Clinical presentation, risk factors and outcome of stroke at a district level teaching hospital

Stroke is a fatal clinical syndrome with mortality rate ranging up to 25%. Hypertension, smoking and diabetes mellitus are common preventable risk factors which are associated with serious outcome. Objective of this study was to determine the clinical presentation, risk factors and outcome of stroke. A cross-sectional study was conducted in the Medical Wards of DHQ Teaching Hospital, Mirpur Azad Kashmir from March 2010 to January 2011. A questionnaire was prepared in accordance with the objectives of the study. Frequency of risk factors in patients with stroke were studied. Different clinical features were also noted and response to the given treatment was checked in the form of mortality and recovery. Frequencies and percentages were calculated using SPSS-12. Two hundred patients with stroke were selected. Of the total, 136 [68%] had hypertension, 55 [27.5%] were smokers, 53 [26.5%] had diabetes and 25 [12.5%] patients had ischemic heart disease. One hundred and two [51%] patients presented with headache, 99 [49.5%] developed hemiplegia and 94 [47%] had loss of consciousness. CT brain showed infarction in 144 [72%] patients while 56 [28%] had haemorrhage. Observed mortality in this study was 18 [9%] while 182 [91%] patients were discharged after treatment. Hypertension, smoking and diabetes mellitus are major modifiable risk factors for stroke. Headache, hemiplegia and loss of consciousness are major clinical features. Ischemic stroke is much common compared to hemorrhagic stroke. With proper care stroke is manageable satisfactorily

Aetiology and types of neonatal seizures presenting at ayub teaching hospital Abbottabad

Neonatal seizures [NS] affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5[th] day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12[th] December 2006 to 25[th] September 2007 on eonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. Tonic clonic seizure was the commonest type [28%] followed by multi-focal clonic, and focal tonic seizures [25% each]. Birth asphyxia was found to be the main aetiology [46%].Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures.

Frequency and clinical presentation of UTI among children of Hazara division, Pakistan

Urinary tract infection is common in children and result in permanent renal damage and end stage renal failure in significant number of patients. It is imperative to diagnose urinary tract infection early and to treat adequately. We carried out this study to look into frequency and clinical profile of UTI in children admitted in our unit. Three hundred and seventy five patients with UTI, diagnosed by urine culture with age from 0-15 years admitted in pediatric unit during 2003-2006 were included in study. Urine sample for culture was collected by midstream clean catch, urine collecting bag and Suprapubic methods depending upon the age of patient. A proforma was used to record clinical presentation and laboratory findings of these patients. Frequency of Urinary tract infections among children examined by urine culture was 375 out of 1000 [37.5%] out of which 36 [9.6%] were male and 339 [90.4%] were females. Almost half of them 48.5% were less than 3 years old. About 60% of patients belong to Kohistan and Batagram districts and failure to thrive was common presenting feature [56.6%] in patients of these two districts. Fever was common clinical presentation 91% followed by Dysuria [65%] and failure to thrive [40%]. Frequency and clinical profile of urinary tract infection in children in Hazara Division is not significantly different from that of developing and developed countries

Clinical outcome in measles patients hospitalized with complications

Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. One hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay [>5 days]. Pneumonia [39.7%] and diarrhoea [38.2%] were the commonest complications. Seven children died and encephalitis [57.1%] was the commonest cause of death. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis

Seroprevalence of hepatitis B and hepatitis C in health care workers in Abbottabad

Hepatitis B and C viruses [HBV and HCV] are hepatotropic viruses causing viral hepatitis, chronic liver disease and hepatocellular carcinoma. Modes of infection are more or less similar. HBV is vaccine preventable while HCV is not. They are prevalent in different parts of the world including Pakistan. The rate of prevalence varies from region to region and among different population segments. The present study was planned to see the prevalence of HBV and HVC among health care workers in various hospitals of Abbottabad. The study was conducted at the District Headquarter Teaching Hospital Abbottabad over a period of one year on 125 health care workers of different categories and either sex. Brief history was taken from each individual and physical examination was performed. Blood samples were taken for HBV and HC serology. Positive sera were confirmed by 3rd generation ELISA. As much as 8% individuals were positive for HBV or HCV. HBV alone was seen in 3 out of 10 [30%] individuals. HCV alone was also found in 3 out of 10 [30%] individuals. HBV and HCV co-infection was seen in 4 out of 10 [40%] individuals. Dental procedures, needle prick and surgical procedures were found the common risk factors. Blood transfusion was known in 2 out of 10 [20%] individuals. Family history of hepatitis was not positive in any individual. Results of the present study differ from those of the previous studies conducted on health care workers in Pakistan

