Frequency of helicobacter pylori among hepatic encephalopathic patients in liver cirrhosis

Objective: to determine the frequency of H. pylori in cases of hepatic encephalopathy with liver cirrhosis

Study design and place: cross-sectional study to observe the role of H. pylori in HE patients of liver cirrhosis, conducted in Department of Medicine with collaboration to Intensive Care Unit [ICU] from January 2009 to December 2009 at Liquate University of Hospital Jamshoro/ Hyderabad

Results: out of 66 patients of HE, 44[66.7%] were male and 22[33.3%] were female, between 20 and 80 years of age. Based on Child-Pough's criteria, severity of hepatic decompensation Grading was as; in grade 1= 07 [10.6%], in grade 2= 21 [31.8%], in grade 3= 20 [30.3%] and in grade 4= 18 [27.3%]. Based on Child-Pough's criteria in class A= 01 [1.5%], in class B= 27 [40.9%] and in class C= 38 [57.6%]. Etiological factors for HE were as; HCV antibodies were positive in 32 [48.48%], HBsAg was positive among 18 [27.27%], HBsAg and HCV antibodies both were positive in 09 [13.64%], Alcoholics were 07 [10.6%] and Frequency of H. pylori was found in 47 [71.2%]

Conclusion: in our study we found that before and after 10 days H. pylori eradication therapy, there was no significant improvement in HE grade and other parameters. While the finding of high frequency of H. pylori in HE patients may be either co-incidence or co-relation that needs further vast studies

C-reactive protein [CRP] and other risk factors in acute ischemic stroke patients

Introduction: Stroke is a common cause of mortality and morbidity in developing countries; stroke is second leading cause of death after cardiac disease worldwide. Apart from established major risk factors for Ischemic Stroke [IS] i.e.; Hypertension, Diabetes Mellitus, Smoking and Hyperlipidemia, a burning but still debatable issue is raised serum C - reactive protein [CRP], that is also thought to be the major risk factor for acute IS due to participation in formation of Atherosclerosis in the cerebral vessels in genetically prone patients

Objective of study: To find out significance of serum levels of CRP among CT scan proved acute ischemic stroke patients

Study Design and Place: This is a prospective observational study was conducted at Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from July 2009 to June 2010

Data Collection: Patients meeting the inclusion criteria were enrolled in this study after obtaining informed consent, and were evaluated thoroughly for c reactive protein and other risk factors. All the selected cases were investigated for; Complete blood count, Urine detail report, CT scan brain plain, Serum C-Reactive Protein [CRP] Level, Fasting and Random Blood Sugar, Fasting Lipid Profile ECG and X-Ray chest PA View. The data was collected on a predesigned proforma designed for this study

Results: Out of 150 selected adult cases of CT scan proved Ischemic Stroke, male were 120 [80 %] and female were 30 [20 %]. Male to female ratio was 4:1. Their ages were between 20-80 years. Among these patients high level of CRP [> 10mg / L] was found in 132 [88 %]. Out of these Male were 110 [73.3 %] and that of Female were 22 [14.7%] respectively. Frequency of other major risk factors in male and female IS patients was also observed

Conclusion: A close relationship between high level of CRP and acute IS was found, because in acute IS patients high levels of CRP was observed but again it needs further studies high sample size to establish the c reactive protein as a independent risk factor for acute ischemic stroke

Frequency of helicobacter pylori in ischemic stroke

Objective: To find out the frequency of helicobacter pylori antibodies [IgG] among cases of ischemic stroke

Study Design: Cross-sectional study

Place and Duration: Medical Unit-II, Liaquat University Hospital Jamshoro/Hyderabad, from July 2009 to June 2010

Methodology:Helicobacter pylori [H.pylori] antibodies [IgG] on ELISA and color doppler ultrasound of carotid arteries were performed in CT Scan confirmed cases of ischemic stroke along with other routine investigations. A pre-designed proforma was used to record the data

Results: Among 150 CT scan confirmed ischemic stroke cases, 110 [73.3%] were males and 40 [26.7%] were females [2.7:1]. The H.pylori antibodies [IgG] were present in 121 [80.7%] cases among which males were 99 [66%] and females were [14.7%]

Conclusion: H.pylori antibodies [IgG] were present in very high proportion [80.7%] among cases of ischemic stroke

Causes of hypoglycemia in diabetes mellitus patients

Objective: to determine the causes of hypoglycemia in diabetics presenting at Liaquat University Hospital Hyderabad/Jamshoro

Study design: descriptive observational study

Place and duration: medical and Cardiology units of Liaquat University of Hospital Hyderabad Jamshoro, from June 2007 to May 2008

Patients and methods: one-hundred and one hypoglycemic cases were analyzed. A detailed enquiry about the presenting symptoms and mode of therapy was made. A thorough physical examination to look for diabetic complications and any concurrent illness was performed. Blood glucose was measured with the help of a Glucometer and response to glucose administration was also noted. Data were computed using SPSS software version 14. P-value up to 0.05 was considered significant

Results: type-2 diabetics presented more commonly with hypoglycemia in adult diabetic population 81/101 [80.1%]. Mean age for type-1 diabetics was 27.7 years and for type-2 diabetics 53.6 years. Male to female ratio was 3.3:1. Type-1 diabetic patients were either brittle diabetic with frequent dosage manipulations or those who had developed chronic complications. Majority of type-2 diabetics 74/81 [91.4%] were more than 40 years of age. Diabetic nephropathy, change in dose of hypoglycemic agents, missed meals, and use of concomitant medications were important associations with hypoglycemia in type 2 diabetic patients. All type-1 diabetics recovered completely after glucose administration. Amongst type 2 diabetics, 5 [6.41%] developed permanent disability and 6 [7.69%] patients died

Conclusion: the adult males having type 2 diabetes suffer more from this complication. Recognition of different causes of hypoglycemia in diabetes patients and prompt treatment of hypoglycemia is important to prevent complications. The reasons of developing hypoglycemia most of the times were on patient's hand

Evaluation of coagulation abnormalities in lung cancer patients

Objective: to determine the coagulation abnormalities in patients with lung cancer

Study design: case-control study

Place and duration: department of Pathology Isra University Hospital Hyderabad, Sindh - Pakistan, and Department of Medicine Liaquat University of Medical and Health Sciences Jamshoro, Sindh - Pakistan, from June 2006 to December 2007

Patients and methods: seventy subjects were recruited for the study by non-probability convenient sampling technique. Forty freshly diagnosed histopathology proven lung cancer patients were taken as cases, whereas 30 healthy subjects comprised the control group. Platelet count [PLT] was done on hematology analyzer while prothrombin time [PT], activated partial thromboplastin time [APTT] and plasma D-dimer tests were performed by commercially available kits at Department of Pathology, Isra University Hospital Hyderabad, and Sindh - Pakistan. T test was applied to determine the significance of differences between two groups whereas P value up to .05 was taken as significant

Results: the mean +/- SD PLT in cases and controls was 394 +/- 170 and 216 +/- 73 respectively. The mean +/- SD values for these respective groups were for PT 14.7 +/- 0.5 and 12.6 +/- 0.4, for APTT 41.5 +/- 6.2 and 25.8 +/- 3.7. D-dimer levels were <500 in all 30 controls whereas these were up to 2000 in cases

Conclusion: there is a strong relationship between coagulation abnormalities and lung cancer. D-dimer is very sensitive for evaluation of fibrinolysis related with lung cancer

Frequency of night blindness in cirrhosis and effective restoration of vision with vitamin A therapy

Objective: To determine the frequency of night blindness among cirrhotic patients and evaluate the restoration of vision with vitamin A therapy. Design: - Case-control observational study. Setting: Medical ward of Liaquat University Hospital Hyderabad / Jamshoro, Sindh - Pakistan; from January 2006 to December 2007

Methods: Two hundred cirrhotic patients admitted at medical unit IV were enrolled in the study. The non-cirrhotic patients were excluded. Fifty healthy volunteers took part as the control subjects

Results: Out of 200 patient, 116[58%] were males and 84[42%] females. The mean age of the cirrhotic patients was 48.46 + 11.97 years. The cause of cirrhosis was hepatitis C virus in 146 [73%] cases, hepatitis B virus in 19[9.5%] cases, hepatitis C and B virus in 7[3.5%] cases, non B and C virus in 24[12%] cases and alcohol in 4[2%] cases. When cirrhotic patients were grouped into Child-Pugh's score, 44[22%] were in class A, 106 [53%] in class B and 50[25%] in class C. Among 200 patients, 122 [61%] had history of night blindness and 25[12.5%] had the colour blindness. Restoration of vision was observed in 105[86%] patients with vitamin A therapy [tablet Vitamin A 50,000 IU, Wilson Pharma], twice daily, for 6 weeks time

Conclusion: The history of night blindness and its restoration of vision with vitamin A therapy is a rough indicator of vitamin A deficiency in cirrhotic patients. The larger studies are required especially RBP [plasma retinol binding protein] and serum vitamin A concentration before recommendation of vitamin A replacement. The Ophthalmic changes in cirrhotic patients are preventable and treatable

