Clinical audit of dengue related deaths in 2011 at mayo hospital lahore pakistan

Background and Objective: Dengue infection has evolved into an epidemic during last few years in Pakistan and has been associated with poor outcomes. Literature with respect to mortality risk factors in Dengue infection is not sufficient. This compelled us to conduct this study to find out major contributory factors to death in patients with dengue viral infection at one of Asia's ancient hospital setting with an aim to recognize complications at earliest and improve case management in future

Methods: A retrospective observational study of 95 adult dengue deaths was performed at Mayo Hospital Lahore from July 1st 2011 to 31st December 2011 during a major dengue epidemic. Patients who tested positive by dengue IgM in the presence of acute fever fulfilling the World Health Organization criteria for Dengue Fever, Dengue Hemorrhagic Fever or Dengue Shock Syndrome and died within same setting, were included. Data regarding demographic profile, clinical and laboratory parameters along with treatment details were obtained and analysed. All records examined were anonymized

Results: Median age was 36 years [range13-80 years] among 95 deaths due to Dengue. Male gender comprised 60 [63.1%]. Co-morbidities existed in 74 [77.9%] with hypertension in 21 [22.1%] diabetes in 11 [11.58%], liver disease in 9 [9.47%] and ischemic heart disease in 8[8.4%] cases. Patients presented at second day of fever for admission [range 1-8 days] and death occurred at a median of 4 days [range 30 minutes to 23 days]. Hospital stay was for less than a week for seventy nine [83.2%] patients and 16 [16.8%] were admitted for more than 7 days, Critical care was required in 67[71%]. Severe hepatitis occurred in 41 [43.1%], acute renal impairment occurred in 32 [33.7%] and disseminated intravascular coagulation in 16 [16.8%]. Deaths were due to prolonged shock 49 [51.5%] fluid overload 46 [48.4%] and massive bleeding 18[19%] leading to organ failure

Conclusion: Decompensated shock complicated by either massive plasma leakage, frank bleeding, multi organ failure or deranged clotting profile results in enhanced mortality in Dengue infection. Co-morbidities especially Diabetes are poor prognostic factors in predicting Dengue mortality

Profile of hepatic involvement in dengue infections in adult Pakistani population

Objectives: To estimate the range of hepatic involvement in dengue infections by assessing clinical and biochemical profile of adult dengue infected patients

Methods: Serologically confirmed 220 adult cases of dengue infections admitted to Mayo hospital from June 2013 to November 2013 were classified as having dengue fever, dengue haemorragic fever and dengue shock syndrome. The frequency and range of bilirubin, liver enzymes derangement and presence of liver enlargement in each group was calculated and further stratified according to age and gender. Patients with positive viral serology, chronic liver disease, malaria and typhoid were excluded from the study

Results: About 60% of DHF patients had hepatomegaly compared to 40% of DF patients. Liver dysfunction was more common in DF compared to DHF [38.15 vs 18.6%]. Hyperbilirubinemia was noted in 40 [18.2%] patients, 28 [12.7%] in DF and 12[5.5%] in DHF. The mean serum bilirubin was higher in DHF [0.87+0.33] compared to DF [0.74+0.27]. Bilirubin was higher in male patients and in younger [<20 years] age group. ALT was elevated more frequently in male patients in age group of 31-40 years and in DF patients as compared to DHF [72[32.7% vs 40[18.2%]]. The mean serum ALT level was 103.7 U/l in DHF and 69.2U/I in DF. AST was raised in all DHF patients as compared to DF in which 40% patients had normal AST levels. Alkaline Phosphate was high in all DHF patients with a mean of 278.7. It was raised in most of the DF patients as well and majority of patients were in age group of 31-40 years

Conclusion: Liver involvement is very common in dengue infections and is not limited to elevation of transaminases only. Bilirubin and Alkaline phosphatase are also raised in considerable number of patients. Therefore in adults with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic

Neck pain-a problem with major effects

To study the prevalence of neck pain in patients and their effects on daily performance. Hospital based observational study. OPD of Mayo Hospital and private chamber of the consultant. Neck pain as a cause of morbidity in both genders with loss of work hours leading to economic and household pressures. A total of 100 patients were studied. Out of these 54% were males and 46% were females. Age range was 15-70 years with the mean of 37 +/- 15.12 years. Duration of pain was from range 1-10 years with the mean of 4 +/- 3.80 years. Sixty nine percent were married and 31% were unmarried, 74% had urban and 26% had rural background. Out of these 69% were working in sitting posture and 31% in standing posture with bent necks on their jobs. Pain was radiating to arms in 53%, dull localized in 34%, stabbing in 9% and of burning character in 4% of patients. No neurological deficit was noted except that movements of neck were painful with associated muscle spasm. These patients were put on muscle relaxants, analgesics, advised extension exercises and told to improve their working conditions by keeping high desks or soft cervical collar. 78% patients showed improvement in the pain and radiation whereas 22% did not get any relief who were referred to physiotherapy department. Neck pain and associated neck muscle pain is a common symptom. The muscle spasm can be overcome by good posture, proper position of neck during work, avoiding very long hours of bent neck. NSAIDs, muscle relaxants and light extension along with exercises of neck can overcome such problems

Is there need of specialized diabetes nurses in Pakistan?

To assess the knowledge of the staff nurses of diabetes mellitus working in the various wards of a teaching hospital of Lahore. Cross-sectional study. Hospital based, on the staff nurses working in medical, surgical, cardiology, emergency and psychiatry wards of Mayo Hospital, Lahore. Main outcome measures: Knowledge of diabetes mellitus of staff nurses. Fifty qualified nurses interviewed through questionnaire designed to assess their knowledge about various aspects of diabetes. Symptoms of disease known to the nurses were polyuria [86%], polydipsia [82%], delayed wound healing [74%] unexplained ill health [72%], whereas pruritus vulvae [62%], big sized babies at birth [42%], impotency [40%] were elicited in response to prompting. Sixty% of them were unaware of gastrointestinal symptoms. They were better aware of hypertension [90%], chronic renal failure [70%], ischaemic heart disease [50%] as associated diseases with diabetes mellitus and least aware of autoimmune diseases. Confusion/drowsiness [92%], profuse sweating [80%], heart sinking [72%], blurring of vision [68%] fatigability [68%] pallor [52%], irritability [34%], lack of concentration [26%], feeling of hunger [20%] were known as hypoglycaemic symptoms. They generally had the knowledge of the treatment and was quite adequate. Diet control [92%], diet and exercise [96%], oral and parenteral hypoglycaemic agents [100%] were known to them. However they were less knowledgeable about alteration in treatment. Majority were of the opinion that patients should be controlled on oral hypoglycaemic agents and avoid parenteral drugs. Although nurses knew the diet plays the role in management of diabetes mellitus, but were not aware of types of food given to the patients or how to make changes in the diet. Nurses working in emergency, medical as well as surgical units should undergo refresher courses for 1-2 weeks in nursing care of diabetics. Effort should also be made to train specialized diabetic nurses. This would reduce the burden on doctors besides improving diabetic care

Patients with postpartum complications admitted in a medical ward of Mayo Hospital, Lahore

To evaluate the postpartum complications and their outcome in patients who were admitted between the periods of 1st July 1999 to 30th June 2000 in a medical ward following delivery. A prospective study of patients who were admitted in a medical ward with various postpartum complications following delivery at home or hospital. Department of Medicine, Mayo Hospital/K.E. Medical College, Lahore, Pakistan. Sixty-four patients who were admitted through emergency or referred/shifted from obstetrical wards attached to the hospital. Out of 64 patients, septicemia was detected in 26 [40.5%], renal failure in 8 [12%], Disseminated Intravascular Coagulation [DIC] in 6 [10%], jaundice in 6 [10%], eclampsia/fits in 8 [12%], tuberculosis in 4 [6%], tetanus in 3 [5%], postpartum cardiomyopathy in 2 [3%], stroke in 1 [1.5%]. Fifty-two [81.24%] were discharged home, 6 [9.38%] died in the hospital and 6 [9.38%] left against medical advice [L.A.M.A.] in moribund condition. Only serious postpartum complications present in medical wards. Physician, obstetrician and other specialties should act as one team to prevent maternal mortality and morbidity

Skin manifestations amongst diabetic patients admitted in a general medical ward for various other medical problems

To calculate prevalence of incidental skin manifestations in patients with diabetes mellitus admitted for treatment of various other medical problems in a general medical ward of a teaching hospital, Lahore, Pakistan. Design: Cross-sectional study. Setting: Hospital based study on admitted patients in a medical ward, Mayo Hospital, Lahore. Subjects: One hundred consecutive adult diabetic patients of any age and either sex admitted for various other diseases/problems. Main Outcome Measures: Skin manifestations. Out of 100 patients, 60% were males, and 40% females. Skin manifestations were seen in 90% of patients. Diabetic neuropathy was seen in 65.6%, cutaneous infections in 62.2%, pruritus in 46.7%, Diabetic dermopathy in 33.3%, skin tags in 21.1%, acanthosis nigricans in 16.7%, eruptive xanthomas in 8.9%, vitiligo in 6.7%, diabetic bullae in 5.6%, diabetic rubeosis in 5.6%, lichen planus in 4.4%, erysipelas like erythema in 4.4%, trophic ulcers in [3.3%], wet gangrene foot in 2.2% and necrobiosis lipodica, granuloma annulare and reacting perforating collagenosis in 1.1% each. Conclusions: There are many skin manifestations amongst diabetics who are also suffering from various other medical problems. Patients in routine do not give much importance to these lesions because they appear harmless to them. They do not seek advice of physician/surgeon/dermatologist unless they develop serious skin and soft tissue infections like carbuncles, trophic ulcers or gangrene

Prevalence of hypertension amongst young, students at the time of entry in a medical college of Punjab

White coat hypertension is a well-known entity, many are declared hypertensive only taking one reading of B.P Hypertension being a silent killer should be diagnosed and managed as early as possible. Unfortunately our general public is not in the habit of annual check up. One hundred and seventy nine medical students were examined at the time of entry to a medical college, out of these 52[29.05%] were hypertensive. These students were followed up for one year and only 4[2.24%] were hypertensive. At the time of first examination majority 69.25% were in stage I, whereas 19.25% were in stage II and 11.5% were in stage III. Male were 39 [75%] and females 13 [25%] with an average age 18.5 years. Students in stage III had higher BMI. Four students who were picked up as hypertensive, had one or= both parents hypertensive. All these students were told about the complications of hypertension and hypertensives were counseled and pursued for control of B.P.