Effects of obstructive sleep apnoea on lipid metabolism: a cross sectional study from a tertiary care hospital of Pakistan

Background: A peak in sudden death during night, disturbed metabolic profile and cardiovascular diseases are the main source of health deterioration and deaths in Obstructive sleep apnoea [OSA] patients. Interest has been focused in recent years to understand the interactions between OSA and cardio-vascular diseases [CVDs]. Studies advocate the possible causal role of OSA in development of abnormal lipid profile which may place a person at a high risk of CVDs progression. Objective of the present study was to examine the effects of OSA on lipid metabolism in our local population in Karachi

Methods: This cross-sectional analytical study was carried out on 100 individuals, including 50 OSA patients and 50 age and BMI matched controls in Sleep Lab, Dow University of Health Sciences, Ojha Campus, Karachi. After verbal and written informed consent, history and complete physical examination was carried out. Individuals having sign and symptoms of OSA and positive Epworth Sleep Scale [ESS] score went through over night polysomnography to diagnose their OSA and its severity. All the elements of lipid profile including high density lipoproteins, low density lipoproteins, total cholesterol and triglycerides were examined and compared with a group of persons without sleep disturbance to determine their correlations with OSA by using SPSS-20

Results: Frequency of dyslipidemia was higher in OSA group. Mean total cholesterol [TC], triglycerides and low-density lipoprotein [LDL] were higher in OSA patients but difference didn't reach to statistically significant level, while mean high-density lipoproteins [HDL] was significantly higher in OSA group. Frequency of subjects with high serum total cholesterol was significantly higher in OSA group. Disturbance in all lipid profile components showed more subjects with abnormal levels in moderate and severe apnoea groups as compare to mild apnoea group, however; high triglycerides showed strong association with the severity of apnoea

Conclusion: OSA is associated with disturbed lipid metabolism in our local population

Knowledge, attitude and practices regarding HIV/AIDS among the community of Rawalpindi and Islamabad, Pakistan.

Background: The study was conducted to assess the awareness regarding Knowledge, Attitude and Practices about HIV/AIDS in the community of Rawalpindi and Islamabad. Methods: The study was conducted in Rawalpindi and Islamabad with age of 18 years and more. The data was randomly selected from 120 people having qualification of undermatric/matric/graduation/masters and above through questionnaire. The duration of the study was one year from April 2012 to March 2013. Results: Study showed that media is major source of awareness through Television (81.7%) and News Paper (67.5%).It was seen that 48.3% knew the difference between HIV and AIDS. 53.3% knew the signs and symptoms of HIV/AIDS but more than 46% did not know clinical features. Most of the community (79.2%) knew about the mode of transmission but small percentage (20.8%) did not have knowledge about transmission of disease. 85.8% knew about mode of prevention of HIV/AIDS. More than 80% of the participants suggested for compulsory screening of HIV/AIDS whereas a small percentage (up to 20%) did not suggest. Attitude of community was mix reply with positive attitude (58.3%) and negative attitude (41.7%).About 40% were in favor of health insurance whereas around 60% feel no need of health insurance to the HIV/AIDS patients.70% of the participants recommended to maintain the confidentiality of patient while 30% gave negative reply. Community was opinion that health awareness would reduce (96.7%) the risk of disease while only a small percentage (3.3%) thought for having no impact on prevention. Conclusions: The study showed sufficient knowledge and awareness but negative attitude of community towards patients of HIV/AIDS.

