Malaria in dengue patients

Objective: To determine frequency of malaria in dengue patients

Study Design: Cross sectional study

Place and Duration of Study: The study was carried out in the Department of Medicine, Civil Hospital Karachi from June 2008 to December 2008

Materials and Methods: 274 dengue patients with Ig M antibody positive results were included in the study after informed consent Malaria parasite peripheral film and malarial ICT [immunochromatography] test of all these dengue patients were performed in order to detect the presence of co-infection with malaria. Age and sex of the patients were also noted

Results: In the study, out of 274 dengue patients, 189 [69%] were males and 85 [31%] were females. Mean age was 31.01 +/- 14.83 years. 41 [15%] dengue patients had concomitant malarial infection. Out of these 41 dengue-malaria co-infected patients, 29 [10.6%] had plasmodium vivax; 8 [2.9%] had plasmodium falciparum and 4 [1.5%] had both falciparum + vivax

Conclusion: Patients with dengue fever are predisposed to have concomitant malarial infection. Hence, these must be investigated for malaria as undiagnosed and untreated malaria can increase the morbidity and mortality of the dengue patients

Gastroesophageal reflux disease in patients with chronic obstructive pulmonary disease

Objective: To evaluate the gastroesophageal reflux symptoms in Chronic Obstructive Pulmonary Disease [COPD] patients and Upper Gastrointestinal [GI] endoscopy findings in these patients

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Dow University Hospital and Civil Hospital Karachi from January 2013 to December 2013

Materials and Methods: 100 of COPD were selected and assessed for presence of gastro esophageal reflux [GERD] symptoms. Data was analyzed on SPSS version 13

Frequency and percentage were computed for categorical variable like gender, gastro-esophageal reflux symptoms and upper GI endoscopy finding in COPD patients with gastro esophageal reflux symptoms. Mean standard deviation was computed for quantitative variables like age, smoking [pack year], solid fuel and tea consumption [cup/day]

Results: In this study of 100 patients 95 were males and 5 were female. Cough was the commonest symptom that was found in 85% patients followed by sputum production in 71% patients, retrosternal burning [68%], acid reflux [54%] and dysphagia [11%]

Gastro-esophageal reflux symptoms were observed in 54 patients. Out of these 54 patients who had GER symptoms, 33 [61%] patients had erosive gastro-esophageal reflux disease while 21[39%] patients non-erosive gastro esophageal reflux disease on upper GI endoscopy

Conclusion: Our study shows that higher proportion of Gastro esophageal reflux symptoms is present in COPD patients. Moreover, upper GI endoscopy can be normal in COPD patients with significant GERD symptoms

Frequency of non-alcoholic steatohepatitis on histopathology in patients of type 2 diabetes mellitus with duration of more than 5 years

Objective: to determine the frequency of non-alcoholic steatohepatitis [NASH] on histopathology in patients of type 2 diabetes mellitus with duration of more than 5 years

Study Design: descriptive, cross-sectional study

Place and Duration of Study: department of Medicine, Dow Medical College, Civil Hospital, Karachi, from November 2013 to April 2014

Methodology: patients with type 2 diabetes mellitus of more than 5 years duration having raised alanine transaminases level and fatty liver on ultrasonography were selected. Informed consent was obtained and liver biopsy was performed in all patients by experienced physician of Civil Hospital Karachi. All samples of biopsy were sent for histopathology. Those patients with hepatitis B, C and D and steatosis like alcoholic and hypertriglyceridemia were excluded from the study. Descriptive statistics were calculated on SPSS version 17

Results: out of the 262 cases, 56.49% [148/262] showed non-alcoholic steatohepatitis on the basis of histopathology. The mean age of the patients was 50.72 +/-8.48 years. Median [interquartile] duration of diabetes mellitus of the cases was 9 years [15 - 4]. Out of 148 NASH cases, 56.1% [83/148] were males and 43.9% [65/148] were females

Conclusion: nonalcoholic steatohepatitis is an increasingly important and unrecognized spectrum of chronic liver disease associated with high prevalence of diabetes that is often overlooked and diagnosed with complications. So early recognition of these patients can prevent further complications

