ABSTRACT
Introduction: The demand of long term central venous access devices has risen over the last few decades. These devices are increasingly being used for administration of antibiotics and chemotherapeutic drugs, for total parentral nutrition and providing high flow access for hemodialysis and plasmapherisis. Inadvertent arterial puncture, ateriovenous fistula, thoracic duct injury, brachial plexus injury, laceration of the subclavian vein, and air embolism are the well described complications of the central line insertion
Objective: This study was designed to find out the frequency of complications during Central venous line insertion via sub clavian route
Methodology: This cross-sectional descriptive study was conducted at DHQ Hospital Sargodha from April 2014 to April 2015. Two hundred patients both male and female requiring hemodialysis were included in the study. All patient underwent double lumen catheterization of subclavian vein after informed consent
Results: Mean Age of the patients was 54.55 +/- 10.45. 71% of the patients were female and 29% of the patients were male. Out of 200 patients subjected to double lumen catheterizations; 28 [14.0%] developed various complications related to insertion. Out of 28 patients who developed complications, in 08 [28.57%] cases complication was failure to cannulate, in 08 [28.57%] cases there was arterial puncture, in 04 [14.28%] cases catheters were mal-positioned/kincking. Hemothorax and subclavian arterio-venous fistula developed in 02 [7.14%] each. 02 [7.14%] cases had arrhythmias and death occurred in 02 [7.14%] cases
Conclusions and Recommendations: Subclavian double lumen catheters proved to be reasonably safe, easy and a reliable way of obtaining vascular access for hemodialysis. The procedure is a short term alternative to AV fistula formation for patients requiring long term hemodialysis. It is recommended that double lumen subclavian vein catheterization should be part of post graduate training in large units where hemodialysis is available
ABSTRACT
Objective: To determine the frequency of different types of stroke in patients with cerebral stroke presenting in DHQ hospital Faisalabad
Study Design: Cross Sectional Descriptive Study
Setting: Study was conducted in Medical Unit IV DHQ Hospital Faisalabad between 01-06-2014 to 30-11-2014
Materials and Methods: 100 patients both male and female of ages more than 16 years admitted with acute stroke with in and after 24 hours of stroke and patients having infarction, hemorrhage and subarachnoid hemorrhage as a cause of stroke diagnosed on Computerized Tomography [CT] scan of the brain were included in the study. After Informed Consent, data collection was carried out after taking history, performing clinical examination and doing investigations. Data was analyzed by using Chi-Square test at 5% level of significance. Statistical analysis was carried out with the use of SPSS Version 21 for Windows. In this study, frequencies of major categories of stroke were found out in relation to different age groups and sex. Hypertension and association between frequencies of various categories of stroke and Diabetes Mellitus, Hypertension and association between frequencies of Diabetes various categories of stroke and irregularly treated Hypertension and Diabetes Mellitus were found out
Results: Our research found the frequency of Infarctive stroke, Intracerebral bleed and Sub-arachnoid hemorrhage as 62%, 28% and 10% respectively. Correlation of gender with major categories of stroke was found to be statistically significant. Peak age range for cerebral infarction was found to be 51-60 years accounting for 22 cases [i.e. 35.48% of all cerebral infarction cases], peak age range for intracerebral bleed was also 61-70 accounting for 12 cases [i.e. 42.86% of all intracerebral bleed patients] and peak age range for Sub-arachnoid hemorrhage was 41-50 accounting for 4[40%] cases. Infarctive stroke was also found in the lowest age range i.e. 21-30 accounting for 3 cases. Patients with uncontrolled Hypertension and Diabetes Mellitus were found to be at more risk of developing cerebral stroke
Conclusion: Infarctive Stroke is more common in our study as compared to hemorrhagic Stroke. Proper awareness and treatment about the major risk factors of stroke such as hypertension and diabetes mellitus can help to reduce the episodes of stroke in population. Patients need proper education about modifiable risk factors for cerebral stroke
ABSTRACT
Objective: To determine the efficacy ofArthemether-Lamefuntrine [AL] in patients withmalaria
Study Design: Quasi-experimental study
Place and Duration of study: Study was conductedin Medical Unit DHQ Hospital Sargodha andMedical Unit V, DHQ Hospital Faisalabad from 1stJanuary 2011 to 30 June 2011
Subjects andMethods: 129 adult patients both male and femalediagnosed to have malaria both on clinical andlaboratory examination were included in the study.Patients were given AL [20/120] 2 tablets 12 hourlyfor three days. An adequate clinical andparasitological response [ACPR] was defined asabsence of fever and parasitaemia [negative slide forMalarial parasite] by day 45 after end of treatment
Results: Out of 129 patients adequate response[ACPR] was seen in 122 patients with efficacy of94.6%
Conclusion: AL is an important andeffective treatment option for treatment of patientswith malaria
ABSTRACT
350 million people are infected with Hepatitis B virus [HBV] and 60 million people with Hepatitis C virus [HCV]. Chronic infection by these viruses leads to cirrhosis of liver and hepato-cellular carcinoma [HCC]. Esophageal varices develop in cirrhotic patients which can be demonstrated by invasive methods or predicted by non-invasive methods. An observational, Cross sectional study was conducted in Medical Unit-IV, Liver Center of District Head Quarters Hospital and Medical units of Allied Hospital, Faisalabad for 6 months from 23 May 2007 to 22 November 2007. The study was conducted on 100 patients diagnosed as post viral cirrhosis of liver of either sex between 25 -70 years of age. The ratio between platelet count and spleen size was calculated .The mean ratio for those with esophageal varices was found to be 650 [100 -1614] and for those without esophageal varices, the mean value of the ratio was calculated to be 2453 [1600-3483], which was significantly different [p<0.05]. Non-invasive markers have been used to predict varices in cirrhotic patients. Cirrhotics with esophageal varices have a significantly lower platelet count and a significantly greater ultrasonographic spleen size as compared to those patients of liver cirrhosis without esophageal varices [13,14] a fact also consistant with our study [p < 0.05]
ABSTRACT
Post-infective polyneuritis, also known as Guillain-Barre syndrome [GBS], is a rare and rapidly progressive immune-mediated disorder that consists of inflammation of nerves and usually causes the muscle weakness, sometimes progressing to complete paralysis. This retrospective study was undertaken to assess the incidence, management and outcome of post-infective polyneuritis in District Faisalabad, Pakistan. We reviewed all the 67 cases, 47 males and 20 females, who were admitted to the ICU of the Allied Hospital, Faisalabad during 2005-2009, and diagnosed as post-infective polyneuritis. The management comprised of treatment of the complications of the disease, and the specific therapy with plasmapheresis or high-dose immunoglobulin. Six paediatric cases were also admitted; two of them were found to be suffering from poliomyelitis. Thirteen cases of muscular weakness due to hypokalaemia mimicked the diagnosis of GBS. The specific therapy involving plasmapheresis or immunoglobulin resulted in [i] fewer patients needing mechanical ventilation, [ii] the decreased duration of mechanical ventilation, and [iii] reduction in the time needed for motor recovery and walking without assistance. Early referral to ICU, management of complications, good nursing care and specific therapy with plasmaphresis or immunoglobulin within seven days of onset of the symptoms improve prognosis