Knowledge, attitude and practice of medical students towards low blood pressure syndrome

Introduction: Normal blood pressure has a certain normal range and therefore it is common to see people having blood pressure towards lower range but considering it as "low blood pressure". Among these majority of the people including medical students consider "low blood pressure" as a disease which once diagnosed, needs to be treated

Objective: The objective of this study is to evaluate the knowledge and attitude of medical students towards low blood pressure

Methodology: This cross-sectional study was conducted by recruiting medical students [MBBS] of Dow Medical College, Civil Hospital Karachi during October 2016 to February 2017. A total of 306 students from first year to final year were approached through after an informed consent and questionnaire regarding the symptoms of low blood pressure were noted. The students were divided equally into pre-clinical [1[st] and 2[nd] year students] and clinical [3[rd], 4[th] and 5[th] year] groups to assess difference in between their knowledge based on their clinical exposure. Every participant underwent blood pressure measurement regardless of the symptoms. Results were compared and analyzed using SPSS software version 16.0

Results: 171 [n=100 from clinical and n=71 from pre-clinical group] students out of a total of 306 participants do not consider low blood pressure a disease. They also believe that low blood pressure among healthy people neither presents with any symptoms nor requires any treatment

Conclusion: It is concluded by our study that most of the students enrolled in a medical college believe that low blood pressure is a normal entity for a person which doesn't require any intervention

Frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital

Objective: To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country

Study Design: Cross-sectional, observational study

Place and Duration of Study: Medical Wards of Civil Hospital, Karachi, from January to June 2013

Methodology: Patients aged > 18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 [SPSS Inc., IL, Chicago, USA]

Results: A total of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 +/- 9.5 years. Among these, 61 [57.5%] were males and 45 [42.5%] females. Among all patients, 51.9% presented with loss of consciousness, 30.2% with slurred speech, 77.4% with limb weakness, and 9.4% with decrease vision. A total of 17 [16%] patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of < 60 years of age, 26% developed hyperthermia compared to 7.1% in patients of > 60 years of age [p=0.008]. On gender stratification, among male patients, 14.8% developed hyperthermia compared to 17.8% in female patients [p=0.43]

Conclusion: It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16% and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia

Frequency of non-alcoholic steatohepatitis on histopathology in patients of type 2 diabetes mellitus with duration of more than 5 years

Objective: to determine the frequency of non-alcoholic steatohepatitis [NASH] on histopathology in patients of type 2 diabetes mellitus with duration of more than 5 years

Study Design: descriptive, cross-sectional study

Place and Duration of Study: department of Medicine, Dow Medical College, Civil Hospital, Karachi, from November 2013 to April 2014

Methodology: patients with type 2 diabetes mellitus of more than 5 years duration having raised alanine transaminases level and fatty liver on ultrasonography were selected. Informed consent was obtained and liver biopsy was performed in all patients by experienced physician of Civil Hospital Karachi. All samples of biopsy were sent for histopathology. Those patients with hepatitis B, C and D and steatosis like alcoholic and hypertriglyceridemia were excluded from the study. Descriptive statistics were calculated on SPSS version 17

Results: out of the 262 cases, 56.49% [148/262] showed non-alcoholic steatohepatitis on the basis of histopathology. The mean age of the patients was 50.72 +/-8.48 years. Median [interquartile] duration of diabetes mellitus of the cases was 9 years [15 - 4]. Out of 148 NASH cases, 56.1% [83/148] were males and 43.9% [65/148] were females

Conclusion: nonalcoholic steatohepatitis is an increasingly important and unrecognized spectrum of chronic liver disease associated with high prevalence of diabetes that is often overlooked and diagnosed with complications. So early recognition of these patients can prevent further complications

Alzheimer and vascular dementia in the elderly patients

Objectives: To find out the frequency of Alzheimer's and Vascular dementia in the elderly patients

