Diagnostic Accuracy of Electrocardiography in Diagnosis of Left Ventricular Hypertrophy

To determine diagnostic accuracy [in terms of sensitivity, specificity, positive predictive value and negative predictive value] of electrocardiography for left ventricular hypertrophy [LVH]. Cross sectional validation type. Pakistan Institute of Medical Sciences [PIMS] from 1 January 2013 to 30 June 2013. A cross-sectional study was conducted at department of cardiology. Two hundred and fifty hypertensive patients, both male and female were included in the study. The data was collected by non-probability, purposive sampling. A performa was filled indicating their bio-data, history and clinical examination. All the patients were then subjected to 12 lead electrocardiogram [ECG] and echocardiography to detect LVH. Sokolow Lyon product index and Cornell product index was calculated on ECG to detect LVH. Data was analysed using SPSS 11. Out of 250 hypertensive patients, a total of 110 [44%] patients had LVH by echocardiography Out of these 110 patients, 60 [54.5%] patients had both positive Sokolow Lyon and Cornell product indices and 50 [45.5%] had negative both Sokolow Lyon and Cornell product indices. The calculated sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of combined Sokolow Lyon and Cornell product indices were 54.5%, 97.9%, 95.2%, 73.3% and 78.8% respectively. The ECG criteria of combined Sokolow Lyon and Cornell product indices had a high specificity and PPV for the detection of left ventricular hypertrophy using echocardiography as a gold standard. However ECG has low sensitivity and NPV for LVH and hence is not a reliable screening tool for detection of LVH

Dyslipidaemia in Newly Diagnosed Diabetic Patients with and without Microalbuminuria

To determine the association of dyslipidemia in newly diagnosed diabetic patients with and without microalbuminuria. Cross sectional study. The study was conducted from December 2009 to July 2011 at Medical Unit 1, Pakistan Railway Hospital, Islamic International Medical College [IIMC] Rawalpindi. A cross sectional study was carried out in Medical Unit 1 Pakistan Railway Hospital Rawalpindi. The newly diagnosed diabetic patients i.e. the patients who have not yet been given any treatment, of both genders, without overt-proteinuria were included in the study. A proforma was filled indicating their bio-data, history and clinical examination and laboratory investigations which included fasting blood glucose, urinary albumin and lipid profile. If albumin was negative with dipstick, a sample of urine was sent for microalbuminuria. Frequency of dyslipidaemia in patients with and without microalbuminuria was determined. Out of the 317 newly diagnosed diabetic patients screened for microalbuminuria, 43 patients [13.5%] had microalbuminuria while 274 patients [86.6%] did not have microalbuminuria. Out of these patients with microalbuminuria, 58.8% [i.e 24] of patients had dyslipidaemia. Among microalbuminuria negative patients only 36% [i.e101] of patients had dyslipidaemia. The dyslipidemia, occurs more frequently in newly diagnosed diabetics who have micro-albuminuria than those without micro-albuminuria

Frequency of latent tuberculosis among diabetics and non-diabetics

To determine the frequency of latent tuberculosis among diabetics and non-diabetics. Adescriptive cross sectional study. At Unit II, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi from October 1,2009 to March 30,2010. Across sectional study was carried out in MUM, BBH Rawalpindi. All patients, male and female, both diabetic and non diabetic, above the age of 18 years, presenting in Out-Patient department for regular check up or follow up were included in the study. Mantoux test was carried out in all patients to find out the frequency of latent tuberculosis in diabetics and non diabetics. A total of 286 patients were initially inducted in the study. However by the end of study, 20 patients dropped out as they lost follow up. So 256 patients were finally included in the study. Amongst them 131 were diabetics i.e., 51.2% and 125 were non diabetics i.e., 48.8%. One hundred and seventeen were male i.e., 45.7% and 139 were female i.e., 54.3%. Mantoux test was carried out in all patients both diabetic and non diabetic. Out of 256 patients Mantoux test was positive in 33 patients i.e., 14.8%. Among diabetics Mantoux test was positive in 27 patients i.e., 10.5%. While among non diabetics Mantoux test was positive in 11 patients i.e., 4.3%, with a p value of .008.This shows that latent tuberculosis is more common in diabetics than non diabetics. Latent tuberculosis is more common in diabetics than non diabetics. Treatment of latent TB in diabetics may have a beneficial impact on TB control

Headache: a useful clinical feature in detecting serious underlying cause

To examine the utility of clinical features in detecting serious underlying causes of headache in patients presenting to an emergency room. Descriptive Observational Study. Pakistan Railway Hospital spanning over a period of one year from July 2010 to June2011. Medical records of the patients attending the Emergency Room with headache as the major complaint were studied. 312 patients presented to ER with a complaint of headache. Of these 7.7% [n=24] had malignant headache and 92.3% [n=288] had benign headache. One hundred and ninety six patients [62.8%] were women and 116 [37.2%] were men. In males there were 86.2% patients with benign headache and 13.8% with malignant headache. While in females 94.9% had benign and 4.1% malignant headache. Ninety percent of patients had altered consciousness at presentation proved to have malignant cause for their headache. This figure was 91% for limb weakness, 100% for papillary and gaze abnormalities, 89% for extensor plantar response, and 85% each for papilledema and neck rigidity. Females present at younger age with headache and tend to have benign than malignant headache in majority of cases. Males present at relatively older age and tend to have malignant than benign headache in majority of cases. Younger patients presenting with headache usually have benign and elderly patients usually have malignant illness as the cause of their headache. With a good history and thorough physical examination Imaging like CT Scan and MRI can be avoided