Mortality associated with burn injury - a cross sectional study from Karachi, Pakistan.

BACKGROUND: Burn injuries are a major cause of medico legal deaths in Pakistan. The present study was conducted with the aim to assess the mortality rate related to different types of burns injuries. FINDINGS: This was an observational prospective cross sectional study conducted in Burns Ward of Civil Hospital, Karachi during a period of two years from January 1st 2010 to December 31st, 2011. Data was collected over a questionnaire containing demographic variables as well as date of burn, date of the death (if patient expired), total body surface area involved, cause and manner of burn. The data was statistically analyzed by SPSS v. 16. A total of 1979 patients were admitted to the department during the study period. Out of them, 715 died, hence a mortality rate of 36.12%. Out of the 715 patients, 380 (53.1%) were males and 335 (46.9%) were females. Mortality was highest in age-group 16-30 years (n = 395, 55.2%). Majority of the deaths were accidental (n = 685, 95.8%). Fire burns was found to be the most common cause of death (n = 639, 89.3%). 35% (n = 252) of the patients who died had more than 60% of total body surface area involved in burns. CONCLUSION: Measures must be taken to inform the general population of the possible causes of these injuries, and to enable the people to be prepared to face any such circumstances.

Post-traumatic stress disorder in patients with acute burn injury.

OBJECTIVE: To determine the risk of PTSD in patients with acute burn incidents. METHOD: This was an observational prospective cross-sectional study conducted in admitted patients in Burns Ward of Civil Hospital, Karachi during a period of 6 months from January 1 to June 30, 2011. Data was collected through questionnaire having socio demographic variables and the Impact of Event-Scale (IES-R) was used to determine the risk of PTSD. RESULTS: Out of 145 patients, 12 (77.3%) were at risk of PTSD with 75 (66.9%) males and 37 (33%) females. Out of these 112 cases, 50% belonged to age group 16-29 years. All burn patients with more than 60% total body surface area (TBSA) involved in injury were at risk. CONCLUSION: The study reports an astronomic number of burns patients with PTSD risk. PTSD drastically affects the quality of life. The earlier this disorder is diagnosed and assessed; better chances are there for enhanced treatment and better recovery.

Gastroschisis.

We report a case of gastroschisis which was not diagnosed antenatally and was delivered through lower segment caesarean section due to non-reassuring cardiotocograph and small for gestational age fetus in a 21-year old mother. It was associated with oligohydramnios and partial extension of wrist joint in the neonate. After delivery, baby was referred to tertiary care for specialized care by paediatric surgeon and neonatologist where he had silo reduction and surgical repair. Postnatally, the baby is in healthy condition till now.

Intramedullary dermoid cyst with relatively atypical symptoms: a case report and review of the literature.

BACKGROUND: Intraspinal dermoid cysts are rare and benign tumors that occur primarily due to the defective closure of the neural tube, an ectodermal derivative, during the process of development. They are slow-growing tumors manifesting in the second and third decades of life. CASE PRESENTATION: We present here a case of a 14-year-old Sindhi boy with a six-month history of paraparesis of the lower limbs and a progressive loss of power of grade 3/5, and hypoesthesia in the L4/L5 dermatomes of his right lower limb. A plain magnetic resonance imaging scan revealed a well-demarcated intraspinal intramedullary cyst containing an abscess at the level of T12 and L1 causing localized cord compression, which was producing the symptoms. Near total excision of the cyst was successfully performed and was sent for biopsy, which revealed keratinocytes and keratin flakes. With one month of follow-up, along with physiotherapeutic management, the patient gradually improved and was able to walk without support. CONCLUSIONS: Critical evaluation of every case with aggravating symptoms should be carried out, and neurological and radiological examinations should be conducted to ensure the well-being of patients.

Increasing ciprofloxacin resistance of isolates from infected urines of a cross-section of patients in Karachi.

BACKGROUND: The objective of the research was to evaluate the current effectiveness of ciprofloxacin on the uropathogens prevalent in infected urines of a cross-section of patients in Karachi, Pakistan. FINDINGS: An observational study conducted in a private diagnostic laboratory and its branches in key areas of Karachi City from February 2010 to July 2011. A total of 2963 consecutive urine samples were cultured on chocolate agar, CLED medium and selective EMB agar. Growth of possible uropathogens was noted, and compared retrospectively with earlier lab data of suggestive urine cultures (n = 1997) recorded during January 2009 and December 2009. The isolates were identified using routine procedures and the API 20 system and evaluated for their sensitivity to ciprofloxacin by Kirby-Bauer disk diffusion method. Data was subjected to statistical analysis on SPSS version 16. Out of the present-day culture-positive urines, 2409 (80.4%) yielded gram-negative rods, and 554 (18.5%) gram-positive cocci. E.coli (43.1%) was most frequent, followed by Klebsiella pneumoniae (22.4%) and Staphylococcus aureus (15.5%). 57.2% of the Gram-negative bacteria and 48.7% of the Gram-positive isolates were resistant to ciprofloxacin. In the earlier (2009) screening, 39% of Gram-negative rods and 48% of Gram-positive cocci were indifferent to the drug. CONCLUSIONS: A decrease in bacterial susceptibility of uropathogens to ciprofloxacin, a commonly prescribed drug in our population, is underlined, occurring possibly due to overuse pressure. Empirical initial treatment with ciprofloxacin would be inadequate in more than half of UTI cases, thereby counseling increased C/S testing of urines to provide existing sensitivity data for apt drug prescription.

