[Show abstract][Hide abstract] ABSTRACT: To determine the frequency and characteristics of carotid artery stenosis in acute ischaemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients.
One hundred consecutive patients admitted with acute ischaemic stroke were included in the study. The relevant history, physical examination and laboratory investigations were done as per the Performa. Doppler ultrasound was performed during the hospitalization to find out carotid artery stenosis. Statistics analysis was done with SPSS v 14.
Out of one hundred (100) patients, sixty one (61%) were males and thirty nine (39%) were females. Thirty nine patients (39%) were found to have carotid artery stenosis, all of them on the ipsilateral side corresponding to the ischaemic lesion. Eleven (11) of these patients had stenosis on the contra lateral side as well. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors. Majority (52%) of the lesions were severe to critical as determined by Doppler peak systolic velocity. Fifty nine (59%) were non calcified.
Carotid artery stenosis is strongly associated with ischaemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischaemic stroke.
Journal of the Pakistan Medical Association 01/2010; 60(1):8-12. · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare liver histology in HCV RNA positive patients with normal and elevated Alanine Aminotransferase Level (AST).
This Cohort (prospective) study was conducted at Civil Hospital Karachi from Jan 2007 to July 2007. Forty patients with positive HCV RNA were included. Their liver function tests were followed for three months. Those having normal ALT on three occasions were taken as controls and those having elevated ALT were taken as cases. Liver biopsy was performed, Specimens were reviewed by single pathologist. Scheuer's scoring for grading of inflammation and staging of fibrosis of chronic hepatitis was used.
Out of Forty patients having positive HCV RNA, 14 (35%) were male and 26 (65%) were female. Mean ALT in control group was 27.3 +/- 6.1 u/l, mean ALT in cases was 91.7 +/- 39.95 u/l. Mean age in controls was 34.2 +/- 10.75 years and in cases was 33.6 +/- 9.40 years. On histopathology, the mean grade of inflammation in controls was 1.40 +/- 0.681 while in cases was 1.20 +/- 0.834, which was not statistically significantly different in the two groups (p = 0.411). Similarly mean staging of fibrosis in controls was 1.20 +/- 0.768 and in cases was 1.35 +/- 1.348 which was also not statistically different in the two groups (p = 0.668). Stage 3 and 4 fibrosis was seen only in raised ALT group and not in the controls.
Patients with persistently normal ALT and elevated ALT, although had similar grading of inflammation but the fibrosis score was more in elevated ALT group. None of the patients with normal ALT had normal histology, so decision for antiviral treatment should be individualized in this group also.
Journal of the Pakistan Medical Association 12/2009; 59(12):832-4. · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the acceptable colonoscopy completion rates in three successive audits, identifying the reasons for failure of completion and rectifying them to improve the performance at our endoscopy unit.
Study was conducted at Endoscopy unit of Medical Unit One Civil Hospital Karachi. The first audit was conducted retrospectively on the colonoscopy results, done from November 2004 to November 2005. As the information was incomplete, a performa was designed for the next prospective audit from December 2005 to November 2006. The shortcomings found in the results of this audit were improved in the third audit done prospectively from December 2006 to November 2007.
In the first audit 164 patients (111 male) underwent colonoscopy. The mean age was 40 +/- 10.08 years. The overall caecal intubation rate was 55%, but adjusted caecal intubation was not calculated because of inadequate documentation. In the second audit, 119 patients (66 male) underwent colonoscopy. The mean age was 45 +/- 10.17 years. After implementing changes the overall crude caecal intubation rate was 54.8% and the adjusted caecal intubation rate was 75% with exclusion of strictures and poor preparation. In the third audit, 122 patients (58 males) underwent colonoscopy. The mean age was 38 +/- 11.07 years. With further improvement in methodology the overall crude caecal intubation rate was (80.3%) and the adjusted caecal intubation rate was (98%).
These audits allowed us to evaluate our endoscopy services and to detect the short comings and deviation from standard techniques and hence improving the performance in the subsequent year for the benefit of patients.
Journal of the Pakistan Medical Association 08/2009; 59(7):461-3. · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the frequency, clinical features, management and outcome of acute acalculous cholecystitis in dengue fever patients.
Forty patients were admitted with the diagnosis of dengue fever, according to the clinical manifestations and laboratory investigations. The diagnosis of dengue fever was confirmed by a positive IgM antibody test result for a late or convalescent phase blood specimen. The diagnosis of acute acalculous cholecystitis was made according to clinical features and sonographic findings. Liver function tests, complete blood counts were determined. Abdominal ultrasound was performed with a real time scanner in patients with abdominal pain and abnormal results on liver function tests.
Eleven out of 40 patients of dengue fever (27.5%) had complication of acute acalculous cholecystitis. There were 8 males and 3 females. The mean and standard deviation from the onset of fever to hospital visit was 3.3 +/- 0.8 days (range 2-5 days). The mean white cell counts was 4154 +/- 1577.5 cmm. The mean platelet counts were 26,727 +/- 10460.3 cmm on presentation in hospital. The mean SGPT level was 148.5 +/- 190.17 mg/dl. Mean alkaline phosphatase was 398 +/- 214.8 mg/dl. On sonography all had thickened gall bladder. The mean gall bladder wall thickness was 5.2 +/- 1.3 mm. Three patients had ascites and one patient had pleural effusion.
Acute acalculous cholecystitis was seen in a significant proportion of patients with dengue fever. All patients improved with good hydration and correction of thrombocytopenia. Based on these observations it is suggested that close observation and initial treatment of thrombocytopenia is mandatory.
Journal of the Pakistan Medical Association 08/2009; 59(8):519-21. · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tobacco use, a leading preventable cause of mortality throughout the world is still very prevalent in developing countries. Tobacco use in diabetic patients is associated with further increase of mortality and morbidity due to its effects on metabolic control as well as increase in the development of macrovascualr and microvascular complications. Objective: To determine the prevalence and pattern of tobacco use in diabetic patients. Study Design and Methods: A cross sectional study of patients visiting Medical and Diabetic clinics of Civil Hospital Karachi. Four hundred twenty five diabetic patients of either sex were interviewed according to the questionnaire which was developed considering the objectives of the study.The data was recorded and analyzed with SPSS 15. Results: Two hundred eighteen patients were females (52.2%) and two hundred seven (47.8%) were males. Mean age of study population was 50.9 ± 11.2 years with a range from 14 to 85 years. Two hundred seven patients (48.7%) were currently using tobacco (P <0.005) in various forms which was more common in males (P <0.005). Smoking (29.9%) was the most common form of tobacco use followed by Chewing of Pan (26%) and Niswar (18.8%). Hypertension (P value <0.027) and ischemic heart disease (P value <0.001) was more common in tobacco users, majority of whom required insulin therapy. One hundred thirty three patients (64.2%) of the current tobacco users had attempted quitting (only 33.8% of them at the advice of doctors) but failed. Eighty nine patients had quitted tobacco use successfully. Conclusion: Tobacco use in various forms is alarmingly and very common in diabetic patients. Tobacco cessation is difficult in diabetic patients. An intensive, structured and integrated approach for tobacco cessation is warranted to reduce the morbidity and mortality in diabetic smokers.