Methods:This cross sectional descriptive study was conducted in Department of Medicine, Ziauddin Hospital Karachi from 1[st] October 2013 to 31[st] March 2014. Patients with symptoms of dementia for more than 6 months duration, and Mini Mental State Examination score <24 were included in this study. Patients who fell in category of dementia were assessed for duration of symptoms. Patients underwent CT scan of brain. Patients with generalized atrophy of brain on CT scanning of brain were labeled as Alzheimer's dementia, while patients with ischemic or hemorrhagic stroke on CT scan of brain were labeled as vascular dementia

Results:Four hundred twenty two patients were included in this study. There were 232 [54.98 %] male and 190 [45.02 %] were female. The mean age +/- SD of the patients was 72.58+/-5.34 years [95%CI: 72.07 to 73.09], similarly average duration of symptoms was 10.14+/-2.85 months. About 18.96% of patients were illiterate, 32.23% were matric, 28.44% were intermediate and 20.33% were graduate and post graduate. Hypertension and diabetes were the commonest co-morbid i.e. 81.3% and 73.7%, hyperlipedimia and smoking were 38.2% and 45% respectively. Frequency of Alzheimer's disease and vascular dementia in the elderly was observed in 3.79% [16/422] and 2.61% [11/422] cases

Conclusion:A good number of patients, 27 out of 422, in this hospital based study were suffering from Alzheimer's disease and vascular dementia. Early detection and prompt treatment can reduce the burden of the disease in our population

Diabetes mellitus type 2; pattern of dyslipidemias

Objective: The objective of this study is to determine the pattern dyslipidimia in patients of Type 2 diabetes mellitus

Study Design: Cross-sectional study

Place and Duration: This study was carried out in General Medicine department of Peoples Medical University and Hospital Nawabshah and Civil Hospital Karachi, from June 2011 to July 2012

Methodology: This study consisted of seventy patients. Detailed history was taken from all the patients with special regard to increased thirst and frequent urination, increased hunger, weight loss, fatigue, blurred vision, slow-healing sores or frequent infections and an areas of darkened skin. Inclusion criteria were that all patients after counseling for study and taking written consent were included in this study >35 years of age with either sex admitted in general medicine ward through outpatient department and diagnosed as case of DM type 2 on the basis of history, clinical examination and investigations. Exclusion criteria included patients on dialysis, patients on lipid lowering agents, patients with acute complication of diabetes mellitus such as diabetic keto-acidosis, patients suffering from hypothyroidism, nephritic syndrome, type 1 DM and HTN, lacticacidosis and hypoglycemia. Results were prepared with the help of tables and graphs. Data was analyzed through SPSS software

Results: Out of 70 patients included in this study 46 were men [65.8%] and 24 patients were female [34.2%]; with male to female ratio of 1.9:1. There was wide variation of age ranging from a minimum of 35 year to 75 year. The mean age was 48.65+7.8 years. Mean total serum cholesterol was 196.04 +/- 44.02mg/dl, mean serum triglycerides was 193.04 +/- 108.64 mg/dl , mean high density lipoprotein 29.28 +/- 8.48mg/dl, mean low density lipoprotein 125.24 +/- 39.68mg/dl and mean very low density lipoprotein was 31.28 +/- 8.48 mg/dl. Total cholesterol was abnormal [>200mg/dl] in 56[80%] patients out of 70[ 21[87.5%] were females and 35 [76.1%] were males], Triglycerides was abnormal [>150mg/dl] in 62[88.5%] patients [ 22 [91.66 %] were females and 40 [86.95%] were males], high density lipoprotein was abnormal [< 35 mg/dl] in 51[72.8%] patients[ 18[75%] were females and 33[71.73%] were males], LDL was abnormal [>130 mg/dl] in 40[57.1%] patients [ 17 [70.83%] were females and 23[50%] were males] and VLDL was abnormal [> 30 mg/dl] in 47[67.14%] patients [19[79.16%] were females and 28[60.86%] were males]

Conclusions: We conclude that dyslipidemia is common among type 2 diabetic patients. Males are more prone to suffer from this complication. Patterns of dyslipidemia found more commonly were decreased HDL levels, increased LDL and Triglycerides levels. There is a need for early detection and treatment of this problem to prevent type 2 diabetic complications

