Skin Changes in Newly Diagnosed Cases of Hypothyroidism

Introduction: Thyroid disorders are frequent in our population that leads to variety of cutaneous manifestations. Aim of our study was to determine the frequencies of skin changes of hypothyroidism and their association with gender. Methodology: This observational study was conducted at RIHS Islamabad (Ist Jun to 31st Dec 2019) after ethical approval. 105 patients (>18years age) of both genders. Confirmed to have hypothyroidism on the basis of thyroid function tests were included. Secondary hypothyroidism, sick thyroid disease, pregnant women, receiving thyroxin therapy, carcinoma of thyroid, critically ill cases, post-thyroidectomy and iatrogenic thyroid cases were excluded. After informed consent, demographic details were documented. Patients were clinically evaluated and examined in detail including dermatological examination for cutaneous manifestations. Various skin findings are studies with respect to gender. Data was analysed by SPSS version 21 with Chi-square test as a test of significance, significant p<0.05. Results: Among 105 cases of hypothyroidism (62% females and 38% males, mean age was 38.04+12.61 years. Mean TSH level was found to be 32.08 + 33.96 (mean TSH was 35.31+37.31 in females Vs. 26.96 + 27.19 in males; p=0.001). Common skin findings were dry skin in 69.5%, diffuse hair loss in 58%, coarse skin in 57%, pruritis in 51.4%, madarosis 37%, seborrheic dermatitis 34%, coarse scalp hairs 27% and slow nail growth in 23%. The brittle nails, alopecia areata, chronic urticaria, acanthosis nigricans, ivory yellow skin, purpura ecchymosis, ichthyosis, herpes simplex and certain other findings were found in <20% cases. Obesity was observed in 53(50.5%) cases, Type 2 diabetes in 20(19%), hypertension in 23(21.9%), dyslipidaemia in 12(11.4%) and anaemia in 9(8.6%). Obesity, diabetes, dyslipidaemia had no association with gender (p>0.05). However, hypertension and anaemia were significantly frequent amongst females (p<0.05). The dry, coarse skin, diffuse hair loss and seborrheic dermatitis were associated with female gender (p>0.05). Slow nail growth, brittle nails, acne vulgaris, acrochordons, vitiligo, xanthelasma were more common in males however the difference wasn’t statistically significant. Conclusion: Skin acts as an important diagnostic window to diseases affecting internal organs including thyroid disorders. Authors recommend screening for thyroid functions, diabetes, hypertension, dyslipidaemia, obesity and anaemia in patients presenting with suggestive dermatological manifestations irrespective of age and gender. KEYWORDS:  Hypothyroidism.  Thyroid Diseases.  Skin Changes. Thyroid Stimulating Hormone. Thyroid Gland

Metacognitive Awareness of Reading Strategies, Reading Practices and Academic Attainments of University Students

This study was conducted to examine the relationship between metacognitive awareness of reading strategies (MARS), and academic attainments (AA) of undergraduate business students. It also investigated the relationship between reading practices (RP) and MARS. There are three different categories of MARS – global, problem solving, and support reading strategies. The Metacognitive Awareness of Reading Strategies Inventory (MARSI), developed by Mokhtari and Reichard (2002) was used as the instrument for this study where the sample consisted of 571 male and female students of undergraduate business program from private and public universities of Karachi. The results showed Metacognitive Awareness of Reading Strategies significantly predicts academic attainments of university students. The findings suggest that conducting workshops or training sessions for promoting MARS may be helpful to enhance students’ concentration towards the reading process that may affect their learning. Keywords: academic attainments, metacognitive awareness of reading strategies, reading practices, undergraduate students

The failure of the Muslim league in post-colonial Pakistan: a critical appraisal

Significance: Nations states in developing societies were a legacy of colonial rule. The catastrophic world wars of the European metropolis had spillover effects in developing countries, where colonialism was replaced by communism and nationalism among post-colonial peoples. The political parties who led anticolonial nationalist movements employed demonstrations, agitation, and mobilization at broader level for their intentions, but without the existential enemy of the colonial oppressor they were prone to division and faced numerous incidentals, natural and hostile challenges, particularly in the case of Pakistan, whose birth was deliberately sabotaged by British imperialism as well as Indian nationalism. Nevertheless, the Muslim League was essentially successful in its fundamental aim of creating a Muslim state in South Asia and began to administer it after independence. This study explores the character and role played by the post-colonial political parties, especially the Muslim League, whose consequences left the effects on dictatorship generally and on politics particularly that have shaped the development of South and Central Asia ever since

Obstetric patients in intensive care unit: Perspective from a teaching hospital in Pakistan

Objective: Review of obstetric cases admitted to the intensive care unit.Design: Ten year retrospective review of individual patients\u27 medical records.Participants: Records of obstetric patients admitted from 2005-2014.Setting: Aga Khan University Hospital Karachi.Main outcome Measures: Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.Findings: A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay was 24 hours and maximum stay was 53 days. Sixty one percent of patients were admitted to with organ system failure. The overall mortality rate was 21.64% (42/194). The mortality rate was five times more likely in patients who had gastro-intestinal complication {Odds Ratio=4.87; 95%CI: 1.65-14.36}. The largest group of patients {28.4%} presented with hematological diagnosis.Conclusion: When the intensive care unit admission became essential, primary diagnosis included: postpartum hemorrhage, hypertensive disorders, sepsis and infectious diseases. An increased vigilance of high-risk pregnant women and a stabilization of their condition before intervention is administered, improves the outcome of these women

Trans-articular chondrosarcoma grade 2 of proximal phalanx resulting in its fracture along with destruction of middle phalanx of 2nd toe right foot: a case report and review of the literature

Foot is an unusual site for chondrosarcoma and involvement of phalanges is extremely rare. We report a case of grade 2 chondrosarcoma of proximal phalanx resulting in its fracture along with transarticular extension to the middle phalanx of the 2nd toe of right foot in a 62 year old female. The patient presented with 1 and ½ year history of pain and swelling in right 2nd toe. X-ray showed presence of expanding lytic lesion with amorphous calcification along with fracture proximal phalanx. Fine needle aspiration cytology showed some pleomorphs, osteoclasts and some giant cells. We went for amputation of toe without a biopsy. Histopathological examination of specimen showed multiple pleomorphic cells, nuclear atypia, hyperchromasia with some giant cells (grade 2 chondrosarcoma)

Comparison of pre and post foley catheter bishop’s score: A retrospective record review at Aga Khan University Hospital Karachi, Pakistan

Objective: To compare pre and post Foley\u27s catheter Bishop Score during labour induction.Methods: This study was a retrospective study conducted at the Aga Khan University Hospital Karachi, Pakistan after approval from ethical review board. All women who underwent induction of labour with Foley\u27s Catheter at gestation of 37 weeks or more from September 2014-October 2015 were included. Data was entered and analyzed in Statistical Package for Social Sciences (SPSS) version 19.0. The comparison between pre and post Foley\u27s catheter Bishop Score during labour induction will be calculated by Wilcoxon sign test.Results: There were 981 cases of inductions of labour, 749 (76.3%) received Foley\u27s catheter, in combination with prostaglandins and oxytocin. About 68% were vaginal deliveries while 32% underwent C-section. Two third of women had bishop Conclusion: Foley\u27s is the better and safer option. In view of our results, It has been recommended to keep the Foley\u27s for 10-12 hours to get significant improvement in bishop score

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries