Young-onset stroke in the rural areas of Sindh

to determine the risk factors and clinical features in the young-onset stroke belonging to the rural areas. Retrospective, Observational. This study was conducted at the Department of Neurology, Medical Unit II, Peoples Medical College Hospital, Nawabshah from 1.1.2006 to 31.12.2006. Hospital records of acute stroke cases aged 20-45 years were reviewed. Stroke was defined according to the WHO criteria. Demographic and clinical data including the risk factors were scrutinized. Laboratory investigations and the CT Scan of brain were evaluated in all cases. Twenty-cases were documented. Male= 12 [60%], Female= 8[40%]. Age ranged from 20-45 years. Majority were uneducated and they were residents of small rural communities. Hypertension was the most frequent risk factor in 13 [65%] of cases [Table 1]. Only 2 [10%] were previously taking antihypertensive treatment while 18 [90%] were not receiving any treatment prior to stroke. Heart disease was present in 2 [10%]. Three [15%] were smokers. One [5%] had Diabetes mellitus, 3 [15%] had previous stroke and 1 [5%] had a family history of stroke. Three [15%] had none of the above risk factors. Hemiplegia was the most common presentation where 8 [40%] had right while 7[35%] had left hemiplegia and in 5 [25%] sidedness could not be ascertained because of deep coma [Table 2]. Glasgow Coma Scale [GCS] ranged from 5-12 out of 15. Cerebral infarction was more common 12 [60%] than cerebral haemorrhage 6 [30%] while in 2 [10%] CT findings were unremarkable [Table 3]. Of the 20 cases 3 [15%] expired and 17 [85%] survived [Table4]. Fatal cases had GCS of below 8 out of 15. This study indicates that hypertension is the major risk factor for stroke in young adults belonging to the rural areas. Hemiplegia was the most common presenting feature. Cerebral infarction accounts for 60% of the cases and the survival rate was 85%. Unawareness and poor control of hypertension appears to be the main reasons behind the young-onset stroke in our region

Frequency of hepatitis-D in HbsAg positive cases at Peoples university of medical and health sciences for women hospital Nawabshah

To find out the frequency of delta virus [HDV] in HBV positive patients. Observational Study. This study was conducted at the Department of Medicine PUMHS Nawabshah form 01-01-2011 to 31-12-2011. 200 adult patents of conformed Hepatitis B were included in the study blood samples of all the patients were screened for HDV by Elisa method / PCR during period of one yare. Clinical status of positive and negative patients was also compared. Anti HDV was found in 32 patients [15%1] among them 20 [62%] were male and 12 [38%] were female. The prevalence of HDV infection in HBV +ve patients is significant our area. Primary eradication of Hepatitis B virus is required

Guillain Barre syndrome [GBS], the leading cause of acute flaccid paralysis at peoples medical college hospital Nawabshah

To identify and treat the acute flaccid paralysis in interior of Sindh reported at PMCH Nawabshah. Retrospective, with proper date and record. Medicine and ICU Department at Peoples Medical College Hospital Nawabshah from 31[st] January to 31[st] October 2009. Patients of all 3 medical units were involved in the study during this period. 50 patients with acute flaccid paralysis [AFP] were admitted in Intensive Care Unit of Peoples medical college Hospital Nawabshshah with support of all emergency measures and were evaluated. 50 patients presented with AFP during study period. 40 were males and 10 were females. GBS was the leading cause of AFP. Majority of the patients were young, out come was excellent. 2 patients died due to respiratory failure. GBS is the leading cause of AFP in adults in interior of the Sindh while facilities for treatment are limited, which need to be extended in the hospitals situated in interior of Pakistan i.e. ICU and plasmopharesis

