Factors associated with tuberculosis treatment default

This study was carried out at Azad Kashmir Combined Military Hospital [AK CMH]/Sheik Khalifa Bin Zyad [SKBZ] Muzaffarabad [MZD] designed for patients defaulting from tuberculosis treatment from 1.1.2013 to 31.12.2013. This study included 110 adults with diagnosis of TB treatment default. The study protocol incorporated structured questionnaire, physical examinations, radiological, laboratory investigations and potential factors for TB treatment defaults. The statistical analysis was performed using SPSS-20, the chi square test was done and p<0.05 was considered as statistical significance. PLUM-Ordinal regression analysis revealed that many clinical variables have statistical significant association with tuberculosis treatment defaults. Factors identified to be associated with treatment default were male gender [p<0.007], distance from the health post [p<0.007], displacement [p<0.024], financial Constraints [p<0.00 1], no body at home to bring medicine or take patients to hospital [p = 0.001], route closed in winters [p = 0.001], improvement from symptoms [0.009] and went abroad [0.001]. Determinants of treatment defaults and associated factors should he considered in treatments plan and Policy actions to tuberculosis control programs. Information on disease, treatment plan and education of the individual along with population should be done in order to minimize treatment default and spread of multi drug resistance to anti-TB drugs

Risk factors for acute myocardial infarction

Objective of the study is to identify risk factors for Acute Myocardial Infarction [AMI]. Prospective cross sectional study. This study was carried out at AK CMH/SKBZ Muzaffarabad from August 2012 to September 2013. This study of first ever AMI patients was carried out in a tertiary care teaching hospital. Standard methods were followed to elicit risk factors. Chi-square and Fishers exact tests on SPSS 20 were done for analysis of risk factors. A total of 210 patients [male [M] = 118 and female [F] = 92] with age range from 30 to more than70 years were included. The mean age of patients was 56.30 +/- 13.79 years. The risk of developing AMI was statistical significantly in both males and female [<0.001]. The significant risk factors for all AMI were: Hypertension [p=0.039], diabetes [p=0.001], Hypercholesterolemia [p=0.05], smoking [p=0.001] and family history of AMI [p=<0.001]. Age [p=<0.001 and age category [p=0.045] were also identified as statistical significance risk factor for AMI. Mortality was 24 [11.4%]. Thus we conclude that CAD is more common in adult and has significant association with modifiable major risk factors in our population. Targeted interventions that reduce/modify these modifiable CAD risk factors could substantially reduce the mortality and morbidity of AMI. Health educations on life style modification, programs to diagnose, control of diabetes, hypercholesterolemia and hypertension have to be initiated at community level in order to reduce the occurrence

Hypertension as independent risk factors for acute stroke

The stroke is leading cause of death in world and many patients die of an acute stroke. This study was conducted to determine whether the hypertension is independent risk factor for acute stroke. Prospective cross sectional. This study was carried out at AK CMH/SKBZ Muzaffarabad from May 2012 to May 2013. In this study 220 patients having first ever acute stroke. Many clinical variables have been investigated as risks factors for stroke.The hypertension was investigated as a risk factor for stroke. The evaluation of patients included structured questionnaire, clinical, neurological examinations, laboratory tests, and computed tomogram scan [CT] brain. The follow-up at 14 days was done for all patients. Out of 220 cases of acute stroke, 171 [[77.73%] were hypertensive, and 49[22.27] % were normotensive. The statistical significant risk factors for stroke were: hypertension [p=0.04] and Hypercholesterolemia [p=0.05]; for cerebral infarction [CI]: [p=<0.001] and hypertension [p = 0.05] and Hypercholesterolemia [p=0.001]; for intracerebral hemorrhagic [ICH] stroke [p = 0.001]. The low Glasgow coma scale [GCS] score [p=0.05] on admission was associated with high mortality and worst outcome in hypertensive patients. Thus hypertension has statistical significant association for both CI and ICH stroke patients. This study confirms the statistical significant association of hypertension with acute stroke and emphasizes the need in preventing and controlling of hypertension in order to avoid stroke and its mortality

