Evaluation of Ischemic and Hemorrhagic Stroke on Computed Tomography

The stroke is the 3rd leading cause of death in Pakistan, wherein back in 2009, stroke used to be the 4th leading cause of death in Pakistan, a 19.2% increase is alarming (IHME, 2019). Ischemic stroke occurs 75-80 percent of the time, while hemorrhagic stroke occurs 8-20 percent of the time. The objective of our study is to evaluate the frequency and ratio of ischemic and hemorrhagic stroke on computed tomography. A Descriptive study was performed using non-probability convenient sampling technique. The study was conducted in Lahore General Hospital, Lahore, Pakistan. The data was collected from November 15, 2020 to February 15, 2021. Informed consent was taken from all the participants. In our study patients with provisional diagnose of clot or thrombosis, History of Ischemic Stroke, History of Hemorrhagic Stroke, patients who came with clinical manifestation of stroke, traumatic or Road Traffic Accidents (RTA) patients, patients with cerebral Transient Ischemic Stroke. Arterial Puncture in Last 7 days, patients with Active bleeding, peroneal nerve injuryand patients who have been injected Botulinum Toxic Injection in last 3 months were included in our study. Patients who had a previous history of Parkinson disease, patients not having any apparent cause or chronic or acute symptoms of stroke, no history of internal bleeding, patients with chronic cerebral disease and patients with other neurological defects were excluded.A total of 85 patients with Stroke were included in our study. Most of the patients were 40 to 65 years of age. The average age of the patients was 59.5 ± 11.1 years. Out of 85 there were 38.8% (P=33) positive with H/O Infarction females (P=11) and males (P=22 ) 55 (62.5%) were males and 33 (37.5%) were females with 1.62: 1 male to female ratio as shown in Fig 5.2. Ischemic stroke was observed in 33 (36.2%) patients and 40 (47.3%) were suffered hemorrhagic stroke and 12 (14.4%) patients were affected with TIA.The conclusion to this study is that to assess early stroke with extreme clarity, computed tomography is the safest modality for evaluating stroke patients and allows radiologists to more accurately assess these patients on CT in terms of prognosis, frequency, morbidity, and legitimacy. Keywords: Stroke, Hemorrhagic Stroke, Ischemic Stroke, Cerebral Infarction, Computed Tomography DOI: 10.7176/JHMN/90-06 Publication date:June 30th 202

Glucose Insulin Ratio in Hyper Insulinemic Women with Polycystic Ovarian Syndrome

Background: Women with polycystic ovarian syndrome (PCOS) have insulin resistance and hyperinsulinemia that may play a key role in the pathogenesis of PCOS. Objectives: To determine and compare glucose-insulin ratio in hyper-insulinemic women with the polycystic ovarian syndrome and healthy controls. Materials & Methods: A cross-sectional comparative study was conducted at Lahore General Hospital. A total of 80 women 24-35 years of age were recruited from Lahore General Hospital. 50 women had PCOS, and 30 were healthy controls. PCOS was diagnosed by using the Rotterdam criteria. Height, weight, and waist circumference were measured. Glucose and insulin were estimated by the glucose oxidase method and ELISA, respectively. HOMA-IR was calculated to determine insulin resistance (IR). HOMA- β was calculated to assess the β-cell function. Fasting glucose and insulin ratio were also calculated. Results: Mean age of the women with PCOS and healthy controls was 29.89±3.54 and 28.60±1.12 years, respectively (p>0.54). BMI and waist circumference of women with PCOS were higher compared to healthy controls (p>0.45). Fasting glucose, fasting insulin, HOMA- β, and IR were significantly higher in women with PCOS compared to healthy controls (p<0.001). Conclusion: In addition to HOMA IR, the glucose-insulin ratio may be considered to assess hyperinsulinemia in women with polycystic ovary syndrome

Association of the angiotensin-converting enzyme (ACE) gene G2350A dimorphism with essential hypertension

Although the angiotensin converting enzyme (ACE) is a strong candidate gene for hypertension, the extensively studied insertion-deletion dimorphism in intron 16 was not found to be associated with it. Several new polymorphisms in the ACE gene were identified, among which a dimorphism in exon 17, ACE G2350A, has a significant effect on plasma ACE concentrations. To assess the value of genotyping the ACE G2350A dimorphism in a genetically homogeneous population, we carried out a retrospective, case-control study of dimorphism G2350A for a putative association with essential hypertension (EH) in a Gulf population (Emirati)--an ethnic group characterized by no alcohol intake and no cigarette smoking. We investigated a sample population of 254 Emirati, comprising 136 normotensive controls, and 118 patients with clinical diagnoses of EH. ACE G2350A alleles were visualized by assays based on polymerase chain reaction and restriction endonuclease analysis. The ACE G2350A dimorphism showed an association with EH (chi2=6.71, 2 df, P=0.05). Further analysis revealed that the ACE G/G 2350 genotype was positively associated (OR=1.06-3.07, P=0.02) with EH. This is the first association study of the ACE G2350A dimorphism with EH, and the positive result might indicate that ACE could be a QTL for EH as originally thought

Correlation of refractory hypoxemia with biochemical markers and clinical outcomes of COVID-19 patients in a developing country: A retrospective observational study: Running head: Predictors of hypoxemia in COVID-19.

Introduction: COVID-19 is mainly a respiratory illness, causing hypoxemia in the majority of those been infected. In our study, we aimed to correlate the biochemical markers with hypoxemia and predicting the prognosis of COVID-19 patients. Materials and methods: A retrospective, observational study was conducted to include all the admitted COVID-19 patients (n = 183) diagnosed by a real-time Polymerase chain reaction and evaluated those for hypoxemia and disease outcomes by utilizing the biochemical markers. Results: Out of the 183 patients, 117 were in the ward, 66 were in ICU, 148 of them recovered, while 35 deaths were reported, 89 patients were having persisting hypoxemia (despite oxygen therapy) during the hospital stay, and the remaining 94 were non-hypoxemic with or without supplemental oxygen therapy. There were significant differences in mean hemoglobin (p = 0.028), total leukocyte count (p = 0.005), Neutrophil-to-Lymphocyte ratio (p = 0.001), serum urea and creatinine (p = 0.002), serum potassium (p = 0.009), C-reactive protein (p = 0.001), Lactate dehydrogenase (p = 0.005), and Ferritin (p = 0.042) of the hypoxemic patients versus non-hypoxemic group. Amongst the deceased patients, there was significant leukocytosis (p = 0.008), increased Neutrophil-to-Lymphocyte ratio (p = 0.001), elevated C-reactive protein (p = 0.001), and Lactate dehydrogenase (p = 0.009). Receiver operating characteristic curves showed Neutrophil-to-Lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001), and Lactate dehydrogenase (p < 0.001) most significantly associated with hypoxemia and death. Conclusion: The inflammatory markers are a good guide for predicting the hypoxemia and disease outcome. The results concluded Neutrophil-to-Lymphocyte ratio, C-reactive protein, and Lactate dehydrogenase were effective biomarkers in predicting a severe course of COVID-19, but could not establish significant associations of serum Ferritin, Procalcitonin, and D-Dimer