A DEBILITATING COMPLICATION OF MEASLES VIRUS: SSPE

Subacute sclerosing panencephalitis (SSPE) is a rare and chronic neurodegenerative disease caused by an unceasing infection of the brain by an altered form of the measles virus acquired earlier in life. The initial symptoms usually involve regressive changes in intellect and personality. Over a span of several months, the psychological symptoms are augmented by neurologial symptoms, which most often composes of myoclonic jerks. This disorder more often affects male children or adolescents as compared to females and adults. SSPE cases are now mostly seen in developing countries where measles virus is still highly prevalent. Here we report a case of a 6 years old male who presented to the Primary Health Care Centre in a small settlement area of Karachi; with complaints of gradual weakness of all four limbs associated with loss of power and mild fever. The boy was also having myoclonus seizures involving right upper arm and right facial jerks. Brain MRI showed no physical abnormality although the Electroencephalogram revealed abnormal signals which confirmed SSPE

Association of Iron Deficiency with Electronic Gaming Addiction and Low Health Influencing School Performance

Background: Anemia does not only have a deleterious effect on the physical growth of children but also impairs mental development and slows down memory, cognitive functioning, and academic performance. The study aimed to assess the association between video gaming, iron deficiency anemia and school performance in children 5-16 years of age.  Methods: A cross-sectional study was conducted on 306 children 5-16 years of age between grades 1 and 10 in various schools in Sikandarabad for one academic year. The iron deficiency, screen time along with past health records were noted. School assessments were analyzed for academic achievements, and class concentration and Intelligent Quotient (IQ) tests were done multiple times. Hemoglobin was checked to establish an association with learning difficulties. Multivariate logistic regression was done to see the association of electronic gaming with academic performance. p-value <0.001 was considered significant. Results: Mean age of children was 11.73+1.8 years. Mean hemoglobin was 12.3+1.2g/dl. Children with iron deficiency had a poor concentration in class (p<0.001) and achieved below-average assessment results (p<0.001). Also, anemic children participated less in extra-curricular activities (p=0.004). Children who played excessive video games, 63.2%, had (p<0.001) lower IQ in comparison to the ones exposed to less screen time. Moreover, kids who scored less than average grades in school had also shown to have low IQ (p<0.001) with statistically significant results. Conclusion: Excessive video gaming was associated (p<0.001) with anemia and low IQ in this study. Anemic children participated less in extracurricular activities and were shown to have poor scholastic performance. Keywords: Iron Deficiency Anemia, Academic Performance, IQ (Intelligent Quotient)

LIFESTYLE FACTORS INFLUENCING THE PREVALENCE OF SKIN DISEASES AT A PRIMARY CARE CENTER IN KARACHI

Background: To determine the burden and assess the risk factors of skin diseases in Primary Health Care Centers in Karachi. Methods: A total of 360 patients came to the primary health care center over the span of 6 months from May 2017 to October 2017 .Out of them 151 had some sort of dermatological ailment. They were examined thoroughly for skin lesions and interviewed. Data was collected by reading out questionnaires to the patients, and filled accordingly. Results: It was observed in our study that 151(41.9%) patients presenting to primary care center had dermatological complaints. Mean age determined was 25 years. 87% of the study population was female whilethe rest were males. In our study, skin ailments were broadly divided into 3 categories out of which chronic skin conditions ( 43%) like lichen planus, alopecia and pityriasis alba turned out to be most common, followed by infectious skin diseases ( 36.4%) such as scabies, tineas and impetigo. Least recurring were allergic skin disorders ( 20.5%)such as atopic dermatitis. Sharing of personal items and animal contact were statistically significant variables and had strong association with skin ailments. While overcrowding, family history of similar skin condition and past personal history of same skin condition were not determined to be significantly associated with the presentation. Conclusion: Our study shows a spectrum of skin diseases prevalent in high numbers in our population. This identifies the need for qualified family physicians with special training in dermatology to treat the masses effectively and decrease the morbidity. Detailed counseling should be offered to avoid sharing of clothes and minimizing animal contact as muchsince possible since skin diseases are mostly contagious. Community awareness programs should be conducted in which personal hygiene should be discussed. Scarcity of water is a social issue prevalent in this area so some policies regarding this issue should be imposed to improve the situation

Occurrence of severe cognitive impairment in elderly individuals with poor glycemic control Vs elderly individuals with good glycemic control or no DM: a case control study”

