Liver cirrhosis; frequency and severity of thrombocytopenia in patients

To determine the frequency and severity of thrombocytopenia in patients with liver cirrhosis. Cross sectional study. 01-03-2013 to 31-08- 2013. Liaquat University Hospital, Hyderabad. The cirrhotic patients were assessed for thrombocytopenia and its severity. The data was analyzed in SPSS version 11.00 and frequency and percentage was computed. The chi-square test was applied and p -value

Acute myocardial infarction; hypomagnesemia in patients

This descriptive case series study evaluates the frequency of hypomagnesemia in patients with acute myocardial infarction. This multidisciplinary conducted at Liaquat University Hospital Hyderabad and a private hospital Hyderabad from May 2010 to October 2010. All patients diagnosed as acute myocardial infarction were further evaluated for type of myocardial infarction and serum magnesium level. Out of 100 diabetic patients, 77 were males and 23 patients were females. The mean age and standard deviation of patients of male and female was 54.78 +/- 8.82 [SD] and 53.64 +/- 10.82 [SD], respectively. The mean +/- SD for serum magnesium in overall subjects was 1.24 +/- 0.48. Regarding the type of AMI inferior wall in 22 [29%], lateral wall in 17 [22%], anteroseptal in 12 [16%], anterolateral -V1 in 07[09%], right ventricular in 10 [13%] and posterior wall in 07 [09%]. The mean duration of acute MI in male and female population was 8.71 +/- 6.73 hours and 17.70 +/- 14.57 hours [p<0.01] where as the mean duration of acute MI in hypomagnesemic and normomagnesemic patient was 5.16 +/- 2.49 hours and 26.60 +/- 8.27 [p = 0.02] respectively. The mean serum magnesium level in male as well as female population was 1.32 +/- 0.21 mg/dl and 1.46 +/- 0.53 mg/dl p = 0.05, respectively. Regarding the hypomagnesemia in male and female population was 34[75.6%] and 16[53.3%] p=0.04, respectively. The hypomagnesemia was more predominant in inferior 18[36.0%] and lateral 16 [32.0%] wall MI. The hypomagnesemia was observed in patients with acute myocardial infarction with statistical significance

Acute myocardial infarction; serum zinc level in patients

To determine the serum zinc level in patients with acute myocardial infarction at Liaquat University Hospital Hyderabad. This six months study was conducted on the patients with acute myocardial infarction presented at coronary care unit [CCU] of Liaquat University Hospital Hyderabad. All the patients with myocardial infarction, of >/= 30 years of age and either gender diagnosed as acute myocardial infarction were admitted and evaluate for their serum zinc level by taking 2cc fasting venous blood sample on admission and at one or two day interval thereafter. The data entered, saved and analyze in SPSS version 11.00. Total 142 patients with acute MI were registered for study. Of these 92[64.8%] were males and 50 [35.2%] were females. The mean age +/- SD for male and female was 54.98 +/- 11.88 and 50.52 +/- 9.85 respectively. Regarding plasma zinc level, hypozincemia [low zinc level] was observed in 90[63%] patients, of which 53[58.9%] were males and 37[41.1%] were females while the 52[37%] subjects had normozincemia [normal zinc level]. In 33 [36.7%] patients the serum zinc was low at admission, 38[42.4%] patients had hypozincemia on 3rd day of admission while 19[21.1%] had low serum zinc level on 5th day of admission. The mean +/- SD for serum zinc level in overall population was 9.78 +/- 2.31 and the mean +/- SD of patients with hypozincemia was 7.85 +/- 3.42, whereas the mean +/- SD of patients with normozincemia was 16.85 +/- 2.53. During hospitalization the complications of acute MI identified in hypozincemic population were cardiac arrhythmias, cardiac failure, pericarditis, recurrent infarction, thromboembolism and mitral regurgitation. It is observed that serum zinc level appears to be low in patients with acute myocardial infarction

