Gender Differences in Risk Factors of Ischemic Stroke Patients in a Tertiary Care Centre in North India

Every year, more than 33 million people worldwide experience an acute stroke. ischemic stroke is caused by loss of blood supply to brain tissues due to sudden occlusion of arterial system by an embolus or a thrombus. Non-modifiable risk factors are age, sex & genetic factors whereas modifiable ones include hypertension, diabetes, smoking, tobacco chewing, dyslipidaemia, obesity, cardiac disease etc. Aim of the present study is to evaluate & compare the presence of various risk factors of ischemic stroke among males & females.METHODSThe study was conducted at BRD Medical College, Gorakhpur, during the academic year 2019-2020. All patients with ischemic stroke on CT Head & age >18 years were included in this cross-sectional study. Detailed history including age, addictions, comorbidities (diabetes, hypertension), previous stroke history & compliance to treatment was taken. A short neurological & laboratory examination was performed in each patient.RESULTSIn this study, a total of 100 patients was included out of which 57 were male & 43 were female. The mean age of stroke was 64.82 years [males-65.62 years, females-63.5 years]. The most common risk factors responsible for ischemic stroke was hypertension- 52% [males- 50.4%, females- 53.57%]. Other risk factors were diabetes- 28% [males- 29%, females- 25.6%], cardiac disease-13% [males-8.8%, females-18.6%], dyslipidaemia-12.3% in males & none of females. Smoking & tobacco chewing were more common among males (54.4% each). Dyslipidaemia & tobacco use was significantly associated with ischemic stroke in male patients.CONCLUSIONSThere is increasing incidence of acute ischemic stroke which is directly related to modifiable risk factors like dyslipidaemia, smoking & tobacco use in male patients. Advanced age is strongly related to acute stroke in both males & females. Hypertension is the commonest risk factor overall for ischemic stroke.

Absence of Glia Maturation Factor Protects from Axonal Injury and Motor Behavioral Impairments after Traumatic Brain Injury

Traumatic brain injury (TBI) causes disability and death, accelerating the progression towards Alzheimer’s disease and Parkinson’s disease (PD). TBI causes serious motor and cognitive impairments, as seen in PD that arise during the period of the initial insult. However, this has been understudied relative to TBI induced neuroinflammation, motor and cognitive decline that progress towards PD. Neuronal ubiquitin-C-terminal hydrolase- L1 (UCHL1) is a thiol protease that breaks down ubiquitinated proteins and its level represents the severity of TBI. Previously, we demonstrated the molecular action of glia maturation factor (GMF); a proinflammatory protein in mediating neuroinflammation and neuronal loss. Here, we show that the weight drop method induced TBI neuropathology using behavioral tests, western blotting, and immunofluorescence techniques on sections from wild type (WT) and GMF-deficient (GMF-KO) mice. Results reveal a significant improvement in substantia nigral tyrosine hydroxylase and dopamine transporter expression with motor behavioral performance in GMF-KO mice following TBI. In addition, a significant reduction in neuroinflammation was manifested, as shown by activation of nuclear factor-kB, reduced levels of inducible nitric oxide synthase, and cyclooxygenase- 2 expressions. Likewise, neurotrophins including brain-derived neurotrophic factor and glial-derived neurotrophic factor were significantly improved in GMF-KO mice than WT 72 h post-TBI. Consistently, we found that TBI enhances GFAP and UCHL-1 expression and reduces the number of dopaminergic TH-positive neurons in WT compared to GMF-KO mice 72 h post-TBI. Interestingly, we observed a reduction of THpositive tanycytes in the median eminence of WT than GMF-KO mice. Overall, we found that absence of GMF significantly reversed these neuropathological events and improved behavioral outcome. This study provides evidence that PD-associated pathology progression can be initiated upon induction of TBI.

An Aortic Root Abscess Presenting as a Suprasternal Pulsatile Mass / 대한흉부외과학회지

Prosthetic valve endocarditis with aortic root abscess is a serious condition requiring urgent surgical intervention. We present a case caused by an infected Bentall mechanical valve conduit after cardiac surgery in a patient who was referred for a suprasternal pulsatile mass. The patient also had 1 episode of sentinel haemorrhage.