Cross-sectional study: head injury in children of Karachi

A cross-sectional study was conducted to determine the prevalence, causes and outcome of head injury in children at Neurosurgery Department of Jinnah Postgraduate Medical Centre from 1st December, 2013 to 1st February, 2014. A total of 37 patients under the age of 12 years, presented with head injuries to the emergency department, were included in the study. A self-designed questionnaire was filled for these children after getting the oral consent from their parents. The questionnaire comprised a complete detail on the causes of head injury, clinical presentation on reaching the hospital, X-rays and Computed Tomography [CT] scans of the children and their reports. SPSS version 20 was utilized as an analytical tool. The mean age of patients was 6.93 years +/- 3.02. Out of these 37 patients, 54.1% were males and 45.9% were females. Road traffic accidents accounted for most of cases [48.6%] with marked peak observed in boys as compared to the girls. Majority had a good Glasgow Coma Scale [GCS] score [43.2%] whereas a depressed fracture was found to be the dominant feature [21.6%] on X-rays. Additionally, 29.7% of children had intracranial hemorrhage while 32.4% also acquired other injuries. In total 29.7% were offered surgical intervention with majority [83.8%] landing in neurosurgical ward. As head injury in childhood is an important issue, keeping in view the lack of research in this field we need to properly highlight the burden of such injuries in childhood so that all the concerned governing authorities should take every possible step in preventing as well as managing this devastating health concern

Feasibility of using Arabic Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression among patients attending accident and emergency at a University Hospital setting in Riyadh, Saudi Arabia

Objective: To evaluate the feasibility of using Arabic Hospital Anxiety and Depression Scale [HADS] to assess depression and anxiety among patients attending accident and emergency [A and E] at a University Hospital setting in Riyadh, Saudi Arabia

Methods: In this prospective observational study translated questionnaire of HADS was used for patients aged 18 years or above who presented to A and E at King Khalid University Hospital in Riyadh, Saudi Arabia. The study included 257 patients as per an agreed inclusion criteria. The study quantified depression and anxiety and its association with demographic and or illness related variables using SPSS

Results: Out of 257 participants, the dominant age group, ranged between 18-30 years [40.9%] with female participants [55.3%] outweigh the male among all. The overall occurrence of depression was 27.2% [95% Confidence Interval [CI]: 21.8% to 32.6%] and anxiety was 23% [17.8% to 28.2%CI]. Marital, educational and economic status of participants, were statistically significantly associated [p<0.05] with the levels of anxiety whereas age, marital, education, economic and employment status were associated [p<0.05] with the levels of depression

Conclusion: In the A and E setting at University Hospital in Saudi Arabia, comorbid depression and anxiety is not uncommon as enumerated by using HADS. The identified cases could then be sent for appropriate psychiatric treatment promptly not only to improve quality of individual care but also to reduce the overall health care costs in local context

Risk factors associated with decreased mouth opening among patients with oral submucous fibrosis [OSMF]

To determine the risk factors associated with decreased mouth opening among patients with OSMF. A cross-sectional study was performed in out-patient Dental Clinics,Tertiary care hospital and cases [diagnosed with OSMF], and the controls [who did not have OSMF] were recruited. The study questionnaire to collect information on demographics and clinical features were distributed among cases and controls and saliva samples were obtained for malondialdehyde and superoxide dismutase. The variable [decreased mouth opening] was determined as a dependent/outcome variable. A descriptive comparative analysis was performed. The characteristics of cases and controls were compared. Co-relations were studied between various continuous variables. Cross-tabulations were performed between two categorical variables. A multivariate regression analysis was performed to determine the associations between various independent variables, and the dependent variable - decreased mouth opening. Our study demonstrated that the mean age of our patients was cases 22.5 +/- 2.8 vs. controls 23.0 +/- 3.7 year, and they were more male cases as compared to controls. The cases were predominantly from lower socio-economic background. A multivariate regression analysis demonstrated that male gender, educational status [lesser education], higher levels of malondialdehyde, and lower levels of superoxide dismutase were associated with a greater risk of decreased mouth opening among patients with OSMF. Our study concluded that male gender, educational status [lesser education], higher levels of malondialdehyde, and lower levels of superoxide dismutase were associated with a greater risk of decreased mouth opening among patients with OSMF

Association of the use of bacterial cell wall synthesis Inhibitor drugsin early childhood with the Developmental Defects of Enamel

