Criteria indicating morbidity in tuberculous meningitis.

OBJECTIVE: To work out a criterion that may indicate morbidity in tuberculous meningitis. METHODS: The retrospective study was conducted at the Medical Unit of the Liaquat University of Health Sciences, Jamshoro, Pakistan, and included cases related to a period between January 2006 and June 2011. Record of 50 patients were evaluated for clinical features, chest radiograph, Mantoux test, sputum for acid fast bacilli, routine investigations, cerebrospinal fluid studies, computerised tomography scan and magnetic resonance imaging of head. All the patients in the study had been treated with conventional approach. The severity of the condition was classified in stages, I, II and III. Clinical features, laboratory findings and imaging reports were analysed through SPSS 10 to find out the criteria indicating morbidity. Mean, median, standard deviation were calculated. Student t-test was applied on variables. RESULTS: Of the 50 patients, 26 (52%) were male and 24 (48%) were female. Their ages ranged from 12 to 70 years. Mean age was 37.72 +/-19.65 years. Median age was 35.54 years. Of the total, 17 (34%) patients recovered completely without any complications. Their mean age was 24+/-8.98 years and their mean time interval from onset of illness to presentation in the hospital was 21.75+/-9.75 days. Besides, 30 (60%) patients persisted with neurological sequelae, including cranial nerve palsies, hemiplegia, and hydrocephalus. Patients with neurological sequelae had mean age of 48+/-17.48 years and their mean time interval from onset of illness to presentation in the hospital was 41.33+/-14.14 days. Hydrocephalus was seen in 10 (20%) patients. Three (6%) patients expired. Clinical features, laboratory findings and imaging reports analysis showed that the criteria indicating morbidity were increasing age of the patient (p=0.037), late diagnosis (p=0.044), advancing stage of disease, and development of hydrocephalus. CONCLUSION: Increasing age of the patient, late diagnosis, advancing stage of the disease and the development of hydrocephalus indicate morbidity in tuberculous meningitis.

Comparison of frequency of obesity in high risk non diabetic young individuals with low risk non diabetic young individuals.

OBJECTIVE: To assess the body mass index and waist circumferences of high risk non diabetic young individuals and compare them with low risk non diabetic young individuals. METHOD: A cross sectional, case control comparative study was conducted in the department of medicine, LUMHS from January 2008 to March 2009. Five hundred individuals 20-40 years of age were selected and divided into two groups i.e. Group A: high risk (250 individuals) and Group B: low risk (250 individuals) on the basis of same age and gender. Group A included those who had positive family history of type 2 DM in 1st degree relatives while group B had no family history of type 2 DM in 1st degree relatives. The blood pressure, BMI and Waist Circumference was measured and Fasting Blood Sugar was estimated in each individual. In each group 125 (50%) were males and 125 (50%) were females. RESULTS: In group A 58% and in group B 28.8% individuals represented raised BMI whereas 42% in group A and 36% in group B individuals showed an increased waist circumference. Mean fasting blood glucose was significantly higher in Group A than in Group B (P = 0.001). CONCLUSION: Impaired Fasting Glucose is strongly associated with family history of type 2 diabetes mellitus. Presence of obesity specially in high risk non-diabetic young individuals emphasize the need for routine health screening for early institution of preventive measures.

Platelet count in malaria patients.

BACKGROUND: Malaria is a major health problem in the tropics with high morbidity and mortality. This study is conducted to analyse the effects of malaria on platelets. METHODS: This prospective study was conducted on 200 diagnosed cases of malaria in Department of Medicine, LUMHS, Jamshoro/Hyderabad from February to December 2010. The diagnosis of malaria was carried out by thin and thick blood films. Platelet count was performed using an automated counter. Thrombocytopenia was classified as mild (50-150x10(3) cells/microl), moderate (20-50x10(3) cells/microl) and severe (<20x10(3) cell/microl). RESULTS: The age of patients ranged from 16 to 80 (28 +/- 10.5) years, median age was 30 years. Among the study population, males were 124 (62%) and females were 76 (38%). Out of them 105 (52.5%) were cases of Plasmodium falciparum, 93 (46.5%) were of P. vivax, and 2 (1%) were of P. malaria. The data showed that 171 (85.5%) patients were having low platelet count; 141 (70.5%) had mild, 21 (10.5%) moderate, and 9 (4.5%) had severe thrombocytopenia. Twenty-nine (14.5%) patients had normal platelet count. CONCLUSION: Malaria is associated with different degrees of low platelet count with rarely increased bleeding tendency.