Status epilepticus: aetiology and outcome in children

Convulsing Status Epilepticus [CSE] is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus [SE] and outcome during admission and at the time of discharge. A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen [12%] patients expired while neurological complications secondary to brain injury developed in 10[8%] cases. Mean seizure duration was 4.92 +/- 9.18 hours in children with normal outcome, 5.93 +/- 5.76 hours in children who died, and 12.85 +/- 12.91 hours in children with abnormal neurological outcome at discharge [p > 0.05]. Correlation between age and duration of seizure was not significant [p > 0.05]. SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE

Guillain Barre syngdrome: the leading cause of acute flaccid paralysis in hazara division

Acute flaccid paralysis [AFP] can be caused by a number of conditions. A common preventable cause is poliomyelitis which is still being reported in Pakistan, Guillain Barre syndrome [GBS], also know as Acute Inflammatory Demyelinating Polyneuropathy, is another common cause of acute flaccid paralysis. It is important to recognize GBS in childhood as parents consider all acute flaccid paralysis to be due to poliomyelitis. The present study was designed to know the frequency of different causes of acute flaccid paralysis in Hazara division. Hazara division during the period January 2003 to December 2004. acute flaccid paralysis was flaccid paralysis was investigated by appropriate laboratory tests, such as serum electrolytes, virus and other enteroviruses. Diagnosis of Poliomyelitis was confirmed by stool testing for poliovirus. 74 patients presented with AFP during the study period. 36 were male and 38 were female. Guillain Barre syndrome and enteroviral encephalopathy were the two leading causes of acute flaccid paralysis. Majority of the cases were reported from Mansehra district. Children of age groups 12 to 24 months and > 96 months constituted the majority [20% each]. Guillain Barre syndrome was the leading cause of acute flaccid paralysis reported from various parts of Hazara division

Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad

Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005.All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. The main etiology of strokes was intracranial infection causing strokes in 23[56.09%] children and majority of children [78.26%] in this group were below five years. Etiology was un-known in 7[17.07%] children after necessary available investigations. Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad

Prevalence of anti-rubella antibodies in Hazara division

Two hundred and twenty five school going girls belonging to three districts of Hazara Division, Pakistan were sampled for rubella antibodies. Age range selected was 5 to 15 years. IgG was positive in 78.22% of cases and IgM in 24.44% of cases. The antibodies pattern and prevalence was the same in all the three districts. A clear increase of IgG was.seen up to the age of 11 years but between 12 and 15 years of age the increase of IgG was not very significant. This study reveals high prevalence of IgG [78.22%] up to the age of 15 years but still a very high figure of about 21.74% of girls remained susceptible to rubella at a critical period of child-bearing age [i.e. 15 years]. This is in contrast to the susceptible subjects of 1.1-4.2%in developed countries

Characteristics of heroin addicts in government mental hospital, Peshawar

One hundred consecutive admissions for heroin addiction to Government Mental Hospital Peshawar, between June 1989 and December 1989, were studied. Patients were offered a ten day detoxification period. Data were collected by semi-structured interviews. All patients were male, from lower social class, who inhaled the drug. The majority [72%] were unemployed and perceived their families as supportive [62%]. Most patients [7.4%] had previously abused cannabis and had been involved in drug related offences [60%]. The average length of stay in Hospital was 7.7 days

Characteristics of patients, who escape from government mental hospital, Peshawar

The characteristics of 24 patients, who absconded from Government Mental Hospital, Peshawar between 1st July 1990 and 31st December 1990 were studied. All were male with a mean age of 25 years. The majority were from lower social class, who were admitted on a semi-voluntary basis. The predominant psychiatric diagnoses were heroin addiction [50%] and schizophrenia [38%]. The mode of "escape" in most cases [92%] could not be ascertained. No attempt was made to contact the police in any such incident

survey of drug addicts at govt Mental hospital, Peshawar

To study the profile of heroin addicts, 194 severe patients admitted to Govt. Mental Hospital, Peshawar between 1st May, 1988 and 13th June, 1989 were studied. In addition to demographic data, psychiatric diagnosis, if any, was derived using Research Diagnostic Criteria. The majority of heroin addicts were young males holding menial sniffed/smoked the drug. Most patients had also abused cannabis at some point in time. Associated mental illness was noted in only a minority of cases. The study highlights the supportive role played by families in encouraging thier drug addict relations to seek treatment. This could have also accounted for the low criminality rate in the sample. A subsample of the study group 14% individuals were suffering from tuberculosis. This emphasises the need for a full physical examination and basic investigations to identify such cases

Epilepsy and psychiatric disorders at government mental hospital Peshawar

Seventeen patients attending Epilepsy Clinic at Government Mental Hospital Peshawar were retrospectively studied for the type of epilepsy and its relationship to mental illness. The overwhelming majority were young, unemployed males who were brought by their relatives for treatment. All had generalized seizure disorder [tonic/clonic type] and twelve [70%] had an associated schizophrenic illness. The psychosis invariably came on later than the epilepsy. None p had clinical evidence of complex partial seizures. Almost half of patients were on multiple anti-convulsants and had poor drug compliance