To detect the dyslipidemia in patients with rheumatic arthritis

Objective: To determine the abnormalities of lipid profile in patients with rheumatic arthritis

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted in the Department of Medicine, Peoples University of Medical and Health Science, Nawabshah and MMC Mirpur khas from 2011 to 2013

Materials and Methods: Total 48 patients with RA were selected. All the equitable investigation was done. The patients were chosen for the study after a brief medical history. Patients with smoking and alcohol habits, those suffering with systemic disease like diabetes mellitus, hypertension and those on corticosteroids, statins, immunosuppression and vitamins supplementation, liver, kidney, thyroid abnormalities, ischemic heart disease, pregnant and post menopausal women were excluded. Lipid profile HDL, LDL, TC and TG were checked in all the cases after an overnight fasting of 12 hours. All the data was entered in the written proforma

Results: Total 48 cases were selected in the study after diagnosis of RA, mean age of the cases was found 36.5 +/- 7.2 years, female found in the majority 30/62.5%, mostly patients were married 35/72.9.A significant difference was found in the lipid profile, HDL was found low in majority of cases 17/35.4%, while TG was high in the majority of the patients 15/31.2%

Conclusion: In the conclusion of this study dyslipidemia is highly associated with RA disease. In patients with RA disease lipid profile should be checked necessarily, to reduce the morbidity and mortality due to cardiovascular disease

Hepatic cirrhosis association of platelet count, splenomegaly and esophageal varices in patients

To see the association of platelet count, splenomegaly and development of oesophageal varices. Observational study. One year from January 2010 to December 2010. Gastroenterology Department, Medical Unit III, Nishtar Hospital Multan. One hundred ten cirrhotic patients were included. The record of these patients was scrutinized and data collected was entered and analyzed through SPSS 11. The patients were divided into three groups according to platelet count. Group I with platelet count less than 50000/mm3, group II with platelet count of 50000 to 100000/mm3 and group III with platelet count of 100000 to 150000/mm3. Similarly patients were also divided into three groups according to splenic size. Group I with splenic size 11 - 13 cm, group II with splenic size 13-16 cm and group III splenic size more than 16 cm. In each group presence of esophageal varices along with grading was noted. The age of the patients varied from 15 to 80 years and mean age was 48.55 +/- 13.88 years. Sixty five [59.1%] were male and 45 [40.9%] were female. The hemoglobin level of these patients varied from 6.0 to 14.3 gm/100 ml with mean level of 9.23 +/- 2.11gm/100ml. The platelet count varied from 22000 to 385000/mm3. The splenic size varied from 9 to 18 cm with mean of 12.53 +/- 2.14 cm. Esophageal varices were detected in 102 cases. Seventeen cases were of grade I varices, 25 cases were of grade II varices, 40 cases were in grade III varices and 4 cases were in grade IV varices. Maximum number of grade-III [22 patients] and grade IV [3patients] esophageal varices occurred in patients having platelet count less than 50000/mm3. As the splenic size increases the grade of esophageal varices also increases. Maximum number of esophageal varices occur in grade II [25] followed by grade-III [37] in patients with splenic size in the range of 13 to 16 cm. A low platelet count and large splenic size are good non-invasive predictors of esophageal varices. These parameters can also accurately assess the presence of large varices. So a patient of cirrhosis with low platelet count and large spleen has an increased diagnostic yield of esophageal varices on upper GI endoscopy

Diagnosis of pseudoxanthoma elasticum [PXE] from patients presenting with bleeding per rectum

To find out rare cause of bleeding per rectum in young patients in our study of 200 patients presenting with bleeding per rectum. Department of Medicine, Nishtar Hospital, Multan. Durations From July 1998 to July 2000. Two hundred patients presenting with bleeding per rectum were studied. History, general physical examination and systemic examination were done. Then provision clinical diagnosis was made and related investigations were done to confirm the diagnosis. Out of these 200 patients, 164 patients were diagnosed as having bleeding esophageal varices due to cirrhosis of liver. 22 patients were diagnosed as having gastritis [commonly drug induced] on endoscopy, 6 patients were having bleeding hemorrhoids, 3 patients were having bleeding gastric ulcer and 5 patients were diagnosed as having PXE. When young patients presented with bleeding per rectum and if diagnosis become difficult, then PXE must be considered in these patients and investigated properly

Study of 30 Cases of FUO [Fever of Unknown Origin]

