Role of polymorphonuclear leukocyte in diabetic foot

To study the etiopathogenesis of foot injuries in patients of uncontrolled diabetes mellitus. Retrospective study of tissue samples received from diabetic patients clinically diagnosed as gangrene. This study was conducted in the Department of Ophthalmology, JPMC, Karachi from July 2009 to June 2011. 150 cases of uncontrolled diabetes mellitus with wounds of foot were included. 150 cases of known diabetics with peripheral neuropathy and history of loss of sensation were subjected to follow up of 2 years follow up was done on the cases. As a first step blood sugar was brought under control and broad spectrum antibiotic was given. Wound debriment was done in all cases. The specimens were subjected to H/E and Gram's staining. In H/E, liquifactive necrosis, polymorphonuclear leukocyte, mononuclear cell infiltrate, few lymphocyte plasma cells and fibroblasts were seen. New blood capillaries were few or absent. both gram positive and gram negative organisms were isolated. 79% were gram positive and 21% were gram negative. Hyperglycemia causes relative anoxia in the micro environment of the tissue due to damage of peripheral neurons. Lack of adequate circulation leads to ischemia, which is super added by infection of the subcutaneous tissue. The resultant effect is liquifactive necrosis and complete lysis of tissue. Removal of such putrefied tissue is mandatory to stop further damage to the tissue

Risk profile for breast carcinoma and tumour histopathology of medical uninsured patients in Pakistan

Breast carcinoma is an unpredictable disease in the sense that some patients may die at early disease stage due to wide-spread metastasis within six months to one year, while others may survive longer. This study was aimed to evaluate the risk factors for breast carcinoma occurrence and histopathological features of breast carcinoma developed in the social and economical conditions of Pakistan. A total of 224 female breast cancer diagnosed patients with uncovered medical insurance visiting at the Oncology clinic of a teaching hospital at Karachi, Pakistan were selected for the study. Two hundred and twenty-four [224] healthy female subjects free of any cancer diagnosis were selected as control from different areas of the city. Information on stress, occupation, life history, and life style was obtained through personal interviews. Breast tumour pathology was evaluated for histological grade, lymph node metastasis and hormone receptor status by using standard methods. Student's t-test, Chi-square test and ANOVA were used for comparison. Breast cancer patients in significantly high percentage reported early marriages, abortion occurrence, stressful life style, family cancer history and past disease suffering from diabetes and hypertension. Life style including aerosol chewing and fat rich food intake was significantly high among the patients [p<0.05]. On histopathological analysis, patients at the age of 40 years and below were identified in significantly high percentage with tumour grade III, 1-3 lymph node metastasis and hormone receptor negative type. Increasing age was associated with low tumour grade and less percentage of lymph node metastasis. Significantly high percentage of patients were presented with hormone receptor positive tumour [p<0.05]. The contributing factors for breast carcinoma occurrence were related to life history and life-style of the patients. Medical insurance uncovered patients at initial diagnosis were presented in significantly high percentage with advanced disease including high tumour grade and lymph node metastasis due to less use of preventive and screening service which delays the diagnosis, effecting both survival and treatment cost

Relationship of brain natriuretic peptide with serum lipids and body mass index in healthy adult males

Prevalence of morbid obesity has increased dramatically world wide during past three decades. BMP a cardiac lipolytic hormone is found to be decreased in obese hypertensive and heart failure patients. Increasing values of BMI are associated with dyslipidemia. To find out the relationship of BMP with increasing values of BMI and individual serum lipid fractions in apparently healthy adult males. Study Observational, cross-sectional Department of Physiology at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. Study included 85 adult males, aged between 20-60 years. All were non-smokers, non- diabetic, having no other chronic illness and not taking any lipid lowering therapy. Study participants were evaluated for lipid profile and divided into three groups for the calculated BMI values according to WHO and International Obesity Task Force. Brain Natriuretic Peptide was assayed by AxSym technology. Brain Natriuretic Peptide developed a negative correlation with BMI, total and LDL-cholesterol and a positive relation with HDL-cholesterol and triglycerides. This study concluded that Brain Natriuretic Peptide is negatively related with increasing values of BMI and degree of dyslipidemia in apparently healthy adult males

Pathophysiology and appropriate management of acute asthma

To study pathophysiology and guidelines for the diagnosis and management of acute asthma. Prospective study of management of known cases of acute asthma for a period of 3 months. Department of Chest Medicine, Jinnah Post Graduate Medical Centre, Karachi. 300 cases of known acute asthma were included. Management was initiated with saturated oxygen and Salbutamol nebulizer. Subsequent treatment was added if sign and symptom did not regress. Hydrocortisone [after 15 minutes], Ipratropium [after 30 minutes] and Aminophylline [after 1 hour]. 190/250 [76%] males and 40/50 [80%] females, total 210/300 [70%] patients became stable after initial treatment. 3 0/60 [50%] males and 10/10 [100%] female, total 40/70 [57%] were stable after Hydrocortisone was added. 20/30 [66%] male patient became asymptomatic after treatment with Ipratropium. 10 patients became asymptomatic after 1 hour of treatment with Arninophylline. No adverse effects were observed. Acute asthma is highly variable clinical condition therefore the level of control must be monitored on a periodic basis to determine whether therapy should be maintained or adjusted. It includes symptomatic relief as well as arrest of pathophysiolgical mechanism of asthma

Brain natriuretic peptide, systolic and diastolic blood pressures

Hypertension is an increasingly important medical and public health issue. Because of life time risk of hypertension Joint National Committee-7 introduced a new term "Pre-hypertension" for those with systolic blood pressure 120-139 mmHg and diastolic blood pressure 80-89 mmHg. Individuals prone to the development of hypertension often have a hyperdynamic circulation antedating the onset of hypertension by several years. Brain Natriuretic Peptide is a new promising cardiovascular risk marker due to its association with high blood pressure via its key role in salt and water homeostasis and hence blood pressure. This study was designed to find out the levels of plasma Brain Natriuretic Peptide in normotensive, pre-hypertensive and newly diagnosed hypertensive and to observe its association with increasing values of blood pressure. This was an cross-sectional study conducted in the Department of Physiology Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi. Study included 85 adult males, aged between 20-60 years, non- smokers, non- diabetic and having no other chronic illness. Systolic blood pressure and diastolic blood pressure values were measured and divided into three groups on the basis of normotensive to hypertensive as stated by Joint National Committee -7. Brain Natriuretic Peptide was assayed by AxSym technology. Brain Natriuretic Peptide developed a positive and statistically significant correlation with both systolic and diastolic blood pressures and was also found out to be significantly raised in prehypertensive group. His study concluded that Brain Natriuretic Peptide is positively related with increasing values of both variables i.e. systolic as well as diastolic blood pressures. It also concluded out Brain Natriuretic Peptide to be significantly elevated in pre-hypertensive stage which may remain increased in sustained hypertension