SERUM LIPID DERANGEMENTS IN PATIENTS WITH ISCHEMIC STROKE.

Background; Stroke is a global health problem. Stroke is responsible for major disabilities in adult population, and is 2nd leading cause of deaths all over the world. Different studies have reported dyslipidemia as major cause of stroke in different populations. Objective; To determine the frequency of dyslipidemias in patients with ischemic stroke at Nishtar Hospital Multan. Material and methods; All the cases of stroke (n=240) Patients having finding on CT scan brain (plain) consistent with ischemic stroke of either sex aged less than 80 years were enrolled in this cross-sectional study from department of Medicine, Nishtar Hospital, Multan. Complete history about onset of illness, diabetes, hypertension and cardiac illness of the patients was taken. Baseline laboratory investigations including lipid profile and Hb A1c were done. Results; Of these 240 study cases, 155 (64.6 %) were male patients and 85 (35.4%) were female patients. Mean age of our study cases was 68.37 ± 14.55 years (with minimum age was 34 years while maximum age was 79 years). Out of these 240 study cases, 138 (57.5 %) were from poor families, 53(22.1 %) were diabetic and only 11 out of 53 (20.75%) had controlled glycemic levels. Hypertension was present in 182 (75.8%) of our study cases and 39 (16.3 %) were obese. Smoking was present in 101 (42.1%), previous history of stroke was present in 35 (14.6%) and 83 (34.6%) were Saraikis. Mean duration of illness was 2.24 ± 0.53 months and 135 (56.3%) had disease duration more than 1 month. Mean serum cholesterol level was 202.06 ± 45.36 mg/dl, mean serum LDL level was 91.13 ± 10.24 mg/dl, mean serum triglyceride level was 147.51 ± 20.21 mg/dl and mean serum HDL level was 42.92 ± 3.85 mg/dl and dyslipidemia was present in 85 (35.4 %). Conclusion; Frequency of dyslipidemia was high among patients having ischemic stroke in our study. Dyslipidemia was significantly associated with diabetes, hypertension, obesity, smoking, previous history of stroke and ethnicity. Early diagnosis followed by timely management can help reduce disease morbidity and improve clinical outcomes in these patients. Keywords; ischemic stroke, dyslipidemia, frequency.

IDENTIFICATION OF DIFFERENT FACTORS LEADING TO THE DEVELOPMENT OF MULTIDRUG RESISTANCE TUBERCULOSIS.

Background; Despite an overall decreasing incidence and mortality rate for tuberculosis (TB), multidrug resistance tuberculosis (MDR-TB) continues to be a serious threat to the current global tuberculosis control effort. Failure to control MDR-TB may lead to another era with TB being regarded as a fatal disease. Materials and Method; One hundred forty one cases confirmed MDR-TB patient by of either gender aged less than 60 years who were newly diagnosed or who were previously diagnosed cases were enrolled in this descriptive study. Demographic, socioeconomic, clinical as well as laboratory data were recorded for each patient by trained data collector. The data was collected through pre-tested close ended questionnaire. Drug resistant cases was labeled according to sputum culture Sensitivity report and GeneXpert for MTB and were assessed for different factors for MDR. Results; Our study comprised of 141 study cases of MDR TB, 71 (50.4%) were male patients and 70 (49.6 %) were female patients. Mean age of our study cases was 39.99 ± 9.15 years One hundred and five (74.5%) of our study cases were married while 36 (25.5%) were unmarried. Majority of our study cases were less educated as 47 (33.3%) were illiterate and 78 (55.3%) were having primary level of education. Majority of our study cases were living in slum areas and were having poor socioeconomic status as 77 (54.6%) were having their family income less than Rs. 10, 000 per month. Previous history of TB was present in 99 (70.2 %) of our study cases. Good compliance with the treatment was present in only 28 (19.9%) of our study cases. History of close contact with TB patient was reported by 92 (65.2%) of our study cases, 20 (14.2%) were defaulters and 42 (29.8%) presented with treatment failure. History of HIV infection was zero in our study. Conclusion; Previous history of Tuberculosis with poor compliance with drug therapy was the major risk factor for the development of MDR TB in our study. History of close contact with TB patients was another important risk factor in the development of MDR TB. Other important risk factors were previous history of tuberculosis infection, living in urban slum areas, poor educational status and poor socioeconomic status were more common. Keywords; Multidrug resistance, Tuberculosis, Risk factors.  