Our objective of the study was to determine the association between frequent use of Penicillins and Cephalosporins with developmental defects of enamel in pediatric age group. This is a cross sectional study, conducted at Ziauddin University. A total of 367 children, having the history of either Penicillin or Cephalosporin exposure were included. The parents of children were asked to complete a questionnaire related to disease and drug history. Dental examination was carried out to assess the hypomineralization in tooth enamel based on modified Developmental Defects of Enamel [DDE] index. Out of 367 children, 124 [34%] were males and females were 243[66%]. In the study group 22.6% [n= 83] of children were found to be hypomineralized. The maximum type of teeth defects were diffused opacities that was 12.0% [n=44]. The statistically significant association [p-value < 0.05] was found between frequency of antibiotic use and hypomineralization for most teeth. Children who were exposed to either Penicillins or Cephalosporin in early childhood showed significant [p-value < 0.002] hypomineralized enamel. This study concludes that frequent use of antibiotics such as penicillins and cephalosporins has positive association with enamel hypomineralization in developing tooth structure

Co-existence of dengue fever and malaria in thrombocytopenic patients presented with acute febrile illness

Background: Dengue fever and malaria both can present with thrombocytopenia and is regarded as a strong predictor of dengue fever. Thrombocytopenia is also considered criterion of disease severity, bad prognostic factor and its presence is associated with increase probability of malaria

Objective: To determine frequency of co-existence of dengue fever and malaria in thrombocytopenic patients presented with acute febrile illness in tertiary care hospital

Methods: Cross-sectional, observational study conducted at the department of Emergency Medicine, Ziauddin University Hospital, Karachi from April 2013 to January 2014. A total of 159 patients meeting inclusion criteria were included in this study. 5ml of blood by venupuncture in EDTA anti-coagulant for platelet count and preparing thick and thin films and 2 ml of blood in plain bottle for detection of dengue specific IgM was collected from all patients. Thick films are used to identify malarial parasites and thin films to identify specie. Dengue fever was diagnosed on positive dengue IgM. Co-existence was labeled as positive if malarial parasites and dengue IgM found to be present at the same time. This diffusion susceptibility test was use to determine susceptibility of bacterial agents to antibiotics. Data was analyzed by descriptive statistics using SPSS software version 19

Results: Overall mean [+/- SD] age was 38.3 [+/- 7.9] years, with Male to female ratio was 1.1: 1. Coinfections [Dengue and Malaria] were diagnosed in 5 [5.6%] of cases. From 5 cases, 3 [60%] were male and 2 [40%] were female. Mean [+/- SD] age of 5 positive cases of co-infection was 37.8 [+/- 8.3] years

Conclusion: Concurrent infections were found 5.6% in this study, however, this percentage is slightly low; and special consideration should be given to the likelihood of co-infection with dengue and malaria Co-existence of dengue fever and malaria in thrombocytopenic patients presented with acute febrile illness

Bronchoalveolar lavage fluid [BALF] differential leucocyte count in patients with chronic obstructive pulmonary diseases

The aim of this study is to determine Bronchoalveolar lavage fluid [BALF] differential leukocyte count [DLC] in patients suffering from chronic obstructive pulmonary disease [COPD] and to identify the predominant cell type in our set of population. It is a cross sectional study. This study was conducted at a Tertiary Care Hospital in Karachi, Pakistan from March 2012 till October 2012. The study comprises of 140 patients with COPD with no treatment or poor compliance to treatment and no history of any interventional procedures. All patients have undergone pulmonary function tests [PFTs] to differentiate obstructive pattern disease from restrictive. Fiber optic bronchoscopy was also done, after which 10 cc of BALF was collected and run for DLC. Patients were divided in two groups A and B according to gender, and each group was further divided in to two subgroups on the basis of age i.e. above 40 years and below 40 years. All patients have higher percentage of lymphocytes as compared to polymorphs. A higher concentration of lymphocytes as compared to polymorphs in COPD patients is considered to be an uncommon in Pakistan as per literature survey is concerned, because very less work is done on BALF analysis. Our study suggests that percentage of lymphocytes in patients suffering from COPD is quite high and cases are not restricted to classical acute pulmonary infections

