To study the relationship of caffeine elimination and Child's Pugh classification in groups of patients with liver cirrhosis

Serum Caffeine clearance determination is a useful method to evaluate the severity of liver disease and predict short-term survival of cirrhotic patients. Caffeine concentrations correlated well with the score indicating the sufficiency of the organ according to Child- Turcotte classification score. It offers another choice for the quantitative measurement of liver functional reservoir. Study is designed to find out the relationship of Caffeine elimination and child's classification in groups of patients with liver cirrhosis. Cross sectional Study. The study was conducted at the Medical Ward of Services Hospital Lahore from July 2004 to December 2004. Forty patients with liver cirrhosis with age range 40-55 years and 20 aged matched normal healthy volunteers were enrolled in this study. Patients were taken from the medical ward of Services Hospital Lahore. After an overnight fast, the first blood sample was collected at 8 a.m., immediately followed by an oral administration of 200 mg Caffeine. Subsequent samples of venous blood were obtained at 8.30 a.m., 9 a.m., 11 a.m., 2 p.m. and 5 p.m. The Caffeine clearance was determined by reversed-phase high pressure liquid chromatography using a Phenomenex Gemini C18 column using a wavelength of 273 nm. [Jaundice presented with highest frequency distribution and percentages. This was followed with ascities, edema. Family history of hepatitis/jaundice and anemia. Ultrasonographic findings showed that in 50% of the patients. Other 50% of patients have normal and shrunken liver]. Caffeine concentration in child class A was significantly decreased at base line [P<0.001], 3 hours [P<0.05], 6 hour [P<0.001] and 9 hour [P<0.001] as compared to the controls. In child class B the Caffeine concentration was significantly to the controls. On the other hand in child class C the Caffeine concentration was remaining same as in their controls. Caffeine clearance could provide a practical assessment of hepatic function in cirrhotic patients. Our data emphasize the value of the child-Turcotte or child-Pugh classification in assessing the severity of liver cirrhosis in a simple and less time-consuming way than using quantitative liver function tests

Comparison of prophylactic ephedrine against prnephedrine during spinal anesthesia for caesarian sections

The objective of this study was to compare the hemodynamic effects of use of prophylactic intravenous ephedrine with ephedrine use on as needed basis in patients receiving spinal anesthesia for caesarean sections. A double blind, randomized, comparative trial. Department of Anaesthesiology, Critical Care, and Pain Management, Shifa International Hospital Islamabad. October 2007 to March 2008. Seventy patients were recruited who were scheduled to receive spinal anaesthesia for C-section. The patients were randomized into two groups [A and B]. In patients of Group A [control group] ephedrine was used to treat hypotension when indicated, while in Group B [intervention group], patients received prophylactic ephedrine soon after the subarachnoid block. Hemodynamic changes were recorded and the data was analysed. In Group A, the blood pressure dropped in a higher number of patients [23 [65.7%]], as compared to Group B [6[17.1%]]. This difference was statistically significant [p<0.001]. Prophylactic ephedrine is better than ephedrine prn in prevention of hypotension in patients receiving spinal analgesia for C-Section

Comparison of CEA and CA 19-9 with CA 72-4 in patients with upper gastrointestinal carcinomas in local population

Gastrointestinal carcinomas are amongst the most common malignancy showing an annual increase globally. In our population, there is an increase in GIT carcinomas over the years and these are occurring at a much younger age. Tumour markers are molecular substances produced by all tumour cells which are excreted in body fluids or present on the surface of the cells. CEA, CA 19-9 and CA 72-4 are tumour markers for GIT carcinomas. The study included patients of upper GIT carcinoma and controls of both sexes and all ages. Each category included about 30 blood samples. Serum of each sample was evaluated for tumour markers CEA, CA 19-9 and CA 72-4. The estimations were made by using ELISA/EIA. The t-test and ANOVA were performed for comparison of means, specificity and sensitivity of each marker were also calculated. Showed that in our population GIT carcinoma is common in younger age group. Sensitivity of CEA, CA 19-9 and CA 72-4 is 63.33%, 50% and 63.33% respectively whereas specificity of these markers are 60%, 93.33% and 100% respectively in upper GIT carcinoma. CA 19-9 is tumour marker of choice for pancreatic carcinoma and CA 72-4 for gastric carcinoma

Management of HELLP syndrome

We present here successful management of a patient of severe HELLP syndrome, secondary to retained products of conception [POC's]. The management of our patient started just after her presentation in the emergency department of our hospital. Clinical history of post-partum bleeding, fits and confusion, along with deranged laboratory investigations lead us to an aggressive management plan, conducted by a team of healthcare professionals and the patient was saved

role of activated clotting time in heparin administration for cardiopulmonary bypass

In the prebypass preparation of patients it is crucial that heparinization is adequate. Confusion reigns in the literature as to heparin regimen and appropriate levels of heparin effect as measured by the activated clotting time [Hemochron]. We studied 40 patients and measured activated clotting time [ACT] values after two different dosage regimen, i.e. 300 units/kg body weight of heparin [20 patients] or 15000 units/m2 of heparin [20 patients]. At the end, heparin was neutralized with 3 mg/kg body weight protamine sulphate in all 40 patients, regardless of the total heparin dose. Thirty two% of patients had ACT levels less than 400 seconds prebypass who received heparin in the dose of 300 units/kg body weight. From this study it is concluded that that the opitmal loading dose of heparin be 15000 units/m2 and ACT levels be monitored every half hour while on cardiopulmonary bypass