MRI features of spinal fluorosis: results of an endemic community screening

Fluorosis is endemic in many parts of the world. However community studies on MRI features of fluorosis are lacking. The aim of this study was to determine MRI features of spinal changes in a community with endemic fluorosis in the Thar Desert Pakistan. Randomly selected adults from the Village Samorindh, district Thar parker, Sindh, Pakistan, with spinal fluorosis diagnosed on plain x-rays and raised serum fluoride levels were studied from June 2008 to January 2009. MRI was carried out on 0.5 T open magnet MRI system. Features of vertebral body, spinal ligaments, intervertebral disc, facet joints, iliac wings and other incidental findings were noted. Sclerosis was defined as low signal intensity on both T1 and T2 weighted images. Results were described as mean and percentage values. All the studied 27 subjects complained of back ache without neurological signs. The average age was 43.33 +/- 10.45 years; 21 being male [77.8%]. The most frequent findings included generalized vertebral sclerosis [24, 88.8%], ligamentum flavum hypertrophy [23, 85%], anterior [20, 74%] and lateral [17, 62.9%] disc herniation, thickened longitudinal ligaments, and narrowing of spinal foramina. Hemangioma was seen in 04[14.8%]. The most commonly involved level was L1-2, L4-5 and lower dorsal spine. Vertebral sclerosis, a combination of premature degeneration with anterior disc herniation and an unusually high frequency of vertebral hemangioma formed the spectrum of MRI findings in subjects with spinal fluorosis having back ache but no neurological findings

Current criteria for selection of abdominal versus vaginal hysterectomy at civil hospital, Karachi

To determine the frequency of abdominal and vaginal hysterectomies and to evaluate the categorization of hysterectomy cases for abdominal or vaginal route at Civil Hospital Karachi. A cross-sectional, 12-month [2008] prospective comparative study was designed at Civil Hospital Karachi involving abdominal hysterectomy [AH] and vaginal hysterectomy [VH]. Data were extracted on a specially designed proforma including fields for age, parity, menopausal status, indication and route for hysterectomy, uterine size, and previous history of caesarean section, puerperal sepsis, tubal ligation, and laparotomy for gynecological indications. In this study, 107 [18.3%] abdominal and vaginal hysterectomies were done for benign gynecological causes. There was no case of laparoscopically assisted VH [LAVH]. Mean age [57.61 years] and parity [8] for VH were greater than those of AH [48.11 years] and 5, respectively. VH was predominantly done on atrophic uteri [25 [75.76%]]. AH was performed on 20 [27.02%] bulky uteri; in 53 [71.63%], the uterus was larger. Uterovaginal prolapse was the sole [100%] indication for VH with concomitant dysfunctional uterine bleeding [DUB] in 4 [12.13%] cases. The main indications for AH were fibroids in 28 [37.84%], DUB in 30 [40.54%], followed by adenomyosis and endometriosis in 10 cases [31.51%] each. Factors predisposing to pelvic adhesion and uterine immobility were present in 16 patients [18.85%] who underwent AH and 3 [9.09%] with VH. AH was commonly performed on less parous and perimenopausal women with larger uteri while VH was chosen for elderly, more parous women with atrophic and prolapsed uterus

Sick euthyroid syndrome: thyroid function abnormalities in patients with non-thyroid illness

Introduction: Non-thyroid illness is accompanied with many severe illnesses like septicemia, renal failure, cirrhosis of liver, Pulmonary Tuberculosis, chronic heart failure, after major surgical trauma, etc. This study was undertaken on first four illnesses, which are common medical problems, and admitted in medical wards in advanced stages. This is to bring awareness amongst clinicians while interpreting TFT abnormalities in severe illnesses

Objective: To assess the thyroid function status in patients with severe illnesses, which are commonly encountered in Medical wards. Interpretation of Thyroid hormones should be cautiously made in such conditions. Design: Descriptive/Observational, Non-interventional study Place and Duration of Study: Medical unit III, Civil Hospital, Karachi. From 1[st] March 2001 to 1[st] April 2002. The cases were recorded as and when received, keeping exclusion criteria as mentioned below