Frequency of impaired glucose tolerance test in patients with active tuberculosis

Objective: To determine the frequency of impaired glucose tolerance in patients presenting with active pulmonary tuberculosis in tertiary care hospital, Karachi

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Dow University Hospital [Dow University Health Sciences Karachi] from 1stJune 2014to 30thNovember 2014

Materials and Methods: A total of 110 diagnosed adult cases of active pulmonary tuberculosis on the basis of sputum smear positivity were included in this study. Blood samples were drawn for investigations and sent to the same reference laboratory to minimize bias.Data was collected on a pre-tested self administered Performa

Results: There were 59.1% were male and 40.9% were female. Frequency of impaired glucose tolerance in patients presenting with active pulmonary tuberculosis was observed in 20.9%. Rate of impaired glucose tolerance was highly associated with above 40 years of age patients and with family history of diabetes

Conclusion: In Pakistan DM is on the rise and TB has one of the highest incidence in the world. There is emerging evidence that one disease is fuelling the other. The interest in diabetes and TB is mounting rapidly, so the clinician and researchers should prepare themselves to meet the challenges of the two diseasecombined

Clinical pattern and outcome of organophosphorus poisoning

Objectives: to determine the clinical presentation and outcome of acute organophosphorus Poisoning

Methods: this case series included 100 cases from various medical wards of Civil Hospital Karachi from February 2008 to December 2008. We included all patients of organophosphorus poisoning who showed either signs of muscarinic or nicotinic involvement. However we excluded those patients in which organophosphorus poisoning was doubtful and who were intoxicated with poisoning other than organophosphates

Results: hundred patients of organophosphate poisoning were admitted among these 68% was males and 32% were females. Modes of poisoning were suicidal in 65% of cases, accidental in 27% and 8% were homicidal. Though the clinical presentation of acute poisoning was variable however the most consistent feature was miosis [98%]. According to W.H.O. classification for severity of organophosphorus poisoning; 60% cases were moderate, 28% were severe and 12% were mild. The mortality rate was 20% and mostly among patients who presented with severe symptoms and presented late

Conclusion: pesticides are the major chemical agents which pose a health threat particularly to young people, depressed individual and farm worker so this fetal condition needs rapid diagnosis and early treatment

Sjogren's syndrome

Sjogren's syndrome is an autoimmune and a chronic inflammatory disorder characterized by the infiltration of the exocrine glands particularly the lacrimal and the salivary glands by the lymphocytes and the plasma cells resulting in xerostomia and xerophthalamia. We report a case of a lady who presented with right sided stroke involving left leg only. On further work up, the patient was found to have Primary Sjogren's syndrome and vasculitis was the cause of the stroke

Causes and outcome of patients with fulminant hepatic failure

To identify the causes and outcome of patients with Fulminant hepatic failure among 40 patients. Descriptive case series study Study conducted in an ICU of Medical unit II Civil Hospital Karachi, during October 2004 to October, 2006. 40 consecutive patients of either sex having clinical features and biochemical markers suggestive of acute liver failure without prior history of any liver disease were included in study. All patients assessed from day one of admission in ICU till two weeks both clinically and biochemically and data analyzed on SPSS version 10.0. Out of 40 patients 16 [40%] were presented in hyper acute stage, 20[50%] were in acute stage and 4 [10%] were in sub acute stage of Fulminant hepatic failure. The most common etiology found among 40 patients was viral in origin. 29 patients [72.5%] were having different hepatotrophic viral etiology. In this study out of 40 patients 26 [65%] expired and among them 15 [57.60%] were male and 11 [42.30%] were female patients. Majority of patients died were having viral and drug related etiologies. This clinical descriptive study highlight the facts that Fulminant hepatic failure [FHF], is a well known entity in our Medical ICU and is not uncommon in our country where viral, Falciparum and drug related etiologies are frequently seen. The mortality is high all over the world but cases have also shown improvement in survival rate with aggressive therapy and intensive monitoring .Considering the facts and fatal consequences of this entity, short and long term large-scale studies are still needed to predict overall mortality in our Country

