Sphygmomanometers in clinical USE: are they reliable?

Hypertension affects approximately 1 billion individual worldwide. It is responsible for 7.1 million Premature deaths and 4.5% of disease burden. Higher the BP, the greater is the chance of heart attack, heart failure, stroke, and kidney disease. The management of Hypertension depends on stage of Hypertension which is determined by measurement of systolic and diastolic blood Pressure. Accurate assignment of blood pressure status is crucial from a public health standpoint. Overestimating or underestimating blood pressure by even 5 mm Hg can mislabel over 20 million persons as having high normal blood pressure rather than hypertension; conversely, another 20 to 30 million could be misclassified as hypertensive exposing these persons to the expense and adverse effects of treatment. Different type of Blood pressure instruments [sphygmomanometer] like mercury and aneroid type are generally used in our country. Whatever the type for accurate measurement of blood Pressure properly calibrated and validated instrument should be used. To determine the frequency of errors in Blood pressure instruments [sphygmomanometer] in use in different health care facilities All working BP apparatus used in different health facilities Damaged or out of order instruments Blood pressure instruments [sphygmomanometer] in use in different health care facilities were randomly tested on-site with ERKA Made In Germany Model No 83646 BAD Tötz Name of the facility where BP apparatus is used, designation of the user, the type of BP instrument, make of the instrument and error if any was recorded. Any difference of more than 5 mm mercury was taken as an error as recommended. 501 BP apparatuses were tested. All of them were in use. Out of these 252 [50.3%] were being used in teaching hospitals. 48.5% were mercury manometers most of the instrument were purchased six months earlier. Error was present in 30.1% of instruments in use. It was observed in 45.73% of aneroid type of BP apparatus and 13.58% of mercury type of BP apparatus. Difference range from 0 to 70 mm means 4.73 SD 8.313. Error was more in aneroid type of BP apparatus [p= .001] Error was significantly more in older instrument [p=.001] none of the instruments was calibrated. It is recommended that Blood pressure instruments should be regularly calibrated

Diagnostic yield of fast plaque TB TM Test for rapid detection of mycobacterium in tuberculosis suspects

To compare the diagnostic yield of FAST Plaque TB' test with the conventional methods for detection of mycobacterium tuberculosis in sputum of Tuberculosis suspects at Jinnah Postgraduate Medical Center Karachi Pakistan. A comparative study of diagnostic yield of FAST Plaque TB' test with the culture and ZN staining, conducted from January to June 2004. The study was completed on 48 samples, 31 [64.58%] male and 17 females [35.42%]. Half of the cases were sputum positive. Culture positive was in 17 [35.41%] and negative in 28 [58.3%] wereas 3 [6.25%] were contaminated. FAST Plaque TB' test was positive in 16 [33.33%] and negative in 32 [66.6%] specimens. Out of 17 culture positive, 2 [11.7%] were negative and in 28 culture negative, 1 [3.57%] specimen was positive for FAST Plaque TB' test. Out of 24 smear positive, 11 [45.83%] were negative and in 24 smear negative, 3 [12.5%] were positive, for FAST Plaque TB' test. Compared to culture it has sensitivity of 86.23% and specificity of 96.42%, positive predictive value of 93.75% and negative predictive value of 93.1%. FAST Plaque TB' test is a simple test that can detect viable mycobacterium in 2 days. It has a good sensitivity and specificity. The cost is three times less than the other available tests like PCR. Thus it can be useful in the diagnosis of tuberculosis as an adjunct to sputum microscopy in endemic countries

Proportion of gastroesophageal reflux symptoms in patients with chronic obstructive pulmonary disease

To determine the proportion of gastroesophageal reflux symptoms in patients with chronic obstructive pulmonary disease and its association with the severity and worsening of the symptoms of chronic obstructive pulmonary disease [COPD]. A prospective, questionnaire based, case control, analytical study was conducted in the Department of Pulmonology, Jinnah Postgraduate Medical Centre, Karachi during June 2002 to January 2005. Gastroesophageal reflux symptoms were compared between 100 chronic obstructive pulmonary disease patients who fulfilled the inclusion criteria and 150 control subjects. Both groups were interviewed according to modified version of Mayo clinic GER questionnaire. Chronic obstructive pulmonary disease patients were divided into two groups according to pulmonary function tests [PFTs] results into FEV1 <50% and FEV1 >50%. Chronic obstructive pulmonary disease patients had more frequent gastroesophageal symptoms than controls [25% vs. 9.33% respectively; p=0.001], heartburn/acid regurgitation [70% vs. 43.33% and 56% vs. 30.66% respectively; p-value=0.001], dysphagia [15% vs. 4%; p-value=0.002] and chronic cough [89% vs. 29.33%; p-value=0.001]. Twenty six COPD patients reported respiratory symptoms associated with reflux, whereas control subjects denied such association. Of the 11 patients with frequent gastroesophageal symptoms, 10 patients increased their inhaler use [p=0.001]. Frequent gastroesophageal symptoms had shown a significant association with decreased FEV1 [25% vs. 0% p-value 0.001]. In contrast Pulmonary function test results were similar among chronic obstructive pulmonary disease patients with and without gastroesophageal symptoms [48.13+20.81 vs. 50.94+23.33]. Anti-reflux medication proton pump inhibitor and H2-blockers were utilized more by COPD patients as compared to control subjects. A higher proportion of frequent gastroesophageal symptoms were noted by COPD patients than control subjects and higher proportion of gastroesophageal symptoms was present in severe COPD patients