Type 2 diabetes mellitus; dental caries in patients

To determine the frequency and pattern of dental carries in patients with type 2 diabetes mellitus. Cross sectional descriptive study. Patients with history of type 2 diabetes mellitus for >/=02 years duration with >/=35 years of age and of either gender with dental pain visit at medical and dental outpatient department [OPD] of Liaquat University Hospital Hyderabad. The detail history was taken and the blood samples were taken for haemoglobin A1c [HbA1c] to assess the glycemic status. The existence of dental carries and its pattern was diagnosed through dental examination by consultant dentist had clinical experience >/=05 years. The data was collected on pre-designed proforma, entered and analyzed in SPSS version 11.00. A total of 137 type 2 diabetic patients were selected for this study, out of these 82 were males and 55 females. The dental carries was found in 98 [71.5%] patients. Out of these ninety eight, 53 [54.08%] were males and 45 [45.92%] were female. Upper molar teeth involvement was present in 46 patients and lower molar teeth were involved in 52 patients. Dentine carries was seen in 35 patients, enamel carries in 19, white spot carries in 20 patients, pulpitis in 16 patients, and pulp capping in 8 patients. Involvement of individual teeth was also assessed, the upper molar involvement was present in 32 patients, premolar involvement was present in 11, incisor involvement in 03 patients. The lower molars were involved in 28 patients, lower pre molar in 21 and lower incisors in 03 patients. Dental carries was present in 43 [43.9%] patients in patients whose duration of diabetes was between 5-10 years, whereas those patients having duration >10 years had 31.6% frequency of dental carries, while regarding duration of <5 years only 24 [24.5%] patients had dental carries. The diabetic patients are more prone to acquire dental caries

Comparison of King's College Hospital Criteria [KCH] with Model for End-Stage Liver Disease [MELD] for Predicting Outcome in Patients with Acute Liver Failure

To compare the Model for End-Stage Liver Disease [MELD] and The King's College Hospital Criteria [KCH] as early clinical prognostic indicators in patients with Acute Liver Failure. This descriptive Case series study was conducted in emergency medical wards of Liaquat University Hospital Jamshoro and Hyderabad from February 2008 to July 2010. This study included 76 consecutive patients with ALF defined as onset of hepatic encephalopathy occurring within 12 weeks of onset of jaundice. The patients using sedatives, anticoagulants or if any evidence of chronic liver disease were excluded. Laboratory workup was done from laboratory of University. MELD score of >/= 33 and presence of positive criteria for KCH category were taken as a bad prognostic indicator. The primary end point was death during hospital stay. Continuous variables were computed as mean +/- standard deviation [SD] and categorical variables as frequency and percentage. Out of 76 patients 49 were male [64.47%] and 27 [35.53%] female. The mean age of patients was 24.62 +/- 10.3. Out of 76 patients a total of 59 patients [77.63%] died during the study period. The KCH criteria cut off point was reached in a total of 63 patients [out of 76] of which 50 patients died. The MELD criteria cut off point [MELD Score > 33] was reached in 49 patients [out of 76] of which 46 eventually died.KCH predicted outcome with the sensitivity of 80% and Positive predictive value [PPV] of 89% [p=0.001]. MELD predicted outcome with sensitivity of 82.4% and Positive predictive value [PPV] of 94% [p=0.001].Viral hepatitis B was the most common cause of Acute Liver Failure. Both criteria are good predictors of the outcome in acute liver failure

