Showing papers by "Chandka Medical College published in 2020"

Psychological Stress as a Risk Factor for Cardiovascular Disease: A Case-Control Study.

Abstract: Introduction Stress is a phenomenon elicited in response to certain triggers that may be external or internal. Stress has been identified as a risk factor for various diseases, including cardiovascular disease. In this study, we aim to find an association between psychological stress and cardiovascular disease in the local setting Methods This case-control study was conducted in a tertiary care hospital in Pakistan from June 2019 to December 2019. One hundred and seventeen (117) patients with myocardial infarction and unstable angina were enrolled in the case group. One hundred and ten (110) patient's attendants were enrolled in the study as controlled. Results The risk of a cardiovascular event was higher in patients with a history of social isolation (OR, 2.47), marital stress (OR, 2.28), work stress (OR, 3.2), childhood abuse (OR, 2.78), or trauma (OR, 2.67). Conclusion Psychological stress is an important risk for cardiovascular disease, which is often overlooked. Efforts should be made to include questions related to psychological stress in the history-taking of patients at risk of a cardiovascular event and the management plan should include psychological counseling.

The Success Level of Hypospadias Repair in Adults

Abstract: Introduction Hypospadias is the abnormal opening of the urethra at the undersurface of the penis. Hypospadias repair is performed in such patients to treat the condition. The success level of hypospadias repair in adults still needs to be established on a larger scale. Therefore, we conducted this study to document the success level of hypospadias repair in adults in our setting to add to the literature. Materials and methods This prospective study was conducted at a major metropolitan hospital in Karachi over a period of six months. A total of 75 male patients aged between 20-50 years and diagnosed with hypospadias of any level with or without mild to moderate chordee were included. Demographic features such as age and the duration of hypospadias were noted. Hypospadias repair using a tubularized incised plate (TIP) urethroplasty technique was performed, and the patients were observed for three days in the ward and for three months in the outpatient department for any complications. The procedure was considered a success if there were no complications and no need for a second surgery; we also took into account patient satisfaction with the procedure to determine the success level. The mean and standard deviation were calculated for patient age and the duration of hypospadias. Frequency and percentages were calculated for distribution of patient age, distribution of the duration of hypospadias, and the success of hypospadias repair. The correlation of patient age and the duration of hypospadias with the success of hypospadias repair was also determined by applying the Chi-square test, and a p-value of ≤0.05 was considered to be statistically significant. Results The mean age and the duration of hypospadias for the study population were the same at 31.43 ± 8.47 years. Distribution of patient age and the duration of hypospadias was also the same with 51 (68%) patients of ≤35 years of age and 24 (32%) patients of >35 years of age. Hypospadias repair was successful in 52 (69.33%) patients but unsuccessful in 23 (30.66%). The stratification of patient age and the duration of hypospadias with the success of hypospadias repair showed a significant inverse relationship (p = 0.017). The data relating to patient age and the duration of hypospadias showed the same values as hypospadias is a birth defect. Conclusion Adult patients undergoing primary hypospadias repair generally show good outcomes. However, the chances of favorable outcomes gradually decrease with age. Hence, patients should be encouraged to undergo the procedure as early in their lives as possible. Patients who are middle-to-old aged should especially be counseled about the relatively higher risk of unsuccessful procedures. Further analysis is needed to confirm the validity of these findings.

Efficacy of Alternative Medicine in Reducing Hemoglobin A1c (HbA1c) in Type 2 Diabetes Mellitus.

Abstract: Introduction Diabetes mellitus is one of Pakistan's most common diseases, affecting nearly 27.4 million people. Complementary and alternative medicine (CAM) is becoming quite popular for the management of diabetes. We aim to study the subjects that use alternative medicine in order to assess the effect of alternative therapy on the glycemic control and overall health of the patients. Methods This study was conducted from January 2019 to December 2019 in Karachi, Pakistan. A total of 101 diabetic patients who used alternative medicine as part of their diabetes treatment were enrolled in the study after oral informed consent. Patients who were using concomitant conventional therapy were excluded from the study. On day 0, the random blood glucose levels and hemoglobin A1c (HbA1c) levels were noted. Patients were followed up after 12 weeks, and their blood glucose levels and HbA1c levels were noted again. Out of 101 participants, around 92 of them completed the study and were included in the final analysis. Results According to the results, 41 (44.5%) participants admitted that they used Herbal medicine, 32 (34.78%) participants used home remedies through dietary modifications, 11 (11.95%) participants used spiritual healing techniques, and 7 (7.60%) participants used cupping therapy. We found no significant reduction of HbA1c levels at the end of 12 weeks in any group. Conclusion This study failed to show any significant reduction in HbA1c levels after 12 weeks in patients taking various alternative medicine forms. There is a need for further large-scale trials to establish this mode of treatment's efficacy and safety.