FREQUENCY OF CATHETER INDUCED THROMBOSIS IN PATIENTS WITH END STAGE RENAL DISEASE (ESRD) ON HEMODIALYSIS

Objective; To determine the frequency of catheter induced thrombosis in patients with end stage renal disease (ESRD) on hemodialysis. Material and Methods; All the cases (86) undergoing hemodialysis were recruited from Department of Medicine, Nishtar Hospital Multan, Pakistan. Double lumen hemodialysis catheter was inserted by a senior consultant. Color Doppler sonography was done at the 6th day of placement of catheter and presence of thrombus was noted in the study proforma. History was taken for hypertension, smoking, family history and previous history of thrombosis. Results; Of these 86 study cases, 51 (59.3 %) were male patients and 35 (40.7%) were female patients. Mean age of our study cases was 45.62 ± 8.44 years. Of these 86 patients 28 (32.6%) were diabetic, 35 (40.7%) were hypertensive, 34 (39.5%) were smokers and 07 (8.1%) had previous history of thrombosis. Mean duration of catheter placement was 81.62 ± 41.67 days and mean duration on hemodialysis was 22.36 ± 10.43 months. Majority of our study cases i.e. 65 (75.6%) had to undergo hemodialysis three times in one week. Catheter related thrombosis was noted in 29 (33.7%) of our study cases. Conclusion; Frequency of catheter-related thrombosis was high in patients with end-stage renal disease (ESRD) in our study. Thrombosis in ESRD patients was significantly associated with male gender, age, duration of catheter placement and duration of hemodialysis. Keywords; End-stage renal disease, catheter, thrombosis

ROLE OF DIABETES IN ATYPICAL RADIOLOGICAL PRESENTATION OF PULMONARY TUBERCULOSIS

Background; Diabetes mellitus has been reported to modify the presenting features of pulmonary tuberculosis, but there are varying data, particularly regarding the association with lower lung field involvement. This study was conducted to document frequency of atypical radiological presentation of pulmonary tuberculosis in our population of Southern Punjab. Material and methods; A total of 200 study cases having age range; 35 – 70 years of either sex having diabetes for more than 1 year and pulmonary tuberculosis (irrespective of disease duration) were included in our study. Known cases having Malignancies, HIV, pregnant ladies, asthmatic patients and those with COPD were excluded from our study. Patients of pulmonary tuberculosis fulfilling the inclusion and exclusion criteria was included in this study. Sociodemographic and Radiological data from each was collected and recorded on a performa. Results; Of these 200 study cases, 116 (58%) were male patients while 84 (42%) were female patients. Mean age of our study cases was noted to be 55.52 ± 9.33 years (with minimum age was 38 years while maximum age was 70 years). Of these 200 study cases, 117 (58.5%) were from rural areas and 117 (58.5 %) were poor. Mean duration of diabetes in these patients was 7.41 ± 3.76 years (with minimum duration of diabetes was 3 years while maximum duration was noted to 15 years). Mean duration of tuberculosis was 6.74 ± 2.29 months (with minimum duration of disease was 2 months and maximum duration was 12 months). Diabetes was controlled in only 33 (16.5%) of our study cases and only 63 (31.5%) were taking treatment for diabetes. Right side of lungs affected was seen in 105 (52.5%) and lower lung field was affected in 116 (58 %) of our study cases. Atypical presentation was seen in 95 (47.5%) of our study cases. Conclusion; Frequency of atypical radiological presentation of pulmonary tuberculosis was high in our study. Atypical presentation of pulmonary tuberculosis in patients with diabetes is quite common. Atypical presentation was significantly associated with gender, age groups, residential status, socioeconomic status, duration of diabetes, control of diabetes, treatment status of diabetes, lung side affected and lung field affected. Clinicians treating diabetic patients must keep these facts in their minds while treating such patients to avoid miss-diagnosis. Keywords; Diabetes, tuberculosis, atypical presentation

Jaundice: a basic review

Jaundice is a complex disease. Jaundice is actually the high bilirubin level in the body. Yellowing of skin, mucous membranes and skin are common presentations of jaundice. Jaundice has various variants including pre-hepatic jaundice (due to hemolysis of red blood cells), hepatic jaundice (due to defect in capture, conjugation and excretion of bilirubin by liver) and post hepatic jaundice (due to the obstruction of extra hepatobiliary system). The causes of various variants of Jaundice is either acquired or congenital. High plasma bilirubin level can cause various manifestations involving satiety, gastrointestinal bleeding, diarrhea, anemia, edema, weight-loss and can be fatal because it can cause psychosis, lethargy, seizures, coma or even death. High bilirubin level can help in the diagnosis of Jaundice. Differential diagnosis of various variants of Jaundice can be carried out on the basis of bilirubin level (conjugated and unconjugated), ultrasonography and other radiological techniques. The proper management of Jaundice is high water intake and low fat diet. The primary effective treatment for pre-hepatic jaundice and neonatal physiological jaundice is phototherapy. Infusion of immunoglobulins is also used for treatment of pre-hepatic jaundice. Proper nutrition, steroids and immunosuppressant are used for treatment of hepatic jaundice. The treatment for post hepatic jaundice is decompression and surgery