ABSTRACT: Background: There is substantiatial corroboration that diabetes (both T1DM and T2DM) plays an essential role in predisposition to cognitive decline thus leading to dementia in both human and animal studies. (1,2,3). Hypoglycemia has been associated with the increased risk of developing cognitive impairment. (4). There is lack of data from our community to support this. We aim to observe occurrence of cognitive impairment in individuals aged 65 or above with poor glycemic control and compare it with similar age group individuals with no DM or good glycemic control. Frailty independently contributes to the cognitive decline. We also assessed frailty index and incorporated it into our result interpretation. Methods: We conducted a case control study in the primary health care center of Ziauddin University from 1st December 2021 to 30th June 2022. Cases included 83 individuals 65yrs with HbA1c =7 and above and controls included 91 individuals 65yrs and above with HbA1c &lt;7. Both groups were assessed for cognitive decline using MMSE score and CFS score determined their dependency status. Results: Moderately uncontrolled Diabetes had highest association with severe cognitive decline(50%) p-value 0.000 and those who could not manage to do IADLS were severely dementic in our study( p-value 0.046). We also found DM to be associated with high frailty scores. Severely uncontrolled DM was associated with CFS of 5 meaning those who were dependent on others for instrumental activities of daily living. Those who managed well independently was associated with Pre DM in our study.( p-value 0.041) Conclusion: Severe cognitive decline has high association with uncontrolled glycemic control. Keywords: IADLS (instrumental activities of daily living), CFS (chronic frailty scale), MCI (Mild Cognitive Impairment

Frequency And Determinants Of Chronic Lower Back Pain Among Patients Presenting To Primary Care Clinics In Pakistan: A Cross-Sectional Analysis

Objective: To ascertain the determinants of chronic lower back pain among patients presenting in primary care clinics. Methods: 300 participants from 18 to 75 years of age were enrolled from Primary Care Clinics, Primary Health Center, Sikanderabad and Family Medicine Health Center, Clifton, for a Cross-sectional study that was done from December 1, 2020, to June 30, 2021. Consultant family physicians took informed consent and then asked relevant history questions and performed a relevant physical examination, such as a straight leg raise on the patients. Results: The frequency of chronic lower back pain came out to be 16.7%(50). The median age was 31.99+15.7 years. For those who had chronic back pain, the majority were regularly taking Cholecalciferol supplements ( 20.8% p-value 0.05). The effect of depression increases the chances (0.688) of chronic lower back pain. (p-value 0.006) Conclusion: In our study, we concluded that lower back pain, especially chronic in duration, is very rampant in the community with male predominance. The majority reported a dull type of pain. Depressed people are more vulnerable to developing chronic back pain

Prevalence of Polycystic Ovarian Syndrome, Its Associated Conditions And Complications: an Experience from a Low Socio-Economic Population of Sikandrabad, Karachi, Pakistan

OBJECTIVES To study the prevalence of polycystic ovary syndrome, its associated conditions and complications in the low socio-economic population of Sikandrabad, Karachi. METHODOLOGY This cross-sectional study was conducted in a primary health care centre of Ziauddin University, Sikandrabad-Karachi, Pakistan, from January-June 2021. The ethical committee of the university approved this study. All female patients with gynaecological complaints having an age between 18 to 49 years were included. Females with a history of unilateral oophorectomy, uterine abnormality and abnormal karyotype or known malignancies were excluded from the study. A sample size of 118 was calculated using open-epi software. A performed questionnaire was used to collect data from females with gynaecological complaints. PCOS was diagnosed using Rotterdam criteria. Routine examination tests were done at the Primary Health Care Clinic (PHCC) of Ziauddin Hospital, and obesity was labelled through BMI calculation. RESULTSOf 118 females in the reproductive age group screened, 55.93% reported PCOS as a major gynaecological problem, followed by endometriosis at 16.94%, uterine fibroid at 14.46% and urinary tract infections at 9.32% respectively. Patients had infertility as a major complaint, with 54.54% cases followed by menstrual abnormalities at 21.21%, obesity at 16.66% and others at 7.57%. Most patients (38%) were obese, and 34% were overweight. CONCLUSION PCOS is a prevalent complicated endocrine disorder in women in the reproductive age group, and it presents with varying gynaecological complications like infertility, menstrual disturbances, hirsutism, and acne. Obesity, hormonal imbalance and poor dietary intake affect the disease outcomes further. More multi-centred studies are needed to know the exact prevalence and causal relations

Normal Adrenal Versus Adrenal in Acute Abdomen on MDCT

Background: Knowledge of the range of normal size and morphology is useful for adequate interpretation of computed tomography (CT) scans in patients with suspected adrenal pathology.Objective: To compare the size of normal adrenal glands with the cases of acute abdomen on Multidetector CT.Methods: A total of 256 Contrast enhanced CT scans of abdomen where observed. 108 of them were for evaluation of acute abdomen and the rest were reported as normal scans. Adrenal gland measurements were taken at body (at the level of maximum thickness of body), lateral limb and medial limb (a line perpendicular the limb) in both the cases and normal patients.Results: The mean maximum thickness (in mm) of the right adrenal gland body, medial limb, and lateral limb were 5.9 ± 1.6, 4.4 ± 1.4, and 4.8 ± 1.3, respectively, and the mean maximum thickness (in mm) of the left adrenal gland body, medial limb, and lateral limb were 6.7 ± 1.9, 4.9 ± 1.5, and 5.1 ± 1.6, respectively. In cases with acute abdomen mean maximum thickness (in mm) of the right adrenal gland body, medial limb, and lateral limb were 6.2 ± 1.5, 4.2 ± 1.3, and 4.9 ± 1.7, respectively, and the mean maximum thickness (in mm) of the left adrenal gland body, medial limb, and lateral limb were 7.1 ± 1.9, 4.9 ± 1.5, and 5.1 ± 1.9, respectively.Conclusion: There is no significant statistical difference between various measurements of adrenals of normal and cases with acute abdomen

