Vivax malaria; frequency, severity of thrombocytopenia and variation in red cell distribution width [RDW]

To determine the frequency and severity of thrombocytopenia and to evaluate the variation of red cell distribution width [RDW] in patients with acute vivax malaria. Cross sectional descriptive case series study. Six months. Liaquat University Hospital. All the patients with acute vivax malaria were evaluated for thrombocytopenia its severity and RDW. The data was analyzed in SPSS 10 and the frequency and percentage was calculated. Total 126 patients with acute vivax malaria were recruited, of which 88 were males and 38 were females. The mean age +/- SD for male and female subjects was 44.76 +/- 6.83 and 40.83 +/- 7.42. The common features observed were fever 31%, rigor 15% and combined features 14% [p=0.05]. The thrombocytopenia was identified in 86 patients of which 65 were males and 21 were females [p=0.04]. The increased RDW was observed in 75 patients of which 57 were males and 18 were females [p=0.05]. The bleeding was detected in 56 and dyspnea and heart failure was found in 30 thrombocytopenic subjects [p=0.02]. Regarding outcome 82 subjects were recovered while the 04 patients were expired [p=0.05]. Regarding severity of thrombocytopenia majority 48.8% were in moderate category with male predominance [p=0.02]. The thrombocytopenia and increased RDW was observed in patients with acute vivax malaria

Snake bite; frequency of various clinical presentations of admitted patients and average time to reach hospital

To determine the frequency of various clinical presentations of snake bitten admitted patients. Study design: Descriptive case series study. This study was carried out in General Medicine ward, at Medical department of Peoples Medical University and Hospital Nawabshah, from September 2011 to March 2012. This study consisted of 55 patients admitted through the outpatient department, as well as from casualty department of Peoples Medical University and Hospital Nawabshah. Detailed History was taken from all the patients with special regard to type of snake, age, sex, site, time of bite, time lapsed between bite and reaching to hospital. Detailed clinical examination of local features were fang marks, swelling, bleeding from wound, pain and systemic features like nausea, vomiting, echymosis, drowsiness, discharge from wound, hematuria, ptosis, respiratory failure of envenomation. Systemic review was also done to see any co-morbidity. All patients underwent for base line and specific investigations especially clotting time [CT]. Inclusion criteria were that all diagnosed patients of snake bite, aged > 12 year of either sex admitted with the history of snake bite with irrespective of toxicity were included. Patients with history of thorn prick, insect bite were excluded criteria. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Out of 55 patients included in this study, 39 were men [70.9%] and 16 patients were female [29%]; with male to female ratio of 2.4:1. There was wide variation of age ranging from a minimum of >12 year to 60 year. The mean age was 39 +/- 5.8 years. In our study mostly patients 35[63.63%] reached hospital within 60 minutes followed by 12[21.88%] patients within 30 minutes. 5[9%] patients reached within 90 minutes and one patients reported more than 120 minutes. Symptoms of patients were pain at the bite side in 55[100%], ecchymosis in 18[32.72%], discharge from wound in 9[16.36%], bleeding from gum in 8[4.4%] Nausea and vomiting in 7[12.72%], hematuria in 11[20%], ptosis in 8[14.54%], drowsiness in 5[9%] and respiratory failure in 5[9%]. We conclude that males are commonly affected than females and the farmers and labourers are the most vulnerable section of the population for snake bites. In this study age, presence signs and treatment by faith healers is independent predictors of death in case of snake bite. This may provide important evidence to formulate preventive strategies especially health education

Heavy smoking

This study is conducted to observe the serum lipoprotein in chronic heavy smokers in LUMHS Sindh. Analytical study. It was conducted on 60 non obese adult smokers, both sexes, who smoked more than twenty cigarettes or beeries a day regularly fro more than five years. All the participants were current smokers. Sampling technique was simple random technique. The study was conducted in outdoor department of LUMHS Jamshoro/ Hyderabad. Jan 2010 to Jan 2011, Eighteen hours fasting blood sample was sent for lipid studies. Lipid studied were serum cholesterol, serum triglycerides, high density lipoproteins and low density lipoproteins. For control values ATP3 guidelines were used. Mean of statistical values was 25-70 years. Mean age was 47.81 +/- 12.96 years. Median age was 50 years. Male/female ratio was 45/15. Patients were from both rural and urban area. Mean duration of smoking was 25.5 +/- 9.15 years. The study carried out on 60 chronic heavy smokers, showed deranged lipid levels as: Total cholesterol mean 237.57 mg/dl +/- 37.89; TG mean 203.76 mg/dl +/- 47.08; LDL-C mean 158.62 mg/dl +/- 17.25; HDL-C mean 29.67 mg/dl +/- 3.12. Results are shown in Table No I. Our study conducted at LUMHS showed that by continuous heavy smoking the serum lipid levels get deranged

