Risk factors for recurrent cerebral ischemic stroke

Recurrent ischemic strokes are common and often fatal. Hypertension, diabetes mellitus and Cigarette smoking have been recognized as modifiable risk factors for first ever stroke. This study aims to determine the frequency of these risk factors in recurrent ischemic stroke. It was a cross sectional analytical study carriedout at Medical Unit I, Abbasi Shaheed Hospital. 50 patients of both genders, and between ages of 14-80 years, admitted with diagnosis of CT scan confirmed acute ischemic stroke and whose medical history and CT scan [previous or recent showing old ischemic infarct consistent with neurological deficit] confirmed that there was a prior ischemic stroke, were enrolled for the study. All patients admitted in one year meeting the inclusion criteria were analyzed according to the questionnaire for three selected variables, namely, Hypertension, Diabetes and Cigarette smoking. Average age of patients was 61.4 +/- 8.01 years. There were 64% males. Hypertension was found to be a risk factor in 76% of patients while Cigarette smoking and Diabetes in 42% and 36% of Patients respectively. A combination of Hypertension and Diabetes was seen in 18% while Hypertension and Smoking were found in 22% simultaneously. Among the three factors analyzed, data revealed a significant effect of Hypertension in recurrent ischemic stroke as compared with Diabetes mellitus and Cigarette smoking. Combination of Hypertension and Diabetes and Hypertension and Smoking are the commonly occurring co-morbidities in patients with recurrent stroke

Sensitivity of serum / ascitic albumin gradient for detection of portal hypertension

SAAG [serum ascitic albumin gradient], is a liable index of portal hypertension and correlates directly with pressure gradient between portal capillaries and peritoneal cavity. Calculation of SAAG is simple and the procedure can be done safely in in-patients as well as out patients. It was a cross-sectional comparative study, of 6 months duration conducted in Medical unit I of Abbasi Shaheed Hospital. There were 50 patients of ages between 15 and 70 years with ascites secondary to chronic liver disease. All patients were investigated for presence of portal hypertension both by detecting portal vein diameter on ultrasound and serum ascitic albumin gradient. Thirty seven [74%] out of 50 patients had portal hypertension on basis of serum ascitic albumin gradient while ultrasound of portal vein confirmed portal hypertension in 35 [70%] patients. Serum ascitic albumin gradient was found 97.14% sensitive in detecting portal hypertension. Serum ascitic albumin gradient is a reliable marker to differentiate ascites into portal hypertensive and non- portal hypertensive etiology

Pleural biopsy by: abrams punch needle pattern and frequency of histopathological lesions encountered in patients with exudative pleural effusion

Pleural effusion is a very common problem in medical practice, despite the magnitude of the problem; there is severe lack of local data on this problem. The exudative pleural effusion presents a diagnostic problem. In the western countries malignancy is the commonest lesion while in Pakistan tuberculosis is a common histopathological lesion but no study is available to highlight the causes of exudative pleural effusion. To find out by histopathological specimen different types of lesions encountered in exudative pleural effusion using Abrams punch needle with blind technique. Materials and Study was carried out form January 1998 to January 2002. In Abassi Shaheed Hospital medical unit 1 and Saifee hospital [private hospital]. All patients with exudative pleural effusion were included in the study. The patients after consent were subjected to pleural biopsy using local anesthesia. Total numbers of patients were 85.Definitive histopathological results were obtained in 80 patients, which is 93.75% of the total patients. Of those with positive results 49 [61%] were females and 31 [39%] were males. Tuberculosis accounted for 75% of [60/80] patients. Malignancy was seen in 22.5%[18/80]. The commonest malignancy was adenocarcinoma followed by squamous carcinoma and lymphoma. Tuberculosis is the commonest cause of pleural effusion [75%]in this study. In any patients with exudative pleural effusion in our setting, this should be the fore most diagnosis. Malignancy can mimic tuberculous pleural effusion, clinically and radiologically. There fore close needle biopsy [Abrams] is valuable in establishing diagnosis. The pleural biopsy has a yield of 93.7%, which is high for a blind procedure

Indications and relative frequencies for diseases requiring closed tube thoracostomy in medical patients

To determine the indications and relative frequencies for diseases requiring closed tube thoracostomy in medical patients. To determine the frequency of tuberculosis as a causative factor for different indications and the time required for the chest tube to be withdrawn in different diseases. To compare the male: female ratio and also the ratio of right and left side pleural involvement requiring closed tube thoracostomy. Study Design: Descriptive study on 70 patients. Settings: Medical units 1, 2 and 3 of Abbasi Shaheed Hospital, Karachi. Subjects: All patients of both sexes between the age groups of 13 years to 75 years have been included in the study. The Study was done on 70 patients. The frequency of male: female ratio was 37 [52.9%] and 33 [47.1%] respectively. The commonest indication for closed tube thoracostomy was pneumothorax which occurred in 29 [41.4%] patients and the least common was parapneumonic effusion [PNE] affecting 5[7.1%] patients. Tuberculosis [TB] was the single most prevalent etiological factor and occurred in 29 [41.4%] patients. It also required the longest duration for tube placement - average 49.28 +/- 4.70 days. Pleural involvement for right or left side was 36 [51.4%] and 34 [48.6%] respectively. Our study demonstrated that pneumothorax was the commonest disease, requiring closed tube thoracostomy. The most common etiological factor was tuberculosis and patients with tuberculosis also required longest duration of time for chest tube placement

Diabetic nephropathy and its association with cardiac autonomic dysfunction

Diabetic nephropathy is one of the fore runners of almost all complications of diabetes. This is a preventable disease. It can lead to sudden deaths due to arrhythmias in nephropathic patients, which can be due to cardiac autonomic dysfunctions To establish an association of diabetic nephropathy with cardiac autonomic dysfunction by crosses sectional study. Materials and Study was conducted in the Diabetic Clinic of JPMC Ward - 7 from January 1993 to January 1994. Fifty [N= 50] diabetic patients were included in the study with a history of diabetes for more than five years. Thirty six [N = 36] were diabetic proteinuric patients while fourteen [N=14] were non proteinuric diabetes. Patients with severe ischemic heart disease patients and infections anywhere in the body were excluded. Patients were divided[a-e] in to five groups according to severity of protein excretion in 24 hours. They were than assessed for cardiovascular autonomic neuropathy. Four tests for autonomic dysfunctions for selected. 1. Valsalva manoeuvre 2. Systolic blood pressure change to standing 3. Heart rate variation to breathe tests. 4. Heart rate variation to standing Group A was non-nephropathic diabetics while from B to E, were uric diabetics in increasing severity. All autonomic tests showed increased abnormalities with degree of protein excretion. The tests were least abnormal in Group A while mostly abnormal in-group E, group B, C, D showed mostly borderline and abnormal responses. Autonomic abnormalities are increasingly seen with severe diabetic nephropathy, while least observed in non-nephropathic diabetes. This is of immense importance as cardiac arrhythmias and sudden death are encountered more frequently in cardiac autonomic disturbed patients