Association between hypomagnesaemia and foot ulcers in type II diabetes mellitus

The aim of the study was to seek the association between hypomagnesaemia and foot ulcers in type II diabetes mellitus and to verify the effect of age, sex, grades of ulcer, duration of ulcers and duration of diabetes and presence of hypomagnesaemia in the association with type 2 diabetes mellitus. Cross sectional study. This study was carried out in the indoor, setting of Medical Department Peoples Medical College Hospital Nawabshah from September 2009 to May 2010. The subjects were divided into two groups. One was with Grade-I Diabetic foot ulcer and the other with Grade-II diabetic foot ulcers with type II diabetes mellitus. Both the groups contained 50 subjects each and were selected according to the inclusion and exclusion criteria. After a brief interview of 100 patients regarding age, sex, duration of Type II diabetes mellitus, duration of foot ulcer and grade of foot ulcer, both groups underwent fasting serum Magnesium level and categorized on the basis of foot ulcers Grade-I and Grade-II according to Wagner's classification of diabetic foot ulcers. Chi - square test was applied to see the association and then odds ratio was calculated to check the strength of association. Out of 100 Type II diabetic patients, hypomagnesaemia was detected in 20 with grade I diabetic foot ulcer and in 37 patients with grade II diabetic foot ulcers having chi-square value of 13.071 and significance of 0.000 with likelihood ratio 13.554. There is strong association between hypomagnesaemia in foot ulcers with Type II diabetes mellitus

Acute and late complications of organophosphate poisoning

To describe the acute and late complications of organophosphate [OP] poisoning. Case series. Medicine Department at Peoples Medical College Hospital, Nawabshah, from June 2008 to December 2009. A total of 300 patients with organophosphate poisoning admitted to the Medical ICU were included. Baseline investigations included blood complete picture, urea, creatinine, arterial blood gas values, and serum cholinesterase levels. Data was retrieved from the files on a structured proforma. Studied variables included gender, mode of exposure, acute [occurring within 4 weeks] and delayed [occurring after 4 weeks onwards] complications. There were 50 [16.66%] males and 250 [83.33%] females with ratio of 1:5. Two hundred and forty eight [82.6%] had ingested while 18 [6%] had inhaled the poison. Acute complications included fits in 50 [16.66] bradycardia in 30 [10%] and hyperglycemia in 15 [5%] patients. Delayed complications [after 4 weeks and later] included monoplegia and mild sensory loss of lower limbs in 4 [2.66] and paraplegia and weakness of upper limbs in 2 [0.66%] patients each. A total of 50 patients died due to different complications in acute period making a mortality rate of 16.66%. Frequency of acute organophosphate [OP] poisoning complications is much higher and related with high mortality and morbidity and where as late complications are less frequent and less life threatening

Seasonal paradox in acute meningitis at Nawabshah

To assess the reasons for paradoxical increase in cases of meningitis in the summer of the year 2001. Design: An observational study. Place and Duration of Study: Medical Unit III, Peoples Medical College Hospital, Nawabshah, Pakistan, from 1st January, 2001 to 31st December, 2001. Subjects and A total number of 229 cases of meningitis were admitted throughout the year with typical clinical features or CSF findings. Maximum number [179] was noted from April to July, which was alarming. The reason for this change was assessed in these cases. One hundred and seventy-nine cases of meningitis presented from 1st April to 31st July 2001. They were predominantly males n= 107 [59.7%] with age range of 15 to 64 years. Presenting symptoms were fever and headache in all and altered sensorium in 160 [89%] cases with positive signs of meningeal irritation in 175 [97.8%]. Cerebrospinal fluid examination revealed altered biochemistry and neutrophil leucocytosis in all cases. Organism was identified in 139 [77.65%] cases on gram staining. Culture was done only in 61 [34.07%]. Predisposing factors were smoking in 93 [52%] and diabetes in 17 [9.5%] cases. Five female patients were pregnant. Common organisms detected were gram positive diplococci [Streptococcus pneumoniae] in 83 [59.7%], gram negative diplococci [Nisseria meningitides] in 51 [36.7%] and Haemophilus influenzae in 5 [3.6%]. As the frequency of isolates were approximately same as in other seasons, the increased in meningitis cases during summer was probably due to hot and dry weather causing low absolute humidity