Frequency of proven risk factors for deep vein thrombosis in clinical patients: results of a study on patients being treated at a tertiary care hospital in Rawalpindi, Pakistan

To enlist the dominant risk factors predisposing patients to deep venous thrombosis. The prospective study was conducted in surgical and medical departments of Combined Military Hospital, Rawalpindi, and Fauji Foundation, Islamabad, from January 2012 to December 2013. Patients having deep venous thrombosis of lower extremities by duplex scan were enrolled. After taking their detailed personal and biochemical history, frequency of risk factors was noted and graded accordingly. Of the total 120 patients, 71[59%] were males. Overall, left leg was involved in 53[44%], right leg in 34[28%] and both legs in 33[28%]. Of the total, 68[57%] patients were >40 years of age. Immobility was the main cause of deep venous thrombosis in 18[15%], followed by surgical interventions in 10[8%]. Pregnancy and post-partum thrombosis was the major cause in 9[8%] women. Only 6[5%] patients had natural predisposition to deep venous thrombosis. Immobility was an independent and important risk factor for deep venous thrombosis. Thromboprophylaxis is not routinely provided in most health centres in Pakistan, exposing patients to the risk

Splenic abscess in cancer patients: a retrospective review

The objective of the study was to review our experience in the management of splenic abscess in cancer patients at a cancer hospital in Pakistan. This study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and data reviewed from January 2007 till December 2012. Demographic, pathologic, radiologic and treatment records of each cancer patient with splenic abscess were retrieved from the electronic database. Patients were followed for a period of six months. Twelve patients were diagnosed with splenic abscess in the last six years. Males were ten compared to two female patients. Mean age was 41.1 years [range 3-64]. All except one were adults. Six patients had hematological malignancies while six were diagnosed with solid organ tumors, among the solid organ tumors three had metastatic disease with unknown primary. Six patients had multiple splenic abscesses while six patients had solitary abscesses. Bacterial cultures were positive in four patients, Pseudomonas species and Escherichia coli in two patients each; one patient with mycobacteria tuberculosis; no fungal growth identified in any patient. Antibiotics were given to all patients except one patient who died before any therapy due to end stage hepatocellular carcinoma. Three patients were treated with antituberculous therapy, two of them recovered while one was lost to follow-up. Percutaneous aspiration/drainage [PCD] was done in five patients; Surgery was performed in three patients. One patient who underwent PCD died due to septicemia while one patient died of cardiac event, two patients were lost to follow up while eight patients recovered completely. Percutaneous aspiration/drainage is an equally good option for treating splenic abscess as compared to surgery along with adequate antibiotics

Dengue infection in cancer patients

Objective: to study the clinical behavior of dengue infection in cancer patients

Material and Methods: we reviewed medical records of cancer patients who were diagnosed with dengue infection in year 2011 as per discharge notes. Patients fulfilling revised dengue WHO/TDR classification with positive dengue lgM serologist were finally chosen for analysis

Results: from initially screened 63 patients, 43 fulfilled revised dengue WHO/TDR classification criteria, 31 [of these 43] with positive dengue lgM were finally analyzed. There were 16 males and 15 females, mean age was 39.0 [23.0] years. 23 patients were = 18 years of age. 81 % patients reported within first three days of illness. Major cancer bulk was from solid organ cancer group [n=21] followed by hematological group [n=10]. Presenting features were fever [100%] followed by aches [58.1 %], hemorrhagic manifestations [35.5%], vomiting [29%] and diarrhoea [25.8%]. Twelve [38. 7%] patients developed severe dengue with one death making 3.2% crude mortality rate

Conclusion: the spectrum of dengue infection severity in cancer patients seems to be different from general population. Clinically dengue was more severe with solid organ cancers as compared to hematologic cancers possibly highlighting the role of cellular mediated immunity. Other risk factors identified were relatively elder age and more co-morbid conditions

Serum magnesium levels in type 2 diabetic patients presenting with acute coronary syndrome and prevalence of cardiac arrhythmias in these patients

Hypomagnesaemia have been reported to occur with an increased frequency in type 2 diabetics compared with their counterparts without diabetes. Abnormalities of magnesium levels, such as hypomagnesaemia, can result in disturbances in nearly every organ system and can cause potentially fatal complications [e.g., ventricular arrhythmia, coronary artery vasospasm, sudden death]. Premature ventricular complexes [PVC] predict cardiovascular mortality among several adult populations. This study was done to find correlation between serum magnesium levels of diabetics and incidence of arrhythmias. We analyzed the serum magnesium levels in fifty consecutive patients with type 2 diabetes presenting with acute coronary syndrome in CCU of Services Hospital, Lahore and prevalence of cardiac arrhythmias in these patients. Serum magnesium levels were measured at presentation and twenty four hour Holter monitoring was done for the detection of arrhythmias. There were 33 male [66%]; 17 female [34%] patients and mean age of presentation was 60 years [ +/- 20 years]. 7 [14%] out of 50 patients had hypomagnesaemia [<1.7mg/dl], 2 females and 5 males. 'Ventricular premature contractions' in hypomagnesemic patients were 1.5 times the patients with normal magnesium level. There was no definite relationship observed between serum magnesium level and 'supraventricular premature contractions'. Although ventricular premature contractions are more common in patients with hypomagnesaemia and may result into life threatening arrhythmias but no life threatening arrhythmias [e.g., ventricular tachycardia and torsade de pointes] were seen in our study population with hypomagnesemia

Different clinical presentations of dengue at astth

Objective: to observe the different clinical presentations of dengue fever in patients presenting with acute febrile illness

Material and Methods: this retrospective observational study was conducted in medicine department, Akhtar Saeed Trust Teaching Hospital, Lahore in September 2011. Patients presenting with acute febrile illness in both OPD and emergency were included. History was taken and clinical examination was done. Blood samples were collected for Complete blood count, Liver function tests, renal function tests and serology for Dengue virus lgM by ELISA. Symptoms and investigations were analyzed

Results: total 300 patients were included in the study. Females were187 [62.3%] and males were 113 [37.7%]. Mean age of patients was 33.4 years. Headache was the most common presentation in 284 [94.6%] patients, myalgia was present in 271 [90.3%] patients, fever was present in 257 [85.6%] patients, vomiting in 190 [63.3%] and rash with petechie in 53 [17.6%] patients. Leukopenia and thrombocytopenia was present in all 300 patients. Liver function tests were deranged in 209 [69.7%] patients and dengue lgM was present in 127 [42.3%] patients. Serum urea was deranged in 113 [37.7%] patients

Conclusion: fever associated with chills and rigors, headache, myalgia, vomiting, rash, petechie and hemorrhagic manifestations, leucopenia, thrombocytopenia and raised ALT are satisfactory parameters to screen for suspected dengue virus infections. However, diagnosis cannot be confirmed unless supported by dengue specific lgM serology

Influence of gender, BMI, and ethnicity on serum ALT levels of healthy students of a medical school

Alanine Aminotransferase [ALT] is an enzyme found in Liver and indicates injury to Hepatocytes. It is influenced by various factors. The objectives of this study were to identify the correlates of ALT activity among healthy medical students of Army Medical College, National University of Sciences and Technology, aged 18-22 years. This was to establish the mean ALT levels of the students and compare them with those in various parts of the world and observe various correlations that exist and factors that may influence ALT levels. This population included 143 volunteer students [93 men and 50 women] selected on the basis of negative answers to a detailed medical questionnaire including past medical history, drug and alcohol consumption, on the absence of clinical signs of liver disease, on the negativity of serological testing for Hepatitis B and C virus. The mean ALT level of the entire population was 28.7 IU/L. A major sex-difference in ALT value was observed, the mean ALT value being higher in men than in women [32.1 +/- 21.7 vs. 22.6 +/- 9.7 IU/L, p<0.004]. According to WHO criteria for Asians, normal BMI was taken from 18.5-23.0 Kg/m[2]. There was a positive significant correlation between serum ALT level and BMI [p<0.002]. ALT level strongly correlates with body mass index and gender. There was no significant variation in ALT levels among Punjabis and Sindhis, Balochis, Pathans, and Kashmiris. We suggest the need of taking into account these parameters in a clinical interpretation of ALT level

Awareness of novel h1n1 pandemic influenza among non-medical personnel, medical students and medical professionals

To study the awareness of swine flu among general population, medical students and medical professionals Descriptive study. Place and Duration of Study: Study was carried out in the department of Pathology [Microbiology], Army Medical College, the Military Hospital [MH] and Combined Military Hospital, Rawalpindi, from 17th January 2010 to 24th January 2010. Materials and A total of 519 people were included in this study, 228 were medical students, 181 were doctors and 110 were non health care professionals. A questionnaire with closed questions regarding the awareness of the basics of swine flu was required to be filled by all participants. It was found that the general population was totally unaware to the extent that 1/3rd had never heard of this disease. The survey of medical students showed reasonable knowledge in the senior classes [80-85%] knew the main features of the disease], whereas the 2nd year students had the awareness around 40-45%. Among the medical professionals the knowledge was excellent in the seniors, whereas the trainees and house officers had suboptimal knowledge of swine flu. The result of this study show a significant gap between the seniors specialists and the juniors and this gap warrants immediate bridging. The general public also need to be informed by various means more comprehensively