Effect of antenatal counselling on exclusive breastfeeding

The promotion and support of breastfeeding is a global priority. However, in reality most of the mothers are unable to practice exclusive breastfeeding. Most mothers discontinue breastfeeding because of lack of confidence in their ability to breastfeed, problem with infant suckling, breast pain, perception of insufficient milk, in addition to other unspecified difficulties. Some these problems can be solved if the women are counselled antenataly about the benefits of breastfeeding and prepared mentally for exclusive breastfeeding. The aim of the study was to determine whether the mothers with antenatal counselling on breastfeeding would improve their exclusive breast feeding and compare this with that of the mothers without antenatal counselling. It was a cross-sectional comparative study which took place at the Maternity ward of Fauji Foundation Hospital, Rawalpindi. Hundred mothers selected by consecutive non probability sampling divided in two groups. Group A: 50 mothers who were counselled on breastfeeding and Group B: 50 mothers who were not counselled on breastfeeding. Fifty mothers practicing breast feeding after antenatal counselling in the maternity ward of Fauji Foundation Hospital, Rawalpindi were recruited in the study. Another fifty mothers practicing breastfeeding without antenatal counselling were asked to take part in the study as a control group. Performa was completed and an informed consent was obtained. As compared to the not counselled group, the mothers who initiated breastfeeding immediately after birth were statistically significantly higher [p<0.046] in the counselled group [84% and 96% respectively]. Similarly the number of counselled mothers who practiced exclusive breastfeeding was statistically very highly significantly more [p<0.001] than the not counseled group [68% and 16% respectively]. Antenatal counselling helps in motivating the mothers for initiation of breastfeeding immediately after birth and practicing exclusive breastfeeding for first six months of infant's life. Existing antenatal counselling on breastfeeding is inadequate in the population studied and needs to be strengthened.

Effect of maternal anaemia on birth weight

Anaemia is a common medical problem in pregnancy. The extent up to which, maternal anaemia effects maternal and neonatal health is still uncertain. Maternal anaemia is commonly considered a risk factor for low birth weight [LBW] babies. Some studies have demonstrated a strong association between low haemoglobin before delivery and LBW babies. However, others have not found a significant association. Therefore, there is insufficient information to assess the overall adverse impact of anaemia during pregnancy. The aim of this study was to determine whether maternal anaemia would affect the birth weight of the baby and compare this with that of non-anaemic mothers. It was a cross-sectional comparative study carried out at the maternity ward of Fauji Foundation Hospital, Rawalpindi. One hundred subjects divided into two groups each containing 50 subjects on the basis of consecutive non probability sampling were included in the study. Group-A included 50 Anaemic pregnant women and Group-B 50 non-anaemic pregnant women. Information was collected by direct interviewing method through a precoded structured questionnaire. The Hb level and birth weights were taken from the labour room record. The mean age of the mothers in anaemic group was found to be older than the non anaemic group, i.e., [29.44 versus 27.98], though the difference was statistically non significant. The number of low birth weight infants [64%] was statistically very highly significantly more [p<0.001] in the anaemic group of mothers than the non anaemic group [10%]. The results of this study show an association of maternal anaemia in pregnancy with increased risk of LBW babies

