Long-term complications of stroke and secondary prevention: an overview for primary care physicians

Despite a decline in mortality from stroke, the annual incidence in the general population is increasing. For many stroke survivors and their families, the acute stroke is the beginning of an ongoing struggle with physical impairment and subsequent disability. Over time, the immediate clinical consequences of the stroke are complicated by a variety of lesser-known medical, musculoskeletal and psychosocial difficulties. The primary care physician is best positioned to optimise chronic disease control, reduce risk and manage complications of stroke. Early screening and appropriate management is key. Instituting secondary prevention and attention to bowel and bladder problems can help reduce medical complications and re-admissions, while adequate analgesia, positioning/splinting of limbs and physiotherapy can lessen discomfort and preventable suffering. Primary care physicians can identify and treat post-stroke mood issues and involve psychological counselling for patients and caregivers. Adequate education and support may restore the independence of patients with stroke or minimise any resultant dependency.

Spectroscopic and cytotoxic studies of losartan complexes

Use of drug-metal complexes for the treatment of several human diseases has resulted in significant progress in the field of medicinal inorganic chemistry. The current study describes the synthesis and characterization of Cu [II] and Ni [II] complexes of Losartan, an antihypertensive drug. These complexes were evaluated for their cytotoxic activity against four human cancer cell lines; SNB-19, HCT-15, COLO-205 and KB-3-1. Spectroscopic characterization revealed that during complex formation, the metal was bound through the nitrogen atoms of the tetrazole moiety of the losartan molecule. The molecular formulas of copper [[Cu [LS][2] Cl[2]].6H[2]O] and nickel [[Ni [LS][2]Cl[2]]. H[2]O] complexes were found to be in agreement with the analytical data obtained through elemental analysis. For both the complexes, metal to ligand ratios of 1:2 were calculated. As revealed by FTIR, UV-Visible, and 1H-NMR studies, both the complexes displayed octahedral geometries. Scanning electron microscopy [SEM] revealed marked changes in the morphology of the complexes, compared to the pure drug. From XRD studies, characteristic crystalline peaks of pure losartan were observed whereas no prominent peaks were observed for its complexes. Complexes were found to be inactive in the cytotoxic activity test performed using SNB-19, HCT-15, COLO-205 and KB-3-1 cell lines

Fluconazole and its interaction with metal [II] complexes: SEM, Spectroscopic and antifungal studies

The human digestive tract contains some 100 trillion cells and thousands of species of micro-organisms may be present as normal flora of this tract as well as other mucocutaneous junctions of the body. Candida specie is the most common organism residing in these areas and can easily invade the internal tissues in cases of loss of host defenses. Modifications of previously existing antifungal agents may provide new options to fight against these species. Inorganic compounds of different antifungals are under investigations. Present study report six complexes of fluconazole with Cu [II]], Fe[II], Cd[II], Co[II], Ni[II] and Mn[II] have been synthesized and characterized by elemental analysis, IR, UV and H-NMR. The elemental analysis and spectroscopic data were found in agreement with the expected values as the metal to ligand value was 1:2 ratios with two chlorides in coordination sphere. The morphology of each complex was studied using scanning electron microscope and compared with fluconazole molecule the flaky-slab rock like particles of pure fluconazole was also observed as reported earlier. However, the complexes of fluconazole were showed different morphology in their micrograph. Fluconazole and its complex derivatives have also been screened in vitro for their antifungal activity against Candida albican and Aspergillus niger by MIC method. The complexes showed varied activity ranging from 2-20%

Toxic metals in maternal blood, cord blood and meconium of newborn infants in Pakistan

Toxic metals and deficiency/excess of trace elements can have adverse effects on health. The aim of this study was to quantify toxic metals lead, cadmium and trace elements zinc, copper, aluminium [Al] and Iron [Fe] levels in pregnant women, cord blood and meconium of new-born infants from industrial zones of Karachi, Pakistan. Analytical research was performed from 2011–2012 in low socio-economic pregnant mothers and newborn infants from 20 towns near Sindh Industrial Trading Estates, Federal B industrial area and Korangi industrial areas, Karachi, where environmental pollution was anticipated. Blood samples of pregnant women [n = 416], cord blood [n = 309] and meconium [n = 309] were analyzed quantitatively for metals and trace elements. Results indicated that mothers residing in steel towns were found to have the highest levels of lead. Meconium contained high levels of toxic heavy metals and trace elements compared to cord blood and maternal blood. Maternal blood toxic metals were present in high quantities. Therefore, safety measures should be taken when industrial waste is disposed of in order to prevent population contamination

