Sleep quality among medical students of Karachi, Pakistan.

OBJECTIVE: To characterise sleep quality and assess degree of daytime sleepiness among medical students of Karachi. METHODS: The cross-sectional study was conducted between August and December 2013 and subjects were recruited from five haphazardly selected medical colleges in Karachi. A convenience sample of medical students underwent two validated self-administered questionnaires i.e. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. SPSS 17 was used for statistical analysis. RESULTS: Of the 650 students approached, 504(77.5%) subjects completely filled out the questionnaires. Of them, 300(59.5%) were females and 204(40.5%) were males. Overall mean age was 20±1.4 years. Of them, 199(39.5%) were classified as "Poor Sleepers". Poor sleep quality was associated with female gender (p <0.05), excessive daytime sleepiness (p <0.05), total hours slept (p <0.001) and sleep disturbances (p <0.001). Bed-timing analysis showed 365(72%) students went to bed after midnight. CONCLUSIONS: Sleep quality among Pakistani medical students was significantly poor. Efforts must be directed towards proper sleep hygiene education.

Pattern of external injuries sustained during bomb blast attacks in Karachi, Pakistan from 2000 to 2007.

OBJECTIVE: To evaluate patterns of external injury resulting from bomb blasts in Karachi, and compare the injury profile resulting from explosions in open versus semi-confined blast environments. METHODS: The retrospective, cross-sectional study was conducted in Karachi and comprised relevant data from January 2000 to October 2007. Casualty medical records and medico-legal certificates of the victims presented to three large public-sector hospitals were evaluated using a self-designed proforma. SPSS 17 was used for statistical analysis. RESULTS: Of the 1146 victims, data of 481(42%) represented the final study sample. Of these, 306(63.6%) were injured in open spaces and 175(36.4%) in semi-confined spaces. Of the 896 recorded injuries, lacerations were encountered as external injury in 427(47.7%) cases, followed by penetrating wounds in 137(15.3%). Lower and upper extremities were injured in 348(38.8%) and 170(19%) victims respectively. Open and semi-confined blast environments produced specific injury pattern and profile (p<0.001). CONCLUSIONS: External injuries sustained during bomb blast attacks in Karachi demonstrated specific injury patterns and profiles. Further studies are required to account for internal injuries and classification of injuries based on standardised scoring systems.

Persistent Lactic Acidosis: Thinking Outside the Box.

A 54-year-old male presented with possible sepsis and elevated serum lactic acid (LA) of 18.7 mmol/L. Despite the sepsis treatment protocol and the management of other causes of type A lactic acidosis, his LA remained elevated. Herein, we present a case of type B lactic acidosis in the setting of a diffuse large B cell lymphoma. The proposed mechanisms of persistent lactic acidosis in malignancy are highlighted in this case report.

Fatal Hypermagnesemia: an acute ingestion of Epsom Salt in a patient with normal renal function.

BACKGROUND: Generally, it is very rare for clinically significant hypermagnesemia to develop in an individual with normal renal functions as the renal handling of serum magnesium is a very potent process and it has the capacity, under conditions of hypermagnesemia, to completely block Mg (magnesium) reabsorption from the thick ascending limb of Henle. Therefore, hypermagnesemia usually arises in the setting of renal failure. CASE PRESENTATION: We present a very rare case of a 40-year-old African American obese female with prior normal renal functions, who presented post-cardiac arrest following accidental overdose of Epsom salt. The patient was initially given supportive therapy and was later considered for the dialysis despite normal renal functions, as serum Mg levels kept on creeping up and clinical status kept on deteriorating continuously. CONCLUSIONS: Seemingly harmless magnesium containing (over-the-counter) (OTC) can potentially be lethal, and such consequences must always be taken into account when using such medications for a prolonged period of time.