Biomedical subjects
S E Alam
Publications and source records attributed to S E Alam.
Gastric ulcer in Karachi.
Of 138 endoscopically or surgically confirmed cases of gastric ulcer, 102 (74%) were males and 36 (26%) females. Both sexes were affected most commonly in the 6th decade of life. Pain, vomiting and gastrointestinal bleeding were the major presenting symptoms, with a median duration of 6 months. Cigarette smoking was the most common (44%) addiction and 10% were on analgesics or nonsteroidal anti-inflammatory drugs (NSAID). Family history of ulcer was uncommon (2%) and no predilection for any blood group was noted. Among males 53% were skilled workers while 94% of females were housewives. Forty five percent patients were migrants from India and the rest belonged to different provinces of Pakistan. Presentation and behaviour of different sites of gastric ulcers though varied but the results were not significant. Healing rates with H2 receptor antagonists were 33% at 4 weeks and 78% at 8 weeks.
Byssinosis in ginning factories of rural Sindh.
Frequency of byssinosis in 276 workers from 5 ginning factories of rural Sindh are described. Twenty-four (9%) had byssinosis, 178 were asymptomatic and the remaining 74 had other respiratory symptoms. Chronic obstructive pulmonary disease was present both in symptomatic and asymptomatic workers and was equally distributed amongst smokers and non-smokers. A possible involvement of some factors other than cigarette smoking is discussed.
Effect of meal on intragastric pH in patients with duodenal ulcer.
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Maternal morbidity in the Department of Obstetric and Gynaecology, Jinnah Postgraduate Medical Centre Karachi.
Maternal morbidity was observed in 377 obstetric cases at Jinnah Postgraduate Medical Centre (JPMC) during a period of one year. Morbidity rate was 4.4% of total deliveries. Three hundred and twenty-four (86%) mothers had no proper antenatal supervision. Infection was more common after abdominal delivery and injury to genital tract after vaginal delivery. The most serious injury was rupture of gravid uterus. Thirty-seven cases of ruptured uterus were admitted in one year and 5 cases occurred within the hospital (1 in 1225 deliveries).
Misoprostol in the treatment of NSAID-induced gastroduodenal lesions.
The cytoprotective effect of misoprostol co-administered with non-steroidal anti-inflammatory drugs (NSAIDs) was assessed in a double blind, placebo controlled study. Thirty-seven patients with rheumatoid arthritis receiving NSAIDs, having upper gastrointestinal symptoms and endoscopically confirmed gastric and/or duodenal lesions, were randomised to receive either misoprostol 200 micrograms or placebo tablets twice daily for 4 weeks. Of 31 evaluable cases, 13 of 16 (81%) patients receiving misoprostol showed endoscopic improvement as compared to 10 of 15 (67%) receiving placebo (P:NS). A significant decrease in mean (+/- SEM) mucosal lesion score was observed with misoprostol (from 3.38 +/- 0.32 to 1.32 +/- 0.44; P less than 0.001) but no change was seen with placebo (from 2.80 +/- 0.42 to 1.60 +/- 0.53; P:NS). Symptomatic relief was similar in both groups, being 44% and 40% respectively. Two patients complained of diarrhea in each group and one developed menorrhagia with misoprostol. It is concluded that though misoprostol decreased the number of NSAID-induced mucosal lesions, it was unable to relieve gastrointestinal symptoms.
Spectrum of viral hepatitis.
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Differentiation of cirrhotic Vs idiopathic portal hypertension using 99mTc-Sn colloid dynamic and static scintigraphy.
Thirty-seven cases of portal hypertension with endoscopically proven oesophageal varices underwent liver biopsy to determine the etiology of portal hypertension. Of the total, 19 had cirrhosis and 18 idiopathic portal hypertension (IPH). Later all these patients underwent Tc99mSn colloid, static and dynamic scintigraphy of the liver and spleen. Ratios of the area and of the integral and slope of the integral for liver and spleen were calculated to see if any of these ratios can differentiate cirrhotics from IPH. Significant difference (P less than 0.001) was noted in the ratio of the area (L/S) in both patients and controls, but the ratios of the integral and the slope of the integral were not only significantly different (P less than 0.001) in the patients and controls but also in the two groups of patients (cirrhosis and IPH). The sensitivity of this test when compared with the histology was 58% for both cirrhosis and IPH but when compared with clinical diagnosis it was 76% for cirrhosis and 62% for idiopathic group. Therefore by adding the above mentioned test in the routine study of liver scintigraphy in patients with portal hypertension, further differentiation of cirrhotic group can be done from the idiopathic group.
