Comparison of inhalation technique of pressurized metered dose inhaler before and after a session of instructions in male patients of obstructive airway diseases

To assess the inhalation technique of pressurized metered dose inhalers [pMDI] in patients of obstructive air way diseases, to find out common errors and to determine improvement in their inhalation technique after a session of inhaler training. Quasi experimental study. The study was conducted at outdoor department of Military Hospital Rawalpindi from December 2005 to April 2006. A total of 100 male patients, using pMDI on regular basis for their obstructive respiratory symptoms, participated in the study. Patients' inhalation technique of pMDI was recorded against a standardized seven step checklist. Any technique having even a single erroneous step was marked as incorrect. Two weeks later, having given instructions on correct use of the device, the patient's inhalation technique was reassessed. Subsequently, results of both pre and post instruction assessment of inhalation techniques were compared and analyzed. During the 1st visit, only 21 patients [21%] demonstrated correct technique of inhalation. Upon 2nd visit, the number of patients having correct technique rose to 55 [55%] indicating significant improvement in the technique as demonstrated by applying McNemar's test. Erroneous inhalation technique is quite common among patients using pMDI. However, they can improve their technique significantly if they are taught the correct use of inhaler device

Frequencies and patterns of arrythmias in anterior and inferior myocardial infarction

The objective of this study was to identify the frequency and clinical patterns of arrhythmias in anterior and inferior myocardial infarction [MI]. A descriptive study. This study was conducted at critical care unit of Combined Military Hospital Kharian cantonment from January 2006 to December 2006. Hundred patients were included in the study that fulfilled the required criteria. They underwent detailed history taking and systemic examination. Patients were monitored through cardiac monitors and serial ECG recordings were taken especially if any rhythm disturbances were observed or if the patient suffered any symptom, till the time of discharge from the hospital. The relevant information was entered into a specially designed pro forma. All the data collected through the pro forma was analyzed through SPSS version 11 in terms of frequency, percentages and proportions. Premature ventricular contractions [PVCs] were the most common rhythm disturbance followed by ventricular tachycardia [VT]. Both were more common in anterior myocardial infarction [MI] than inferior MI. Bradyarrhythmias were more common with inferior MI. PVCs usually manifested with chest pain, VT was accompanied by palpitations and dyspnoea. Atrioventricular [AV] blocks clinically presented as syncope. PVCs are the most common rhythm disturbance after anterior and inferior MI. VT and ventricular fibrillation [VF] are frequent in anterior while bradyarrhythmias are common with inferior MI