arrhythmias and their outcome in acute myocardial infarction within 24 hours

Background: this study was done to determine the types and outcome of various arrhythmias in Acute Myocardial Infarction within first 24 hours: It was a descriptive study. The study was conducted at Department of Medicine and Coronary care, Bahawal Victoria Hospital, Bahawalpur, from June 2007 to June 2008

Patients and Methods: one hundred cases, both male and female suffering from Acute Myocardial Infarction admitted within first 24 hours were selected for study. The inclusion criteria were age of 20 years and above myocardial infarction, confirmed by ECG and cardiac enzymes. History, clinical examination, and various investigations. were documented The type of arrhythmias, type of Myocardial infarction in relation to age, sex and their outcome was observed and recorded

Results: the age range of patients included in this study was between 20 to 80 years [mean 50 +/- 29.8 years]. The patients included 74 [74%] males and 26 [26%] females. Out of these, 64% patients developed arrhythmias during first 24 to 48 hours. Tachyarrhythmia's occurred in 42 [65%] cases and included supraventricular tachycardia in 12 [18.7%], premature contractions in 11 [18.7%], ventricular tachycardia in 10 [15.7%] and Junctional Tachycardia ii"] 3[4, 6%]. Brady arrhythmias were observed in 22 [35%] patients with complete heart block in 4[18%] cases, 1st and 2nd degree heart blocks in 6[27%], bundle branch blocks in 9 [4.06%] arid one [1 .5%] Sino-atrial. Block. Majority patients [80%] with anterolateral infarction, 75% with lateral. Wall infarction and 72% with inferior wall involvement developed arrhythmias of these cases of acute myocardial infarction that developed arrhythmias 16 [23.5% died

Conclusion: the study concludes that AMI involves dominantly males and 64% of patients developed arrhythmias with 1st 24 hours. Tachyarrhythmia were more common [65%] ·and mortality rate was 23.5% during first twenty four hours of AMI due to arrhythmias

Ascites-a presentation of cirrhosis

Background: the objective of this study was to determine the etiological diagnosis in patients presenting with ascites and to study various modes of clinical presentations as well as the frequency of Hepatitis Band C in patients with liver cirrhosis. It is a descriptive study. The study was performed in the medical department at Bahawal Victoria Hospital, Bahawalpur from 1st December, 2006 to 31st May, 2007 for six months

Subjects and methods: all the patients admitted in the medical wards with confirmed ascites were sorted out for different etiologies. The patients suffering from hepatic encephalopathy, intestinal obstruction and perforation, appendicitis and pregnancy were excluded. A detailed history, clinical examination and laboratory investigations were documented. Ascetic fluid drawn with proper aseptic technique was examined for biochemistry, microscopy, culture and sensitivity as well as cytology. Data was analyzed using SPSS 10.0

Result: a total of 50 patients with ascites [37 males and 13 females, mean age 58.8 +/- 15.9 years] were studied. Liver cirrhosis accounted for 84% of cases [hepatitis B cirrhosis 38% , hepatitis C cirrhosis 42% and both 4%] followed by tuberculous peritonitis 6% , malignancy 6% , and congestive heart failure 2% , and nephrotic syndrome 2% . Other presentations were gastrointestinal bleed 50% , fever 40% , Jaundice 14% , breath less ness 8% and 2% were asymptomatic

Conclusion: the results conclude liver cirrhosis's as the most common cause of ascites. Hepatitis B and C infections are playing this havoc role. The other common clinical presentations were gastrointestinal bleeding, fever, and jaundice

Outpatient services during [1423h] Hajj season

To analyse the pattern of patients attending the Out Patient Department [OPD] during the Hajj season 1423H with respect to their age, sex, nationality, services provided to them, and most importantly the disease trends and the medication given. A descriptive study was done at the OPD department in Al-Noor Specialist Hospital, Holy Makkah for the 15 days period of the Hajj, i.e., 1-15 /12/1423 corresponding to 2-16/ 02/2003. All patients who arrived at the OPD during that time whether on Hajj or non-Hajj and those who registered at OPD service became part of our study. With the help of standard "Blue Form"[provided annually by Ministry of Health exclusively for the OPD patients for every Hajj season], their age, sex, nationality, clinics attended, diagnosis and medications were noted. The results revealed that 3876 patients arrived and 3856 got registration at OPD. Of the registered cases, 1282 [33%] were Hajj patients and of those 873 [22%] were males. The Hajj patients were mostly non-Saudi [30.8%]. The majority of patients, 384 [26.1%], were from the Middle East. The largest category, 240 [6.2%], of Hajj patients were in the age range 51-60 years. The medical clinic was the one attended by the maximum number of patients, 1675 [43.4%], and respiratory disease cases, 1582 [41%], were the commonest. Single medication as monotherapy accounted for 3644 [94.5%] of patients. Non-Hajj patients were in the majority at OPD. Respiratory diseases were the commonest complaints. This study highlights a precarious situation during the Hajj where cross-infection proliferates in a dense population. Effective services and preventative measures need to be contemplated in the light of the present finding

Plasma cell leukemia

Plasma cell leukemia is a rare disorder. A case of 45 years old male, admitted with the complaints of generalized weakness, dizziness, recurrent epistaxis and swelling in front of his neck but not lymphadenopathy or hepatosplenimegaly. There were 24% plasma cells on peripheral film. Skeletal survey did not show any lytic lesions. Cell markers were positive for CD-38 but negative for CD-56. This favours the diagnosis of primary plasma cell leukemia

Critical review of subjects diagnosed as road traffic accident [RTA] at AL-Noor Sspecialist Hospital

Objective To analyze and evaluate the management of RTA subjects received by Emergency room [ER] in relation to time, treatment and outcome. Duration and place of study This descriptive study was conducted over a period of 8 months i.e. March 15, 2002 - November 6 2002 at Al Noor Specialist Hospital, Holy Makkah KSA Material and methods Total subjects labeled as RTA by Accident and Emergency department staff and admitted were 684 for this non seasonal period i.e. March 15 2002 - November 6, 2002 Those who were coded as RTA according to ICD-10 by Medical Record Department [MRD] were 100 Data of all RTAs [n=100] collected was analyzed and results elaborated Results The results of 100 RTAs show that there were 81 males and 62 were Saudis The outcome of the patients was 86 percent got improved and only 7 patients died. Most of the patients 35 were referred to orthopedic ward, 54percent of cases stayed for 13 days in wards In ER majority [36%] stayed up to 6 hours and 4 percent stayed more than 6 hours Conclusion During this non seasonal period the ER department is not extremely busy There were 684 cases of RTAs [86 RTAs per month] brought to ER at Al Noor which indicates that serious cases are received all year round and arrangements should be made to cover such services