ABSTRACT
Objective: To find out risk factors of heart failure after ST Elevation Myocardial Infarction [STEMI] and to see the most commonly involved vessels in myocardial infarction responsible for heart failure
Methodology: This cross-sectional study was conducted from June 2013 to November 2013. 225 patients of heart failure [HF] following STEMI who came in the emergency department of the hospital were included. The selected patients were followed till the angiography reporting. Statistical analysis was done in SPSS version 16
Results: Mean age of patients was 51.42 +/-11.78 years. 49.0% patients were hypertensive, 37.3% patients were diabetic, 44.0% were smokers and 18.2% had positive family history. In this study, anterior wall MI was predominant and found in 30.7% patients. 46.7% patients had triple vessel disease [TVD]. There was 33.7% involvement of Left main stem [LMS]
Conclusion: Hypertension and smoking are most common risk factors of heart failure. The patients who present with heart failure are most who have involvement of triple vessel coronary artery disease. Left main stem [LMS] is most commonly involved vessel in these patients
ABSTRACT
Objective: To determine the effect of Vildagliptin in non-alcoholic, fatty liver disease patients with dyslipidemia
Methods: A randomized placebo controlled trial was conducted at outpatient clinic of Medical Unit-I of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, in which fifty eight patients of NAFLD with dyslipidemia were divided in to two, case and control groups. The case group was given tablet Vildagliptin 50mg twice a day for twelve weeks and control group was given placebo in same way. Body weight, body mass index [BMI], lipid profile, liver enzymes and ultrasound finding of fatty liver were assayed before and after treatment
Results: After 12 weeks treatment of vildagliptin there was significant improvement in following parameters. Body weight and BMI decreased significantly from 88 +/- 11 to79 +/- 12 kg [p0.036] and 30 +/- 4 to 27 +/- 5 kg/m2 [p 0.005] respectively. Notable reduction in the value of TC, TG and LDL-C [TC: 252 +/- 24 to 220 +/- 20mg/dl [p 0.031]; TG: 190 +/- 24 to115 +/- 22 mg/dl [p 0.005]; LDL-C 160 +/- 15 to 145 +/- 13mg/dl [p 0.004]. HDL-C level increased significantly from 29 +/- 5to45 +/- 4 mg/dl [p 0.001].There was remarkable reduction in aminotransferases level [ALT: 78 +/- 17 to 48 +/- 14IU/L [p 0.036]. AST: 63.3 +/- 13 to41 +/- 11IU/L [p 0.002]. There was overall 65.5% improvement in fatty liver grading on ultrasound with vildagliptin while non significant effects were seen in placebo group in all of the above parameters
Conclusion: Vildagliptin exhibited beneficial effects in non-alcoholic fatty liver disease, Nondiabetic patients with dyslipidemia
ABSTRACT
Objective: To see the role of Vitamin D supplementation on physical status of patients suffering from Congestive Heart Failure [dilated cardiomyopathy]
Methods: In this nonrandomized clinical trial, Forty three Patients with dilated cardiomyopathy who were not showing any significant improvements in physical performance on optimal treatment of heart failure were included. Vitamin D [200,000 IU] supplementation on weekly basis for a period of 12 weeks was added to heart failure treatment. And its effect was seen on 6 minutes' walk distance and Pro-BNP levels. SPSS version 19 was used for data analysis. Dependent sample t-test was used to see the significant effect of vitamin D supplementation on pre-intervention vitamin D levels, 6MWD and Pro-BNP. Taking p-value <0.05 as significant
Results: On clinical assessment most of the patients were in NYHA class II [65%], the percentages of NYHA Class I, III and IV was 19%, 9% and 7% respectively. The baseline mean vitamin D level of the study group was 16.59 +/- 3.54ng/ml and it raised to 31.97 +/- 3.64ng/ml after 12 weeks of supplementation with vitamin D, p value <0.0005. The mean distance travelled by the study group before the intervention was 806 +/- 380ft while it increased to 945 +/- 393ft after the intervention, p value of 0.008. The mean of pro-BNP level of the study group before the intervention was 1024 +/- 635 while it improved to 159 +/- 80 after the intervention with a significant p value <0.0005