Frequency of HBsAg positivity: a laboratory data analysis.

The objective of the study was to evaluate the current frequency ratio of HBsAg seropositivity in a laboratory-based setting. It was a retrospective study, conducted during September 2009 and November 2010 at Dr. Essa's Diagnostic Laboratory and its branches in Karachi, Pakistan. Blood samples of 8,648 individuals were screened for HBsAg using the BioRad EVOLIS EIA method. Pertinent questionnaires filled in by 50 practicing physicians were also evaluated. The 551 subjects (6.4%) that tested positive for HBsAg included 360 males (65.3%) and 191 females (34.6%). The highest frequency of HBsAg was noted in those aged 16 - 29 years (43.9%). HBsAg rate in the studied population has steadily increased and is more common in the sexually active age group, with males tending to be more often seropositive than females.

Intra-medullary tuberculoma of the spinal cord presenting with typhoid and paraplegia: a case report.

INTRODUCTION: Intra-medullary spinal tuberculoma is a rare form of tuberculosis, with an incidence of only two in 100,000 patients with tuberculosis. We present a case of intra-medullary tuberculoma from Pakistan, which was diagnosed by radiological findings and analysis of cerebrospinal fluid using polymerase chain reaction testing. CASE PRESENTATION: We present the case of a 28-year-old Sindhi male with intra-medullary tuberculoma of the spinal cord at the C3 level. Our patient was treated solely with anti-tubercular drug therapy with no surgical intervention. CONCLUSIONS: We discuss the possible clinical management of such rare cases, considering both chemotherapeutic and surgical options. Additionally, diagnostic procedures and findings are discussed; we suggest cerebrospinal fluid analysis via polymerase chain reaction and gadolinium-diethylenetriamine pentaacetic acid magnetic resonance imaging as important chemical and radiological tests to be performed in such cases.

Exhumation - Nuisance to the dead, justified?

OBJECTIVE: Exhumation stands as a very significant feature of forensic investigations. The legal excavation of dead bodies for ascertainment of the cause of death has always aided the law enforcement agencies to comprehend the anonymity of any suspicious case and further convict the criminal in cases of homicides. This study analyses the different aspects of the exhumations which were carried out and were autopsied in Karachi during the study period. METHOD: This was a cross-sectional study, and included all the exhumations carried out in Karachi during a period of 7 years and 7 months from 1 January 2004 to 31 July 2011. RESULTS: A total of 101 exhumations were carried out during the study period. Out of 101 cases, 63 were males (62.4%) and 38 females (37.6%) giving a male to female ratio of about 3:2. Causes of death were ascertained in 75 cases, thus the success rate was 74.3%. Head injury by hitting with hard blunt object was the most frequent cause of deaths (17.8%), followed by asphyxia due to strangulation (15.8%). DISCUSSION: Exhumations must be ordered by the Judiciary in suspicious cases as it aids in determining the actual causes of death and leads to convictions. It also brings a great deal of satisfaction for the relatives of the deceased and halts any doubts in their minds. As shown by our study, much attention is given to the cases in urban areas by the relatives who are determined to find the cause of death even after burial procedures.

Prevalence and factors associated with irritable bowel syndrome among medical students of Karachi, Pakistan: a cross-sectional study.

BACKGROUND: Irritable bowel syndrome (IBS) and its association with stress, has not been studied among university students in Pakistan. We investigated the prevalence and the pattern of anxiety related IBS symptoms among medical students of Karachi. FINDINGS: An observational case-control study was carried out at three medical colleges of Karachi, Pakistan. Random sampling was done on 360 medical students. Data was collected using validated tools "Rome III Criteria" and "Generalized Anxiety Disorder Questionnaire". Participants with IBS were diagnosed on the criteria having experienced abdominal discomfort at least 2-3 days/month associated with high level of anxiety. The apparent prevalence of IBS was found to be 28.3%, with a predominance of 87 (85.29%) females (85.29%) over males (14.71%). The psychological symptoms of anxiety were encountered in 57 (55.8%) participants with IBS, among which males were 15.7% and females 84.2% respectively. CONCLUSION: Students who more frequently suffer with mental stress and anxiety are more associated with IBS.