Diabetes insipidus: the basic and clinical review

Diabetes insipidus (DI) is a complex disease. DI is inability of the body to conserve water. Polydipsia and polyuria are the major manifestations of DI. DI has various variants including central diabetes insipidus (due to defect in ADH secretion), nephrogenic diabetes insipidus (due to defect in ADH receptors or urea receptors), gestational diabetes insipidus (due to catabolism of ADH by placental vasopressinase) and primary polydipsia (due to massive fluid intake). The cause of various variants of DI is either acquired or congenital. High plasma osmolality due to hypotonic urine excretion can be fatal because it can cause psychosis, lethargy, seizures, coma or even death. Polyuria and polydipsia help in the diagnosis of DI. Differential diagnosis of various variants of DI can be carried out on the basis of water deprivation test, MRI and other radiological techniques. The proper management of DI is the replenishment of water loss and correction of clinical presentations produced as a result of DI, major is hypernatremia. The best management for primary polydipsia is fluid restriction while fluid intake is used for adipsic diabetes insipidus. ADH replacement therapy is widely used to treat DI. DDAVP or desmopressin is mostly preferred ADH analogue because it has less side effects and resistant to placental vasoprssinase

Biology of Spodoptera litura on natural and artificial diet under laboratory conditions

Armyworm, Spodoptera litura (Lepidoptera; Noctuidae) is one of the most economically significant insect pests in global agriculture. The current study was performed to study the biology of S. litura under laboratory conditions. In the current study, the biological parameters of pests i.e., egg, larva, pupa and adult along with the duration were determined. The mean incubation period of pests on cabbage, maize and artificial diet was 2.86±0.33, 3.09 ± 0.12 and 3.97±0.77 days, respectively. S. litura had five instars. The mean developmental period of the first, second, third, fourth, fifth and sixth larval instar on cabbage was 3.44±0.11, 2.09±0.12, 4.11±0.12, 3.00±0.20, 6.68±0.23 and 5.94±0.18 days, respectively while 2.81±0.77, 3.55±0.33, 3.64±0.45, 4.43±0.71, 6.55±0.21 and 5.98±0.19 days on the maize, respectively. The mean developmental periods were 3.85±0.54, 3.45±0.63, 3.67±0.67, 4.37±0.82, 6.55±0.23 and 5.30±0.38 days of first, second, third, fourth, fifth and sixth larval instars on artificial diet, respectively. The mean total life period of S. litura was 33.43±5.86 days on cabbage and 34.79±6.95 days on maize while 35.98±7.86 days on an artificial diet. The longest developmental period of S. litura was recorded on the artificial diet while the minimum was on cabbage. The mean developmental period of pupa was 7.50±0.71 days on cabbage, 9.87±0.94 days on maize and 11.63±0.99 days on an artificial diet. Females were short-lived as compared to males. The pre-oviposition, oviposition and post-ovipositional period of S. litura on cabbage were recorded as a minimum while maximum on an artificial diet. The maximum number of eggs laid by females with the highest hatchability on cabbage followed by maize and artificial diet. An artificial diet was not good for pest development and growth as compared to a natural diet i.e., cabbage and maize. The findings will provide basic information about food pests which help in pest management

SIGNIFICANCE OF ANTIOXIDANTS IN MAINTAINING DAIRY AND BEEF ANIMALS’ HEALTH

Oxidation and reduction reactions occurring inside the cell must be maintained in the state of equilibrium so that the integrity of cells can be maintained and production of the animals remains at optimum. If there is imbalance between redox reaction, health of the animals gets affected in terms of onset of various reproductive disorders and diseases like mastitis. A number of antioxidants are produced naturally inside the body but under stressful endogenous and exogenous environment, their production is hampered. Thus, supplementation of animals with antioxidants like vitamin C and Vitamin E in feed or parenteral administration is essential to keep the animal healthy to get maximum possible production