Congenital Myopathy of Neonatal Onset - A Case Report

Congenital myopathies (CMs) are a diverse group of rare inherited muscle disorders characterized by muscle weakness and hypotonia. Very few studies have outlined the cases of CM in Pakistani immigrant families. The following is a case of a premature male neonate who was born with global hypotonia, cryptorchidism and scoliosis. He was vitally stable at birth, but his respiratory function deteriorated over time and was on ventilatory support. Chest X-rays suggested atelectasis while lab findings revealed deranged arterial blood gas (ABG) and abnormal complete blood count (CBC) levels. Creatine kinase levels were normal however; electrocardiogram (ECG) showed atrial defect and right ventricle and pulmonary artery hypertension. Nerve conduction studies (NCS) and electromyography (EMG) results were suggestive of Myopathy. The patient succumbed to respiratory failure 12 days after birth. Due to the low incidence of CMs and their variable presentation, it is easy to misdiagnose and hence, this delays the timely and effective intervention. Keywords: Congenital Myopathy; Arterial Blood Gases; Electromyography; Nerve Conduction Studies

Hypertension and Its Predictors in a Squatter Settlement of Karachi

Background: Hypertension, the ‘silent killer’, is the cause of high mortality and is one of the major health problems worldwide. This study aimed to determine the frequency of hypertension and its predictors in a squatter settlement in Karachi. Methods: A cross-sectional study (n=212) was conducted at the Family Medicine Clinic, Karachi. The participants aged 18 to 65 years, from Jan 1st to 30th June 2020 were recruited. Thorough examination (including blood pressure, weight, and height) and interviews of the participants were done regarding lifestyle, cardiovascular risk factors, personal and family history of cardiovascular diseases, or other chronic illnesses. The Chi-square test was used to identify the association of the risk factors with hypertension and a p-value <0.05 was considered statistically significant. Results: The overall burden of hypertension calculated was 63(29.7%). The mean age of participants was 39.3+15.4 years. A very strong association (p<0.01) of hypertension (76.5%) was seen with a history of dyslipidemia compared to non-hypertensives (23.5%). Among diabetics, it was found that 84% were hypertensive and 16% were non-hypertensive with a statistically significant (p =0.00) association. Personal history of ischemic heart disease (77.8%, p-value 0.003), transient ischemic attack (TIA)/stroke (100%, p-value 0.087) and family history of premature coronary artery diseases (88.9%, p-value <0.01) were seen more common in individuals with high blood pressure. Conclusion: The frequency of hypertension is high in a squatter settlement in Karachi and it is highly associated (p<0.01) with the development of dyslipidemia, diabetes, family history of coronary artery and cerebrovascular diseases respectively. Keywords: Hypertension; Dyslipidemia; Coronary Artery Disease; Cerebrovascular Disorders

Efficacy of Liraglutide: GLP 1 Receptor Agonist on Glycemic Control and Weight Loss among Patients with Type 2 Diabetes

Background: American Diabetes Association (ADA) made conspicuous changes in its 2019 Standards of Care Diabetes guidelines by choosing Glucagon like Peptide 1 (GLP1) receptor agonists and Sodium Glucose co-transporter 2 (SGLT2) inhibitors as the second line treatment options after metformin because both classes of drugs are cardiovascular friendly as proved in the Cardiovascular Outcome Trials (CVOT). GLP analogs show massive weight loss benefits apart from offering good glycemic control. We aimed to determine the impact of liraglutide on correction of hyperglycemia and body weight in Asian population. Methods: A cross sectional pre-post observational study enrolling 49 Type 2 diabetic patients with uncontrolled blood glucose, 15 years and above who agreed to use liraglutide apart from standard care, for glycemic control were recruited in the study. Study site was general practice clinic in Clifton and family medicine health care center Ziauddin University. Pre and post treatment HbA1C and BMI were observed after adding on Liraglutide 1.8 mg to metformin 1 gm bid, over a period of 12 weeks. Differences in the changes in BMI and HbA1C were examined using McNemar’s test. Results: Mean age of the participants was 44.4 years. Duration of Diabetes was 65.1 months i.e. 5.4 years. At week 12, liraglutide 1.8 mg significantly reduced HbA1C levels by 0.94% (8.53+1.07 vs. 7.56+1.04 p-value <0.05) and BMI by 6.2kg (37.23+ 5.3 vs. 31.27.6+5.5 p-value <0.05) statistically significant. Conclusion: Liraglutide 1.8 mg over a period of 12 weeks, significantly reduced body weight (6.2kg p-value 0.05) and improved glycemic control (0.94% p-value<0.05) without causing hypoglycemia