Eradication of H. Pylori by quadruple or triple therapy.a comparative study

Quadruple therapy appears to be more effective than standard therapy in management of patients with helicobacter pylori infection. No data is available on the relative efficacy of triple and quadruple drug regimens from Pakistan. Consecutive patients with peptic ulcer and H. pylori infection were randomized to receive omeprazole 20 mg twice daily along with either amoxycilline [500 mg four times daily] and clarithromycin [500 mg twice daily] [Group A] or tri-protassium dicitrate hismuthate [120 mg four times daily], metronidazole [400 mg thrice daily] and tetracycline [500 mg 4 times daily] [Group B] for 10 days. Presence H. Pylori infection was looked for using an fecal antigen test before treatment and 30 days after completion of treatment. 17 of 21 patients in Group A and 16 of 23 in Group B had eradication of infection [80.9 and 69.56% respectively by protocol analysis]. Side effects occurred in 2 [1%] and 4[2%] patients in Group A and B, respectively. Discontinuation of drug was not required in any patient. Quadruple therapy for initial therapy of H. Pylori infection does not offer any advantage over standard triple therapy

Siriraj score as a tool for clinical diagnosis of stroke

Siriraj stroke score is a diagnostic tool to differentiated ischemic from haemorrhagic shock. This study was carried out to access SSS accuracy as compared to CT scan. This study was carried out in the Department of Medicine and Neurology of Mayo Hospital, Lahore. Thirty two patients were included in the study who had stroke SSS was applied as well as CT scan was done. Out of them 6% were misdiagnosed. Overall predictive accuracy was 87.5%. Siriraj stroke score is not 100% accurate. CT scan should be advised before starting definitive stroke therapy

Causes and outcome of suicidal cases presented to a medical ward

Suicide is one of the leading causes of death in world but its causes and methods may vary. We enrolled patients who presented to the emergency with attempted suicide. The end point was death, discharge or leaving the hospital against medical advice. The study was designed to know the modes of committing suicide and underlying causes. Of the total 107 patients, who presented to the emergency 59 [55%] were males and 48 [45%] were females. Most common poison ingested was wheat pill in 35 [33.3%] patients followed by bleach/bathroom cleaner in 27 [25.7%], benzodiazepines in 20 [19%] and a small proportion of patients had copper sulfate, organophosphorus compounds, rat pills, lice powder, dettol and varnish. Two patients presented after hanging. Twenty eight [26%] patients died, just after reaching hospital and 10 had permanent disability. For suicide the most common poisons used were those that were easily available and without any ban on their sale. So general awareness should be created among masses about them and legal restrictions should be imposed on their sale

audit of indoor morbidity and mortality in a medical ward at a tertiay care, hospital

There is a great geographical variation in disease burden around the world, which is due primarily to environmental, genetic, social and economic factors. Similar variations exist in worldwide mortality figures from a particular disease that can be attributed almost entirely to the access and efficacy of healthcare facilities. We did this audit to identify the major causes of morbidity and mortality in patients admitted in a medical unit of a tertiary care hospital and to highlight the importance of primary prevention. The audit was carried out in West Medical Ward Mayo Hospital Lahore, Pakistan from 1st January 2004 to 31st December 2004. All patients admitted with medical problems from the Outpatient and Emergency Departments were included. During the year 2004, a total of 2045 patients were admitted, out of which maximum number of patients admitted in the ward were suffering from chronic liver disease [17%] followed by ischemic heart disease [14.4%] cerebrovascular accidents [10.4%] and renal diseases. Total number of deaths were 321 with male mortality was 167 [14.40%] and female mortality 154 [17.40%]. Chronic liver disease also had the highest mortality [16.8%] followed by cerebrovascular accidents [14%], renal disease [11.5%] and ischemic heart disease [7.8%]. Even the mortality due to chronic liver disease was significantly higher [p <0.01] than ischernic heart disease. The number of patients having the four common diseases having age 45 years or more [770] was significantly greater [p <0.0001] then the number of patients [279] in the age range of 15 to 44 years. It was observed that significantly greater number of male patients [595] had morbidity than females [462], [p <0.0001], while mortality has no difference. Chronic liver disease, ischemic heart disease and cerebrovascular accidents are the diseases putting maximum burden on our health resources and disabling our productive population. This audit highlights the fact that all these three groups of diseases can be prevented and thus obviates the need of primary prevention of these major killers