Prevalence of drug resistance in pulmonary tuberculosis

Objective: To determine the prevalence of primary and secondary drug resistance to first line anti-tuberculous drugs. Study Design: A hospital-based cross-sectional observational study. Place and Duration: Department of Medicine Liaquat University Hospital Hyderabad/ Jamshoro and Institute of Chest Diseases Kotri from April 2005 to March 2007

Patients and Methods: Fifty cases of Pulmonary tuberculosis [TB] randomly selected from both institutes who fulfilled the following criteria 1] Sputa showed positive smear for Acid Fast bacilli on Zeil Nelson Stain. 2] Chest x-ray showed shadow consistent with TB. A detailed history, contact with TB patients, previous use of anti-tuberculous drugs and Chest x-ray was done. Sputa of all patients were sent for detail report and culture sensitivity. Descriptive and inferential statistical analysis was performed using SPSS version 14.0

Results: Among 50 patients, 28[56%] were males and 22[44%] females, age ranged from 16-80 years [38.14 + 15.69]. All 50 [100%] patients presented with fever and cough, haemoptysis in 36 [72%], chest pain in 9[18%] and dyspnea in 11[22%] cases, anemia in 39[78%] and lymphadenopathy in 12[24%]. On chest x-ray examination, 19[38%] patients had multiple infiltrations, cavitations in 10[20%], fibrosis in 9[18%], consolidation in 5[10%], pneumothorax in 4[8%] and pleural effusion in 3[6%] cases. Sputum for AFB was positive in all cases. Twenty-one [42%] culture positive patients were of primary resistance and 29[58%] were of secondary resistance. Twenty [40%] were sensitive to five drugs, 9[18%] resistant to one drug, 11[22%] to two drugs, 7 [14%] to three drugs, 3[6%] to four drugs and none resistant to five drugs

Conclusion: In our setting, the prevalence of resistance to anti-tuberculous drugs is high and alarming. Strategy should be made for proper treatment and compliance of patients to avoid the development of drug resistance

Stroke: frequency of risk factors in patients admitted at Liaquat university hospital Hyderabad/Jamshoro

Objective: To determine the frequency of various risk factors for stroke and its sub-types among males and females. Design: Cross sectional /Observational study. Place and Duration of Study: The study was conducted at the Medical Department of Liaquat University Hospital Hyderabad/Jamshoro from January 2006 to March 2007

Material and Methods: Patients with features of stroke confirmed by CT scan brain were enrolled. Brain imaging showing abnormality e.g. brain tumour, meningitis, multiple sclerosis and metabolic derangements that could explain focal neurologic deficit were the exclusion parameters. The frequency of various risk factors for stroke and its types among males and females were evaluated

Results: Out of total 100 patients, 78[78%] presented with infarction stroke and 22[22%] with hemorrhagic stroke. Their mean age at presentation was 56.89 with SD=8.92 years. Hypertension 35[59.3%] and smoking 18[94.7%] were the most important risk factors among males, while the presence of diabetes mellitus 16[55.2%] and IHD 10[62.5%] were found to be more common among females. Forty-two [42%] and 11[11%] males, while 36[36.3%] and 11[11%] females suffering from cerebral infarction and cerebral hemorrhage respectively. In-hospital mortality was 09[09%]

Conclusion: Frequency of various risk factors was high in this study which is similar to that observed in developed countries. Hypertension and smoking were the major risk factors for males, while diabetes mellitus and IHD were more common in females. We did not find any significant gender difference between the two stroke types. Category: Internal Medicine

Frequency of control of blood glucose in patients with type 2 diabetes mellitus at tertiary medical care unit

Objectives: Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia resulting from the defective secretion or action of the insulin. As the serious complications of diabetes mellitus are associated with control and duration of the disease, so this study was planned to observe the frequency of control of blood glucose in patients with diabetes mellitus. Design: A descriptive study Setting: This study was designed at Mohammad Medical College Mirpurkhas Sind. Patients were collected in months of Jan-Mar 2008 in a weekly blood sugar camp arranged at MMC hospital

Methods: Five hundred diagnosed patients of Type 2 diabetes mellitus were included in this study. Their parameters were recorded in detail on pre-designed proforma. Control of blood sugar was evaluated by fasting blood sugar, 2 hours postprandial blood sugar, urine detailed report and hemoglobin A1C

Results: Majority of patients had unacceptable control of diabetes mellitus. Three hundred and sixty-six [73.2%] patients had poor control of blood glucose, while only 134[26.8%] patients had acceptable control of blood glucose

Conclusion: This study proved that control of blood glucose remained poor, i.e. 73.2% patients remained uncontrolled even after attempts to treat the disease; it shows that because of this poor control of blood glucose huge number of patients in future will land up with serious complications. Huge number [93.2%] patients had no knowledge about the disease