frequent radiographic patterns were apical cavitations 12[40%], apical infiltrates 5 [16.6%], bronchopneumonia 6[20%], interstitial infection3 [10%].Dominant symptoms were weight loss 29[93.3%] and fever 24[80%]. Majority of HIV seropositive patients with pulmonary tuberculosis were male. Common radiographic patterns were normal radiographs and apical infiltrates. Atypical radiographic presentation is particularly related in advance stages of immunosuppresion. Cavitatory lesions and pleural effusion were rare findings. Non HIV seropositive pulmonary tuberculosis patients were both male and female. Common radiographic patterns were apical cavitatory lesions, bronchopneumonia, interstitial infiltrations and pleural effusion. This radiographic presentation is particularly related to delayed hypersensitivity reaction

Sensitivity pattern of causative microorganisms in septicemia

The study was conducted to find out the various etiological organisms in septicemia and their sensitivity to different antimicrobial drugs. Observational study. This study was conducted in Medical units of Civil Hospital Karachi from January 2010 to December 2010. A total of 90 patients between the ages of 15 years to 80 years, irrespective of gender with septicemia were included in this study. Total number of patients was 90. There were 47 [52%] male and 43 [48%] were female. Staphylococcus aureus and Salmonella Typhi were the most common organisms isolates in 26% cases. Regarding the sensitivity pattern of bacteria to different antimicrobial drugs, the results showed that Staph. Aureus had good sensitivity to Augmentin, Imipenem and Tazobactum and marked resistance to Ciprofloxacin. No MRSA was isolated in the study. Salmonella Typhi showed good sensitivity to Quinolones and Ceftriaxone and marked resistance to Chloramphenicol, Co-trimaxazole and amoxicillin [Table 4]. Klebsiella showed good sensitivity to Amikacin, Ceftriaxone, Imepenem and marked resistance to Ampicillin and Carbencillin, Pseudomonas aeuroginosa had good sensitivity to Tazobactum, Amikacin and Ceftriaxone. Septicemia is a major cause of death worldwide and the random use of antibiotics has considerably increased the resistance to commonly used antibiotics. Blood culture should be sent immediately to know the spectrum of microorganisms, and their sensitivity pattern, however this may not delay the empirical use of antibiotics to hasten recovery

Various clinical presentations of falciparum malaria and outcome: a study of 100 patients

Various clinical presentations of falciparum malaria and outcome. Malaria is an important disease worldwide, result in estimated 300-500 million new cases and 1.5-2.7 million deaths per year. Most deaths occur due to Plasmodium Falciparum infection. Falciparum malaria is a major community problem in our country. Presentation of falciparum malaria with paroxysms of fever chills and rigors are easy to diagnose and treat. Case series study. This study was conducted at DUHS from January 2011 to December 2011. 100 patients above 12 years of age with any gender, presenting with high grade fever and diagnosed as a case of Falciparum malaria on thick and thin film are included in this study. Among 100 patients 69 were male and 31 females. Clinically all patients presents with fever, while 69 with headache, 39 with vomiting and 28 with altered level of consciousness. The most common sign was anemia i.e. in 40 patients, splenomegaly in 37, and jaundice was found in 35 patients. 7 patients were expired during the study. Falciparum malaria is a notorious for various presentations which may mimic like upper and lower respiratory tract infection, acute gastroenteritis and bacterial meningitis. The treating physician should be aware of the various presentations because early detection and treatment may reduce the morbidity and mortality associated with falciparum malaria

Comparison of hemodynamic responses of intrathecally placed hyperbaric 0.75% bupivacaine hydrochloride in different height groups of patients undergoing caesarean section

To compare the Hemodynamic response of intrathecally placed 1.5 ml of 0.75% hyperbaric bupivacaine hydrochloric in different height groups of patients undergoing caesarean section in spinal anesthesia. Quasi experimental study. This study was carried out in the Department of Anesthesia, Sindh Govt, Lyari General Hospital, Dow Medical College, Dow University of Health Sciences from July 2009 to December 2009. In this study patients enrolled for elective caesarean section, were divided into two groups. In Group-A the height of the patients was equal or less than 60 inches [5 feet] and the height of the patients of Group-B was between 60 -66 inches [5 - 5.5 feet]. Hypotension was observed in 67 patients. 46 patients belonged to Group-A and 21 patients from Group-B. The study showed that height of the patients influenced the hemodynamic response of local Anesthetics given during spinal anesthesia