Dermatological Manifestations of Parkinson's Disease: Clues for Diagnosis.

Abstract: Background and objective Parkinson's disease (PD) is a common neurodegenerative disorder. There are various manifestations of PD. Among them, motor dysfunction has been studied in many research studies; however, few studies are available related to the dermatological manifestations of PD. This study was conducted with the aim to shed light on various skin conditions that occur in PD. Methods This cross-sectional study was conducted at a tertiary care hospital in Pakistan for a period of nine months; 107 patients with PD were included after obtaining informed consent. A self-administrated questionnaire was used to record demographic data and dermatological findings. Results Among the various dermatological manifestations, patients with PD most commonly presented with seborrheic dermatitis (46.7%) and rosacea (10.2%). Other manifestations included bullous pemphigoid (7.4%) and melanoma (4.6%). Conclusion The study revealed several dermatological manifestations of PD, which usually get overlooked by neurologists. Through this study, we want to emphasize that PD, apart from all the motor signs and symptoms, can also present as skin problems, and hence, a multi-disciplinary approach should be taken while managing PD.

Atypical Hemolytic Uremic Syndrome Associated With Clostridium Difficile Infection.

Abstract: Atypical hemolytic uremic syndrome (aHUS), defines as non-Shiga toxin HUS, is thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, consumptive thrombocytopenia, and renal impairment aHUS is associated with high morbidity and mortality, necessitating the need for an early diagnosis to limit target organ damage Mutations or autoantibodies against specific complement factors over-activate the complement system forming microthrombi aHUS has the potential to cause multi-organ system dysfunction, but it predominantly affects the kidneys aHUS is treated with eculizumab, a terminal blocker of the complement system Clostridium difficile infection is a rare precipitant of aHUS We present a case of aHUS associated with Clostridium difficile infection in a 60-year-old female patient that was successfully treated with eculizumab

Quality of Life in Gastroesophageal Reflux Disease Three Months After Laparoscopic Nissen's Fundoplication.

Abstract: INTRODUCTION Gastroesophageal reflux disease (GERD) affects various elements of life including sleep, daily and social functioning, and physical and emotional activities. This study aims to determine the impact of laparoscopic Nissen's fundoplication (LNF) on health-related quality of life. METHODS This prospective study was conducted in a tertiary care hospital, Pakistan, from Jan 2019 to Feb 2020. Forty-seven participants completed the study. All patients completed the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQoL) questionnaire both pre-operatively and three months after LNF. RESULTS There was significant difference in pre- and post-operative median Health-Related Quality of Life score (p value: 0.0073). There was improvement in items related to heartburn in HRQoL questionnaire, while questions related to swallowing and bloating either showed no change or worsening. CONCLUSION LNF has a significant impact on health-related quality of life. It is important for the physician to consider the impact of GERD in daily life. Management goals for GERD should also include improvement in quality of life of the patient.

Role of Montelukast as Monotherapy in Improving Quality of Life of an Asthmatic Patient in Pakistan

Abstract: Introduction Uncontrolled and inadequately managed asthma substantially reduces Quality of Life (QOL) and can lead to premature death. The aim of this study is to understand the role of montelukast in improving quality of life in asthmatic patients by comparing it with placebo. Methods This prospective, single-arm, interventional study was conducted from September 2019 to February 2020 in the pulmonology outpatient department of a tertiary care hospital in Pakistan. All patients were prescribed montelukast (10 mg once daily). Results At day 28, participants had a higher score on the Asthma Quality of Life Questionnaire-Standard (AQLQ-S) overall and in all sub-domains compared to day 0. The improvement was significant overall and for the sub-domains of symptoms, activity limitations, and environmental stimuli. Conclusion Montelukast has an effective role in asthma control as well as in improving the quality of life in the Pakistani population.

Clinical Presentation, Complication and Outcome of Black Stone (Paraphenylene Diamine) Poisoning.

Abstract: Introduction In recent time, developing countries of South Asia and Africa have seen significant increase in ingestion of Para-Phenylene Diamine (PPD), locally known as Kala Pathar, either accidental or for suicide. Through this study, we aim to study the clinical presentations and outcomes among patients who have ingested PPD. Method This retrospective case series study was conducted in a tertiary care hospital of Pakistan, from April 2013 to August 2017. Data of patients of PPD poisoning was archived from the hospital’s medical records. Around 174 consecutive cases were included in the study. Patients were evaluated based on self-administrated proforma. Result Out of 174 cases of PPD poisoning that were identified, 57(32.8%) were males and 117(67.2%) were females. The mean age ± SD (range) of the patients was 24.16±9 (10 to 70) years. Approximately 170 (97.8%) patients used PPD for suicidal intention. The most common presentation was facial swelling which was present in 144(82.8%) patients followed by dysphagia in 143(82.2%) patients. Complications include metabolic acidosis in 50 (28.7%) patients and aspiration pneumonia in 36 (20.7%) patients. A total of 101 (58%) improved, while others were either referred or left against medical advice (LAMA). Conclusion Increasing incidence of ingestion of PPD for suicide warrants the regulatory authorities to restrict the use of PPD in hair dyes and implement strict measures to educate masses and curtail the easy access of such poisonous substances among common people.