Peripheral arterial disease. [PAD] in type 2 diabetic patients

The increase in prevalence of type 2 diabetes and its complication is alarming. The incidence of diabetic foot ulcers due to peripheral arterial disease, which leads to foot amputations far too often, is unacceptably high especially in developing countries. This study has been conducted to find out frequency and degree of peripheral arterial disease in type 2 diabetics having foot ulcers at tertiary care settings in Abbottabad. This was a prospective descriptive study-being conducted at Northern Institute of Medical Sciences [NIMS] and Ayub teaching hospital Abbottabad from August 2009 to June 2010. Type 2 diabetics with non-healing foot ulcers lasting longer than then days, were selected for this study by non-probability purposive sampling method. All study subjects have undergone for palpation of peripheral arterial pulses in the lower limbs. Ankle-brachial index [ABI] is the ratio of the systolic blood pressure at the ankle to that in the arm Peripheral arterial disease [PAD] was considered to be present if ABI was less than 0.90. It was further graded as mild, moderate and severe according to ABI values between 0.70-0.90, 0.50-0.69 and less than 0.49 respectively, as per recommendations of American Diabetes Association. A total of 83 type 2 diabetics with foot ulcers were enrolled during eleven months period of this study. The mean age of study subjects was 53.68 +/- 9.51 years. There were 33 [39.75%] males and 50 [60.24%] females with M to F ratio of 1: 1.51. Mean duration of diabetes was 13.67 +/- 5.80 years [ranging from 9-23 years]. Majority 57 [68.67%] of our patients were obese having poor glycemic control. Peripheral arterial disease has been fond in 35 [42.16%] patients, out of them 18[51.42%] had mild PAD as their ABI values remained between 0.70-0.90, 15[42.85%] had moderate PAD due to their ABI values between 0.50- 0.69 and 2 [5.71%] had severe PAD as their ABI values lie below 0.49. Ankle-brachial index is a non-invasive, inexpensive and office-based diagnostic tool for peripheral arterial disease in type 2 diabetics having foot ulcers, Healthcare professionals must be trained about early referral and regular feet care of these patients

Dengue infection; study for evaluation of enzyme immunoassay [EIA] test for rapid diagnosis

Dengue fever [DF] has emerged as a major public health problem across the world in terms of health cost, morbidity and mortality. The objective of our study was to determine frequency of seropositive dengue virus infection by using enzyme immunoassay [EIA] test in patients with probable dengue infection at a tertiary care hospital of Hyderabad. This crosssectional, observative, hospital-based study. Liaquat University Hospital Hyderabad. 1st June 2010 to 31st December 2010. Patients presenting with acute febrile illness [i.e. documented fever of>38°C], skin rashes with or without bleeding manifestations [petechiae, epistaxis, hematemesis, menorrhagia or malena] plus cytopenias [leucopenia and/or thrombocytopenia] on peripheral smear examination, were evaluated for probable dengue virus infection. Serologic diagnosis has been carried out by using enzyme immunoassay [EIA] test with differential detection of IgM and IgG. Out of 340 cases who fulfilled WHO criteria of probable dengue fever, 152[44.70%] were enzyme immunoassay [EIA] test reactive, while 188[55.29%] EIA non-reactive. The primary dengue infection was found in 102[67.10%] patients and secondary infection in 50[32.89%]. Among both groups, males were predominantly affected. Majority of patients were hospitalized during the month of October. In addition, large number of patients aged between 13-35 years. Only two patients expired due to dengue shock syndrome and they were suffering from secondary dengue infection. Case fatality rate was 0.3% in our study. On conclusion, early detection of primary and secondary dengue virus infections via enzyme immunoassay [EIA] being important, as it is simple and rapid diagnostic tool having high sensitivity. This is especially valuable in alleviating psychological fear, disease-progression and mortality associated with dengue fever epidemics