Material and Methods: 50 adult patients of either sex, admitted in the hospital for nonthyroidal illness were tested for the thyroid function status by means of T3, T4 and TSH analysis. Results were evaluated for the presence of Sick Euthyroid Syndrome

Results: Of the 50 patients, 24 [48%] had a low T3, low T4 or both but with normal TSH

Conclusion: Sick Euthyroid Syndrome should be considered while managing the patients with serious and debilitating illnesses

Measuring the blood pressure, do we really need sleeves rolled up?

Technical issues and techniques are very important while measuring the Blood Pressure. It has been recommended that blood pressure should be measured on bare arm. In Pakistani society especially in females, this procedure becomes difficult to practice due to social and cultural issues. This study is carried out to check that measuring the Blood Pressure with cuff placed over the sleeve or without sleeve [bare arm] makes any difference

Method: two hundred subjects admitted in Civil Hospital Karachi, attending the OPD of CHK and their attendants were examined under standard conditions and Blood Pressure was measured by mercury sphygmomanometer. Three readings were recorded first with cuff placed over sleeves and with cuff placed on bare arm. Mean of systolic and diastolic blood pressure with and without sleeve were analysis on SPSS Version 11.5

Result: difference in means of systolic blood pressure between clothed and unclothed arm was 0.94 mmHg with a standard deviation of 4.32 and difference of means of diastolic blood pressure for the same was 0.58 mmHg with a standard deviation of 3.80. This was clinically insignificant

Conclusion: the difference found in blood pressure with and without sleeve was not significant clinically

Frequency of impaired glucose tolerance in hypertensive patients

Objective: To determine the frequency of impaired glucose tolerance [IGT] in hypertensive patients

Design: Descriptive cross-sectional study

Place: Civil Hospital Karachi

Sample Size: Eighty patients

Duration: July 2001 to July 2002

Patients and Methods: All the hypertensive patients above 30 years of age of both sexes were included in this study. A detailed relevant history, physical examination including BP was carried out and all the base line investigations and Glucose Tolerance Test [GTT] were performed. Data of each patient were entered on a separate perfoma

Results: Eighty hypertensive patients were studied, out of these 46 [57.5%] were females and 34 [42.5%] were males. The ages of patients were between 32-80 years, mean age + SD was 55.725 + 13.364. The maximum patients were in 41-60 years of age [56.25%]. Results of this study showing that the frequency of IGT was 46.2%, prevalence of impaired fasting glucose [IFG] was 8.7% and prevalence of diabetes was 5% in these hypertensive patients

Conclusion: It is concluded hat impaired glucose tolerance is related to hypertension and other clinical and metabolic abnormalities such as obesity, smoking, hyperlipidemia and family history of DM and positive history of intake of diabetogenic antihypertensive drugs such as diuretics and beta-blockers. Hypertensive patients should be screened for glucose tolerance by OGTT on mass level for the prevention of diabetes. It is an easy and cost effective approach

Otitis in Children

This study had conducted in the ENT out patient department of Rajshahi medical college Hospital and Microbiology department of Rashahi Medical College during the period April 2001 to July 2001. Out of 48 cases, the prevalence of only bacteria, only fungus and both bacteria and fungus cases were 45.83%, 16.66% and 37.50%respectively. Maximum [25%] numbers of cases were from age group 2.5 to 3.5 years. Only bacteria cases were common in the younger age group [0.5 to 3.5year] and only fungal cases were common with increase of age [3.5 to 6.5 years]. There was no specific relationship of age with both bacteria and fungal cases. Among the fungal causes candida albicans was predominant followed by Aspergillus spp. and occasionally Rhizopus spp. The isolated bacteria were Esh.coli, Staph. aureus, strept. Pyogens, proteus and pseudomonas. Male was 28 [58.33%] and female was 20 [41.67%] and female was 20 [41.67%] and majority cases were from urban area