Serum vitamin D deficiency, a new epidemic

Vitamin D deficiency has profound adverse effects on health. Serum calcium, phosphorus and even alkaline phasphatase cannot predict underlying vitamin D deficiency. 1. To determine the frequency of vitamin D deficiency in outpatient private clinic 2. To determine the relation of vitamin D deficiency with the presenting symptom of bone or body aches. To see the relation of its deficiency to the serum calcium, alkaline phosphate and phosphate levels. Descriptive study. One of the local private clinic. 800 patients who presented to the clinic due to any ailment, having presenting complains with bone or body aches or not, were included in this study. The duration of study was 7 months from June to December 2008. The study showed among total 33% [n=264] were male and 67% [n=536] were female. 33 patients [4.1%] were below age of 20 years, 364 patients [45.2%] were having age between 20-40 years, 252 [31 .5%] were between 41 -60 years, 1 43 [1 7.8%] were between 61 -80 years and only 8 patients [1%] were above 80years. Over all vitamin D present in sufficient amount [>30 ng/ml] in only 4 patients [0.5%], reaming patients [n=796, 99.5%] were deficient in vitamin D were further divided into those who were having deficiency [serum level <20 ng/ml] [n=636, 79%] and insufficiency [serum level between 21-29 ng/ml] [n=160, 20%]. All the deficient patients were having normal serum calcium and phosphate levels and only 33 patients were having modestly raised serum alkaline phosphate. Among the sample only 318 [39.7%] were having bone or body aches as a presenting feature while remaining 482 [60.3%] were having no pains. More ever pain has got insignificant relation to any level of serum vitamin D level [p-value=0.201], however younger deficient patients were having lesser chance of bone or body aches as compared to age more then 60 year [p-value<0.001]. Vitamin D deficiency is more prevalent in our community, as compared to published data, targeting young population. Vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health

Effect of vitamin d replacement in patients of fibromyalgia

Fibromyalgia is a common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues. It is a chronic pain disorder that is difficult to treat. Recently Vitamin D has shown promising impact in the treatment of this disorder. To see the therapeutic role of vitamin D replacement in patients of fibromyalgia. Prospective study. Multicentre, Three private clinics. Out of 223 patients presenting with body aches and pains over the course of six months [January to June 2008], 100 patients [96 females and 4 males] between 20 to 50 years of age fulfilled the American College of Rheumatology [ACR] criteria of fibromyalgia and were included in the study. Using standard proforma, frequency of complaints other than ACR criteria were also documented.All of them were on some form of pain medication by various general practitioners/ consultants for more than three months but their symptoms were persistent. After informed consent, their serum vitamin D3 [25OHD3] level was requested as the cost of investigation was to bear by patients themselves. Patients were then replaced with vitamin D with an expected target of > 50 ng/ml and followed for 6 months duration. Supplementation with calcium in a dose of 1000mg/day was also done. In this study 83% of patients were having vitamin D between 11-20 ng/ml[mean =13 +/- 2], 11% between 5-10 ng/ml [mean=7 +/- 1] and 6% were below 5ng/ml [table-2]. There were four male patients, all [100%] with age distribution of 41-50 year and all were deficient in vitamin D [<20ng/ml]. Among 96 female patients 80[76.8%] were having level between 11-20 ng/ml, 10 [9.6%] between 5- 10ng/ml and 6 [5.7%] were below 5 ng/ml. After replacement with vitamin D achieving expected target serum levels >50ng/ml. Improvement in ACR criteria of fibromyalgia syndrome consisting of widespread musculoskeletal pains and 11 out 18 tender points was improved in more than 76% of the patients. Improvement in the associated conditions was also observed e.g. restless legs in 91.3% chronic fatigue in 97.6%. Similarly 85% reported relief from muscle spasm and 65% from tingling. There was also improvement in neuropsychiatric conditions like depression 71%] and anxiety 46.8%. Moreover, improvement in cognitive function like concentration and forgetfulness was also reported by 69.8% and 67.7% respectively [Table-4]

Frequency of peptic ulcer in patients having decompensated cirrhosis of liver

Hepatitis B and C are spreading like an endemic disease in developing countries like Pakistan, due to many reasons. The late diagnosis of HCV and HBV infection has resulted in increased number of patients with decompensated liver disease. One of the common complications of cirrhosis is upper GI bleed caused by peptic ulceration in UK. Local data shows peptic ulceration was the second commonest of the lesions causing upper GI bleed after esophageal varices. Present study was conducted to determine the frequency of peptic ulcer in patients having decompensated cirrhosis of liver presenting with upper GI bleed, also to emphasize the importance of primary prophylaxis with proton pump inhibitors for prevention of peptic ulcer in these patients. Descriptive study. MU-III Allied Hospital Faisalabad. Hundred consecutive patients having decompensated cirrhosis of liver were selected according to pre designed proforma and endoscopy was performed to determine the site of bleeding, from Jun to November 2007. This study showed peptic ulcer as the second most important cause of upper GI bleed [34%] after esophegeal varices [57%], also decompensate cirrhotics have increased incidence of peptic ulceration [34%] as compared to general population [8.3%]. Also significant relationship between source of upper GI bleed and serum albumin level in patients having decompensated cirrhosis of liver. [P value = .019] was found. There is definitely an increased frequency of bleeding peptic ulcer in patients having decompensated liver cirrhosis as compared to general population necessitating the need of primary prophylaxis of peptic ulcer with proton pump inhibitor in decompensated cirrhotics

Organophosphorus compound poisoning; epidemiology and management [atropinization vs pralidoxime] a descriptive analysis, in allied hospital Faisalabad

1] To have an overview of epidemiological factors. 2] To determine the outcome of victims. Mil-III Allied Hospital Faisalabad, from June 2007 to Dec 2008, 484 consecutive patients who were admitted, from June 2007 to December 2008, in Medical unit III with history of having organophosphorus poisoning were analyzed for the epidemiological factors, time to arrive in the hospital, conscious level, mode of poisoning [homicidal, suicidal or accidental] treatment given and outcome. The results of the study showed that age 14-30 years is the major group involved in poisoning 87.9% as compared to ages 31-45years [10.5%] and age more then 45 years [12%], also age group 14-30 years is having more suicidal tendencies as well as accidental poisoning and these tendencies decrease with increasing age [p=0.000]. Male victims are more as compared to female victims [52.9% vs. 46.7%] in the study group. Suicidal tendencies as well as homicidal poisoning is more in female [n= 127 and 44, respectively] while accidental poisoning is more in male population [n=106], [p=0.001]. Urban population is more at risk of poisoning in all three, homicidal, suicidal and accidental, as compared to the rural population [p=0.018]. Importantly study showed that outcome of the poisoning from organophosphorus is directly proportional to the interval between poisoning and presentation in emergency ward [p= 0.000], conscious level of the victim [p=0.000] and does not depend upon the mode of management [oxime or atropine] [p=0.026]. Younger urban population have increased tendency of poisoning with a dominance of female population. Rapidity of treatment, time to arrival to hospital and conscious level at presentation are the factors deciding outcome of a given patient rather than the mode of treatment [oximes and atropine both are equally effective]