Prevalence of ACS and Causal Relation of Hypomagnesaemia.

Magnesium is an important intracellular cation [1], actually the second most abundant cation after Potassium, which has gained an essential role in normal human homeostasis. Low serum magnesium has been detected commonly in around 12% hospitalized patients and even more commonly in Intensive Care Patients as high as 60 to 65%. The link of low serum magnesium with acute coronary syndrome is being discussed widely and its actual role is being scrutinized [2,3]. Recently, Hypomagnesaemia has also been found to play an important role in the pathogenesis of a variety of clinical disorders including Hypertension, Diabetes Mellitus, Atherosclerosis and Acute Coronary Syndromes [4-8]. Acute coronary syndrome (ACS) has been defined as a group of conditions due to decreased blood flow in the coronary arteries. Acute coronary syndrome includes a vast spectrum like: ST elevation myocardial infarction (STEMI / 30%), non ST elevation myocardial infarction (NSTEMI / 25%), or unstable angina (U.A. / 38%).These are described according to ECGs and Cardiac Biomarkers of myocardial necrosis (troponin T, troponin I, and CK MB), in patients presenting with acute cardiac chest pain (Medscape). Aim: To look for any association between Hypomagnesaemia and Acute Coronary Syndrome. Materials and Methods: It’s a retrospective study involving 1198 patients who presented to the Accident and Emergency department (A & E), Trauma Center, Rashid Hospital, Dubai, with Acute Coronary Syndrome (ACS) between April 2010 and May 2013. We reviewed the records of all patients including their clinical history and presentation. The Magnesium levels of all the patients in the ACS pathway were checked along with, Cardiac biomarkers - Troponin, CPK and CK MB and Lipid profiles were also analyzed. A Chi-Square test was performed at 5% level of significance to test the null hypothesis of no association between cardiac markers, lipid profile and magnesium level. Inclusion Criteria: All new patients presenting to A & E Department at Rashid Hospital with an acute coronary syndrome (both NSTEMI & STEMI). All new patients presenting with non-specific chest pain who test positive for cardiac markers. All the age groups presenting to A & E Department at Rashid Hospital from 11/04/2010- 30/05/2013 were included. Both the genders were included. Exclusion Criteria: Patients diagnosed initially with acute coronary syndrome that eventually had negative cardiac markers. Results: Out of 1198, 1087(91%) patients were male. 49% were between 50 and 75 years of age group whereas 46% were between 25 years and 50 years of age. 77% patients were Asians and 17% belonged to Arabic peninsula. The Magnesium level was normal in 1097(92%), low in 63(5.3%). Troponin was negative in 431(36%) and positive in 767(64%) patients with low, medium and high levels in 338(28.2%), 426(35.5%) and 03(0.3%) respectively. These results indicate that there is no statistically significant association between Magnesium levels and Troponin groups (positive and negative) (chi-square with two degree of freedom = 3.30, p = 0.192). Conclusion: Our study proves that there is no significant association between Hypomagnesaemia and Acute Coronary Syndrome.

Near total thyroidectomy; role of drain

To evaluate the role of surgical drains in near total thyroidectomy. It was a Randomized clinical trial conducted at department of surgery, DHQ teaching Hospital, Dera Ghazi Khan from Jun 2012 to May 2013. Patients were randomized into two groups by lottery method. Group A were those in which drains were placed and Group B patient were operated and no drains were placed. Inclusion criteria included all patients presenting for near total thyroidectomy for benign diseases. Those with massive goiters or nodules larger than 6 cm were excluded. 40patients were enrolled in the study. Complications, length of hospital stay, and overall cost were evaluated. In the Group B [no drain group], there was 03 days mean hospital stay with no increase in postoperative complications like swelling. While Group A [drain group] mean hospital stay was 06 days. Thyroid surgery without the use of a drain decreases the length of hospital stay, with no increase in patient morbidity. The overall cost is significantly reduced

Prediction of large esophageal varices in patients with decompensated cirrhosis by child-pugh score, in medical unit-ii, chandka medical college hospital, larkana

To assess prediction of large esophageal varices in patients with decompensated cirrhosis by Child-Pugh score, in Medical Unit-II, Chandka Medical College Hospital Larkana. Cross sectional study. This study was carried out at Medical Unit II, Chandka Medical College and Hospital, Larkana from November 2011 to November 2012. In this study 88 consecutive cirrhotic patients with ascites [those Patients who fulfilled the inclusion criteria] were included; blood samples for Serum bilirubin, serum albumin, and INR ratio were sent to single laboratory. Then, child Pugh score were assigned to each patient on the basis of clinical and to laboratory parameter. The ultrasound of abdomen was carried out for size of liver and spleen, portal vein diameter, and quantification of ascits. Eligible patients were subjected for upper gastrointestinal endoscopy for the presence of esophageal varices and their grading. The data was analyzed using SPSS version 19. The mean age of enrolled patients was 43.19 +/- 7.1 years. Of 88 patients, 69 [78.4%] were male and 19 [21.6%] were female. Child Pugh class relation to number of patients were; 52, 20, and 16 in class A, B, and C respectively. While Child Pugh class relation to frequency of esophageal varices were; 6, 11 and 14 in class A, B, and C respectively. Frequency of grading of esophageal varices was; 4, 13, and 14 in grade one, two, and three respectively. Distribution of large esophageal varices [LEVX] in relation to child Pugh class is one in class A, two in class B and 11 in class C. It is concluded from this study that; as the child pugh score advances, the number and size of esophageal varices increases, and chance of absence of varices decreases

frequency of impaired glucose tolerance in patients of essential hypertension in tertiary care Hospital, Larkana

