Hyponatraemia: etiology, management and outcome

To determine the etiology of hyponatraemia, the treatment instituted and the outcome of treatment in a tertiary care hospital setting. Case series. The Aga Khan University Hospital, Karachi, between January and June 2004. Case records of 220 patients admitted to the medical service were identified through computerized hospital patients' data. All patients >/= 15 years with a sodium level on admission of 10 mmol/L/ 24 hours in 17% patients. The average duration of stay was 4 days. The mortality was 6.8%. Medicines accounted for 30% cases of hyponatraemia, of which diuretics, angiotensin converting enzyme inhibitor [ACEI] and angiotensin receptor blockers [ARBs] were top of the list. Other causes were gastrointestinal in 25%, chest infection in 11% patients, depletional hyponatraemia in 10% patients, SIADH [Syndrome of Inappropriate Antidiuretic Hormone] in 6% patients, congestive cardiac failure and malignancy in 5% each and chronic liver disease in 3.6% patients. Hyponatraemia was seen more commonly in the elderly, major causes being gastrointestinal losses and use of drugs. Serum sodium correction should be less than 10 mmol/L/24 hours. The treatment plan be directed to correction of the underlying cause. Diagnosis of SIADH should be sought with appropriate investigation

Career goals of trainee physicians in internal medicine

To survey Internal Medicine trainees' future career choices and factors influencing their decision-making. Cross-sectional study. The Aga Khan University Hospital, Karachi, from November 2006 to January 2007. A standard questionnaire was administered to the residents and Interns working in the Department of Internal Medicine of The Aga Khan University Hospital. The questionnaire covered demographic details, specialty choice, work-time distribution and factors influencing career choice. Descriptive statistics were applied. A total of 49 doctors participated with 57% females; and 43% males, having 33% interns and 67% residents. A minority [22%] opted for internal medicine, while 78% selected sub-specialties with cardiology [20%] being the most sought- after sub-specialty. Majority [69%] wanted to spend more time in clinical activities compared to administration [18%] or research [13%]. Majority [92%] wanted to work in an academic setting. Availability of a structured training program [61%], ability to practice broad area of medicine [41%] and prestige of the specialty [41%] highly influenced their career choices. Forty one [82%] wanted to proceed abroad for further training and 80% wanted to eventually practice in Pakistan. Most of the interviewed under-training physicians wanted to pursue sub-specialty. Clinical work was more attractive compared to research. A structured training program was detrimental in affecting their choices. Majority wanted further training abroad but eventual settlement in Pakistan. The study results can help us create the basis for reforming the current training programs

Delayed puberty and short stature in an adolescent

Delayed puberty associated with short stature can be due to a number of causes. A focused medical history, a directed physical examination and appropriate diagnostic tests are needed to diagnose the underlying cause. A case of an adolescent with delayed puberty and short stature is presented to highlight the diagnostic approach. The most common cause of delayed maturation in adolescents is constitutional delay of puberty, however other causes should also be considered. Treatment for disorders of puberty is determined by the underlying cause