Prevalence of examination related anxiety in a private medical college.

BACKGROUND: To assess examination related anxiety among first professional medical students and to determine the factors contributing to this kind of anxiety among them. METHODS: A cross-sectional study using structured self-administered questionnaire was carried out over 10 days in Frontier Medical and Dental College, Abbottabad, in December 2012, using sample size of 200 students,. Survey questionnaire consisted of twenty questions regarding life style, study style, psychological and social problems, and results were analyzed by Visual Analogue Scale (VAS). RESULT: A total of 200 students out of 220 (90.90%) filled in the questionnaire. There were 61.50% male and 38.50% female students. The average maximum Examination related Anxiety marked on VAS was 47 +/- 21. Among different factors contributing to exam anxiety, inadequate rest (89%), irrational thoughts (67.50) and excessive course load (60%) were the most important factors reported by the students. Most of the students were aware of anxiety-reduction techniques but seldom implement them. CONCLUSION: On a VAS, examination, in its own right, has been established as a definite cause of anxiety, although the magnitude is not alarming. Students who regularly participate in class tests and perform well there, are least affected by this anxiety.

Relationship between anaemia and simple febrile convulsions.

BACKGROUND: Simple febrile seizures are the commonest convulsions occuring in children and its exact pathophysiology is unknown. Among other postulated reasons anaemia has been thought to be a possible aetiology. This study was conducted to find out any relationship between anaemia and simple febrile convulsions. METHODS: We studied notes of 1,951 patients retrospectively who were admitted in the Women & Children Hospital Abbottabad from Jan 2013 to Aug 2013. Thirty-one patients with febrile seizures were included in the study as group I and another 31 patients matched for the demographic data were taken as group II. Degree of temperature, family history of simple febrile convulsions, underlying focus of infection and haemoglobin level were recorded. RESULTS: Sixty-eight percent of patients in group I had Hb level below 11 gm/dl compared to 39% of patients in group II: 32% patients of group I, had level on/above 11 gm/dl but none of them had Hb above 11.5 gm/dl in comparison to group II where 61% had Hb level on/above 11 gm/dl with upper limit of 13 gm/dl. CONCLUSION: Significant association was found between anaemia and Simple Febrile Convulsions.

Mesalazine-induced eosinophilic variant of Wegener's granulomatosis in an ulcerative colitis patient.

A 24-year-old woman presented with two weeks history of progressive shortness of breath associated with sharp chest pain. She had been on mesalazine for two years for Ulcerative Colitis. Chest X-ray showed bilateral pulmonary infiltrates with left sided pleural effusion. Blood investigations revealed, positive pANCA, negative cANCA and peripheral eosinophillia. Video assisted thoracoscopic lung biopsy specimen was consistent with eosinophillic variant of Wegener's granulomatosis. She responded to combination of withdrawal of mesalazine and high dose steroids. To our knowledge this is the first reported case of mesalazine induced eosinophilic variant of Wegener's granulomatosis.

Comparison between efficacy of MDI+spacer and nebuliser in the management of acute asthma in children.

BACKGROUND: Due to changing evidence on efficacy of MDI+spacer as compared to nebuliser, two types of managements were going on in our Day unit, depending on the presence of different medical professionals. We wanted to find out the evidence of the best practice from within our unit, and then to formulate guidelines based on it for the management of paediatric acute asthma. METHODS: We isolated 54 cases of children suffering from acute asthma attack from admissions during Oct 2004-March 2005 within the age range of 3-14 yrs. We categorised them into four classes of mild, moderate, severe and life threatening acute attack depending on its severity and then separated them in two groups. Group I received salbutamol Via MDI+spacer and Group II received salbutamol via nebuliser. Our outcome measure was time to clinical improvement and duration of hospital stay. RESULTS: We didn't find any major difference between the two groups, moreover MDI+spacer was better than nebuliser for the treatment of severe acute asthma attack in children. CONCLUSION: Our study supported and confirmed the evidence that MDI+spacer is least as effective as nebuliser in the management of acute asthma in children.