Comparison of the impaired fasting blood glucose in young healthy individuals with diabetic and non-diabetic first degree relatives.

OBJECTIVE: To compare the fasting blood glucose (FBG) level in the healthy young individuals with diabetic first degree relatives considered as high risk and non-diabetic first degree relative considered as low risk. STUDY DESIGN: Cross-sectional, comparative study. PLACE AND DURATION OF STUDY: Department of Medicine, Liaquat University of Medical and Health Sciences Hospital, Hyderabad/Jamshoro, from January to November 2008. METHODOLOGY: Individuals aged between 20-40 years were selected and divided into two groups. Group A was considered as high risk included non-diabetic young offspring's of type-2 diabetic parents. Group B was considered as low risk nondiabetic offsprings of non-diabetic family (control group), of same age and gender. Fasting blood glucose levels were measured in each individual. Exclusion criteria were known diabetes and pregnancy. Mean glucose levels were compared using t-test. Proportions of impaired glucose level versus positive family history were compared using chi-square test. Significance was considered at p<0.05. RESULTS: There were a total of 500 subjects including 250 in each group with equal gender distribution in each group. The mean age was 27.46+/-5.71 years. Mean FBG was 87.4+/-13.82 mg/dl in group A and 77.7+/-15.18 mg/dl in group B (p=0.001). Twenty five (10%) in group A and five (2%) in group B individuals showed impaired fasting blood glucose (p=0.001). CONCLUSION: Impairment of fasting blood glucose was with family history of type-2 Diabetes mellitus in comparison to those without type-2 Diabetes mellitus.

Frequency of anaemia in patients with systemic lupus erythematosus at tertiary care hospitals.

OBJECTIVE: To analyze the frequency and causes of anaemia in systemic lupus erythematosus (SLE) patients attending in department of medicine at tertiary care hospitals. METHODS: This retrospective, descriptive and analytical study was planned to analyze the frequency and causes of anaemia in SLE patients attending the department of medicine at (MMC) and (LUMHS) hospitals during the period of Jan 2006 to Nov 2008. The criteria used in this study were from the American College of Rheumatology. Investigations recorded were blood complete picture, absolute values, peripheral smear, and reticulocyte count in all patients of anaemia. These investigations were necessary to analyse the cases of anaemia in SLE. All investigations were not done in all cases. Patients with hypochromic microcytic anaemia were advised to have serum iron and ferritin levels, seven patients with macrocytic anaemia were advised to have direct and indirect coomb's test, LFTs, serum LDH, serum B12 and folate levels. Patients with normochromic and normocytic anaemia were considered to have anaemia of chronic disease. Bone marrow aspiration and Hb electrophoresis were done in two patients with anaemia of chronic disease. Thirty adult patients were included in this study. Special proforma were prepared to record the information from case sheets of patients including basic information, symptomatology and laboratory investigations. Severity and various types of anaemias were recorded. Anaemia was graded according to severity, as mild (Hb 10-12 G/dl), Moderate (Hb 8-10 G/dl) and severe (Hb < 8 G/dl). Haemoglobinopathies and other types of anaemias were excluded from study. RESULTS: Thirty adult diagnosed patients of SLE, were included. Their ages ranged from twenty years to fifty years at time of presentation. The mean age +/- SD (range) was 28 +/- 6.22 (20-50) years and median age was 31 years. Out of thirty patients, twenty seven (90%) were females and three (10%) were males. Twenty eight (93.33%) patients presented with anaemia, 14 (46.66%) patients were of mild anaemia, 8 (26.66%) patients were of moderate grade anaemia and 6 (20%) patients had severe anaemia. Iron deficiency anaemia was found in 9 (30%) patients, 12 (40%) patients had anaemia of chronic disease and 7 (23.33%) patients had haemolytic anaemia, out of theses 7 patients, 5 (16.66%) patients had Coomb's positive haemolytic anaemia. All thirty patients had ANA positive titres > 1:80; and nineteen (63.33%) patients had anti ds DNA positive, titres > 1:10. CONCLUSION: Haematologic abnormalities are common manifestations in patients with SLE. Most patients exhibit anaemia at some point during their disease course.

