ABSTRACT
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
ABSTRACT
To determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis. This Descriptive case series study was conducted in Medical Department of Liaquat University Hospital Jamshoro / Hyderabad from 3rd January 2009 to 16th June 2009.This study included 74 consecutive cases of cirrhosis of liver of either sex above 14 years of age. Firstly, resting ECG was done in all the patients. QTc values were calculated from lead II. QTc interval of > 0.44 sec were considered as prolonged. Systolic dysfunction was assessed by ejection fraction [value of >55% was considered as increased]. Diastolic dysfunction manifested by reduced E/A ratio [< 1 was considered as decreased]. Thirdly, all patients had determination of proBNP levels. The presence of cirrhotic cardiomyopathy was confirmed by abnormal ECG or echocardiography, along with proBNP abnormalities. Statistical package for social sciences [SPSS[TM]] version 16 was used for data processing purpose. Means +/- Standard Deviation of age and pro BNP levels were calculated. Frequency and percentage were computed for cirrhotic cardiomyopathy in cirrhosis patients. A total of 74 patients were selected for this study, out of which 41 [55.41%] were male and 33 [44.59%] were female. The mean age was 46.2 years [ +/- 10.8 SD]. Out of 74 patients 9 [12.2%] belonged to child Pugh A, 29[39.2%] to child-Pugh B and 36[48.6%] in child-Pugh C. Elevated pro BNP was present in 42[56.8%] cases, E/A ratio < 1 in 15 [20.3%] cases, prolong QT interval [>0.44sec] in 16 [21.6%], Ejection fraction [EF] >/= 0. 55 was present in 25 [33.8%] patients. Cirrhotic cardiomyopathy was present in 33[44.6%] cases. A strong relation was found between cardiomyopathy and severity of cirrhosis of liver [p=0.001], pr0-Bnp levels [p=0.003], QTc > 44 sec [0.004], Ejection fraction > 55% [0.004] and E/A ratio < 1 [p=0.005]. Cirrhotic cardiomyopathy was present in a sizeable proportion of cirrhotic patients, more so in the later stages of cirrhosis of liver
ABSTRACT
Objective: To determine the prevalence of primary and secondary drug resistance to first line anti-tuberculous drugs. Study Design: A hospital-based cross-sectional observational study. Place and Duration: Department of Medicine Liaquat University Hospital Hyderabad/ Jamshoro and Institute of Chest Diseases Kotri from April 2005 to March 2007
Patients and Methods: Fifty cases of Pulmonary tuberculosis [TB] randomly selected from both institutes who fulfilled the following criteria 1] Sputa showed positive smear for Acid Fast bacilli on Zeil Nelson Stain. 2] Chest x-ray showed shadow consistent with TB. A detailed history, contact with TB patients, previous use of anti-tuberculous drugs and Chest x-ray was done. Sputa of all patients were sent for detail report and culture sensitivity. Descriptive and inferential statistical analysis was performed using SPSS version 14.0
Results: Among 50 patients, 28[56%] were males and 22[44%] females, age ranged from 16-80 years [38.14 + 15.69]. All 50 [100%] patients presented with fever and cough, haemoptysis in 36 [72%], chest pain in 9[18%] and dyspnea in 11[22%] cases, anemia in 39[78%] and lymphadenopathy in 12[24%]. On chest x-ray examination, 19[38%] patients had multiple infiltrations, cavitations in 10[20%], fibrosis in 9[18%], consolidation in 5[10%], pneumothorax in 4[8%] and pleural effusion in 3[6%] cases. Sputum for AFB was positive in all cases. Twenty-one [42%] culture positive patients were of primary resistance and 29[58%] were of secondary resistance. Twenty [40%] were sensitive to five drugs, 9[18%] resistant to one drug, 11[22%] to two drugs, 7 [14%] to three drugs, 3[6%] to four drugs and none resistant to five drugs
Conclusion: In our setting, the prevalence of resistance to anti-tuberculous drugs is high and alarming. Strategy should be made for proper treatment and compliance of patients to avoid the development of drug resistance