Conclusion: Vitamin D supplementation decreases the severity of HF as reflected by reduction in serum pro-BNP levels and significant increase in six minutes' walk distance
ABSTRACT
Background: Isolated gastric varices [IGV] are one of the major causes of upper gastro intestinal bleeding in cases with liver cirrhosis. They are difficult to manage and N butryl cyanoacrylate is one of the options
Objective: To determine the efficacy of N butryl cyanoacrylate in cases with isolated gastric varices due to liver cirrhosis
Methodology: This cross-sectional study was conducted at Endoscopy unit of Hamza Medicare Hospital, Rahim Yar Khan from 1st January 2015 to 31 th July 2016. The cases presenting with upper GI bleedy and history of liver cirrhosis [documented by presence of jaundice, ascites, hepatic encephalopathy, deranged LFTs, i.e. serum bilirubin, PT, albumin] irrespective of etiology and the child pugh class were included. The endoscopy was done by Olympus GIF-XQ140 and the site of bleeding varices were documented. The cases of isolated gastric varices of any type or severity were considered. Then glue comprising N butryl cyanoacrylate with lipoid solution in a ratio of 5:8 was injected into the varices in a dose of 2.5 to 5 cc and were then followed for next 5 days for any re bleeding episode and control of homeostasis. The cases, in which no such event was noted, were labeled as with positive efficacy. The data was entered and analyzed by using SPSS version 21
Results: In this study out of total 54 cases of IGV, there were 34 [62.96%] males and 20 [37%] females. The mean age was 58.50 +/- 15.54 years. There were 47 cases with hepatitis C and 7 has hepatitis B. Efficacy was seen in 52 [96.30%] out of 54 cases. Thirty-three out of 34 males and 19 out of 20 females has shown efficacy with p value of 0.80. The efficacy was better seen with age group of 15 to 35 years with cure in 5 [100%] out of 5 cases as compared to lower rate in others with p= 0.27. The cases with Child pugh class C contained the both failure cases with significant p= 0.04. There were one case each with hepatitis B and C with failure with p= 0.39
Conclusion: N butryl cyanoacrylate has a high efficacy rate in shortterm relief for bleeding and Child pugh class C is significantly associated with lower success rate
ABSTRACT
Background: Liver cirrhosis, associated with upper gastrointestinal [GI] bleed, is one of the leading cause of morbidity and mortality. Esophageal and isolated gastric varices, both are common but the later is the more difficult to treat
Objective: to determine the frequency of isolated gastric varices in cases with liver cirrhosis presenting with upper gastrointestinal bleeding
Methodology: This cross sectional study was conducted at Hamza Medicare Hospital, Rahim Yar Khan from 1 January 2015 to 31 July 2016. The cases with upper GI bleeding due to liver cirrhosis [assessed by presence of ascites, splenomegaly and deranged liver functions like LFTs, PT] were included in this study. Sociodemographic data was collected like age, gender and other data like type of viral hepatitis and other examination to label for their child pugh class. The cases then underwent upper GI endoscopy with Olympus GIF-XQ140 and were assessed for presence of ulcers or varices from esophagus to stomach. The cases with varices of any size or type only in the gastric area were labeled as isolated gastric varices [IGV]. The data was entered and analyzed by SPSS version 21
Results: In this study there were total 662 cases of liver cirrhosis out of which 180 [27.19%] were females and 482 [72.81%] males. The mean age was 58.50+/- 15.51years. There were 495 [74.77%] cases with hepatitis C and 167 [25.23%] with hepatitis B virus. Isolated gastric varices. [IGV] were seen in 54 [8.17%] cases. All the cases were in GV1 class and all has size of more than 10 mm. IGV were seen in 34 [7.05%] males as compared to 20 [11.11%] females [p value= 0.53]. There was no significant association of GV with any age group with p= 0.17. There was significant association of IGV with child pugh class C [p=0.03]. There was no significant association with type of hepatitis with IGV [p=0.21]
