Prediction of large esophageal varices in patients with decompensated cirrhosis by child-pugh score, in medical unit-ii, chandka medical college hospital, larkana

To assess prediction of large esophageal varices in patients with decompensated cirrhosis by Child-Pugh score, in Medical Unit-II, Chandka Medical College Hospital Larkana. Cross sectional study. This study was carried out at Medical Unit II, Chandka Medical College and Hospital, Larkana from November 2011 to November 2012. In this study 88 consecutive cirrhotic patients with ascites [those Patients who fulfilled the inclusion criteria] were included; blood samples for Serum bilirubin, serum albumin, and INR ratio were sent to single laboratory. Then, child Pugh score were assigned to each patient on the basis of clinical and to laboratory parameter. The ultrasound of abdomen was carried out for size of liver and spleen, portal vein diameter, and quantification of ascits. Eligible patients were subjected for upper gastrointestinal endoscopy for the presence of esophageal varices and their grading. The data was analyzed using SPSS version 19. The mean age of enrolled patients was 43.19 +/- 7.1 years. Of 88 patients, 69 [78.4%] were male and 19 [21.6%] were female. Child Pugh class relation to number of patients were; 52, 20, and 16 in class A, B, and C respectively. While Child Pugh class relation to frequency of esophageal varices were; 6, 11 and 14 in class A, B, and C respectively. Frequency of grading of esophageal varices was; 4, 13, and 14 in grade one, two, and three respectively. Distribution of large esophageal varices [LEVX] in relation to child Pugh class is one in class A, two in class B and 11 in class C. It is concluded from this study that; as the child pugh score advances, the number and size of esophageal varices increases, and chance of absence of varices decreases

frequency of impaired glucose tolerance in patients of essential hypertension in tertiary care Hospital, Larkana

To determine the frequency of impaired glucose tolerance in patients of essential hypertension. Descriptive Cross sectional study. This study was conducted at the Medical Outpatient department of Chandka Medical College Hospital Larkana, over one year period from February 2012 to February 2013. Total 171 patients of age 40-70 years having hypertension more than 2 years were purposively selected, while Known cases of DM, secondary hypertension and metabolic syndrome were excluded. Oral glucose tolerance was performed on selected patients of essential hypertension and plasma glucose was measured 2 hours after giving 75 g of glucose to each patient. Patients with [2 hours plasma glucose] level of 140-199 mg/dl were considered impaired glucose tolerance. Frequency was calculated for gender, number and type of medication and impaired glucose tolerance. The mean and SD were calculated for age, height, weight, BMI and duration of HTN. Stratification of age, gender, BMI and duration of hypertension done while applying Chi-Square with p value <0.05 as significant. One hundred and seventy one [171] patients met the inclusion criteria with mean age of 53.42 +/- 8.059 among those 104 were males [60.81%] while 67 were females [39.19%]. Duration of hypertension ranged 3-15 years with a mean duration of 7.47 +/- 3.26 years. Mean Body mass index [BMI] was 25.95 +/- 4.32, minimum BMI 17.88 and maximum BMI was 39.91. Frequency of IGT was 39.2% [n=67]. Mean serum glucose level at 2 hours in these patients was 159.33 +/- 27.937 grams/dL. Males were more affected while age has little effect on IGT frequency. More the duration of hypertension more was the prevalence of IGT. BMI was significant effect modifier for IGT; in overweight and obese patients the frequency of IGT was much higher [40.58% in overweight and 69.23% in obese] than normal weight patients [27.78%]. [p value <0.003]. IGT is much frequent in essential hypertension. Hypertensive males, elder age, longer duration of hypertension, high BMI and use of more than one antihypertensive medicine are associated with higher rates of IGT. This study suggests that all the patients with essential hypertension should be scrutinized for blood glucose levels

Diabetes mellitus [diagnosed and undiagnosed] in acute myocardial infarction

To determine the proportion of Diabetes Mellitus [DM] in patients with documented first episode of Acute Myocardial Infarction [AMI], in both genders. A prospective, case control observational study. Emergency Room, CCU and Medical wards of Chandka Medical College Hospital Larkana, Pakistan, from January 2005 to August 2005. 200 patients 100 consecutive males and 100 consecutive females, presenting with definite first episode of AMI. Diagnosis of D.M established on previous history of D.M, medical record and medications used by patient, patients without previous diagnosis of D.M [Undiagnosed], were diagnosed by performing Fasting Plasma Glucose [FPG], once within around 72 hours and 8 weeks later on. Out of 200 patients 49 [24.5%] were known diabetics, 20 [10%] revealed hyperglycemia [suspected diabetics] on routine plasma glucose level and Fasting Plasma Glucose [FPG] petformed within 72 hours of the onset of AMI and on subsequent follow up after 8 weeks, FPG level performed revealed 12 [6%] newly diagnosed definitive diabetics, while 5 [2.5%] revealed Impaired Glucose Tolerance Test [GTT] and 3 [1.5%] were found to be non-diabetics, so that a total 61 [30.5%] were labeled as diabetics. one out of every three patients with AMI had DM, elevated levels of random blood glucose and FPG at the time of admission are not reliable measures to establish the diagnosis of diabetes in cases of AMI and thus follow up measurements after a period of 6-8 weeks are necessary to establish the diagnosis. Awareness in general public regarding deleterious effects of DM should be promoted