Epidemiological survey of varicella-zoster infection in faisalabad city v/s various adjoining areas of faisalabad in 2017

Objective: To study the distribution and frequency of Varicella infection and the influence of socioeconomic status or facility of better health care on the outcome of infection in Faisalabad city and its periphery

Study Design: An Epidemiological Survey

Setting: It was carried out at Allied Hospital Faisalabad

Period: Cases presented from Faisalabad city and its peripheral areas, from January to October 2017 were included

Sample Size: Overall 323 patients, irrespective of the time of their presentation since the appearance of varicella rash, were included in this survey

Methodology: Data was analyzed and concluded in Statistical Package for the Social Sciences [SPSS] version 17

Result: Total of 323 cases was reported all over the district Faisalabad in 2017, out of which 206 [64%] cases were from Faisalabad city and remaining 117 [36%] were from adjoining areas [Tehsil] of Faisalabad. They were then distributed according to the day of their presentation in Teaching Hospital, which reveals that among 44 late presenters only 18 [41%] cases were reported from Faisalabad city while remaining 26 [59%] cases were from peripheral areas [Tehsils] of Faisalabad. Out of 279, those who presented to the hospital early, only 5 [1.8%] cases were expired, as compared to 4 [9.1%] cases among 44 late presenters

Conclusion: Varicella infection is more common in urban areas, which are more densely populated. While the proportion of deaths among infected people is higher among those who dwell in peripheries, away from the better healthcare facilities

Role of branched chain amino acids in hepatic encephalopathy

Introduction: Hepatic encephalopathy [HE] or portosystemic encephalopathy is a state characterized by disordered central nervous system functions because of failure of liver to detoxify nitrogenous agents originating from gut because of dysfunction of hepatocytes and portosystemic shunting. Patients with HE often present alteration of mental status varying from minor psychological abnormalities to deep coma. Multiple studies conducted worldwide suggest that the branched-chain amino acids [BCAAs] leucine, isoleucine, and valine may be useful in improving survival and reducing morbidity in patients with HE

Objectives: To compare the efficacy of branched chain amino acids in reversal of hepatic encephalopathy in patients with cirrhosis of liver with placebo

Study Design: Randomized control trial Setting: Medical Unit V, DHQ Hospital Faisalabad

Duration: Study was carried out over a period of 6 months from 1st July 2016 to 30 December 2016

Results: A total of 60 patients [30 in each group] were enrolled, majority of the patients were between 41-50 years in both groups, 36.67% [n=11] in Study and 43.33% [n=13] control group, mean and standard deviation of age was calculated as 43.56+/-5.21 in study and 45.78+/-4.98 years in control group, 70% [n=21]patients were male in study group and 63.33% [n=19] in the control group, 30% [n=9] patients in study group and 36.67% [n=11] in control group were females, comparison of efficacy of BCAAs in reversal of HE with placebo reveals 63.33% [n=19] patients in study group showed reversal of HE and 26.67% [n=8] patients in control group

Conclusion: The results of the study conclude that branched chain amino acids are significantly effective in reversal of hepatic encephalopathy when compared with placebo.

Frequency of carotid artery stenosis in ischemic stroke

Stroke continues to be a significant cause of morbidity and mortality throughout the world. According to the world health organization, 15 million people suffer stroke worldwide annually. Despite maximal medical management, carotid artery atherosclerosis leading to stenosis continues to portend a poor prognosis. Conservative management frequently fails in this disease, leaving patients at high risk for cerebral infarction and death

Objective: To determine the frequency of carotid artery stenosis in patients with stroke using Doppler Ultrasonography

Study design: cross-sectional analytical study

Setting: outpatient and emergency department of Medical Unit-I, Allied Hospital, Faisalabad

Duration of study: Study was carried out over a period of seven months from 01-03 2014 to 30-09-2014

Subjects and methods: A total of 100 cases were included in this study. Every patient was undergone a list of investigation including lipid profile, electrocardiography [ECG], X-ray chest [PA], computed tomography [CT] scan brain and echocardiography to rule out any cardiac source of embolism

Results: Out of 100 cases, 12 patients [12%] were between 18-40 years old, 34 patients [34%] were 41-60 years of age while 54 patients [54%] were 61-80 years old. Mean age of the patients was 51.9 +/- 5.1. Regarding gender distribution, 62 patients [62%] were male and 38 patients [38%] were female. Of 100 patients, 56 patients [56%] had carotid stenosis on color Doppler Ultrasonography of carotid arteries. 29 patients [51.8%] had mild stenosis, 17 patients [30.3%] had moderate stenosis and 10 patients [17.9%] severe stenosis