Urinary tract infection frequency and pattern in patients with diabetes mellitus

To determine the frequency and pattern of urinary tract infection in patients with diabetes mellitus. Descriptive case series study. February 2009 to July 2009. Department of medicine at Liaquat University Hospital]. All patients >/= 18 years of age, of either gender were known diabetes for >/= 2 years duration. The infection was labeled when>5/hpf leukocyte in urine and growth of organism on urine for C/S. The blood sugar and hemoglobin A1C [HbA1C] was also advised to evaluate the status of their diabetes i.e. control or poorly control. During study period total 150 diabetic patients were evaluated for urinary tract infection, of which 92[61%] had UTI. Out of ninety two 80[87%] had diabetes type 2 and 12[13%] were diabetes type 1. The female gender was predominant. The mean +/- SD for age of patients with type 2 and type 1 diabetes mellitus was 53.52 +/- 10.74 and 20.77 +/- 1.65 whereas the mean random blood sugar level in patients with type 2 and 1 diabetes was 232.85 +/- 5.87 and 288.99 +/- 7.87. The mean +/- SD for duration of diabetes type 2 and 1 was 4.77 +/- 2.31 and 2.56 +/- 1.42. The isolated microorganism were Staphylococcus aureus, Escherichia coli, Proteus, Pseudomonas aeruginosa, Klebsiella, Enterobacteriaceae and C.albicans. The urinary tract infection is more prevalent in patients with diabetes mellitus

MELD Era: is this time to replace the original child-pugh score in patients with decompensated cirrhosis of liver

To compare the predictive value of MELD [Model of end stage liver disease] and Child-Pugh [CP] scores in patients with decompensated cirrhosis of liver. Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007. This study included 110 consecutive patients with decompensated cirrhosis of liver diagnosed either clinically or radiologically were followed-up during hospital stay. Studied variables included demographic data, cirrhosis related complications and investigations. Patients were classified according to original CP classification into A, B and C. MELD score was estimated from serum bilirubin, serum creatinine and INR [International normalized ratio] of the patients. Duration of hospitalization and in-hospital mortality were made as the end points of the study. T-test and Chi-square test were done for continuous and categorical data. Original CP and MELD score were compared by the ROC curve. 0.05 was kept as the level of significance. There were 110 patients with decompensated cirrhosis of liver. Mean age was 46.76 +/- 12.93 years. There were 72 [65%] male and 38 [35%] females patients. Hepatitis C was the most prevalent cause of cirrhosis of liver present in 60/110 [60%] cases. Ascites was present in 93/110 [83%] patients. The mean MELD scores were 2.23 +/- 0.712 [95% CI 2.09-2.36] and for CTP 2.52 +/- 0.586 [95%; CI 2.41-2.63]. The outcome of the patients were 12 deaths [11%]; 54 [49%] remained hospitalized for up to 14 days and 44 [40%] for>14 days. The majority of deaths and prolong hospitalization were found in patients with MELD score>15 as well as with Child-Pugh grade C. The c-statistic was 0.726 [p=0.001] for CP score, and 0.642 for MELD score [p=0.021]. The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study

Scabies epidemic at Tando Muhammad Khan, Sindh

Scabies is the most common dermatosis as reported at District Hospital, Tando Muhammad Khan. Scabies has become an epidemic in the newly created District Tando Muhammad Khan previous Taluka of District Hyderabad, Sindh. To assess prevalence of scabies, to determine causes and hurdles in management of scabies. A hospital-based observational study was conducted at dermatological out-patient department of Government District Headquarter Hospital, Tando Muhammad Khan. Duration of study was six months from 1[st] January, 2007 to 30[th] June, 2007. All patients of scabies were included in the study irrespective of any concomitant disease. Patients were diagnosed clinically. During six months study period, 5484 [70.2%] patients of scabies were enrolled. Out of these, 3456 [63%] were males and 2028 [37%] females. 69% of adult males and 92% of adult females were illiterate. Over 75% adult patients belong to low socioeconomic group. Scabies was found to be very common among patients attending dermatology clinic at District Hospital, Tando Muhammad Khan. It is associated with poor hygiene, overcrowding, illiteracy and low socioeconomic conditions. Management of scabies requires special skills including health education and counseling

Validation of three non-invasive markers in assessing the severity of liver fibrosis in chronic Hepatitis C