An Aortic Root Abscess Presenting as a Suprasternal Pulsatile Mass

Prosthetic valve endocarditis with aortic root abscess is a serious condition requiring urgent surgical intervention. We present a case caused by an infected Bentall mechanical valve conduit after cardiac surgery in a patient who was referred for a suprasternal pulsatile mass. The patient also had 1 episode of sentinel haemorrhage.

Association of in-hospital outcome of acute kidney injury [AKI] with etiology among newborns at a tertiary care unit

Objective: To determine association of in-hospital outcome of AKI with etiology in newborns at a tertiary care hospital

Methods: This descriptive cross-sectional study was conducted at Department of Pediatric Neonatology, The Children's Hospital and Institute of the Child Health, Multan by using non-probability purposive sampling technique from June 2016 to June 2017. A total of 101 newborns diagnosed with acute kidney injury were registered. Etiological factors were assessed and these patients were followed till discharge to monitor in-hospital outcomes

Results: Of these 101 newborns, 75 [74.3%] were boys while 26 [25.7%] were girls. Mean age of these newborns was 7.59 +/- 6.13 days [range; 1 day to 28 days]. Mean age of the boys was 5.73 +/- 7.20 days while that of girls was 6.77 +/- 6.16 days. [p=0.515]. Mean weight of these neonates was 2545.05 +/- 600.42 grams [range; 1000 grams to 4000 grams]. Mean serum potassium level was 4.94 +/- 0.92 mgEq/L ranging from 3.1 mgEq/L to 7.0 mgEq/L. Mean urea level was 73.35 +/- 27.65 mg/dl ranging from 18 mg/dl to 206 mg/ dl. Mean serum creatinine level was 1.98 +/- 0.27 mg/dl, ranging from 1.6 mg/dl to 2.8 mg/dl. Mean serum sodium level was 145.72 +/- 12.64 mgEq/L ranging from 126 to 166 mEq/L. Eighty one [80.2%] were term babies while 20 [19.8%] were pre-term babies. Of these 101 study cases, 29 [28.7%] delivered vaginally while 72 [71.3%] through cesarean section. Delayed crying was noted in 48 [47.5%], dehydration 13 [12.9%], sepsis in 36 [35.6%] and renal malformation in only 4%. Neonatal mortality in these patients was 15 [14.9%] while 86 [85.1%] were discharged from hospital after recovery

Conclusion: Acute kidney disease in newborns is associated with significant disease morbidity and mortality with asphyxia and sepsis are the main etiological factors responsible. It is predominantly more common in boys compared with girls. Mortality rate was high in our study and it was significantly associated with female gender. Mortality was also associated with elevated serum sodium and urea level

Validation of serum C-reactive protein for the diagnosis and monitoring of antibiotic therapy in neonatal sepsis

Objective: To evaluate the adequacy of serum C-reactive protein [CRP] in diagnosing neonatal sepsis and role of CRP in determining the duration of antibiotic treatment in neonatal sepsis

Methods: In this validation study, we included 135 neonates with suspected diagnosis of sepsis within duration of nine months from September 2016 to May2017 in Children Hospital Multan. Blood samples were drawn from every neonate for culture sensitivity and measurement of serum C-reactive proteins. In all suspected neonates, empirical antibiotics e.g. Gentamycin or Ampicillin were started after taking blood samples. Serum CRP levels >5 mg/dl were marked as positive results. 2nd blood samples for measurement of serum CRP were taken after 72 hours of the first sample. There were two primary endpoints; one to determine the sensitivity and specificity of CRP against blood culture and second was to determine the negative predictive value of CRP in determining the duration of anti-biotic in neonates presenting with sepsis

Results: Out of these 135 babies, 102 [75.5%] were confirmed to have sepsis using blood culture reports. CRP results were Positive in 85 [62.9%] neonates on first baseline measurement and were positive in 103 [76.29%] neonates after 72 hours of admission. The sensitivity of CRP in diagnosing sepsis was 98.03%, specificity was 91.0%, positive predictive value [PPV] was 97% and negative predictive value [NPV] was 93.7%. The mean duration of antibiotic treatment in CRP guided group was 5.03 days versus 7.02 days in standard treatment duration group [p-value <0.001]. The NPV of CRP in determining the duration of antibiotics was 100.0%

Conclusion: Serum CRP level is a reliable test in establishing the diagnosis of neonatal sepsis. It accurately monitors the duration of antibiotic therapy and results in significant reduction in the treatment duration of neonatal sepsis