To determine the frequency of impaired glucose tolerance in patients of essential hypertension. Descriptive Cross sectional study. This study was conducted at the Medical Outpatient department of Chandka Medical College Hospital Larkana, over one year period from February 2012 to February 2013. Total 171 patients of age 40-70 years having hypertension more than 2 years were purposively selected, while Known cases of DM, secondary hypertension and metabolic syndrome were excluded. Oral glucose tolerance was performed on selected patients of essential hypertension and plasma glucose was measured 2 hours after giving 75 g of glucose to each patient. Patients with [2 hours plasma glucose] level of 140-199 mg/dl were considered impaired glucose tolerance. Frequency was calculated for gender, number and type of medication and impaired glucose tolerance. The mean and SD were calculated for age, height, weight, BMI and duration of HTN. Stratification of age, gender, BMI and duration of hypertension done while applying Chi-Square with p value <0.05 as significant. One hundred and seventy one [171] patients met the inclusion criteria with mean age of 53.42 +/- 8.059 among those 104 were males [60.81%] while 67 were females [39.19%]. Duration of hypertension ranged 3-15 years with a mean duration of 7.47 +/- 3.26 years. Mean Body mass index [BMI] was 25.95 +/- 4.32, minimum BMI 17.88 and maximum BMI was 39.91. Frequency of IGT was 39.2% [n=67]. Mean serum glucose level at 2 hours in these patients was 159.33 +/- 27.937 grams/dL. Males were more affected while age has little effect on IGT frequency. More the duration of hypertension more was the prevalence of IGT. BMI was significant effect modifier for IGT; in overweight and obese patients the frequency of IGT was much higher [40.58% in overweight and 69.23% in obese] than normal weight patients [27.78%]. [p value <0.003]. IGT is much frequent in essential hypertension. Hypertensive males, elder age, longer duration of hypertension, high BMI and use of more than one antihypertensive medicine are associated with higher rates of IGT. This study suggests that all the patients with essential hypertension should be scrutinized for blood glucose levels

Experience of acute systemic lupus erythematosus in indoor and outdoor patients

The aim of this study was to determine spectrum of clinical and Laboratory diagnosis of Systemic lupus erythematosus at tertiary care unit. Descriptive type, [cross sectional]. This study was conducted at the Department of General medicine and Paediatric Medicine in indoor and outpatients CMC, Shaheed Muhatarma Benazir Bhutto University Medical Larkana from February 2010 to February 2012. We studied prospectively 44 patients with SLE who were seen consecutively either as inpatients or outpatients. All were met the American College of Rheumatology [formerly American Rheumatism Association, ARA] revised criteria for SLE and underwent medical interview as well as routine general physical examination by a researcher, and the laboratory investigations were carried out from single laboratory of Larkana, all these characteristics features of patients were collected in a protocol form. These investigations were includes the CBC, serology for ANA, anti dsDNA and urine for protienuria. X-ray chest and echocardiography was also done for pleural and pericardial effusion. Forty-four patients fulfilled the ACR criteria for SLE, most common presentation were cutaneous 30 [68.2%] cases, mucocutaneous ulceration 26 [59.1%] Fever 26 cases [59.1%], pallor 47 [67.14], cough 34 [48.57%], swelling of body 12 [17.14%], headache in 10 [22.7%] and Major physical signs were arthritis and arthralgia 30 [68.2%], Hepatosplenomegaly 20 [45.5%], generalized lymphadenopathy 12[27.3%], pleural effusion 08 [18.2%] and 02 [4.5%] patients had pericardial effusion, Raynaud's phenomenon 10 [22.7%], while direct comb test, ANA, anti dsDNA antibodies were found to be positive in 10 [22.7%], 42 [95.5%], 34[77.3%] cases respectively. Most patients presented almost universally with fever and arthralgias or arthritis in combination with malar rash or oral ulcers and in some patients a combination of all of the above was observed. A combination of positive anti nuclear antibody test, increased ESR and proteinuria were found to be a sensitive and cost effective set of laboratory findings for the diagnosis of patients suffering from SLE. The set of these clinical and laboratory features would help in the correct and early diagnosis of patients suffering from SLE, a relatively rare disease, in the busy medical outpatient and inpatient departments in our set up

retrospective analysis of road traffic accidents in Khoula Hospital, Muscat -A national Trauma Centre

A retrospective study was conducted to determine the morbidity and mortality among road traffic accident patients reported to Accident and Emergency Department, Khoula Hospital, Muscat, Sultanate of Oman. Analysis of medical records done from January 1998 to December 1999 and review of 4669 road traffic accident patients revealed that most were males [64%], adults [84%] and nationals [79%]. This study shows that the majority of road traffic accidents occurred during weekends [46%] and those accidents were more frequent in the afternoon between 2pm to 10pm [45%]. Most common injuries seen were soft tissue injuries [40%] followed by head injuries [20%]. 12% of the total admissions in Khoula Hospital were accident victims. Out of the total road traffic accident victims, 48% got admitted to the hospital with the maximum admissions to the orthopedic ward [37%]. Mortality among those patients was 3.2% and most of patients who died were adults [83%], males [79%] and nationals [89%]. Major cause of death was head injury [67%]

Assessment of elbow function after stable fixation of AO type C fractures of the distal humerus in adults

Thirty five patients AO Type C fractures of the distal humerus reporting to Orthopedic Department were studied over a period of three years from January 2000 to March 2003. Close fractures and Gustilo Grade I and II fractures were included in the study. Age ranged from fifteen years to sixty years. all the patients were operated under general anaesthesia. A comparison b/w transolecranon approach [1] and Shahane and Stanley approach [2] was done. At a follow-up of six months the results using the Jupiter's modification of Cassebaum's rating system[3]. According to it thirteen results were rated excellent, eleven good, six fair and five poor. Complications included tourniquet palsy, infection, stiff elbow and prominent hardware