Maternal factors affecting birthweight of uncomplicated pregnancy.
Two hundred full-term pregnant mothers with no complication of pregnancy and no associated disease selected from Jinnah Postgraduate Medical Centre were studied for their nutritional status and other characteristics. The effect of these factors on birthweight of their new-born was determined. Total calorie intake per capita per day was low being 1913. The mean birthweight was 2.9kg, 26% weighed 2.5kg or less. No significant sex difference was observed in the birthweight. Variables having a significant positive influence on birthweight were maternal age at first delivery, up to 25 years, beyond which correlation was not significant; maternal weight and maternal total calorie intake (irrespective of source) up to an intake of 2500 calorie per day, beyond which correlation was not significant. Combined effect of these three maternal factors on birthweight was highly significant. Coefficient of correlation, R being 0.81.
Evaluation of nutritional status and its effects on morbidity and mortality of surgical patients.
Sixtynine patients (31 males and 38 females) above the age of 12 years undergoing surgery under general anaesthesia were selected for this study. Thirty percent males and 29% females were depleted, 55% and 37% males and females, respectively, were normal and 13% and 34% males and females, respectively, were obese as indicated by Body-mass index (BMI). Measurement of midarm-muscle-circumference (MAMC) indicated mild to moderate protein deficiency in 32% of the patients while triceps skinfold thickness (T.S.T) indicates mild to severe calorie deficiency in 68% males and 50% females. Dietary intake both pre and post operatively was unsatisfactory. Pre-operatively 26% of the females had Hb level below normal (less than 11 G%). Only 3-5% of the patients had protein and albumin level below normal (less than 3.5 G%). Post-operatively all the anthropometric measurements as well as serum protein and albumin levels decreased and BUN increased significantly indicating body catabolism. Post operative hospital stay was significantly more in undernourished patients.
Basic statistics in medical practice.
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Criteria for diagnosis in pulmonary tuberculosis.
In a retrospective study, case records of 1061 patients treated with antituberculosis drugs were examined to assess the criteria for diagnosis in each case. Seventy six percent had sputum examined for A.F.B. and 45% had mantoux test done. Five hundred and eighty one (55%) were diagnosed on radiology alone, while 262 (25%) had positive sputum for A.F.B. Only 50 (5%) of cases had positive Mantoux in addition to positive sputum and radiological changes. Practical significance of this practice is discussed.
Basic statistics in medical practice.
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Basic statistics in medical practice.
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Basic statistics in medical practice.
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Site of duodenal ulcer and its influence on the mode of presentation and prognosis.
Two hundred and forty-five endoscopically proven or surgically treated duodenal ulcers were retrospectively evaluated to see if the site of ulcer has any influence on the clinical presentation, and healing and relapse rates. Anterior wall ulcer was present in 42%, posterior wall in 33%, lesser curve side of the cap in 12% and greater curve side in 13% cases. Ulcer site showed no correlation to age, sex, duration of illness, analgesic intake or smoking habits. Bleeding (116 cases) and perforation (15 cases) were the major complications encountered; of these perforation was invariably found on the anterior wall, while bleeding was more frequent in ulcers present on the lesser curve side of the cap. Better healing and high relapse rates were seen in ulcers situated on the greater curve, and low healing and relapse rates in lesser curve duodenal ulcers.
Basic statistics in medical practice.
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Pattern of duodenal ulcer in Karachi.
Seven hundred and twenty cases of endoscopically proven peptic ulcer were seen at PMRC Research Centre, Jinnah Postgraduate Medical Centre, during the last 13 years (June 1976-June 1989). Duodenal to gastric ulcer ratio was 5:1. Duodenal ulcer was predominantly seen between 3rd and 5th decade of life, with a male to female ratio of 5. 7:1. Seventy five percent cases were skilled persons. Places of origin showed 50% to be migrants; mostly from India while the rest belonged to various provinces of Pakistan. Sixty percent patients were smokers/tobacco chewers and 3% were simultaneously taking alcohol. History of NSAID intake was present in 5% cases only. Majority (85%) of the patients presented with pain, 42% had upper G.I. bleeding, 11% perforation and 1% pyloric stenosis.