Radiographic patterns in HIV associated pulmonary tuberculosis

To evaluate Radiographic patterns in HIV associated PULMONARY TUBERCULOSIS. Observational, retrospective, descriptive study. This study was conducted in the Department of Infectious Diseases, Civil Hospital, Karachi between July 2008 to April 2009. This study is conducted by reviewing the admission records of 54 HIV diagnosed patients. A total of 30 patients presented with pulmonary symptoms were evaluated by sputum smear for acid fast bacilli [AFB] and chest radiographs. Out of 30 HIV seropositive patients, 29 were male and 1 was female of mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 10 patients [33.3%]. Frequent radiographic patterns were 12 [40%] normal, 5 [16.6%] apical infiltrate, cavitatory lesion was observed in 1 patient. Dominant symptoms were weight loss 29 [93.3%], fever 24 [80%]. Majority of HIV seropositive patients with pulmonary tuberculosis were male, common radiographic patterns were normal radiograph, apical infiltrates atypical radiographic presentation is particularly related in advance stages of immunosuppressant. Cavitatory lesions and pleural effusion were rare findings

To compare the efficacy of rocuronium bromide and succinylcholine in elective surgery for endotracheal tube

To compare the efficacy of rocuronium bromide and Succinylcholine in elective surgery for endotracheal tube. Randomized, double blind study. This study was conducted in the Department of Anesthesia and Surgical ICU, Civil Hospital Karachi over a period of six months i.e. January 2009 to August 2009. This study was conducted on sixty patients. They were aged between 20-60 years. Patients were divided into two groups following inclusion i.e. Group A and Group B. Patients in Group A were given inj. Rocuronium 0.9mg / kg and group B received inj. Succinylcholine 1.5mg / kg. In group A which was received rocuronium bromide 0.9mg / kg, showed excellent intubating conditions in 83.33% of patients as compared to group B which was given Succinylcholine 1.5mg / kg, showed 96.66%. The intubating conditions were significantly better in group B which received inj. Succinylcholine 1.5mg / kg as compare to group A was given inj. Rocuronium 0.9mg / kg

Headache of 1st day of Ramadan

To evaluate headache in fasting state on first day of Ramadan in general population with respect to its character, relation with duration of fasting and effect of abstinence of caffeine and nicotine. Descriptive study Department of Medicine, Unit 6, Liyari General Hospital, Karachi, during the month of Ramadan. In this study, 180 people were taken, 57 of them were males and 123 were females. Age range in our study is 20-60 years. All people were interviewed in detail. Printed Performa was filled in inquiring about sehri, previous history of headache due to tension headache, migraine, pre-menstrual headache, history of smoking, diabetes mellitus, hypertension and psychiatric illnesses .They were also questioned about drug history. The male population consisted of 57 men. 8 out of 57 men had previous history of headache, 11 were smoker, 12 were diabetic, virtually all were on oral hypoglycemic agents, 6 were hypertensive while 21 had no history of any systemic illness. In female population out of 123 women, 50 had previous history of headache, there was no smoker, 2 were diabetic, and 10 were hypertensive while 60 had no history of any systemic illnesses. In general, this study has shown that 23.8% of the population complained of headache in the fasting state, the number of the headaches nearly doubled in afternoon. In female population 34/123 [27.6%] women complained of headache in the fasting state, 16 [32%] had previous history of headache. While in male population 9/57 [15.78%] complained of headache out of which 4[36.3%] were smoker and 3[37.5%] has pervious history of headache on the first day of Ramadan. One quarter of patients complained of headache in the fasting state, fasting is strong headache precipitator more so in chronic headache sufferers, frequency increases with the duration of fasting. Caffeine and nicotine withdrawal is also headache precipitator with some contributory role of relative lower glycemic values and dehydration