Disposal of syringes, needles, and lancets used by diabetic patients in Pakistan

To assess the use, handling and disposal of insulin injection equipment by diabetic patients in Pakistan. We conducted a cross-sectional study at diabetic clinics in five tertiary centers in Pakistan. All diabetic patients [type 1/type 2] who were on insulin for more than 1 month, were included. An Urdu [local language]-translated questionnaire was used to collect information on insulin administration equipment, the site and frequency of needle use, insulin syringe/pen/lancet disposal, sharing of needles and knowledge about diseases that are spread by sharing contaminated needles. Of 375 patients, 58% were female. The mean [SD] duration of diabetes was 12.3 [7.3] years, and the duration of insulin use was 4.4 [4.3] years. The majority of the patients used syringes [88.3%] for insulin administration. Additionally, the majority of the patients disposed of used devices [syringes, 92%; pens, 75%; and lancets, 91%] in the household garbage collection bin. About half of the patients [n = 185] reported being educated by their physicians about the disposal of sharps. Those who were educated by a physician [adjusted odds ratio [adjOR]: 0.36; 95%CI: 0.16-0.81] or could read/write English [adjOR: 0.32; 95%CI: 0.11-0.92] were less likely to dispose of syringes and needles in the household garbage. The common disposal of sharps in the household garbage has implications for disease transmission. Education on the safe disposal of sharps may improve the disposal practices

Remission of Grave's disease after oral anti-thyroid drug treatment

To evaluate remission rate of anti-thyroid drug treatment in patients with Grave's disease, and to study the factors associated with remission. A cross sectional study. The Endocrine Department of the Aga Khan University Hospital, Karachi from 1999 to 2000. Seventy four patients of Grave's disease were recruited who were prescribed medical treatment. Grave's disease was diagnosed in the presence of clinical and biochemical hyperthyroidism along with anti-microsomal [AMA] and anti-thyroglobulin antibodies [ATA] and thyroid scan. These patients were prescribed oral anti-thyroid drugs using titration regime and followed at 3, 6, 12 and 18 months. Patients were categorized into two groups: "remission group" and "treatment failure group" and results were compared using a chi-square test, t-test and logistic regression model with significance at p < 0.05. A majority of the patients were females [62.6%, n=46]. During the follow-up period of 18 months, 41.9% patients went into remission. Univariate analysis showed that the initial free T4 level was significantly different [p < 0.05] in patients in remission and treatment failure groups. Multivariate analysis showed only initial free T4 level was a significant predictor of outcome. Positive AMA patients [n=27] had higher treatment failure [odds ratio: 2.55: 95%, CI 0.69 - 9:31], although the difference was not statistically significant [p = 0.13]. Remission rates with oral anti-thyroid agents is markedly high. Patients should be offered alternate treatment options to those who do not enter remission during a period of 12-18 months of treatment, those who develop relapse, and those who have aggressive disease on initial presentation

Outcome of cardiopulmonary resuscitation - predictors of survival

To assess the outcomes of patients undergoing cardiopulmonary resuscitation [CPR]. A cross-sectional study. Shifa International Hospital, Islamabad from January 2005 to December 2005. Data were collected retrospectively of all adult patients who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from hospital. Factors associated with survival were evaluated using logistic regression analysis. Of the 159 patients included, 55 [35%] were alive at the end of CPR and 17 [11%] were discharged alive from the hospital. At the end of CPR, univariate logistic regression analysis found the following factors associated with survival: cardiac arrest within hospital as compared to outside the hospital [odds ratio = 2.8, 95% CI = 1.27-6.20, p-value = 0.01], both cardiac and pulmonary arrest as compared to either cardiac or pulmonary arrest [odds ratio = 0.37, 95%CI = 0.19- 0.73, p-value = 0.004], asystole as cardiac rhythm at presentation [odds ratio = 0.47, 95%CI = 0.24-0.93, p-value = 0.03], and total atropine dose given during CPR [odds ratio = 0.78, 95%CI = 0.62-0.97, p-value = 0.02]. In multivariate logistic regression, cardiac arrest within hospital [odds ratio = 2.52, 95%CI = 1.06-5.99, p-value = 0.04] and both cardiac and pulmonary arrest as compared to cardiac or pulmonary arrest [odds ratio = 0.44, 95%CI = 0.21-0.91, p-value = 0.03] were associated with survival at the end of CPR. At the time of discharge from hospital, univariate logistic regression analysis found following factors that were associated with survival: cardiac arrest within hospital [odds ratio = 8.4, 95%CI = 1.09-65.64, p-value = 0.04], duration of CPR [odds ratio = 0.91, 95%CI = 0.85-0.96, p-value = 0.001], and total atropine does given during CPR [odds ratio = 0.68, 95%CI = 0.47-0.99, p-value = 0.05]. In multivariate logistic regression analysis cardiac arrest within hospital [odds ratio = 8.69, 95%CI = 1.01-74.6, p-value = 0.05] and duration of CPR [odds ratio = 0.92, 95%CI = 0.87-0.98, p-value = 0.01] were associated with survival at discharge from hospital. In-hospital cardiopulmonary arrest was associated with better clinical outcomes as compared to outside hospital arrest. Public education is needed to improve clinical outcomes in patients who need CPR outside hospital

young man with backache and symmetrical peripheral polyarthritis

We report a case of a 35-year-old male who has ochronotic arthropathy involving his spine and peripheral joints. He was diagnosed as having Alkaptonuria,which is a rare disorder of tyrosine catabolism with an autosomal recessive trait