Proteinuria in HIV positive patients; Determine the frequency at a tertiary care hospital in Karachi

To determine the frequency of proteinuria in HIV positive patients at a tertiary care hospital in Karachi. Cross-sectional. This study was carried out in lnfectious diseases wards and all medical wards of Civil Hospital Karachi, from Jan 201 1 to the Dec 2011. A total of 170 patients from infection diseases wards and all medical wards of Civil Hospital Karachi. Age more >12 years of either sex who were newly diagnosed cases of HIV based on positive HIV serology by ELlSA and Western blot in infection diseases ward were included. Patients having known kidney disease. urinary tract infection, serum creatinine more than 1.5 mg/dI, diabetes mellitus, high blood pressure and old diagnosed cases of HIV who have already taken or who are taking HIV infection treatment were excluded from this study. Spot urinary sample was taken to measure the proteinuria by urine dipstick. To minimize bias all specimen sent to same laboratory of the hospital. 170 newly diagnosed cases of HIV were included in this study. Gender distribution showed male preponderance [Male: Female = 6.4:1]. Majority of cases 120 [70.6%] had age between 26 - 50 years. Mean age of women was 30.3 +/- 7.4 years [min - max = 18 - 45 years] and for males was 34.3 +/- 9.6 years [min - max = 15 - 56 years]. Out of 170 HIV positive cases frequency of > 1+ protein in urine on urine dipstick analysis was found in 27 [15.9%] cases. Out 27 cases, 16 [59.3%] cases had age between 26-50 years [mean +/- SD =32 +/- 10.1 years, min - max = 18 - 55 years]. Proteinuria was high in increasing age groups. Proportion of proteinuria was high in married and depressed patients, out of 27 cases, 18 [66.7%] were married and 9 [33.3%] unmarried, Frequency of proteinurta was high in labor class, 11 of 27 [40.7%] were labors followed by house wife 6[22.3%], while 5 [18.5%] were private job holder. ln this study I found a high prevalence of proteinuria in HIV positive patients. Such subjects show male preponderance disiribution. We conclude that HIV positive patients should be screened for proteinuria and if they found to have proteinuria, they should be subjected to appropriate treatment to retard the progression of nephropathy and associated complications.

Difference in lipid levels; Among ischemic and hemorrhagic stroke patients at civil hospital Karachi

To determine the frequency of dyslipidemias in patients with stroke and to compare the lipid levels in ischemic and hemorrhagic stroke patients. An observational study. Medical wards of Civil Hospital Karachi. January 2010 to June 2011. A total of three hundred and fifty- five patients above the age of 18 years with clinical evidence of stroke. CT scan brain and fasting lipid levels were done in all patients. The lipid levels were compared between the ischemic and hemorrhagic stroke patients. Data was analyzed with SPSS version 16.0. Out of the 355 patients 161 [45.4%] had dyslipidemia. Among the dyslipidemic patients, there was not a statistically significant difference in serum cholesterol, triglycerides, and LDL and HDL levels between ischemic and hemorrhagic stroke. [p- value > 0.05]. There is a high frequency of dyslipidemia in stroke patients. While comparing ischemic and hemorrhagic strokes there was not a significant difference between the various lipid fractions.

Frequency of proteinuria in patients with older-onset diabetes mellitus attending civil hospital Karachi

To determine the frequency of proteinuria in patients with adult-onset diabetes mellitus. Descriptive study. This study was conducted at Medical Wards of Civil Hospital Karachi from 1[st] November 2010 to 30[th] April 2011. In this study 100 patients of adult onset diabetes mellitus were enrolled who were admitted in medical department at Civil Hospital Karachi. The duration of the study was 6 months. Diagnosed all patients with type 2 diabetes mellitus and > 40 years of age were included except for patients with urinary tract infection, haematuria, acute febrile illness, congestive cardiac failure, uncontrolled hypertension. A mid-stream urine sample was collected for the determination of UAE; Macroalbuminuria was tested first if it was found negative then urine was tested for Microalbuminuria. Out of 100 patients 55% patients had normal Albuminuria [<20 mg/liter] while 45% patients had evidence of increased proteinuria [>20 mg/liter]. Out of 45 proteinuric patients, 28[62.2%] patients had evidence of Microalbuminuria [cutoff; 20-200 mg/liter] and 17[37.8%] patients had Macroalbuminuria [cutoff; >200 mg/liter]. The concluded that the frequency of microalbuminuria is higher than macroalbuminuria in type 2 diabetic subjects