Furosemide-Associated Drug Reaction With Eosinophilia and Systemic Symptoms.

Abstract: To the Editor: Drug reaction with eosinophilia and systemic symptoms (DRESSs), also called drug-induced hypersensitivity syndrome, is a life-threatening adverse drug reaction with mortality rates of up to 10%–20%.1 The clinical presentation includes mucocutaneous rash, fever, lymphadenopathy, hematologic abnormalities such as eosinophilia and atypical lymphocytes, and multiple organ dysfunction, including liver, kidneys, heart, and lungs.1 Although fever and rash are the most common presentations, the defining characteristic of the syndrome is organ dysfunction. It usually presents 2–8 weeks after the introduction of the causative agent and symptoms may persist for a longer period of time, despite discontinuing the offending drug. Most commonly associated medications are aromatic antiepileptics.2,3 Others include sulfonamides/sulfones, nonsteroidal anti-inflammatory agents, angiotensinogen-converting enzyme inhibitors, and antidepressants. The precise incidence of DRESS is yet to be determined; an estimate is 1/1000 to 1/10,000 new users of antiepileptic therapy may present with this hypersensitivity reaction.4,5 The patient is a 29-year-old woman with a history of chronic pancreatitis and gastric bypass surgery, who initially presented with lower extremity swelling in the setting of hypoalbuminemia and protein-calorie malnutrition. She was started on a high calorie/protein diet and was discharged on furosemide andmultivitamin tablets. Three weeks after discharge, she noticed peri-oral rash, which extended to lower extremities, groin, and trunk. On presentation she had multiple areas of erythema and crusting over body, with small tense vesicles of legs and bilateral lower extremity edema. Blood work showed elevated liver enzymes, elevated International normalized ratio, low vitamin D, macrocytic anemia, and elevated eosinophils. She underwent skin biopsy of the left forearm, which showed spongiotic epidermis with paucicellular intraepidermal vesicle/bullae with scattered eosinophils and neutrophils. Rare necrotic keratinocytes sites were identified within the epidermis. The Naranjo algorithm score was 5 that indicated probable adverse dug reaction to furosemide, and no other offending agents were identified. She was diagnosed with DRESS syndrome secondary to furosemide and was started on oral prednisone therapy in view of liver dysfunction. The rash and liver function improved with oral steroid therapy. Hospital course was complicated by sudden drop in hemoglobin. No source of bleeding was identified. Hemolysis workup came back positive with elevated Lactate Dehydrogenase, low haptoglobin, elevated reticulocyte count, and positive C3 and poly antibody Coombs tests (negative Immunoglobulin G Coombs test). She was diagnosed with autoimmune hemolytic anemia refractory to oral prednisone therapy and received 1 dose of intravenous immunoglobulin therapy. She also received 1 unit of packed red blood cells. Her hemoglobin remained stable, without any further drop. She was discharged on oral prednisone therapy and completed prednisone taper over the next 12 weeks as an outpatient. No recurrence of hemolytic episodes is seen in 6 months outpatient follow-up. DRESS syndrome is a severe delayed type hypersensitivity (type IV hypersensitivity) reaction with a prolonged latency period of 3–8 weeks. The clinical course of the syndrome varies widely. Early in the course it may present with prodromal symptoms (fever, pruritus, dysphagia, or lymphadenopathy) and a mucocutaneous rash.1 Internal organ involvement is the characteristic feature of DRESS syndrome, and the most commonly involved organs are the liver, kidneys, heart, and lungs. Although fever and rash are the most common presenting features, liver damage may develop before the onset of a rash in up to 10% of patients.6 Hematologic abnormalities, including eosinophilia and atypical lymphocytosis may be seen on initial presentation. The most commonly associated drugs are aromatic anticonvulsants (carbamazepine, phenytoin, and phenobarbital). Although cross-sensitivity as high as 75% has been reported among the aromatic anticonvulsants, carbamazepine remains the most widely reported agent.7 There are only a few case reports of DRESS syndrome in association with loop diuretics (furosemide and torsemide). American Journal of Therapeutics 0, 1–3 (2020)