To diagnose cause of Prolonged fever in patients suffering from FUO. Patients suffering from FUO were admitted in Medical Ward in Nishtar Hospital Multan and investigations were done to find out the cause of FUO. Medical Ward, Nishtar Hospital, Multan from 1.7.1998 to 30.6.2000. Patients presenting with FUO were admitted and investigated. Out of 30 patients of FUO, causes of FUO in 27 patients were diagnosed and in 3 patients, cause of FUO could not be established but these 3 patients responded to ATT [ANTI-Tuberculous Therapy]. It has been concluded that patients suffering from FUO becomes a challenge for treating. Physician and with Intensive investigations causes of FUO can be determined in most patients and in those patients in whom causes can not be identified these can be treated with ATT and most patients respond to ATT, confirming the diagnoses of hidden Tuberculosis

Endoscopic evalution of acute dysphagia due to mechanical obstruction

To find out the common causes of mechanical dysphagia in South Punjab and determine the endoscopic features of benign and malignant stricture to decide for either therapeutic intervention [endoscopic dilatation/stunting] or biopsy. This descriptive study was conducted in Medical Unit-1, Gastroenterlogy Nishtar Hospital Multan Pakistan during the period from September 2004 to December 2005. A total 50 patients were included in the study. Foreign body in esophagus, was seen in 3 patients [6%] 2 female and one male. Two patients [4%] had esophageal web, both patients were female and upper part of oesophagus was involved in both of them. Benign stricture was the commonest abnormality. Lower third of oesophagus was the commonest site of involvement [62.5%], middle one third was involved in 31.25% of cases while upper third was involved in only 1 patient [6.25%]. Carcinoma oesophagus was predominantly found in males and lower one third was the commonest site [71.4%]. No patient had involvement of upper third while middle third was involved in 28.6%. Mean age of the patients was 42; age range was 14 to 63. Duration of dysphagia ranged from one day to 35 days; mean duration was 18 days. Upper gastrointestinal endoscopy is a safe and valuable procedure in individuals of all age groups with dysphagia and often leads to positive therapeutic intervention even in quite frail subjects. Benign esophageal stricture, esophagitis and esophageal carcinoma, are the commonest causes of dysphagia in South Punjab

Association of dyslipidemia with acute and myocardial infarction

Ischaemic heart disease is a leading cause of death throughout the world. CAD has been recognized among all age groups especially above forty years of age more frequently in recent years. To determine the dyslipidaemia and waist hip ratio as a risk factor of Myocardial Infarction [MI]. This descriptive comparative type of study was conducted in the medical Ward, Nishtar Hospital, Multan during the period from January 2006 to January 2007. A total of 150 patients of first acute myocardial infarction age ranges from 35 years-70 years were included in the study. Among these patients 74% were males and 26% females. Two modifiable or controllable risk factors including dyslipidaemia. [Truncal obesity] were studied in this study. Patients were diagnosed on he bases of typical history of chest pain, ECG changes, raised cardiac enzymes or troponin T positive. Fasting lipid profile was done. Dyslipidaemia i.e. high total cholesterol, low density lipoproiein cholesterol and low HDL-cholesterol was statistically significant in all patients of ML 74% patients have dyslipidaemia including high total cholesterol, high LDL-C and low HDL-C. Triglyceride level was not found statistically significant. Incidence of IHD showed linear relation with age i.e. risk increased with the age only 14% patient belonged to age group 35-30 year as compared to 34%i patient who belong to age group more than >50 years. Mostly females were post-menopausal. It was also found that upto 80% had two or more than two risk factors. In conclusion, dyslipidaemia and Truncal obesity are important modifiable risk factors. These risk factors must he sought out in all high risk groups and where possible be treated for both primary as well as secondary prevention of CAD

Body ache and pain in school children associated with school bag carriage in Multan - Pakistan

In Pakistan anecdotal evidence of shoulder, back pain in school children is alarming but no scientific studies have been carried out yet. This study was carried out to find out any association between pain and school bag carriage in students, since almost all school management including public and private in Pakistan putting extra loads on the children in the form of heavy school bags. Children and in the phase of growth and development. So there is continuous endanger of growth and developmental retardation due to growth due to pulling heavy school bags load not only but also some sort of body aches and pains occur. This study was carried at four different schools in Multan. Schools were selected by convenience sampling. Two hundred children between the ages of 11 and 14 years correctly filled out a questionnaire with open ended and closed ended questions. Each child also had his/her body and bag weight measures. In this study, most of the children experienced shoulder and a combination of shoulder and other bodily pain. The majority of the children carried school bags over two shoulders. The type of bag carried was significantly related to pain experienced. A significantly larger number of female students experienced pain. The shoulder and other bodily pain experienced by the students are strongly related to the type of bag and the gender of the children