Clinical spectrum and outcome of patients with tuberculous meningitis

The study was basically conducted to analyze the various clinical presentation in patients with tuberculous meningitis and to access their outcome. Descriptive study. Medical Unit II, Civil Hospital Karachi from October 2005 to September 2006. Forty patients of either sex admitted in Medical ward showing signs and symptoms suggestive of TBM were selected in this study. All patients were analyzed by using SPSS version 10.0. The age of patients range between 14-75 years. Mostly they were young and the mean age was 29.65 years. Mean duration of illness was 45 days. Majority of the patients were presented with fever, headache, vomiting, neck stiffness and altered consciousness. 12 [30%] were having fits. Hemiparesis/hemiplegia was seen in 5 [12.5%] cases. Cranial nerve palsies in 9 [22.5%]. Hydrocephalus was observed in 10 [25%] patients. Mostly patients showed lymphocytic pleocytosis with high protein and low sugar in their CSF except in two cases where it was neutrophilic predominance. X-ray chest was suggestive of pulmonary tuberculosis in 14 [25%] cases. Among 40 cases 16 [40%] patients fully recovered without complications, 14 [35%] had partial recovery with complications and 10 [25%] were expired. TBM is a chronic serious illness with varied presentation and relatively high mortality and morbidity. Early treatment has considerable impact to decrease both

Electrocardiographic changes in patients with acute stroke: an overview

To determine the frequency of ECG changes in patients with acute stroke but without any underlying cardiac disease. Observational study ICU Medical unit II, Civil Hospital Karachi Nov, 2004 to Nov, 2006. All the patients who were admitted in the ICU and had first time stroke were taken in the study. Patients who had TIA, preexisting cardiac disease or on cardiac medication, electrolyte imbalances and brain-stem stroke were excluded from the study. Day one ECG considered in the study and data analyzed on SPSS version.10.0. This was the prospective observational study based on two years. The frequency of ECG abnormalities [n = 64 or was 64%].The most common stroke related ECG abnormality among 100 patients was prolonged QT interval and was found in 64% of the patients with SAH and 56% in ICH and 36% ischemic stroke. Characteristic T-wave inversions were seen commonly in ICH 46% as compared to 33% in SAH and 21% in Ischemic stroke. Electrocardiographic changes are commonly seen in patients with acute stroke, both in ischemic and hemorrhagic variety. Theses changes sometimes create diagnostic and management dilemmas especially with no preexisting cardiac disease. Patients with ECG abnormalities in acute stroke should be advised for long term follow-up to predict outcome as well

Risk factors and outcome in 114 young stroke patients

Incidence of young stroke is increasing world wide and it is important to identify the precipitating factors for prevention of stroke. This study was conducted to identify the risk factors and outcome of stroke in young patients who were admitted to Civil Hospital Karachi. It is a descriptive correlational study. The young stroke patients who were admitted in neurology and all medical units of Civil Hospital Karachi from 2003 to 2005 were evaluated for the factors responsible for stroke and their outcome. 114 young stroke patients were included in this study who were clinically diagnosed as a case of stroke and their lesions were confirmed through CT/MRI of brain .Non-stroke lesions presented as motor neurological deficit were excluded. Detailed clinical history, comprehensive neurological examination, CT/MRI of brain and in certain cases conventional cerebral angiography was done. The sample contained 79 males and 35 females. Hypertension was the most common risk factor: The other risk factors were smoking, hyperlipidemia and family history of stroke. Cerebral infarction was diagnosed in 78[68.4%] patients and intracerebral hemorrhage/sub-arachnoid hemorrhage was seen in 36 [31.6%]. Small vessel occlusion was common than large artery atherosclerosis. Hypertensive intracerebral hemorrhage was the most common sub-type of intra cerebral hemorrhage. 47.3% patients were discharged as independent, 31.6% as dependent and 21.1% died. The frequency of hypertension and hypertensive intracerebral hemorrhage suggests accelerated hypertensive arteriolar damage, possibly due to poor control of hypertension. The causes of stroke among young adults are more diverse than in the elderly and require a thorough diagnostic work up for further prevention of stroke