To determine patients' perceptions and attitudes for blood transfusion

Background: Blood transfusion is a risky procedure due to transmission of various infections and reactions of unmatched blood transfusion. Many blood transfusion related problems can be prevented to some extent if patients and their family members are involved in transfusion related procedure

Objectives: To determine patients' perceptions for the recall of consent process, risks, benefits and attitude for blood transfusion

Study design, settings and duration: Hospital based cross-sectional study done on adult patients admitted in Orthopedic and Surgical wards of Civil Hospital, Karachi from November 2014 to January 2015

Patients and Methods: Using convenient sampling, a total of 350 patients who were admitted and received blood transfusion were included in the study. Variables included age, gender, educational status, language spoken, recall of consent for blood transfusion, risks, benefits and attitudes for blood transfusion. Questionnaire based instrument was used for data collection. SPSS version16 was used for descriptive frequencies

Results: Of the total 98% patients were neither asked nor recalled for the consent of blood transfusion. Only 19 [5%] patients were informed about the risks and 77 [22%] about the benefits of blood transfusion. About 236 [67%] patients were of the opinion that blood of family members, if transfused, carries fewer chances of risk/reactions and 213 [61%] patients stated that they will prefer to receive blood transfusion from their family members. Only, 16 [5%] said that would refuse blood transfusion even if it was needed and will prefer blood alternatives. Overall 326 [93%] patients had poor perception and 262 [75%] good perception for blood transfusion

Conclusion: The consent for blood transfusion was missing in majority of the cases and risks and benefits were not explained to the patients

Policy statement: Institutional Bioethics Committees should take notice of these shortcomings

Undiagnosed mandibular condylar fractures causing temporomandibular joint ankylosis: A problem in northern India.

Background.Temporomandibular joint (TMJ) ankylosis due to undiagnosed condylar fractures has a high incidence in India compared to western countries. We evaluated the demographics, injury pattern, hospital reporting and referral pattern of undiagnosed condylar fractures complicating TMJ ankylosis in northern India. Methods.We did a retrospective analysis by retrieving medical records of patients with post-traumatic TMJ ankylosis reporting to the Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences between 1July 2012 and 30June 2013. Results. Of 90 patients with post-traumatic TMJ ankylosis, 74 (82.2%) resided in rural areas. Sixty-three (70%) patients were from the states of Uttar Pradesh, Bihar and Jharkhand. Only 8.8% had higher education and 10% had an annual income of more than `2 lakh. In 69 (84.4%) patients, fall was the aetiological factor. Primary health centres (42%) and private clinics (20.5%) received the major share of patients immediately following injury. Few patients (19.3%) had some radiographic examination done and only 17% were referred by the primary healthcare provider. Of those referred only 3 were examined by a dental practitioner. Only 10% of all were diagnosed with condylar fractures. Conclusion.Patients with TMJ ankylosis presenting to us have poor literacy and income levels. A missed diagnosis of condylar fractures by rural healthcare providers contributes to its high incidence in India. Improving awareness of clinicians and improved rural healthcare infrastructure can help prevent this complication.

Pattern and outcome of neonatal ailments in a tertiary care hospital

The pattern and outcome of neonatal diseases varies not only in different geographical settings and time spans but it also changes within the same unit at different times. Moreover, it can also be used to determine the availability, utilization and effectiveness of mother and child health services in the community. To determine and correlate the pattern and outcome of neonatal ailments in a tertiary care children hospital Karachi. Descriptive observational study carried out at National Institute of Child Health Karachi from 1st February 2011 to 31st January 2012. Subjects and The data regarding the demography, diagnosis and outcome of all admitted neonates was obtained from the patient's files. The data was entered and analyzed on Statistical Package for Social Sciences 17 to find out the frequency and mortality rate of various diseases among the patients. [p value of <0.05 was taken as significant]. A total of 4747 neonates were admitted during the study period. The male to female ratio was 1:0.6. Majority [66.2%] were referred within 72 hours of birth. The major causes of admission were sepsis [29.2%], low birth weight [23.4%], birth asphyxia [11.3%], prematurity [9.8%], meconium aspiration syndrome [8.9%], neonatal jaundice [7.0%] and pneumonia [6.4%]. Almost 55.6% cases were discharged after improvement, 29.9% expired, and 12% left against medical advice [LAMA]. Sepsis and low birth weight showed strong correlation [>/= 57.81] with overall mortality rates. Sepsis and low birth weight were the major causes of death. Public awareness and use of MNCH facilities by the communities need to be further stressed to reduce neonatal mortality and morbidity. Policy message: Monitoring of high risk pregnancies at the antenatal checkups, timely referral and availability of resuscitation facilities at delivery sites must be ensured. Regular awareness workshops for health care providers and community especially mothers could also be helpful