Psycho-social causes of suicide in Multan

Suicide occurs when the present and the future is seen bleak and negative. Suicidal people are preoccupied with their problems, lose perspective and see suicide as an effective solution to their difficulties. "Suicide is not a disease". "Suicide is the act of taking one's own life on purpose. "The man who kills himself is through with life; he has literally died psychologically before he kills his body." Society exists within the minds of the individuals who exist within society, and when individuals interact the idea of society becomes an ever-changing "whole" product of this interaction. This helps relate sociology and psychology, and also gives insight into the cause of suicide which is often termed "tunnel vision". Because people internalize all thoughts, emotions, interpretations of society, etc., and because these forces, external and internal, strongly act upon them, they feel there is no way to escape in a conscious, or even semi-conscious, state

Working intensity of children walking with different school bag loads in Multan - Pakistan

In Pakistan anecdotal evidence of shoulder, back pain in school children is alarming but no scientific studies have been carried out yet. This study was carried out to find out any association between pain and school bag carriage in students, since almost all school management including public and private in Pakistan putting extra loads on the children in the form of heavy school bags. Children are in the phase of growth and development. So there is continuous endanger of growth and developmental retardation due to growth due to pulling heavy school bags load not only but also some sort of body aches and pains occur. To determine the relative working intensity of children walking with different school bag loads. Fifty male children, aged 9-15 years were selected from a primary school of Multan city to carry school bags of 10, 15 and 20% of their body weights, and no load was used as control. Heart rate, blood pressure, respiratory rate, education proficiency, tiredness of every subject was measured using a continuous incremental protocol. In the load carriage test subjects walked 500 meter [at a school distance]. Based on the results of heart rate, blood pressure, respiratory rate, tiredness walking intensity at different load conditions were calculated. Heart rate of subjects were monitored and recorded by electrocardiograph until five minutes after walking. Blood pressure was measured before, immediately, 3 and 5 minutes after every trial. There was a significant difference found on the human working intensity between 10 and 20% body weight load conditions, but not among the 0%, 5% body weight load conditions. Heart rate responses among all load conditions showed similar trends, 60% maximum heart rate was obtained at different load conditions among the subjects. It is concluded that 10% body weight is recommended as the weight of school bags for children

Comparison of exercise tolerance tests and thallium 201/MIBI scan in the diagnosis of ischemic heart disease

Coronary artery disease is one of the commonest causes of death throughout the world. Despite impressive study in diagnosis and management over the last three decades acute myocardial infarction [AMI] continues to be a major public health problem in the industrialized world. To compare the sensitivity and specificity of ETT alone and stress MIBI scan for the diagnosis of coronary artery disease. The study was started in year 2000. Fifty patients were randomly selected. They were referred from the outpatient departments of general medicine and cardiology of Nishtar Hospital, Multan. Fifty patients were included in my study. Out of these 37 [74%] were males and 13[26%] were females. Out of 50, 37[74%] patients showed positive ETT. Among these patients, 30[81%] were male and 7 [19%] were females. Among 21 hypertensives, 17 [81%] patients showed positive ETT. Out of these 17 patients, 14 [82%] patients were male and 3[18%] were females. It is concluded the same observation that radiopharmaceutical scans is better tool for the diagnosis of coronary artery disease

Prevalence of Hepatitis B surface antigenaemia amongst nursing staff of tertiary care hospital

The main object of study was to find out the number of positive cases of hepatitis B virus amongst nursing staff working in Nishtar Hospital Multan. This descriptive study was conducted in Nishtar Hospital, Multan. A total 136 staff nurses were included in the study. The prevalence of Hepatitis B among staff nurses of Nishter Hospital Multan According top the study was [2.20%]. The prevalence of Hepatitis B antigenemia in staff Nurses of Nishtar Hospital Multan According to the above study was 2.20%. 18 of the total 154 staff nurses were vaccinated against Hepatitis B infection. The prevalence rate was lower in comparison with the other studies