Auto-amputated ovary presenting as abdominal mass in an infant

Among female infants, a mass in the abdomen carries a large number of differential diagnoses. A relatively uncommon condition is ovarian cyst, which may be encountered among such patients. Even more rare condition is auto-amputation of ovary. We herein, present a case of a female infant who presented as abdominal mass and turned out to be autoamputation of right ovary attached to mesentery of intestine. It was excised successfully and the patient is doing well at 3 years follow-up

Efficacy of intra-vitreal bevacizumab combined with phaco-emulsification in the prophylaxis of macular edema in patients with non-proliferative diabetic retinopathy

Objective: This study was designed to evaluate the prophylactic efficiency of intra-vitreal Bevacizumab combined with cataract surgery in patients of non-proliferative diabetic retinopathy without macular edema for the prevention of macular edema by assessing the visual outcome

Methodology: This was interventional, randomized, open-label and control study of two parallel groups of already diagnosed patients with pre-proliferative diabetic retinopathy without macular edema. The study included sixty eyes of sixty patients, having non-proliferative diabetic retinopathy without macular edema and lens opacity [grade 1 to 3]. One group [n=30] received intra-vitreal injection of Bevacizumab and the control group [n= 30] did not received intra-vitreal injection of Bevacizumab at the time of standard phaco-emulsification. Main outcome measure was best-corrected visual acuity [BCVA] at the end of two months compared with the baseline visual acuity recorded along with central macular thickness [CMT] measured on optical coherence tomography [OCT] as required

Results: The outcome was an improvement of BCVA at the end of 8[th] week compared with that at baseline in the Bevacizumab group and a worsening of visual acuity in the control group [p = 0.005]

Conclusions: Prophylactic use of intravitreal Bevacizumab combined with phacoemulsification appears to be beneficial in preventing post-surgical visual loss in eyes with NPDR by preventing the chance of macular edema

Profile of ocular trauma in patients under the age of sixteen years in allied hospital, Faisalabad

Aims and Objectives: Evaluation of epidemiological contributing factors in occurrence of ocular trauma in patients under the age of 16 years. Study Design: Descriptive and analytical study carried on 216 children. Period: 13-02-2014 to 26-12-2015. Setting: At Ophthalmological Department, Allied Hospital, PMC, Faisalabad

Patients and Methods: The patients with eye injury who presented to the ophthalmological Department of Allied Hospital, PMC, FSD from 13-02-2014 to 26-12-2015 were included in the study. The Activity at the time of injury, place of injury, identifiable objects causing trauma, age 1-16 years, any sex, use of eye protectors, were noted

Results: Out of 216 patients, there were 166 male [76.85 %] while female were 50 [23.15 %]. There were 76 patients having age between 0-5 years while 78 [36.11 %] were between 6-10 years of age. Out of 216 only 62 [28.7 %] patients were of age between 11 years to 16 years. The injuries due to knife and scissors, occurred in home and were the commonest [17.59 %]. The injuries occurring due to fire cracker and vegetable matter outside home were also common 16.20% and 13.89 % respectively. The fist and hand bite injuries in this group were least common [0.93 %]. In our setting commonest eye injuries involving corneo-scleral were [35+25] [27.78 %]. The frequency of subconjuctival hemorrhage was 11.11 %. The cases having lid tear and canicular cut were 6.48 %

Conclusion: Ocular trauma is an important cause of preventable visual morbidity particularly among younger people who are at the lower risk for chronic ocular diseases. Pediatric ocular trauma is a common cause of ophthalmic consultation

Duplication cyst presenting as hydrocoele in a child

Enteric duplication cyst can occur anywhere in Gastrointestinal Tract [GIT], from oropharynx to rectum. Their presentation depends upon the portion of GIT involved. The most common site of GIT involved is small intestine, in 50% of cases. Small intestinal duplication cyst usually present with abdominal pain or mass and rarely as intussusception, volvulus or small bowel obstruction. It may also present very rarely as inguinal hernia of which only 2 cases have been reported yet. We report a 3 years child presenting as hydrocoele of the cord which turned to be duplication cyst which is very rare presentation