Treatment profile of hepatitis C patients - a comparison of interferon alpha 2a and 2b treatment regimes

To compare the side effects, cost, end treatment response [ETR] and Sustained viral response [SVR] with combination therapy of either interferon alpha 2a or 2b in combination with Ribavarin. Randomized Control Clinical Trial [RCCT]. The study was conducted at Sarwar Zuberi Liver Centre [SZLC], Civil Hospital Karachi [CHK], from May 2004 to July 2009. Patients positive for qualitative HCV ribonucleic acid [RNA] by Polymerase chain reaction [PCA] and genotype 3 were included. Patients with decompensated cirrhosis, severe depressive illness, autoimmune hepatitis, hyperthyroidism, pregnancy, heart failure, uncontrolled diabetes, obstructive pulmonary disease, children less than three years and patients who had previously received treatment were excluded. Single blind randomization using computerized randomization list was done and patients divided into groups A and B, those requiring treatment were given injection Interferon 3 million units [MU] subcutaneously [SC] three times/week and Ribavarin 1000 mg per day [weight 75kg] orally with either interferon alpha 2a [group A; FDA approved products] or alpha 2b [group B; non FDA approved product]. Demographics, side effects, ETR and SVR were noted. ETR was defined as absence of virus at the end of treatment and SVR was taken as absence of HCV RNA at 6 months after completion of treatment. There were a total 310 patients with mean age of 34.07 +/- 9.38 years including 52.4% males, [n=162]. Majority of the patients were from North Pakistan. There were 155 patients each in group A and group B respectively. The cost of treatment for interferon alpha for a single patient for 6 months was Rs 60,000, while for Interferon alpha 2b was Rs 30,000. Side effects [fever initially, followed by fatigue, headache, musculoskeletal pain, depression, alopecia, insomnia, and anorexia] were more prominent in group B when compared with group A. In group A, ETR was 83.8% [130/155] while in group B was 83.2% [129/155]. While SVR available in group A was 61/70 [87.1%] and in group B was 60/72 [83.3%]. Response to combination therapy for HCV was 83%. ETR and SVR were similar for both interferon alpha 2a and 2b. Side effects though minor are more with alpha 2b [non FDA approved products]

Age specific histologic types of carcinoma breast in Malaysians

The influence of age on various histological types of breast cancer at both age < 50 years and > 50 years to simulate menopause was studied retrospective from 2002 to 2004 in Malaysia. One hundred and fifty five cases were reviewed. Ninety two cases recorded at age < 50 years, 60 [65.2%, 95%CI: 54.6 - 74.8%] were infiltrating ductal carcinoma in 11[12.0%, 95% CI: 6.1-20.4%], ductal carcinoma in situ [DCIS] in 9 [9.8%, 95% CI: 4.6-17.8%], medullary carcinoma in 6 [6.5%, 85%CI: 2.4-13.6%], invasive lobular carcinoma in 4 [4.3%, 95%CI: 1.2-10.8%], mucinous carcinoma and poorly differentiated carcinoma in 2 cases [2.2%, 95%CI: 0.3-7.6%]. At > 50 years of age, 63 cases were recorded. Forty seven [74.6%, 95%CI: 62.0- 84.7%] cases were of infiltrating ductal carcinoma, ductal carcinoma in situ in 9 [14.3%, 95%CI: 6.7-25.4%], mucinous carcinoma in 5 [7.9%, 95%CI: 2.6-17.6%], medullary carcinoma [8.5%] and papillary carcinoma in 1 case each [1.6%, 95%CI: 0.0-8.5%]. Infiltrating ductal carcinoma was the commonest histology at both age < 50 years and > 50 years