Conclusion; Isolated gastric varices are common entity and every twelfth case of liver cirrhosis develops this. Child pugh class C is significantly associated with isolated gastric avarices
ABSTRACT
Background: Vitamin D deficiency is now documented as pandemic. It has been estimated that 1 billion people worldwide have vitamin D deficiency or insufficiency and Pakistan, is not an exception
Objective: The objective of present study was to determine the frequency and risk factors for vitamin D deficiency among patient attending out patients department
Patients and Methods: This was a cross sectional study, conducted from 1[st] July to 31[st] December, 2013 in the outpatient department of Sheikh Zayed Medical College/Hospital Rahim Yar Khan. A total of 140 consecutive women with complaint of generalized body aches, of 15 years and above age, who have given verbal consent, were included in the study. The data was collected on a predesigned and pretested questionnaire which included variables on age, residence [rural/urban], number of rooms in house, exposure to sunlight, type of clothing [full sleeve/half sleeve] dietary intake of vitamin D such as milk and food supplement. Serum vitamin D [25 OH vitamin D] level >/=30ng/dl, was taken as normal, 21-29 ng/dl as insufficient and 11-20 ng/dl as deficient. Chi square test was applied for comparing groups for risk factors association, with p-value of <0.05 as significant. The data was entered and analyzed in SPSS version 16.0
Results: A total of 150 women of 15 years and above were included in study, with 73% having vitamin D. level of <30 ng/dl. The mean level of serum vitamin D level was 19 +/- 2.1 ng/dl, with minimum 4 ng/dl to maximum of 43.7 ng/dl- Urban residence, illiteracy, poor housing, lack of sun exposure, wearing veil, lack of milk, meat and vitamin D supplement intake as significant [p-value <0.05] risk factors
Conclusion: Our findings revealed that there is a very high burden of vitamin D deficiency among females of our region. Urban residence, illiteracy, poor housing, lack of sun exposure, wearing veil, lack of milk, meat and vitamin D supplement intake as significant risk factors of low serum vitamin D levels
ABSTRACT
Bronchogenic carcinoma can present in many ways. The diagnosis of its different types is important because of its effect on prognosis and management. Geographical and socio-economic factors such as climate, culture, ethnic origin, diet and life style have been noted to influence the occurrence of this disease. We conducted this study to document the frequency of various histological types of bronchogenic carcinoma and correlated it with their demographic characteristics. This descriptive study was carried out in the Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan. Thirty consecutive histopathologically and /or cytologically confirmed cases of bronchogenic carcinoma were included in the study. These patients were admitted from January 2001 to May 2002. History was taken in detail with emphases on personal particulars, past and present occupation and living conditions. Specimens for histopathological study were collected by trans-thoracic needle aspiration or bronchoscopy. Four types of bronchogenic carcinoma were found; squamous cell carcinoma 60%, small cell carcinoma 20%, adenocarcinoma 13.33% and large cell carcinoma 6.66%. Among these, seventeen males and one female patient proved to have squamous cell carcinoma were in the age group between 46-89 years and the majority was from the urban areas. While cases with small cell carcinoma belonged to the age group between 56-74 years, being six in total and all were males; four from urban and two from rural areas. On the other hand patients with adenocarcinoma belonged to the age group 50-89 years, being four in total with three females and one male, with only one female from rural area. In addition we found two city dweller males with large cell carcinoma belonging to the age group of 50-79 years. Bronchogenic carcinoma in our setup is more frequent beyond the middle age. It is more common in males and urban dwellers. On histological examination, squamous cell carcinoma is the commonest variety followed by small cell carcinoma. Adenocarcinoma is more common in females