Comparison of treatment of chronic obstructive pulmonary disease [COPD] by family physician and consultants

The goal of the study is to determine whether care for COPD patients is more consistent with guidelines when a Consultant rather than a Family Physician treat the patients. We use the Global Initiative for Obstructive Lung Disease Guidelines as a standard 1. We studied seven parameters, offering Pulmonary Function Test, Smoking cassation guidance, vaccination, use of oral steroid, inhaled steroids, inhaled Impratropium bromide, and symptom documentation. We concluded that both Family Physicians and Consultants are not fully following the guidelines. In compression Consultants are better than Family Physicians

Profile of patients presenting with heartburn and treatment of erosive esophagitis with esomeprazole- an experience

It's a descriptive analytical study done at Lahore Gut and Liver Centre during March 2005 to February 2006. 260 patients who presented with heartburn were included in the study. Their symptoms are recorded and graded a/c to severity. Upper GI Endoscopy done to grade the mucosal injury a/c to LA Classification. First forty patients who were having Erosive Esophagitis were started on Esomeprazole 40mg once daily. Patients reviewed after every 2 weeks for symptom improvement and adverse events. After 8 weeks UGIT Endoscopy repeated to see mucosal improvement in those patients in which mucosal break was recorded at the start of therapy [a/c to LA Classification]. Dose increment to 40 mg twice a day made, if no symptomatic improvement in 2 weeks. 260 patients in the range of 16 to 75 years, with mean age 37 years, with male to female 1:1.4, mean BMI 29%. 40% were smokers and 10% taking regular Alcohol [25 units/week], 12% got DM. 3% got Chronic Liver Disease due to HCV infection. Regurgitation 75%, Nausea/Vomiting 30% Chest Pain. 20% dysphagic 10%, water brash 60%, Epigastric pain 30%, Early Satiety 35%, Bloating 20%. 95 patients [36.53%] had Erosive Esophagitis; 155 patients [59.6%] no evidence of mucosal injury; 10 patients [3.84%] got Barret's Eshophegitis. First forty patietns who showed Erosive Esophagitis has age range of 16-60 years. 38 patients completed the therapy, 2 patients lost to follow up. Main age was 35 years with male to female ratio of 1.2:1.45% patients were smokers, average BMI of 30. An improvement trend in symptoms by at least 2 levels a/c scale was seen in 20% in 2 weeks, 50% by 4 weeks and 95% by 8 weeks. At the end of study [8 weeks] improvement in mucosal change is 100%. The adverse events noted are bloating 45% and loose stools and headache 20% each. Various overlap symptoms are common in GERD. Endoscopic negative GERD is common, Esomeprazole is effective in GERD

Adverse effect profile of patients receiving anti viral treatment for chronic hepatitis C virus infection

Chronic hepatitis C virus infection is present in 3 - 10% of Pakistani population and genotype 3 is the most prevalent subtype in our patients. In a suitable candidate interferon along with Ribavirin is the main stay of treatment for these patients. These drugs have short as well as long term safety problem. Morbidity and frequency of discontinuation of therapy correlate directly with the frequency of adverse events while on treatment. This observational study has been conducted to find out the adverse effect profile of anti viral treatment for our Chronic HCV patients. From 1st March 2005 to 30th March 2005, 100 consecutive patients suffering from chronic HCV infection receiving standard interferon alpha 2 b and ribavirin were included. All of them were inquired on a questionnaire about the adverse events and then analyzed. In as many as 65% of the patients receiving anti viral treatment complained of an adverse event. The events were in the form of Flu like symptoms, abdominal pain, sleep disturbance, lack of appetite, dry cough and breathlessness, Depression, persistent fever, anemia, thrombocytopenia, neutropenia and skin rash. A high number of pts receiving anti viral treatment for ch. HCV infection suffer from adverse events