Sick euthyroid syndrome: thyroid function abnormalities in patients with non-thyroid illness

Introduction: Non-thyroid illness is accompanied with many severe illnesses like septicemia, renal failure, cirrhosis of liver, Pulmonary Tuberculosis, chronic heart failure, after major surgical trauma, etc. This study was undertaken on first four illnesses, which are common medical problems, and admitted in medical wards in advanced stages. This is to bring awareness amongst clinicians while interpreting TFT abnormalities in severe illnesses

Objective: To assess the thyroid function status in patients with severe illnesses, which are commonly encountered in Medical wards. Interpretation of Thyroid hormones should be cautiously made in such conditions. Design: Descriptive/Observational, Non-interventional study Place and Duration of Study: Medical unit III, Civil Hospital, Karachi. From 1[st] March 2001 to 1[st] April 2002. The cases were recorded as and when received, keeping exclusion criteria as mentioned below

Material and Methods: 50 adult patients of either sex, admitted in the hospital for nonthyroidal illness were tested for the thyroid function status by means of T3, T4 and TSH analysis. Results were evaluated for the presence of Sick Euthyroid Syndrome

Results: Of the 50 patients, 24 [48%] had a low T3, low T4 or both but with normal TSH

Conclusion: Sick Euthyroid Syndrome should be considered while managing the patients with serious and debilitating illnesses

Measuring the blood pressure, do we really need sleeves rolled up?

Technical issues and techniques are very important while measuring the Blood Pressure. It has been recommended that blood pressure should be measured on bare arm. In Pakistani society especially in females, this procedure becomes difficult to practice due to social and cultural issues. This study is carried out to check that measuring the Blood Pressure with cuff placed over the sleeve or without sleeve [bare arm] makes any difference

Method: two hundred subjects admitted in Civil Hospital Karachi, attending the OPD of CHK and their attendants were examined under standard conditions and Blood Pressure was measured by mercury sphygmomanometer. Three readings were recorded first with cuff placed over sleeves and with cuff placed on bare arm. Mean of systolic and diastolic blood pressure with and without sleeve were analysis on SPSS Version 11.5

Result: difference in means of systolic blood pressure between clothed and unclothed arm was 0.94 mmHg with a standard deviation of 4.32 and difference of means of diastolic blood pressure for the same was 0.58 mmHg with a standard deviation of 3.80. This was clinically insignificant

Conclusion: the difference found in blood pressure with and without sleeve was not significant clinically

Frequency of impaired glucose tolerance in hypertensive patients

Objective: To determine the frequency of impaired glucose tolerance [IGT] in hypertensive patients

Design: Descriptive cross-sectional study

Place: Civil Hospital Karachi

Sample Size: Eighty patients

Duration: July 2001 to July 2002

Patients and Methods: All the hypertensive patients above 30 years of age of both sexes were included in this study. A detailed relevant history, physical examination including BP was carried out and all the base line investigations and Glucose Tolerance Test [GTT] were performed. Data of each patient were entered on a separate perfoma

Results: Eighty hypertensive patients were studied, out of these 46 [57.5%] were females and 34 [42.5%] were males. The ages of patients were between 32-80 years, mean age + SD was 55.725 + 13.364. The maximum patients were in 41-60 years of age [56.25%]. Results of this study showing that the frequency of IGT was 46.2%, prevalence of impaired fasting glucose [IFG] was 8.7% and prevalence of diabetes was 5% in these hypertensive patients

Conclusion: It is concluded hat impaired glucose tolerance is related to hypertension and other clinical and metabolic abnormalities such as obesity, smoking, hyperlipidemia and family history of DM and positive history of intake of diabetogenic antihypertensive drugs such as diuretics and beta-blockers. Hypertensive patients should be screened for glucose tolerance by OGTT on mass level for the prevention of diabetes. It is an easy and cost effective approach