Risk factors for stroke; a prospective hospital based study

The stroke is third leading cause of death in world and most patients die with an acute event in stroke. Various clinical variables have been investigated as risks factors of stroke. The study was aimed to identify these risks factors for stroke. This prospective study included 205 consecutive patients of stroke admitted in Combined Military Hospital/Sheik Khalifa Bin Zyad Hospital Muzaffarabad Azad Kashmir. The risk factors of stroke were investigated. Examination included clinical, neurological evaluation, laboratory tests, and brain CT. The follow-up at 14 days were done for all patients. Patients included were with acute first ever stroke onset of 48 hours of hospital admission. All patients completed a structured questionnaire and a physical examination and most provided blood for relevant investigations. Two hundred and five cases stroke sub-types were [n=156, 76%, with ischemic stroke [CI]; n=49, 24%, with intra-cerebral hemorrhagic stroke [ICH]. The significant risk factors for all stroke were: Hypertension [p=0.003], diabetes [p=<0.001], Hypercholesterolemia [p=0.686]; atrial fibrillation [p=0.445], cardiac diseases [p=0.938], smoking [p=0.926] for brain infarction and hypertension [p=0.002], diabetes [p=<0.001], Hypercholesterolemia [p=0.018]; atrial fibrillation [p=0.449], cardiac diseases [p=0.749], smoking [p=0.829] for hemorrhagic stroke. Age significance [CI; p=0.247 vs. ICH; p=0.013] and age category significance were [CI; p=<0.001 vs. ICH; p=0.871] for subtype of stroke. High mRS [p<0.001] low GCS score [p<0.001] on admission were associated with worst outcome for both stroke subtype. These risk factors were all significant for CI as well as ICH. This study signifies the association of risks factors with acute stroke. Targeted interventions that reduce these risk factors could substantially reduce the burden of stroke

Predictors of in-hospital mortality in acute myocardial infarction

Acute myocardial infarction is the leading cause of death. This study was conducted to identify the predictors of in-hospital mortality in acute myocardial infarction. Prospective cross sectional study. This study was carried out at AK CMH/SKBZ MZD from January 1[st] 2011 to 31[st] December 2012. This prospective cross sectional study was carried out at AK CMH/SKBZ MZD from January 1[st] 2011 to 31[st] December 2012 of 151 patients having acute first ever acute myocardial infarction [AMI]. Of these 151 patients 133 were discharged from the hospital and 18 died. Both categories were analyzed regarding sex: age; time elapsed from onset of the symptoms of myocardial infarction to assistance at the hospital; family history of AMI; use of streptokinase; risk factors for atherosclerosis and electrocardiographic location of myocardial infarct. Among 151 patients, 114 [75.5%] were males and 37 [24.5%] were females. Mean age was56.59 +/- 14.47. Out of theses 67 [44.3] received streptokinase. Hospital mortality was 12% [18/151] within 14 days. Age and age category has impact and gender has no impact on mortality. Age category [p=0.02], Hypercholesterolemia [p=0.043], Time of onset of chest pain to SK given [p=<0.001], left ventricular failure [p=0.001] asystole [p=0.001] and ventricular septal defect [VSD] [p=0.007]. on admission were important prognostic predictors of mortality in AMI. Mortality associated with AMI needs control and prevention of modifiable risk factors. Mean time of onset of chest pain to SK given was 2.62 +/- 1.46 hours. In-hospital mortality in SK was 8[1 1.9%] [p=0.002]. Complication of AMI such as asystole 6[75%], VSD 3[50%] and LVF 13[27.7%] has statistically significant predictors of higher in-hospital mortality. General Linear Model [GML], Multivariate statistical analysis revealed that topical presentation of AMI, test between the subject effect association of hypertension with age p=0.036 vs. age category p=0.030] [hypertension p=0.059 vs. mortality p=0.018], hypertension level [SBP level p=0.000 1vs DBF p=0.137], cholesterof level with mortality [p=0.006], AF with mortality [p=0.047], duration of chest pain with mortality [p=0.002] and streptokinase with in-hospital mortality [p=0 .01] and anteroseptal or extensive anterior infarction [p:=0.034] had statistical significant association with in-hospital mortality. Age category, Time of onset of chest pain to SK given, left ventricular failure, asystole and ventricular septal defect [VSD] on admission were statistically significant predictors of mortality in AMI. Mortality associated with AMI needs prompt management and its prevention by control of modifiable risk factors