To compare various biochemical markers i.e. APRI [AST to platelet ratio index], aspartate aminotransferase [AST] alanine aminotransferase [ALT] ratio, FIB-4 [AST, platelet, AST and age] with biopsy for assessing the severity of hepatic fibrosis in patients with hepatitis C. Study Design: Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2005 to March 2007. Consecutive hepatitis C virus RNA positive and previously untreated patients were studied. Liver biopsy with histological evaluation and AST/ALT ratio, AST to platelet ratio index and FIB-4 were assessed in all patients. Receiver operative curves were developed. There were 158 patients [109 males, 49 females]. On histological grounds non-advanced fibrosis [F0-1] was present in 74 [46.5%] of cases, whereas 84 [53.5%] patients had advanced [F2-4] fibrosis. The area under the receiver operating characteristic curves of APRI < 0.05-1 and FIB-4 < 1.45 were 0.7 and 0.74 respectively, which means that APRI < 1 and FIB-4 < 1.45 will exclude advanced fibrosis in 70% and 74% of patients respectively. An APRI of > 1 and FIB-4 will predict advanced fibrosis in 87% and 98% of patients respectively. AST/ALT ratio was inferior to both of these biomarkers. Both APRI and FIB-4 not only exclude minimal fibrosis but can predict advanced fibrosis in the majority of the patients. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy

Serum zinc and magnesium in Type-2 Diabetic Patients

To assess serum zinc and magnesium level in type-2 diabetic patients and the effect of age, gender, glycemic control and duration of diabetes on these trace elements in comparison with those of control subjects. Non-interventional case control study. Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, from October 2007 to March 2008. There were 42 diabetic patients and 42 age matched non-diabetic [control] subjects included in this study. Serum zinc, serum magnesium and fasting blood sugar measured among the diabetic and control groups and association of both trace elements were assessed with glycemic status, age, gender and duration of diabetes using SPSS version 16.0 for analysis. Serum zinc level was significantly lower [mean 2.03+0.39 mg/dL] in diabetic patients as compared to control subjects [4.84 +/- 4.217 mg/dL, p = < 0.001]. No significant difference was found in serum magnesium level with mean of 22.67 +/- 24.5 mg/dL in diabetic patients as compared to controls [18.3 +/- 3.4 mg/dL, p = 0.26]. Serum zinc level was significantly lower in type-2 diabetics, whereas no significant difference was found in serum magnesium level when compared with control subjects. There was no association of age, gender, glycemic status and duration of diabetes on the serum concentration of these trace elements in type-2 diabetic patients

Frequency of thyroid disorders during interferon and ribavirin therapy in chronic hepatitis C infection

The objective of this study was to assess the frequency of thyroid dysfunction in response to combination of interferon and ribavirin therapy in chronic hepatitis C [CHC] patients and HCV outcome. Descriptive study. This study was conducted at Outpatient Department of Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad from September 2005 to September 2007. One hundred cases of CHC, proven by anti-HCV and HCV RNA-positive with baseline TSH, FT[4] and FT[3] within the normal reference range, who were treated with interferon alpha-2b [3 million unit subcutaneously three times per week] and oral ribavirin [1000-1200 mg per day] were included in this study. All patients were assessed for TSH, FT[4], FT[3] levels at 12 weeks and 24 weeks during therapy. Among the 100 patients, overt thyroid disease developed in 13 [13%] and sub-clinical thyroid disease in 5 [5%]. Out of 13 patients of overt thyroid disorders, 11 [84.6%] had hypothyroidism and 02 [15.3%] hyperthyroidism. Four [80%] patients were of sub-clinical hypothyroidism and 01 [20%] patient was of sub-clinical hyperthyroidism. Overall, thyroid disorders developed in 18 [18%] both as overt and sub-clinical thyroid disorders. Ninety one [91%] patients became negative by HCV RNA. Treatment of HCV with IFN-alpha and ribavirin can be safely continued in patients with over and sub clinical hypothyroidism because thyroid disease responds well to treatment