Acute renal failure in diabetes mellitus

To study the causes and outcome of Acute renal failure [ARF] in diabetes mellitus. This prospective study was conducted at nephrology unit of SIUT Karachi, Pakistan from November 2012 to May 2013. All adult patients with known underlying diabetes presenting with suspected ARF were included in the study. The treatment options were conservative and dialysis. Renal biopsy was performed in selected patients. All patients were followed for a period of six weeks for outcome of renal failure i.e. recovery, dialysis dependency and death. A total of 95 patients with suspected ARF were enrolled during this period. We found sepsis as the single most common factor causing ARF in 66 [69.5%] patients and the most common focus of infection was found to be urinary tract in 47 [71.2%] patients. Other factors leading to ARF included volume depletion in 19 [20%], cardio renal in 13 [13.7%], acute glomerulonephritis in 3 [3.15%] and contrast exposure in 2 [2.1%] patients. In all 72 [75.8%] patients required dialysis, while 23 [24.2%] were managed conservatively. Eventually 62 [67.39%] patients recovered, 14 [15.21%] became dialysis dependent, and 16 [17.39%] died. Among those who expired, all underwent dialysis and sepsis was the leading cause of death in 13 [81.25%] patients. Infection, especially of urinary tract is the leading cause of ARF in Diabetics. Outcome is favourable in those who dot require dialysis

Gitelman's syndrome complicated by mild renal insufficiency and high anion gap acidosis; a rare presentation in a young female

Gitelman's syndrome [GS] is a rare autosomal recessive renal tubular disorder that is characterized by episodic clinical manifestations and persistent biochemical abnormalities. The disorder manifests in adolescent or adult age and is characterized by transient episodes of muscle weakness and tetany. Its diagnosis requires a high index of suspicion and skillful interpretation of laboratory investigations. We herein present a case of a 20-year-old female patient who presented with generalized muscle weakness and mild renal insufficiency. Laboratory investigations revealed mild azotemia, high anion gap acidosis, hypokalemia, hypomagnesemia, and hypocalciuria. She recovered her renal functions and muscle power with appropriate management and is doing well seven months after her first presentation to our hospital. This case highlights the need to create high index of suspicion among the general practitioners about this syndrome and an early referral of such patients to nephrologists for an accurate diagnosis and appropriate management

Acute disseminated encephalomyelitis [ADEM] presenting as a multiphasic encephalopathy: a case report

Acute disseminated encephalomyelitis [ADEM] is one of the demyelinating disorders of central nervous system [CNS] causing acute or relapsing-remitting encephalopathy. We report a male child, who presented with fever, fits and altered sensorium, with two identical events, 3 1/2 months apart. Neuroimaging showed high signal lesions on the T2 weighted images reflecting areas of demyelination and edema, consistent with ADEM. He responded with complete recovery after pulse steroids and intravenous immunoglobulin [IVIG] therapy

Fibrolamellar hepatocellular carcinoma- a rare clinical variant

Fibrolamellar type is a rare variant of hepatocellular carcinoma [FLHCC]. A 20 year old boy presented with pain and mass in the epigastric region for the last six months. Early diagnosis and confinement of the lesion to a lobe made it possible to perform complete resection of tumour along with subtotal gastrectomy. Patient recovered well and was sent to oncologist for further treatment

Urinary tract infections [UTI] among females caused by staphylococcus saprophyticus

Staphylococcus saprophyticus is a uropathogen frequently isolated from young female outpatients presenting with uncomplicated urinary tract infections[1]. Antibiotic resistance in uropathogen is increasing worldwide in out patients as well as hospitalized patients[2]. Cross-sectional study. The urine specimens were obtained from Nephrology, Urology and gynecology/ Obstetric and outpatient departments of JPMC, Karachi for three years. They were processed in the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from May 2003 to May 2005. The proper and necessary records of the patient were maintained, then the samples were processed by the standard methods. Blood agar plates and MacConkey's agar plates were used for culture. The biochemical tests were done by using different sugar media, TSI, Simon citrate agar, urease, indole and MRVP tests. Out of 175 urinary pathogens isolated from female patients complaining from symptoms of UTI, 28 [16%] yielded Saprophyticus predominantly in pure culture and in high counts. In the age group of 18-28 years, this organism was found in 10 [36%], while in the age group of 29-39 years it was found in 8 female patients i.e. it was 28%. Hence it is observed that as the age advances staph saprophyticus becomes a rare finding so it is not a common organism in elderly males as well as females of all ages. But the sensitivity pattern must be seen to commonly use antimicrobial agents for proper and timely therapy