Frequency of diabetic retinopathy in patients after ten years of diagnosis of type 2 diabetes mellitus.

BACKGROUND: Diabetic retinopathy is one of the most common and serious complications of type 2 diabetes mellitus and a leading cause of blindness not only in Pakistan but also worldwide. So we conducted this study to record the frequency of diabetic retinopathy in known diabetic patients ten years after diagnosis of type 2 diabetes mellitus. METHODS: The study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan for a period of 1 year from January 2008 to January 2010. The study group comprised of 200 patients of type 2 diabetes mellitus attending the medical clinic. All patients who were diagnosed as type 2 diabetes mellitus since ten years duration were included in the study. Retinopathy was graded into background, pre proliferative and proliferative retinopathy. Type 2 diabetes was diagnosed using the WHO criteria. Statistical analysis was carried out using the SPSS-11. RESULTS: Diabetic retinopathy was found in 25.5% of the total Type 2 patients after ten years of diagnosis, and of these 4% of patients had proliferative retinopathy. CONCLUSION: Type 2 diabetic patients should be screened as early as possible to prevent permanent visual loss by timely management of diabetic retinopathy because diabetes is one of most common preventable cause of blindness in the world.

Frequency of causes of ascites in patients admitted at medical unit of a tertiary medical care facility.

BACKGROUND: Ascites can be defined as accumulation of free fluid in the peritoneal cavity. It is the most common complication of cirrhosis and is associated with a poor quality of health, increased risks of infections, renal failure and a poor long-term outcome. This descriptive analytical study was conducted on one hundred and fifty diagnosed patients of ascites consecutively admitted in medical unit of tertiary care facility attached to Muhammad Medical College, Mirpur Khas, Sindh, from Oct 2006 to Sep 2008. METHODS: Special proforma was prepared containing patients' basic information, history, clinical findings and investigations necessary to diagnose the cause of ascites. Patients with ascites due to perforation and intraperitoneal bleeding were excluded from the study. Serum-ascitic albumin gradient (SAAG) was calculated and patients were grouped into high and low SAAG groups. The obtained data was analysed using SPSS- 11. RESULTS: In this study 150 patients of ascites were included. Patients were arranged in two groups. High SAAG 'high portal pressure' group and low SAAG 'low portal pressure' group. In high SAAG group patients included were 128 (85.33%), and in low SAAG group patients included were 22 (14.66%). In high SAAG group, out of 128 (85.33%) patients 122 (81.33%) were of cirrhotic ascites, [(viral hepatitis B, C and combined 105 (70%), alcoholic 7 (4.66%), cryptogenic 10 (6.66%)], heart failure ascitic patients were 5 (3.33%), and constrictive pericarditis 1 (0.66). In low SAAG group out of 22 (14.66%) patients malignant ascites was (primary peritoneal carcinomatosis and metastasis) 11 (7.33%), tuberculous ascites was 10 (6.66%), and ascites due to nephrotic syndrome was 1 (0.66%). CONCLUSION: As large number of cases of ascites are due to cirrhosis of liver that has little or no cure in developing countries. Media and NGO's should further work to increase awareness of this deadly problem.