Frequency of dyslipidaemia in young patients with acute myocardial infarction

To study the frequency of dyslipidaemia in young patients aged between 20-40 years, with Acute Myocardial Infarction in our population. Descriptive study. Coronary Care Unit [CCU] of Armed Forces Institute of Cardiology [AFIC]/ National Institute of Heart Diseases [NIHD], Rawalpindi from December 2008 to May 2009. One hundred patients of acute myocardial infarction [AMI] fulfilling the World Health Organization [WHO] diagnostic criteria of AMI, having ages between 20-40 years, were included in the study after full informed consent using non-probability consecutive sampling. Blood samples for serum lipid profile were taken after 12 hours fasting [within 24 hours of presentation], and analyzed in laboratory of AFIC. Individual patients' results were compiled with respect to age, gender, serum total cholesterol, serum triglycerides, serum low density lipoprotein [LDL] cholesterol, serum very low density lipoprotein [VLDL] cholesterol and serum high density lipoprotein [HDL] cholesterol. The data was entered in SPSS [version 11.0] and analyzed. Of the 100 patients with AMI, 47 were found to have dyslipidaemia. Hypertriglyceridaemia was the most common lipid abnormality as it was found in 32 [68.1%] patients; followed by raised serum VLDL, hypercholesterolemia, raised serum LDL and low serum HDL found in 25 [53.2%], 16 [34.0%], 4 [8.5%] and 2 [4.3%] patients respectively. Out of 47 patients with dyslipidaemia, 28 [59.6%] had more than one lipid abnormality. Frequency of dyslipidaemia in young patients with AMI in our population is high.

Failure to thrive, can this be Bartter's syndrome?

A case series of four children, of different age groups, having complaints of polyuria and failure to thrive. These cases include two infants, a toddler and a child and investigations revealed that they had hyponatremia, hypokalemia, hyperchloremia and metabolic alkalosis, leading to a diagnosis of Bartters syndrome. Two of the patients also had hypomagnesemia. All the children were put on treatment for Bartter's Syndrome, and they responded well but unfortunately one of them was lost to follow-up

Effect of natural honey on human platelets and blood coagulation proteins

Present study was conducted to determine the effects of honey on blood hemostasis, in-vitro effect of honey was observed on platelet aggregation and blood coagulation employing, activated partial prothrombin time [aPTT], prothrombin time [PT], thrombin time [TT] and fibrinogen levels in blood. Honey samples showed moderate inhibition of platelet aggregation with IC[50] 5-7.5%. The coagulation assays showed that at higher concentrations [>/= 15%] honey samples increased whole blood clotting time. When assayed in platelet poor plasma [PPP], honey samples significantly [P >/= 0.005] prolonged aPTT, PT, and TT. The honey samples [at 3.75% and 7.5% concentrations] cause mean increment of aPTT = 19 +/- 10% and 62 +/- 10%; PT 6 +/- 5% and 40 +/- 5%; TT 35 +/- 15% and 112 +/- 30% respectively. Moreover, PPP isolated from whole blood pre-incubated with honey samples [9.0% for 10 minutes] showed mean prolongation of aPTT, PT and TT of 45 +/- 21%, 26 +/- 9% and 105 +/- 24% respectively. Interestingly, incubation of honey at 6.25% and 11.75% concentrations in PPP considerably [P >/= 0.005] reduced fibrinogen levels i.e. 13 +/- 4% and 86 +/- 30% respectively. The present study outlines the inhibitory effect of natural honey on platelet aggregation and blood coagulation. These observations provide first line data for modulatory role [s] of honey on process of hemostasis

review of 52 cases of empyema of thorax in adults [etiology, microbiology and management]

Fifty two cases of empyema of thorax were admitted in Chest Medicine Unit, JPMC from January 1995 to August 1997. There were 39 male and 13 female, with average age of 42 years [14 to 70 years]. 70% [36] had empyema secondary to bronchopulmonary infection, 5.76% [2] had ruptured liver abscesses and 13.46% [7] had iatrogenic empyema. The most common clinical manifestation was fever 82%, cough and chest pain [59%], dyspnoea [32%] and weight loss [19%]. The commonest organism isolated was Pseudomonas aeurogenosa [13%], followed by E. coli and Staph, aureus 11% each. Therefore it is necessary that Bronchopulmonary infection should be adequately managed to prevent Empyema Thoracis