Comparison of methods for diagnosing bacterial vaginosis

To determine the laboratory method that best predicts Bacterial Vaginosis. Descriptive Observational study. This study was conducted in the Department of Microbiology, Sindh Medical College [DUHS] and Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from Jan. 2005 to Feb. 2007. A total of 150 randomly selected women were included in this study from OPD of various tertiary care hospitals and family planning clinics of the city. In this study we compared and calculated the sensitivity, specificity and predictive value of positive and negative tests for wet mount, Gram stained vaginal smears and Gardnerella vaginalis [G.vaginalis] cultures with clinical sign Amsel's criteria [Gold standard], for the diagnosis of bacterial vaginosis [B.V]. We diagnosed 54 [36%] cases of bacterial vaginosis by Gram's staining method, 61 [41.7%] cases by Wet Mount method, and 42 [28.0%] cases by Amsel's criteria and 47 [31.3%] cases by culturing. Amsel's criteria were comparable with other laboratory tests for diagnosis of BV. Culture was laborious, expensive and least sensitive method

Serum vitamin D and osteoarthritis

To determine whether the serum vitamin d level is associated with increasing age in female OA patients. Experimental and Observational Study. This study was conducted at the Department of Orthopaedic, Civil Hospital, Karachi from Feb. 2006 to Jan. 2008. Sixty female patients who were suffering from OA were studied. Patients were classified according to their stage of severity of OA in knee joints. Serum vitamin D was measured in serum by ELISA technique. According to distribution patients of group 3 having the age between 61 - 70 years. Serum vitamin D was detected in serum. Group 3 has high serum Vitamin D levels as compared to group 1 and 2 [P<0.5]. The age group of between 61 years and 70 years has low vitamin D levels, indicating that old age may be one of risk factor for OA

Seroprevalence of toxoplasmosis [by detecting IgM antibiodies] in women with repeated abortions

To determine seroprevalence of Toxoplasmosis in women with repeated abortions in our local population. Prospective Cross-sectional study. This study was conducted in the Department of Microbiology Basic Medical Sciences Institute [BMSI] Jinnah Postgraduate Medical Centre [JPMC] Karachi from April 2006 to May 2008. Sera from 130 pregnant and post-aborted women with history of repeated abortions [group A] and 50 pregnant women with no history of abortion [group B - as controls] were analyzed for Toxoplasma IgM antibodies by ELISA technique to see the prevalence of toxoplasmosis. 24% of women of group A and 14% of women of group B were seropositive for toxoplasma IgM antibodies. Most of the cases with toxoplasmosis have had their abortions in the first trimester. Gradual increase in Toxoplasma antibody positivity with increasing gravida was observed. Women with negative serological status are at risk of acquiring a primary infection during pregnancy, hence education regarding preventive measures should be provided to them and every pregnant woman may be advised for Toxoplasma IgM antibodies investigation

Risk factors in various subtypes of ischemic stroke according to TOAST criteria

To identify the frequency of risk factors in various subtypes of acute ischemic stroke according to TOAST criteria. Cross-sectional, observational study. Ziauddin Hospital, Karachi, from January to December 2007. Ziauddin Hospital, Karachi, from January to December 2007. Patients with acute ischemic stroke were enrolled. Studied variables included demographic profile, history of risk factors, physical and neurological examination, and investigations relevant with the objectives of the study. Findings were described as frequency percentages. Proportions of risk factors against subtypes was compared using chi-square test with significance at p< 0.05. Out of the 100 patients with acute ischemic stroke, mean age at presentation was 63.5 years. Risk factor distribution was hypertension in 85%, Diabetes mellitus in 49%, ischemic heart disease in 30%, dyslipedemia in 22%, smoking in 9%, atrial fibrillation in 5%, and previous history of stroke in 29%. The various subtypes of acute ischemic stroke were lacunar infarct in 43%, large artery atherosclerosis in 31%, acridoembolic type 8%, stroke of other determined etiology in 1% and stroke of undetermined etiology in 18%. Hypertension and Diabetes were the most association was found with ischemic heart disease [p=0.01]. Importance and relevance of risk factors evaluated for subtypes rather than ischemic stroke as a whole should be reflected in preventive efforts against the burden of ischemic stroke