Lab diagnosis and evaluation of fungal keratitis

This study is aimed to evaluate the usefulness of Sabouraud dextrose agar in the confirmatory diagnosis of suspected cases of fungal keratitis. Pre-designed prospective study of corneal scraping obtained after detailed slit-lamp examination and documentation from all patients seen for non-viral microbial infective keratitis. This study was conducted in the Department of Ophthalmology, JPMC, Karachi from July 2008 to June 2011. 128 cases of non-viral microbial infective keratitis. Corneal scraping of 128 patients with microbial keratitis Smears of corneal scraping were stained with Gram's Method and inoculated specimens on Sabouraud dextrose agar [SDA] and incubated for 3-4 days. In a series of suspected cases of fungal keratitis, 119/128 [75% patients] had positive results for fungus in corneal scrapings by direct microscopy using Grams staining method and culture on Sabouraud dextrose agar [SDA]. 43% males and 32% females had Candidial keratitis and 11% males and 7% females had Fusarium infection. Other samples showed presence of Gram positive cocci on smears and were negative for SDA. Fungal keratitis continue to be an important cause of ocular morbidity, since it becomes difficult to clinically diagnose and differentiate between bacterial and mycotic keratitis in complicated cases. It is better to use a standard culture medium like Sabouraud agar [SDA] when confirming ocular mycosis

Pathophysiology and appropriate management of acute asthma

To study pathophysiology and guidelines for the diagnosis and management of acute asthma. Prospective study of management of known cases of acute asthma for a period of 3 months. Department of Chest Medicine, Jinnah Post Graduate Medical Centre, Karachi. 300 cases of known acute asthma were included. Management was initiated with saturated oxygen and Salbutamol nebulizer. Subsequent treatment was added if sign and symptom did not regress. Hydrocortisone [after 15 minutes], Ipratropium [after 30 minutes] and Aminophylline [after 1 hour]. 190/250 [76%] males and 40/50 [80%] females, total 210/300 [70%] patients became stable after initial treatment. 3 0/60 [50%] males and 10/10 [100%] female, total 40/70 [57%] were stable after Hydrocortisone was added. 20/30 [66%] male patient became asymptomatic after treatment with Ipratropium. 10 patients became asymptomatic after 1 hour of treatment with Arninophylline. No adverse effects were observed. Acute asthma is highly variable clinical condition therefore the level of control must be monitored on a periodic basis to determine whether therapy should be maintained or adjusted. It includes symptomatic relief as well as arrest of pathophysiolgical mechanism of asthma

Comparison of Losartan and Amlodipine in hypertensive type-II diabetic patients

The present study assesses whether Losartan and Amlodipine, alone or in combination, prevent microalbuminuria in hypertensive type II diabetic patients. Department of pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre, Karachi from June 2006 to January 2007. In this study 60 hypertensive diabetic patients were divided into 3 groups having 20 each. Group 'N' patients were kept as control, group 'A' patients were treated with Losartan, 50 mg once daily, group 'B' with Amlodipine 10 mg once daily and Group 'C' patients were given a combination of both the drugs i.e. tab losartan and tab amlodipine. Tablet Glibenclamide 5 mg was given according to the glicemic control. Although all the three groups showed a comparable effect in lowering both the systolic and diastolic blood pressure but the effect on proteinuria was variable. Losartan treated patients in Group 'A' shows marked reduction of proteinuria but non-significant change in creatinine clearance. In Group 'B' the patients who were treated with Amlodipine showed significant reduction in creatinine clearance, but non-significant change in proteinuria and Group 'C' patients showed countable reduction in proteinuria but a non-significant increase was observed in creatinine clearance. The results suggest that in hypertensive type II diabetic patients Losartan is worthwhile reducing both systolic and diastolic blood pressure and proteinuria significantly

Proteinuria a target for reno-protection in hypertensive patients with type 2 diabetic nephropathy

To study the response of angiotensin II [ATI] receptor antagonist ARE [Losartan] as monotherapy in diagnosed hypertensive, non-insulin dependent diabetes mellitus [NIDDM] patients with nephropathy [albuminuria]. Department of pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi. This study is a randomized trial used to examine the effects of ARB [Losartan] on the renal outcome of 20 diagnosed cases of hypertensive noninsulin dependent diabetes [NIDDM] with base line proteinuria. 20 normal subjects were also selected as control group. Baseline albuminuria is almost linearly related to renal outcome, and is the strongest predictor among all measured well-known baseline risk parameters. The changes in albuminuria in the first 3 months of therapy are roughly linearly related to the degree of long-term renal protection. ARB [Losartan] showed 58% [P<0.001] reduction in proteinuria, 4.7% reduction in serum urea, 7.06% [P<0.01] reduction in serum creatinine, creatinine clearance by 4.72%, serum potassium increases by 5.07% [P<0.01] and FBS reduced by 33.29% I [P<0.001]. Baseline to final change for SBP as well as for, DBP was significantly reduced i.e.19.20% [P<0.001] and 16.16%[p<0.001] respectively. In conclusion, albuminuria should be considered a risk marker for progressive loss of renal function in hypertensive type 2 diabetic patients with nephropathy, as well as a target for therapy. Reduction of residual albuminuria to the lowest achievable level should be viewed as a goal for future renoprotective treatments