Evaluation of adrenal function in long standing pulmonary Tuberculosis a study of 100 cases

Tuberculosis is a major public health problem in Pakistan and adrenal involvement in long-standing tuberculosis has been found to be common. A multi-center study was conducted to assess the adrenal function using short Synacthen test in one hundred patients with tuberculosis of more than 6 months duration at three hospitals of Rawalpindi and Islamabad. Forty patients demonstrated impaired response to Synacthen test. In 21 [52.5%] the increment from basal level was less than 300 nmol/L with a peak level increasing to over 600 mmol/L in 15 [37.5%] patients, the increment from basal level was less than 300 nmol/L as well as the peak level was also less than 600 nmol/L. In 4 [10%] patients the increment was more than 300 nmol/L but they were not able to obtain a peak level of 600 nmol/L. No significant difference was found between the patients with normal response and the impaired response with regards to their clinical features, duration of illness, body mass index [BMI], blood pressure variation and routine biochemical profile. It is concluded that adrenal dysfunction is common in patients with long-standing tuberculosis. Diagnosis of hypoadrenalism is not possible on clinical grounds and routine biochemical examinations. Synacthen stimulation test is necessary for its diagnosis

Knowledge, attitude and practice survey of acquired immune deficiency syndrome [AIDS] among paramedicals in a tertiary care hospital in Pakistan

A knowledge, attitude and practice survey of Acquired Immune Deficiency Syndrome [AIDS] was conducted among 805 paramedics at a tertiary care hospital in Islamabad in mid 1993. The mean age of the study population was 29.0 +/- 7.2 years and 59% were males. Almost 25% individuals either had no or upto primary level education. Initial response of 10% subjects was not having heard of AIDS and 70% thought their knowledge was sketchy, while 43% could not mention any cause for the disease. Almost 50% did not know that HIV infection could be asymptomatic. With respect to attitude about AIDS, 30% subjects thought that changing life style shall have no effect on avoiding AIDS, 50% were of the view that at present AIDS did not pose a significant threat to them and 4% individuals however, admitted to having risk of contracting the disease. There existed significant gaps in the knowledge and attitude of paramedical staff about AIDS and correlated with the level of education of the staff. These deficiencies need to be addressed through developing health education packages in local languages, targeted especially towards paramedical staff

Modes of presentation and clinical manifestations of systemic lupus erythematosus observed in an urban hospital in Pakistan

A retrospective study of 18 consecutive case of SLE was carried out and their clinical and laboratory manifestations evaluated. Ninety four percent of patients were female in the reproductive age group with the mean duration of symptoms at the time of presentation being twenty months. Polyarthritis prolonged fever and haematological disturbances were the three most common presenting features. Six patients had an associated infection complicating SLE. The diagnosis of SLE was confirmed in fifteen patients on the basis of positive anti ds DNA antibody test and in three a renal biopsy substantiated the diagnosis. SLE is underdiagnosed in Pakistan and should specifically be looked for in young females presenting not only with arthritis and skin manifestations, but also when presenting with prolonged fever undiagnosed anaemia, and significant proteinuria. Renal biopsy is a useful diagnostic tool when the anti ds DNA antibody test is negative

Rate dependent bundle branch block

Eight cases of intermittent bundle branch block showing rate dependence are presented. Six cases were tachycardia dependent, one bradycardia dependent and one case showed both Right Bundle Branch Block and Left Bundle Branch Block at different rates. Tachycardia - dependent bundle branch block was explained on the basis of cycle-length recovery time relation and revealed a critical rate for normal intraventricular conduction. Bradycardia - dependent bundle branch block was best explained on the basis of enhanced phase-4 depolarisation of the bundle branch block system. Ischemic heart disease and Hypertension appeared to be the most important aetiological factors. The appearance of intermittent bundle branch block in younger age groups could be a marker of ischaemic heart disease developing in the later part of life