Mortality in patients presenting with organophosphorus poisoning at Liaquat university of medical and health sciences

Organophosphorus [OP] poisoning leads to high morbidity and mortality. The objective of this study was to evaluate the mortality due to Organophosphorus poisoning. This descriptive and analytical study was conducted at a Medical Unit-1 and Intensive Care Unit of Liaquat University Hospital [LUH] Hyderabad/Jamshoro from October 2009 to Feb 2011. All patients with suspicion of OP poisoning were admitted. Their history and clinical features were recorded. The diagnostic criteria of the study were history from parents about ingestion of organophosphorus poison and clinical signs like excessive bradycardia, salivation, meiosis and wheezing. The exclusion criteria were absence of meiosis and patients who expired in emergency department before reaching in intensive care unit or medical wards. The data was analyzed with SPSS version 11. During the period of study 100 patients were studied with the diagnosis of OP poisoning divided into grades according to severity. Their age ranged 18-58 years with mean age of 37.5 +/- 9.5 years and median age was 43 years. Males were 78 [78%] and females were 22 [22%] with M/F ratio of 7.8/2.2. 20 [20%] patients were of mild severity, 40 [40%] were of moderate severity, and 40 [40%] were of severe grade. The most common route of OP exposure was ingestion 79 [79%], followed by inhalation and dermal absorption 21 [21%]. The clinical features as hyper salivation, meiosis, wheezing and depressed mental status were present in all [100%] of the patients followed by lacrimation 90 [90%], bradycardia 58 [58%], hypotension 76 [76%], chest crepitations 80 [80%], vomiting 69 [69%], abdominal cramps 40 [80%]. Respiratory failure was seen in 42 [42%], sepsis in 5 [5%], seizures in 9 [9%], Pulmonary edema in 19 [19%] and ARDS in 10 [10%] patients. Forty [40%] patients were given mechanical ventilation with inotropic support. Average duration of hospital stay was 4.5 days +/- SD 2.5 [range 3-22] days. Out of 100 patients 82 [82%] survived and the mortality was 18 [18%]. Cause of death was mainly due to respiratory failure. Mortality due to Organophosphate poisoning is extremely high in our part of the world. Recognition of clinical features will make easy and early diagnosis

Platelet count in Malaria patients

Malaria is a major health problem in the tropics with high morbidity and mortality. This study is conducted to analyse the effects of malaria on platelets. This prospective study was conducted on 200 diagnosed cases of malaria in Department of Medicine, LUMHS, Jamshoro/Hyderabad from February to December 2010. The diagnosis of malaria was carried out by thin and thick blood films. Platelet count was performed using an automated counter. Thrombocytopenia was classified as mild [50-150x10[3] cells/microl], moderate [20-50x10[3] cells/microl] and severe [<20x10[3] cell/microl]. The age of patients ranged from 16 to 80 [28 +/- 10.5] years, median age was 30 years. Among the study population, males were 124 [62%] and females were 76 [38%]. Out of them 105 [52.5%] were cases of Plasmodium falciparum, 93 [46.5%] were of P. vivax, and 2 [1%] were of P. malaria. The data showed that 171 [85.5%] patients were having low platelet count; 141 [70.5%] had mild, 21 [10.5%] moderate, and 9 [4.5%] had severe thrombocytopenia. Twenty-nine [14.5%] patients had normal platelet count. Malaria is associated with different degrees of low platelet count with rarely increased bleeding tendency

Comparison of the impaired fasting blood glucose in young healthy individuals with diabetic and non-diabetic first degree relatives

To compare the fasting blood glucose [FBG] level in the healthy young individuals with diabetic first degree relatives considered as high risk and non-diabetic first degree relative considered as low risk. Cross-sectional, comparative study. Department of Medicine, Liaquat University of Medical and Health Sciences Hospital, Hyderabad/Jamshoro, from January to November 2008. Individuals aged between 20-40 years were selected and divided into two groups. Group A was considered as high risk included non-diabetic young offspring's of type-2 diabetic parents. Group B was considered as low risk non-diabetic offsprings of non-diabetic family [control group], of same age and gender. Fasting blood glucose levels were measured in each individual. Exclusion criteria were known diabetes and pregnancy. Mean glucose levels were compared using t-test. Proportions of impaired glucose level versus positive family history were compared using chi-square test. Significance was considered at p < 0.05. There were a total of 500 subjects including 250 in each group with equal gender distribution in each group. The mean age was 27.46 +/- 5.71 years. Mean FBG was 87.4 +/- 13.82 mg/dl in group A and 77.7 +/- 15.18 mg/dl in group B [p=0.001]. Twenty five [10%] in group A and five [2%] in group B individuals showed impaired fasting blood glucose [p=0.001]. Impairment of fasting blood glucose was with family history of type-2 Diabetes mellitus in comparison to those without type-2 Diabetes mellitus