Empysematous Gastritis - a case report with literature review

Emphysematous gastritis is a condition characterized by gas within the wall of the stomach and associated, systemic toxicity. We are reporting to our knowledge the first case of emphysematous gastritis in a 76 year old female from Islamabad, Pakistan. She was admitted with five day history of upper abdominal discomfort and vomiting. Diagnosis of emphysematous gastritis was made on CT scan. She was treated successfully with conservative management including IV antibiotics and few sessions of dialysis, and was discharged home within two weeks

Patterns of pancytopenia patients in a general medical ward and a proposed diagnostic approach

Background: There has been little systematic study on the clinical spectrum of pancytopenia. This study was done to describe the etiology, presentation and outcome of patients with pancytopenia presenting in a general medical ward

Methods: Hundred patients with pancytopenia were included in the study from October 2001 to October 2002. Patients on cancer chemotherapy were excluded. Blood counts, bone marrow examinations and trephine biopsies were performed according to standard methods

Results: In all cases, megaloblastic anemia constituted the largest group [n=39], and also seen in conjunction with hemolytic anemia and septicemia. Hypersplenism secondary to portal hypertension [cirrhosis] was the second most common diagnosis [n=19]. Aplastic anemia, septicemia and myelodysplasia were other common causes. Two patients were the suspected cases of viral hemorrhagic fever. Thirteen [13%] patients expired. Absolute neutrophil count [ANC] less than 500 /microl was seen in 14 [14%] patients, among which 6 [15.3%] had megaloblastic anemia, 3 [37.5%] had aplastic anemia, and 2 [40%] had myelodysplasia. Eleven patients with platelet counts 100fL and > 110fL were more frequent in patients with megaloblastic anemia with most prominent anisopoikilocytosis, microcytosis and fragmented RBCs. Macrocytosis was noted in 35 [89.7%] patients with megaloblastic anemia and 12 [63.1%] with hypersplenism, 4 [50%] with aplastic anemia. Hypersegmented neutrophils were noted in the blood films of 36 [92.3%] patients with megaloblastic anemia

Conclusion: Megaloblastic anemia, hypersplenism and aplastic anemia are the common causes of pancytopenia in our study

Comparison of store and forward method of teledermatology with face-to-face consultation

To compare the accuracy of store and forward method of teledermatology with the traditional face-to-face consultation. The comparison was done between Institute of Dermatology King Edward Medical College Lahore that served as teledermatology center and Dermatology Department of Pakistan Institute of Medical Sciences Islamabad from where patients were selected. Telmedpakª provided the technical support. Thirty three patients were selected from outpatient department of PIMS and images were taken using a digital camera. Images were stored in computer and were sent to Institute of Dermatology via email for Teleconsultation along with a short history and examination findings. Diagnosis of consultant after face-to-face consultation was then compared with the image based diagnosis that is after teleconsultation. In 81% of the cases the diagnosis on face-to-face consultation was same [p<0.05] while in 18% of the cases the two diagnoses differed. In 9% [n=3] of the cases, image resolution was not good but out of these three, diagnosis was same in two and differed in one case. This study concludes that store and forward method of teledermatology is reliable and can provide a means of increasing access to dermatological care in rural and under-served areas

evaluation of exercise stress test for coronary artery disease and outcome

To describe the frequency of indications, results and different parameters observed during the test. Design: A descriptive study. Place and Duration of Study: This study was carried out in coronary care unit of Holy Family Hospital, Rawalpindi from January, 2001 to January, 2002. Subjects and One hundred booked patients were selected by non-probability convenient sampling. Exercise stress test was done on Quintron Q710 Exercise and Resting ECG System. Patients having suspected coronary artery disease having typical or atypical angina pectoris, any rhythm disorders, and known coronary artery disease 6-8 weeks after myocardial infarction were included in the study. Out of 100 patients, 75 were males and 25 females. Twenty-seven% patients presented with typical chest pain [resting and exertional] and among them 18 had positive test. Among these, 9 [56.25%] male and 2 [33.3%] female patients developed significant ST-T changes in recovery period. Most common ST-T deviation lead was v4 [n=5] in males and lead III [n=2] in females. Out of 60 patients [60%] with atypical chest pain, only 3 [5%] males were found positive. Fifty-eight% patients [44 males, 14 females] were older than 40 years. Patients with inconclusive or borderline test included 10 [10%] males and 2 [2%] females. For primary care physicians, exercise stress testing is a cost-effective tool to evaluate patients presenting with symptoms of classical as well as atypical chest pain. It helps to stratify those with probable coronary artery disease into a high-risk group needing referral and a low-risk group that can be observed