Eating disorders in medical students of Karachi, Pakistan-a cross-sectional study.

BACKGROUND: To assess the incidence of high-risk population of medical students with eating disorders in Karachi by using validated self-administered questionnaires. The earlier these disorders are diagnosed and assessed, the better the chances are for enhanced treatment and fuller recovery. Therefore, we intended to undertake a study to find out the frequency of such disorders among medical students of Karachi and design strategies to overcome them. FINDINGS: A descriptive cross sectional study was conducted in 435 medical students of Karachi. Data was collected using 2 self administered questionnaires, the SCOFF Eating Disorders Questionnaire and the Eating Attitudes Test (EAT-26). Subjects' body mass indexes (BMI) were also calculated. The data was sorted and analyzed in SPSS version 16. According to EAT-26, 22.75% individuals were found to be at high-risk of eating disorders, with 87.9% females and 12.1% males. However, according to SCOFF questionnaire, 17% individuals were found to be at high-risk, with 78.4% females and 21.6% males. According to BMI calculation, 9% were severely underweight, 41.4% underweight, 41.1% normal, 7.6% overweight and 0.9% belonged to obese class 1. CONCLUSIONS: A significant fraction of medical students in Karachi are at high risk of development of eating disorders, females being more prone than males. Strategies should be designed to prevent occurrence of such disorders among medical students that would undoubtedly hamper the availability of dependable medical services in future.

Intracranial cystic chondroma: a case report.

INTRODUCTION: Intracranial chondromas are rare benign tumors with an incidence of 0.2% to 0.3% of all intracranial tumors. This is the first case of an intracranial chondroma reported from Pakistan. CASE PRESENTATION: We report a case of a 23-year-old Asian man presenting with intracerebral chondroma of the left frontal lobe, which was eroding the dura matter. The intracranial chondroma was completely removed by surgery. CONCLUSION: Intracranial chondromas are rare benign cartilaginous tumors. Through this case presentation we have discussed the diagnostic procedures, radiological and pathological findings. The purpose of presenting such a rare case is to develop awareness among clinicians and medical students and to highlight the requirement of immediate actions to ensure proper management of such cases.

Audit of custodial deaths in Karachi--an autopsy-based study.

OBJECTIVE: To assess the causes and manner of custodial deaths in Karachi, and to determine the factor of negligence on the part of the custodians behind such deaths. METHODS: The cross-sectional study involved the deaths in custody undergoing autopsy at Civil Hospital, Karachi, from January 2005 to December 2010. Autopsy was followed by histological examination, X-ray or CT scan wherever required. A proforma was also filled as per the standard autopsy protocol. RESULTS: There were 61 custodial deaths in Karachi during the six-year study period which met the inclusion criterion. There were 58 (95.1%) males and 3 (9.4%) females. Natural causes accounted for a majority of deaths (n = 36; 59%), the most common disease being coronary artery disease (n = 13; 21.3%). Unnatural causes accounted for 25 (41%) deaths, comprising 13 (21.3%) homicidal, 7 (11.5%) suicidal and 5 (8.2%) accidental. Deaths were more frequent in the age group ranging from 30-39 years (34.4%), while the overall age-range was from 19 to 75 years. DISCUSSION: Measures need to be taken to provide a wholesome environment for the prisoners. Code of conduct for the prisoners should be followed and judicial procedures shall be conducted at a quick pace. Torture should be avoided under all circumstances, and proper vigilance shall be kept to prompt suicidal deaths.

Omphalocoele, ten years experience at a tertiary care hospital.

Omphalocoele is a rare congenital anterior abdominal wall defect. We present 12 cases of Omphalocoele seen in our hospital. Further, we have discussed the clinical presentation, antenatal diagnosis, associated abnormalities and final outcome of the cases.

Audit of sharp weapon deaths in metropolis of Karachi--an autopsy based study.

BACKGROUND: Sharp weapons are one of the most violent and abhorrent means of deaths. This study assesses the frequency of sharp weapon deaths in Karachi. METHODS: This was a cross sectional study, and involves the deaths by sharp weapons autopsied in Karachi during Mar 2008-Feb 2009. RESULTS: This study reports that the frequency of sharp weapon deaths in Karachi is similar to some other studies conducted in different regions of Pakistan, yet it is very high as the population of Karachi is way more than any other metropolis of Pakistan. Our study reported that out of 2090 medico-legal deaths in Karachi during the study period, 91 deaths were due to sharp weapons, including 73 (80.2%) males and 18 (19.8%) females. 100% of the deaths were homicides, so none were suicides. Deaths were more frequent in age group ranging from 20-39 years (59.3%). CONCLUSION: Sharp weapon deaths continue to be a means of quite a number of deaths in Karachi. Such violence depicts intolerant and frustrated nature of the citizens.