Stroke in elderly patients admitted at Mayo Hospital, Lahore

Early constitute a major proportion of our population. Our study at West Medical Unit of Mayo Hospital, Lahore was based on elderly patients presenting with various types of stroke. Out of 206 elderly patients, 28 had stroke. 12 were female and 16 male. 3 had transient ischemic attack [TIA], 16 suffered from thrombotic stroke and 9 from haemorrhagic event. 6 patients from study group died and 2 left against medical advice. We concluded that stroke is a disease of the elderly imposing major impact on their mortality rates, age being a major risk factor. Hence stress should be laid on the disease as well on the elderly which constitute a major portion of our population

Rosiglitazone and metformin in patients with type-2 diabetes mellitus who are inadequately controlled on metformin alone

Type 2 Diabetes Mellitus is almost reaching epidemic levels. With tight hyperglycemic control the risk reduction is 24% for any diabetes related end-point and 32% for death related to diabetes, against only 0.9% decrease in HbAlc level. Complementary mode of actions of Rosiglitazone and Metformin can be used to maximize the therapeutic effect and to decrease the side effects. We evaluated the efficacy, safety and tolerability of the combination of Rosiglitazone and Metformin on change in HbAlc levels from baseline over a period 24 weeks in patients with type 2 diabetes mellitus. Twenty eight type 2 diabetes mellitus patients were recruited randomly presenting to West Medical Ward, Mayo hospital Lahore, through OPD, Diabetic Clinic and Emergency, who were on Metformin alone and were poorly controlled from September 2003 to July 2004. They were given Rosiglitazone 4 mg/day or 8 mg/day with metformin for a period of 24 weeks. Only 2 patients were dropped and 26 patients completed the study [46% were males and 54% were females], and none of patient was dropped due to adverse effects. Their fasting blood sugar measured at baseline and at 4, 8, 16 and 24 week. HbAlc was measured at start and at 24 weeks. The fasting blood glucose responders were 84.6%, with mean fall of 46 mg/dl. HbAlc responders were 73% patients. Average weight gain was 1.125 kg over 24 weeks. Out of 26 patients, 89% showed a mild decrease in hemoglobin concentration but none reaching anemic levels. Only 10% patients had a rise in liver enzymes, which was less than 2 times the normal. Addition of rosiglitazone, in patients with type 2 diabetes mellitus, who are inadequately controlled on metformin alone, resulted in better glycemic control but a large scale study is required and other combinations with Rosiglitazone like sulphonylurea and insulin should be compared

Causes and outcome of suicidal cases presented to a medical ward

Suicide is one of the leading causes of death in world but its causes and methods may vary. We enrolled patients who presented to the emergency with attempted suicide. The end point was death, discharge or leaving the hospital against medical advice. The study was designed to know the modes of committing suicide and underlying causes. Of the total 107 patients, who presented to the emergency 59 [55%] were males and 48 [45%] were females. Most common poison ingested was wheat pill in 35 [33.3%] patients followed by bleach/bathroom cleaner in 27 [25.7%], benzodiazepines in 20 [19%] and a small proportion of patients had copper sulfate, organophosphorus compounds, rat pills, lice powder, dettol and varnish. Two patients presented after hanging. Twenty eight [26%] patients died, just after reaching hospital and 10 had permanent disability. For suicide the most common poisons used were those that were easily available and without any ban on their sale. So general awareness should be created among masses about them and legal restrictions should be imposed on their sale

Erythrocyte sedimentation rate in smokers, hypertensives and in patients of ischaemic heart disease

To see the levels of ESR in clinically healthy Smokers and compare it with clinically healthy controls. To show the ESR in IHD and hypertension and compare it with controls. To correlate ESR with fibrinogen and haematocrit. Design: ESR measured according to the method recommended by International Committee for Standardization in Haematology to see its levels in clinically healthy controls, smokers, patients of IHD and hypertensives. Setting: epartment of Physiology, Dow Medical College, CHK and BMSI, JPMC, Karachi. Subjects: 148 adults [43 IHD patients] none of whom had diabetes mellitus, liver disease, CCF, malignancy, bleeding disorders and respiratory disease. Main outcome Measures: To study the effects of persistently raised ESR as a risk factor for IHD. ESR was found to be 7.93 +/- 0.63 [mean +/- sem] in controls, 1 1.63 +/- 0.41 in smokers, 20.4 +/- 1.4 in hypertensives and 22.5 +/- 2.00 in IHD patients with P < 0.001 when compared to control group. Correlation of ESR / fibrinogen and ESR/haematocrit were r = 0.7 and r = -0.2 in controls while these correlations were found to be r = 0.45 and r = -0.16 in 118 cases. ESR is found to be higher in clinically healthy smokers so there is a need to compile a laboratory data for healthy persons excluding smokers. ESR is also found higher in hypertensives and is highest in IHD patients than controls. Persistently raised ESR may be regarded as a risk factor for IHD. ESR still is a useful test if performed with strict precautions and keeping in view the factors affecting its results