Prevalence of cardiomyopathy in Duchenne and Becker's muscular dystrophy.

BACKGROUND: Cardiac assessment was not done routinely in Duchenne (DMD) and Becker muscular dystrophy (BMD) patients in Northern region of England while evidence was gathering on progressive cardiomyopathy in these patients. We wanted to find out the prevalence, progression and clinical features of cardiac involvement in Duchenne and Becker muscular dystrophy. METHODS: It is a retrospective review of clinical, electrocardiographic and echocardiographic assessments. RESULTS: The notes of 52 Duchenne and Becker muscular dystrophy patients were reviewed out of which 32 had DMD, 6 had Intermediate muscular dystrophy (IMD) and 14 had BMD. Prevalence of preclinical and clinically evident cardiac involvement was 88.4% in DMD and BMD patients. Sixty nine% of patients had clinically evident cardiac involvement but only four patients had cardiac symptoms in the form of palpitations, out of which two were due to respiratory dysfunction and others was due to cardiac failure. Clinical examination of the rest of all of the patients was unremarkable. Electrocardiogram was abnormal in 88.4% of patients. Conduction defects were found in 19.4% of patients. Echocardiogram was abnormal in 80.7% of patients but all were poor echo subjects including those who had normal echocardiogram. CONCLUSIONS: Though most patients were asymptomatic, a high percentage had evidence of preclinical and clinically evident cardiac involvement. So in all patients with Xp21 linked muscular dystrophy a routine baseline cardiac assessment should be done at the age of 10 years and reviewed after intervals of one to two years.

Waist hip ratio as an index for identifying women with raised TC/HDL ratios.

BACKGROUND: Obesity cannot be described solely as fat mass but the location of fat deposition is very important to determine the relation between obesity and disease. Abdominal type of obesity is linked to risk factors of atherosclerosis and to metabolic disease. Waist Hip Ratio (WHR) is a practical, simple and non-invasive index of adipose tissue distribution. METHODS: We looked for a relation between WHR and TC/HDL-C ratios of a group of postmenopausal women. All the subjects in each major group were of comparable age and BMI, but the WHR varied from subject to subject. Each group was sub-divided into three tertiles based upon the WHR. Serum total cholesterol (TC) and HDL cholesterol (HDL-C) values were determined for all the subjects and TC/HDL-C ratio, which is a recognized CHD risk screening index was calculated. RESULTS: The WHR distribution was significantly different in postmenopausal women from the pre-menopausal controls, and most of the postmenopausal women showed android type of obesity with no subject in the tertile with least WHR. It was noted that the TC/HDL-C ratio increased in direct proportion with the increase in WHR and its mean value was above the desirable value in both the tertiles of postmenopausal women. The test performance characteristics of WHR showed that WHR is a sensitive and specific index for screening of high TC/HDL-c ratio. CONCLUSION: We conclude that WHR (at a cut-off point of 0.84) can serve as a sensitive and specific outpatient screening index to detect postmenopausal women with an elevated TC/HDL-C ratio.

Effect of menopause on serum HDL-cholesterol level.

BACKGROUND: There is a marked difference in the risk of coronary heart disease between men and women of reproductive age but this gap closes with advancing age. It seems likely that some factors of reproductive physiology are responsible for this. The present study was designed to evaluate the difference in HDL Cholesterol level in premenopausal and postmenopausal women in relation with change of estradiol level. METHODS: Fifty premenopausal and 50 postmenopausal women were included in the study. Estradiol was estimated by radioimmuoassay while HDL-C was estimated by Kit method. RESULTS: There was a significant (p < 0.01) decrease in the HDL-C level of the postmenopausal women (46.72 +/- 1.009) as compared with premenopausal women (63.68 +/- 1.78). CONCLUSION: HDL-C is an independent risk factor for coronary heart disease. This study favours the view that decrease in estradiol level and associated decrease in HDL-C seen in postmenopausal women may be responsible for the increased risk of coronary heart disease after menopause.