Conclusion: It is concluded that carotid artery stenosis is strongly associated with ischemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke

Non contrast CT evaluation of lumbar pain presenting in medical emergency

Objective: To evaluate the value of non contrast CT in patient with lumbar pain

Methods: 1432 patient with lumbar pain, presenting in Medical emergency of Allied Hospital were taken, all of them under went Ultrasound abdomen and CT Abdomen. CT abdomen was conducted on optima 660, 128 slice CT scanner

Results: CT showed that out of 1231 patients 998 had either of multiple renal, ureteric and / or vesicle stones. 110 had normal scan and 123 had alternate or incidental diagnosis. Patient with multiple pathologies were excluded from the study which was 201 patients

Conclusion: In comparison with ultrasound CT was superior in detecting Ureteric stones and more correct in renal stones. CT was also superior in detecting alternate or incidental diagnosis

Prolongation of QTc duration and increased heart rate in patients with cirrhosis of liver

Objective: To compare QTc duration and increasedheart rate in patients with cirrhosis with noncirrhoticcontrols

Design: Cross-sectionalanalytical study

Place and Duration of Study:Medical Unit 1 Allied Hospital Faisalabad between1st March 2011 to 30th August 2011

Patients andMethods: 50 patients of cirrhosis were selected inGroup-I. An equal number of non-cirrhotic patientswere taken as control and were included in Group-II. ECG was recorded and Heart rate[HR] and QTcinterval was calculated in both the groups.Comparison of increased prolongation of QTc andHeart Rate were done using independent samples ttest with significance level at 0.05

Results: Fiftypatients of cirrhosis of liver were inducted in Group-I with same number of non-cirrhotic patients ascontrol in Group-II. The mean +/- SD of QTc ofGroup-I was 0.472 +/- 0.012 sec and that in Group-IIwas 0.434 +/- 0.014 sec and that for HR in Group-Iand II were 79.26 +/- 10.08 and 74.24 +/- 7.58beats/min respectively. The mean QTc and HRvalues were significantly more in Group-I ascompared to Group-II with p value = 0.0001

Conclusion: Means of both HR and QTc weresignificantly higher in cirrhotic patients as comparedwith non-cirrhotic controls

Arterial phase CT for early detection of HCC in cirrhotic patients

Objective: To know the effectiveness of EarlyArterial phase CT in detecting the small focusof HCC in Cirrhotic Patient

Material andMethods: 135 patient of Cirrhosis werescanned on a Multislice CT scanner with boluschase contrast tracking. All the patient had amass lesion on Ultrasound. Inclusion criterionwas a solitary lesion in the liver. The patientwere scanned in arterial phase, Portal venousphase and delayed phase CT. The scans weredone with an injector using a 100 ml of contrastvolume with the flow rate of 3.5ml / sec

Findings Total lesions identified on scans were210 on early arterial phase of the imaging. 145in portal venous phase and 142 in delayedphase. 43 patient showed multiple lesions -31.8%. That is to suggest that ultrasoundpicked less lesions as compared to CTMaximum number of 210 lesions wereappreciated in early arterial phase of the CT

Conclusion: Early Arterial phase CT is betterfor early detection of smaller sized HCC

Diagnosing gossypiboma of abdomen

1. To analyze the imaging findings of Gossypiboma [Retained intra abdominal post operative sponge]. 2. To propose the surgeons with a solution. Five proven patients, from June 2001 till June 2006 with intra abdominal sponge after various operation were retrospectively evaluated for the findings on plain x ray, ultrasound and CT scans. Findings found on various modalities are as under Simple X-ray findings were normal in one patient [20%], showed haze in one patient [20%] and specks of contained air in three patients [60%]. Ultrasound findings were of a mass with echogenic area having acoustic shadowing, three patients had surrounding thickened walls and two had surrounding free fluid. T showed air filled mass in four patients with unusual pattern of air in 1 patient and all five of them had surrounding fat stranding surrounding the air filled mass. Among imaging modalities CT is the best modality if there is suspicion of retained sponge/guaze. It is highly recommended that during surgical procedure such things should be slightly soaked with aseptic iodinated contrast so that imaging features are readily accepted by all, including the surgeons or newer version of guaze piece with small internal metallic strip should be used