Clinical audit of stroke patients presenting at a teaching hospital

To determine the mode of presentation, etiology and outcome of patients with stroke. This retrospective one year study was conducted on 50 diagnosed patients with stroke, in the Department of Medicine, Muhammad Medical College Hospital [MMCH] Mirpurkhas from 1[st] August 2007 to 31[st] July 2008. All the information was collected from attendants of patients admitted in the intensive care unit for the management of stroke. Collected information was summarized for mode of presentation, etiology such as cerebral hemorrhage, infarction and subarachnoid haemorrhage with the help of computed tomography [CT] scan and outcome of patients with stroke. The data was entered and analyzed in SPSS V 10.1 software Total 50 patients [30 males and 20 females] were studied. The average age at presentation was 59.5 years. The most common complains were unilateral weakness seen in 16 [32%] patients, loss of consciousness reported by 25 [50%] patients while fever with vomiting was observed in eight [16%] patients. Hypertension was the most frequent risk factor found in 28 [56%] patients whereas 18 [36%] patients were smokers as well as diabetic. Cerebral hemorrhage was seen in 18 [36%] patients, whereas ischemia was responsible for 31[62%] patients. Subarachnoid hemorrhage was found in one [2%] patient only. Eighteen [36%] patients were discharged alive while the remaining 32 [46%] patients died due to fatal nature of disease. This study showed that the ischemia was the predominant cause of stroke in our patients. Mostly observed in older age group, hypertensive and smoker males. Morbidity and mortality was observed in those patients who reached hospital late. Further basic studies should be conducted for the prevention, early recognition and proper management of risk factors to reduce the incidence of disease and its fatal outcome

Disseminated intravascular coagulation in abruption placentae

To assess the proportion of Disseminated Intravascular Coagulation [DIC] in abruptio placentae and outcome of such patients with DIC. This Descriptive study was conducted in the Department of Obstetrics and Gynecology [OBG] ward 8, unit -1 at Jinnah post Graduate Medical Centre [JPMC] Karachi from 1[st] January, 2001 to 31 December 2002. This study was carried out on 100 diagnosed cases of abruptio placentae; and its adverse effects were noted on haemostatic system. Patients who came through the Emergency Department of [OBG] or Main Emergency of JPMC with a history of ante partum hemorrhage was included in this study. Written consent was taken from patients for using information regarding history, clinical Examination and related investigations for the research purpose. DIC was found in seven out of 100 patients, they were relatively younger and Multiparous. Mean age was 27.5 years while parity ranged between Para 5-11 with mean gestational age of 33.14 weeks. Six [85.7%] patients had severe vaginal bleeding, abdominal pain and uterine tenderness. Coagulation profile and routine laboratory investigations revealed that all patients had raised fibrin degradation products, clotting, and prothrombin and activated thromboplastin time, while decreased serum fibrinogen, platelets and hemoglobin. All cases were immediately managed with fluid replacement and blood transfusion. Six [85.7%] cases were delivered by spontaneous vaginal delivery and only one [14.3%] case by caesarean section. Fetal mortality was high 6 [85.7%] all were fresh still birth while only one [14.3%] baby was alive. There was no maternal death. The proportion of DIC in abruptio placentae was found to be 7%. Early diagnosis and immediate treatment of abruptio placentae are important factors for successful therapy of DIC. Fetal mortality was directly proportional to amount of blood loss, initial level of maternal hemoglobin and gestational age. No maternal death occurred

Oesophageal carcinoma: a review of endoscopic biopsies

To evaluate the frequency and pattern of esophageal carcinoma with respect to age and sex groups. All esophageal biopsies received in the Department of Pathology Muhammad Medical College Hospital Mirpurkhas over a five years period from January 2004 to December 2008 were reviewed and the cases of esophageal cancers studied in detail. A total of 215 cases were reviewed. There were 57 benign lesions and 158 were malignant. Out of 158 malignant lesions, the common carcinoma was squamous cell carcinoma 150 [95%] followed by five [3%] cases of adenocarcinoma and three [2%] cases of undifferentiated carcinoma. Females were predominant 57% as compared to males 43% with female to male ratio 1.3:1. Maximum number of the patients was seen in 5th decade of life followed by 4th and 6th decades. Squamous cell carcinoma is the commonest esophageal carcinoma followed by Adenocarcinoma