Frequency of microalbuminuria in patients with ischemic stroke

To determine the frequency of microalbuminuria in patients with ischemic stroke. This cross-sectional study was conducted from 1[st] April 2009 to 30[th] September 2009 at Allied Hospital, Faisalabad. 195 patients of ischemic stroke, with or without diabetes mellitus and hypertension were tested for early morning urine albumin to creatinine ratio. A urinary albumin to creatinine ratio of 30 to 300 micro g/mg was considered as microalbuminuria. Out of 195 patients, microalbuminuria was present in 94 [48.2%] patients. Out of 68 diabetic patients, microalbuminuria was present in 37 [54.4%] patients while out of 127 non- diabetics, 57 [44.9%] had microalbuminuria. Out of 113 hypertensive patients, microalbuminuria was present in 56 [49.6%] while out of 82 non hypertensives, 38 [46.3%] had microalbuminuria. Among 28 patients having both diabetes mellitus and hypertension, 16 [57.1%] had microalbuminuria. Out of 42 patients without both diabetes and hypertension, 17 [40.5%] had microalbuminuria. We found high frequency of microalbuminuria in patients with ischemic stroke. Therefore, microalbuminuria could be is a useful modifiable factor, in addition to conventional risk factors, in identifying those at increased risk of ischemic stroke

Dengue fever; clinico-pathologic correlations and their association with poor outcome

One of the major health hazards that has erupted in Pakistan within the recent past years and has caused loss of life of many young people is Dengue Fever. Main objective was to find clinico-pathologic parameters which are essentially associated with complications and contribute to the adverse outcome. This prospective study was conducted on 106 seropositive cases of dengue fever. Patients were taken from Abbasi Shaheed Hospital, Karachi from June 2008 to March 2009. The most common 3 hematological abnormalities were thrombocytopenia and leucopenia. Platelets count below 50 x 10 / microL was seen in [78%] cases and 49% 3 patients had total white cell count below 4 x10 /microL. Partial thromboplastin time was significantly prolonged in [26%] cases whereas prothrombin time was normal in all patients. Liver enzymes both Aspartate Aminotransferase [AST] and Alanine Amino-transferase were significantly elevated in [60%] patients. Blood urea nitrogen [BUN] and creatinine was deranged in [23%] patients. Fever was the most common clinical presentation [86% of the patients]. Hematological parameters [low platelet count, low total leucocytes count, prolonged APTT and raised hematocrit] and biochemical parameters [raised aminotransferases, blood urea nitrogen] have strong association with the complications of dengue fever and hence are associated with the poor outcome of disease

Etiological determinants of congenital pelviureteric junction obstruction

Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases