Common trend of antibiotics usage in a tertiary care hospital of Peshawar, Pakistan

Antibiotics are used to eradicate the pre- and postoperative infections in surgical procedures and in all others medical cases. However, inappropriate and indiscriminate use of antimicrobial agents can potentially have a number of problems. The emergence of antimicrobial resistant bacteria, an increased number of patients experiencing adverse drug events, and increased drug-related cost have been documented. The objective of the study was to determine the trend of use of antibiotics and hospitalisation of patients in various units of a tertiary care hospital, to investigate practice variation of antimicrobial agents within the hospital, and to identify and document any opportunity for its improvement. A questionnaire containing relevant information about the study was prepared. Patients' age, sex, diagnosis, duration of hospital stay and type of antibiotic used were recorded and analysed, with particular reference to antibiotic group and disease pattern, in 3 different treatment areas of Hayatabad Medical Complex [HMC], Peshawar, Pakistan, from July 2006 to June 2007. During the period under report, a total of 519 patients were studied for their disease and the type of antibiotics used. The leading type of antibiotics reported were 3rd generation antibiotic used on 147 [28.33%] patients in the 3 units collectively, 1[st] generation 127 [24.47%], and penicillin 99 [19.08%], while macrolides were the least used. The available resources are needed to be effectively utilised, to minimise the hospital stay due to rational use of antibiotics, and to minimise burden of antibiotics on poor patients

Study of rickets in admitted patients at lady reading hospital, Peshawar

Objective: a survey of rickets in Postgraduate Medical Institute, Lady Reading Hospital Peshawar and to pinpoint the cause

Material and Methods: this study was carried out in children A unit, Postgraduate Medical Institute Lady Reading Hospital, Peshawar from September 1998 to August 2001. During the three years period 300 cases were included in the study. Total number of admitted patients during three years period were 10161

Results: frequency of Rickets was found to be 2.25%. 198 [66%] patients were less than one year of age, 72 [24%] were of 1-2 years age, 18 [6%] were of 2-3 years old and 12 [4%] patients were above 3 years age. Rickets was predominant in less than one-year age group. 192 [64%] patients were male and 108[36%] were female patients. Male to female ratio was 1.77: 1. Rickets was predominant in male children. 228 [76%] patients were of low socioeconomic group, 54 [18%] were of middle and 18 [6%] patients were of high socioeconomic group. Rickets was predominant in low socio- economic group. 162 [54%] patients belonged to urban areas and 138 [46%] patients were of rural areas of different districts of NWFP. 144 [48%] patients were malnourished, and 120 [40%] patients were associated with acute respiratory infections[AR1]. 78 [26%] were associated with gastroenteritis, 30[10%] were associated with hypocalcemic fits, 24 [8%] had with meningitis, 21 [7%] were associated with various other diseases. Rickets was commonly found in malnourished children. 273 [91%] patients had nutritional rickets and 27 [9%] had of non-nutritional rickets in our study. In these 300 children of rickets, 273 [91%] patients responded to treatment with vit.D3 and 27 [9%] patients were resistant to treatment with vit. D3

Conclusion: it is clear that in our province [NWFP] most cases of rickets are nutritional and responsive to vit. D3 treatment

Validaty of siriraj Stroke scoring

To study the sensitivity and specificity of Siriraj Stroke Scoring [SSS] and to validate the accuracy of SSS in acute supratentorial stroke syndromes. Design: Noninterventional descriptive study. Place and Duration of Study: Department of Neurology, Pakistan Institute Of Medical Sciences, Islamabad, and Department of Medicine, Federal Government Services Hospital, Islamabad, from July to December 2000 and February to July 2002, respectively. Subjects and One hundred [100] consecutive cases of acute supratentorial strokes were studied in accordance with SSS and sensitivity and specificity of SSS for supratentorial infarction and haemorrhage was tested against the computerised brain scanning [CT] as a gold standard. Siriraj Stroke Scoring was applied. Patients with subarachnoid haemorrhage and transient ischemic attacks were excluded from the study. The findings were recorded, compared and statistically analyzed. Out of 100 patients 45 were male and 55 female with mean age of 59 years. Sixty-two patients had hypertension, 36 patients had one or more atheroma markers [diabetes, coronary artery disease and claudication]. Mean diastolic blood pressure was 98 mmHg with range of 60-140 mmHg and mean systolic blood pressure of 163 mmHg with the range of 90-240 mmHg. Forty-eight patients had cerebral infarction, 36 had cerebral hemorrhage while 16 were borderline cases on the basis of Siriraj stroke scoring. CT brain showed 56 and 39 patients had cerebral infarction and haemorrhage respectively while 5 of CT scans were normal. The sensitivity and specificity of SSS for cerebral infarction was 71 and 85 respectively and for intracerebral haemorrhage, it was 73 and 90 respectively. The positive predictive values of SSS for cerebral infarction and haemorrhage were 87% and 83 respectively. The siriraj stroke scoring system is a valid and specific scoring system for the diagnosis of acute supratentorial stroke and intracerebral haemorrhage

Clinical evaluation of patients with acute flaccid motor weakness

To differentiate Guillain Barre' syndrome from hypokalemicperiodic paralysis on basis of clinical features and simple laboratory investigations like serum potassium level, E.C.G, blood gases analysis. Patients and methods: Patients presented between January 1999 to June 2000 to the department of Neurology of Pakistan Institute of Medical Sciences Islamabad were included in this study. Patients more than 13 years of age and of both sexes, who were conscious, with lower motor neuron type of weakness, which developed within a period of four weeks with no sensory level, were included in this study. All patients who were unconscious, who were having sensory level, in whom weakness developed in a period of more than four weeks, patients with diabetic neuropathy, acute renal failure, porphypria and lead poisoning were excluded. Out of 33 patients, 22 [66.7%] were suffering from Guillain Barre' syndrome [G B S], 5[15.1%] from hypokalemic periodic paralysis [HPP], 4[12.1%] from hypokalemic paralysis [HP] with hypokalemia secondary to renal tubular acidosis type-1 and 2[6.1%] from critical illness neuropathy[CIN]. All 22 patients with GBS developed distal weakness except one patient. Serum potassium level was 3.9 to 4.6 mmol/l [mean level 4.72 mmol/l]. Respiratory failure was present in 9[40.9%] patients; bulbar palsy in 13 [59.1%] patients and 2[9.1%] patients expired. All patients with HPP developed proximal as well as distal weakness. Serum potassium level was 1.5-mmol/l to2.5mmol/l [mean 2.06 mmol/l]. Two [40%] patients developed respiratory failure and 2[40%] bulbar palsy. One [20%] patient expired. Family history and history of repeated episodes of weakness was positive in 3[60%] patients. While in 2[40%] patients, there was no family history and no past history of weakness. Cause of hypokalemia was renal tubular acidosis type -1, in all HP patients. All developed both proximal as well as distal weakness. Serum potassium level was 1.9 to 2.9 mmol/l [mean 2.22 mmol/l]. Respiratory failure was present in 2[50%] patients and 2[50%] patients developed bulbar palsy. Two [50%] patients expired. Critical illness neuropathies were present in two patients. Both patients were on mechanical ventilator. One patient [50%] expired. Certain clinical and laboratory criteria differentiate HPP from GBS, which includes Positive family history and similar episodes of weakness in the past, rapid onset of weakness in hours, quick recovery in 24 to 72 hours, and low serum potassium during the episodes of weakness

Increasing prevalence of chronic hepatitis and associated risk factors

To know the prevalence of hepatitis B and C in patients with chronic hepatitis and to identify the associated risk factors responsible for the increasing prevalence of chronic hepatitis "B" and "C" Patients and methods: Retrospective and observation study was conducted in the Department of Medicine, Federal Government Services Hospital, Islamabad, from July 2000 to march 2002,by including all patients with chronic hepatitis "B" and "C" of age 13 years and above of either sex. Total patients were 108, out of which 54 [50%. P=. 361] were males and 54 [50%. P=. 463] were females between the age group 20 to 75 years.The prevalence of hepatitis "B" was 15 [13.9%. p=. 174], hepatitis "C" 86 [79.6%. p=. 039] and hepatitis "B" and "C" 7 [6.5%. p=. 144]. The associated risk factors were transfusion in 39 [36.1%. p=.452] patients, surgery in 48 [44.4%. p=.o56] patients, tooth extraction in 57 [52.8%. p=. 060] patients, injection from quack in 44 [40.7%. P=. 025] Patients and shaving from the barber in 51 [47.2%. p=. 194] patients. The prevalence of hepatitis C is more than hepatitis B and the risk factors are transfusion of contaminated blood, surgical instruments, dental surgery with contaminated instrument, repeated injection, and shaving and unhygienic sexual relation