Serum vitamin D deficiency, a new epidemic

Vitamin D deficiency has profound adverse effects on health. Serum calcium, phosphorus and even alkaline phasphatase cannot predict underlying vitamin D deficiency. 1. To determine the frequency of vitamin D deficiency in outpatient private clinic 2. To determine the relation of vitamin D deficiency with the presenting symptom of bone or body aches. To see the relation of its deficiency to the serum calcium, alkaline phosphate and phosphate levels. Descriptive study. One of the local private clinic. 800 patients who presented to the clinic due to any ailment, having presenting complains with bone or body aches or not, were included in this study. The duration of study was 7 months from June to December 2008. The study showed among total 33% [n=264] were male and 67% [n=536] were female. 33 patients [4.1%] were below age of 20 years, 364 patients [45.2%] were having age between 20-40 years, 252 [31 .5%] were between 41 -60 years, 1 43 [1 7.8%] were between 61 -80 years and only 8 patients [1%] were above 80years. Over all vitamin D present in sufficient amount [>30 ng/ml] in only 4 patients [0.5%], reaming patients [n=796, 99.5%] were deficient in vitamin D were further divided into those who were having deficiency [serum level <20 ng/ml] [n=636, 79%] and insufficiency [serum level between 21-29 ng/ml] [n=160, 20%]. All the deficient patients were having normal serum calcium and phosphate levels and only 33 patients were having modestly raised serum alkaline phosphate. Among the sample only 318 [39.7%] were having bone or body aches as a presenting feature while remaining 482 [60.3%] were having no pains. More ever pain has got insignificant relation to any level of serum vitamin D level [p-value=0.201], however younger deficient patients were having lesser chance of bone or body aches as compared to age more then 60 year [p-value<0.001]. Vitamin D deficiency is more prevalent in our community, as compared to published data, targeting young population. Vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health

Effect of vitamin d replacement in patients of fibromyalgia

Fibromyalgia is a common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues. It is a chronic pain disorder that is difficult to treat. Recently Vitamin D has shown promising impact in the treatment of this disorder. To see the therapeutic role of vitamin D replacement in patients of fibromyalgia. Prospective study. Multicentre, Three private clinics. Out of 223 patients presenting with body aches and pains over the course of six months [January to June 2008], 100 patients [96 females and 4 males] between 20 to 50 years of age fulfilled the American College of Rheumatology [ACR] criteria of fibromyalgia and were included in the study. Using standard proforma, frequency of complaints other than ACR criteria were also documented.All of them were on some form of pain medication by various general practitioners/ consultants for more than three months but their symptoms were persistent. After informed consent, their serum vitamin D3 [25OHD3] level was requested as the cost of investigation was to bear by patients themselves. Patients were then replaced with vitamin D with an expected target of > 50 ng/ml and followed for 6 months duration. Supplementation with calcium in a dose of 1000mg/day was also done. In this study 83% of patients were having vitamin D between 11-20 ng/ml[mean =13 +/- 2], 11% between 5-10 ng/ml [mean=7 +/- 1] and 6% were below 5ng/ml [table-2]. There were four male patients, all [100%] with age distribution of 41-50 year and all were deficient in vitamin D [<20ng/ml]. Among 96 female patients 80[76.8%] were having level between 11-20 ng/ml, 10 [9.6%] between 5- 10ng/ml and 6 [5.7%] were below 5 ng/ml. After replacement with vitamin D achieving expected target serum levels >50ng/ml. Improvement in ACR criteria of fibromyalgia syndrome consisting of widespread musculoskeletal pains and 11 out 18 tender points was improved in more than 76% of the patients. Improvement in the associated conditions was also observed e.g. restless legs in 91.3% chronic fatigue in 97.6%. Similarly 85% reported relief from muscle spasm and 65% from tingling. There was also improvement in neuropsychiatric conditions like depression 71%] and anxiety 46.8%. Moreover, improvement in cognitive function like concentration and forgetfulness was also reported by 69.8% and 67.7% respectively [Table-4]

