ABSTRACT
Evans syndrome (ES) is an autoimmune disorder characterized by the simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) and/or immune neutropenia in the absence of any underlying cause. Evans syndrome is a rare disorder although the exact frequency is unknown. No sex predilection is known and Evans syndrome has been described in all ethnic groups and at all ages. Classification of ES includes primary, with this being an exclusion diagnosis with no underlying condition, and secondary in the presence of an underlying disease. Clinical features are associated with anemia and thrombocytopenia including pallor, weakness, fatigue, jaundice, petechiae, ecchymosis, gingivorrhagia and epistaxis. First, a detailed history must be taken from the patient to determine the risk factors for developing ES then a family history of immune disorders along with a thorough physical examination. The management of Evans syndrome remains a challenge. Steroids with and without IVIG are recommended as front-line therapy. Red blood cell/platelet transfusion is indicated only in severe symptomatic patients due to the risk of exacerbations. Splenectomy may also be considered a second-line treatment.
ABSTRACT
Background: Acute coronary syndromes (ACS) are an imbalance between myocardial oxygen supply and demand, and the presence of anaemia further potentiates this imbalance. The burden of anaemia in patients presenting with acute coronary syndromes (ACS) is significant. Anaemia has the potential to worsen myocardial ischemic insult by decreasing the oxygen content of the blood supplied to the jeopardized myocardium. Present study investigates the prevalence of anaemia in ACS patients attending a tertiary health care institute.Methods: A total of 148 patients with ACS were recruited in the study from July 2018 to October 2018 in Multan institute of cardiology, Pakistan. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent. Patient having any other diseases known to cause anaemia were excluded.Results: Mean age of patients was 49 years. Out of 148, 114 (77%) were males and 34(23%) were females. Prevalence of anaemia was 38% in Male and 58.8% in Female. Among Male, 18.8% were microcytic, 4.54% were macrocytic and 77.27% were normocytic. Among Female, 50% were microcytic and 50%% were normocytic. Prevalence of ACS was higher is patients with diabetes and hypertension combined (31%) than in patient with diabetes alone (17.56%) or hypertension alone (21.62%). 13.51% were pure vegetarians while 78.37% were on mixed diet consisting of vegetables+meat+pulses.Conclusions: Higher incidence of anaemia was reported in subjects having acute coronary syndrome. Incidence of anaemia in STEMI patients was greater than NSTEMI and unstable angina patients. Severe form of acute coronary syndrome i.e. STEMI was associated with higher incidence of anaemia.
ABSTRACT
Background: Bipolar affective disorder is cyclic swinging of mood between mania or hypo-mania and depression. Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 1 to 3% in the general population. Despite a growing body of knowledge on bipolar spectrum disorder (BSD), relatively little is known about the clinical characteristics of BSD in medical students. This study evaluates the prevalence and severity of BSD in medical students in relation to certain socio-demographic factors like age, sex and class of education.Methods: A questionnaire based study was done on 298 medical students of Nishtar Medical University, Multan and Shaikh Zayed Medical College, Rahim Yar Khan chosen on basis of random sampling to test the prevalence of bipolar spectrum disorders using Mood Disorder questionnaire (MDQ). Out of these students 161 were males and 137 were females. Students were interviewed to obtain information about age, sex and academic year of education.Results: According to mood disorder questionnaire scoring, of the total 298 students 80 (26.84%) screened positive for bipolar spectrum disorder (BSD). Among 80 students who screened positive for BSD 43 (53.75%) are males while 37 (46.25%) are females. Class-wise distribution of BSD is as follows: Out of 80 students screened positive 15 (18.75%) are from 2nd year, 22 (27.5%) from 3rd year and 43 (53.75) from 4th year. Age-wise distribution of BSD is as following: Students of age 19, 20, 21, 22 and 23 years suffering from BSD were 5 (6.25%), 17 (21.25%), 23(28.75),22 (27.5%) and 13 (16.25%) respectively.Conclusions: In our study, the estimated rate of prevalence for bipolar spectrum disorder among medical students of Pakistan is 26.84%. There was no significant difference in prevalence on the basis of gender. Prevalence was increasing with both age and class wise distribution.
ABSTRACT
Background: Insomnia, the most common sleep disorder, is the perception or complaint of inadequate or poor-quality sleep because of one or more of the following conditions: difficulty in falling asleep, frequent waking up during the night with difficulty for returning to sleep, waking up too early in the morning, or unrefreshing sleep. It is the most common sleep related complaint reported in the primary care setting. Medical students are specially at risk of developing insomnia and its consequences. This study evaluates the prevalence and severity of insomnia in medical students in relation to certain socio-demographic factors like age, sex and class of education.Methods: A questionnaire based study was done on 135 medical students of Nishtar Medical University, Multan chosen on basis of random sampling to test the prevalence of insomnia using Athens Insomnia Scale (AIS). Out of these students 75 were males and 60 were females. Students were interviewed to obtain information about age, sex and academic year of education.Results: According to Athens insomniac scale scoring, 55 (40.74%) students were found insomniac while 80 (59.25%) were non-insomniac. Out of 55 insomniac students, 23 (41.81%) were males while 32 (58.18%) were females. Likewise, out of 80 non-insomniac students, 52 (65%) were males while 28 (35%) were females. The prevalence of insomnia in medical students was found to be increased with the increasing age. It was found that the females have more insomnia prevalence as well as more severe signs and symptoms of insomnia. Moreover, final year students tend to show more prevalence and severity of insomnia than their juniors.Conclusions: According to this study, 2 out of every 5 students were insomniac. Demographic comparison showed that the prevalence and severity of insomnia was more in females and final year students. Also, it was increasing side by side with increasing age.