Frequency of peptic ulcer in patients having decompensated cirrhosis of liver

Hepatitis B and C are spreading like an endemic disease in developing countries like Pakistan, due to many reasons. The late diagnosis of HCV and HBV infection has resulted in increased number of patients with decompensated liver disease. One of the common complications of cirrhosis is upper GI bleed caused by peptic ulceration in UK. Local data shows peptic ulceration was the second commonest of the lesions causing upper GI bleed after esophageal varices. Present study was conducted to determine the frequency of peptic ulcer in patients having decompensated cirrhosis of liver presenting with upper GI bleed, also to emphasize the importance of primary prophylaxis with proton pump inhibitors for prevention of peptic ulcer in these patients. Descriptive study. MU-III Allied Hospital Faisalabad. Hundred consecutive patients having decompensated cirrhosis of liver were selected according to pre designed proforma and endoscopy was performed to determine the site of bleeding, from Jun to November 2007. This study showed peptic ulcer as the second most important cause of upper GI bleed [34%] after esophegeal varices [57%], also decompensate cirrhotics have increased incidence of peptic ulceration [34%] as compared to general population [8.3%]. Also significant relationship between source of upper GI bleed and serum albumin level in patients having decompensated cirrhosis of liver. [P value = .019] was found. There is definitely an increased frequency of bleeding peptic ulcer in patients having decompensated liver cirrhosis as compared to general population necessitating the need of primary prophylaxis of peptic ulcer with proton pump inhibitor in decompensated cirrhotics

Re-do orchidopexy in a general surgical unit-reliability of clinical diagnosis and the outcome of surgery

Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable. This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor. Out of 11 boys included in the study, 7 [63.63%] had failed orchidopexy. Another 3 [27.27%] were opened for 2nd stage orchidopexy and 1 [9.09%] had iatrogenic ascent of testis after herniotomy. On clinical examination 4 [36.36%] had a palpable testicle at the superficial ring, 2 [18.18%] were in inguinal canal [1 doubtfull], and no testicle could be palpated in 5 [45.45%]. Ultrasonography picked up 2 testicles [18.18%] at the superficial Inguinal ring, 1 [9.09%] in Inguinal canal and 1 [9.09%] testicle in the abdominal cavity. On reexploration, 10 [90.9%] testicles were found and brought down, 7 [63.63%] being considered of reasonable consistency and size. Another 3 [27.27%] were considered soft or small in size, and in 1 [9.09%]], no testicle was found. In 5 patients [45.45%], the testicle was at superficial ring, in 3 [27.27%] in the inguinal canal, and in 2 [18.18%] in the abdominal cavity. Results were considered good in 6 [54.54%], fair in 3 [27.27%]] and poor in 2 [18.18%]. Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent

Organophosphorus compound poisoning; epidemiology and management [atropinization vs pralidoxime] a descriptive analysis, in allied hospital Faisalabad

1] To have an overview of epidemiological factors. 2] To determine the outcome of victims. Mil-III Allied Hospital Faisalabad, from June 2007 to Dec 2008, 484 consecutive patients who were admitted, from June 2007 to December 2008, in Medical unit III with history of having organophosphorus poisoning were analyzed for the epidemiological factors, time to arrive in the hospital, conscious level, mode of poisoning [homicidal, suicidal or accidental] treatment given and outcome. The results of the study showed that age 14-30 years is the major group involved in poisoning 87.9% as compared to ages 31-45years [10.5%] and age more then 45 years [12%], also age group 14-30 years is having more suicidal tendencies as well as accidental poisoning and these tendencies decrease with increasing age [p=0.000]. Male victims are more as compared to female victims [52.9% vs. 46.7%] in the study group. Suicidal tendencies as well as homicidal poisoning is more in female [n= 127 and 44, respectively] while accidental poisoning is more in male population [n=106], [p=0.001]. Urban population is more at risk of poisoning in all three, homicidal, suicidal and accidental, as compared to the rural population [p=0.018]. Importantly study showed that outcome of the poisoning from organophosphorus is directly proportional to the interval between poisoning and presentation in emergency ward [p= 0.000], conscious level of the victim [p=0.000] and does not depend upon the mode of management [oxime or atropine] [p=0.026]. Younger urban population have increased tendency of poisoning with a dominance of female population. Rapidity of treatment, time to arrival to hospital and conscious level at presentation are the factors deciding outcome of a given patient rather than the mode of treatment [oximes and atropine both are equally effective]