The case for building residential facilities [Sarais'] for patient visitors. If not now, when?

Objective: To gather the opinion of attendants accompanying admitted patients in CMH Lahore about their satisfaction with existing eating and sleeping arrangements

Study Design: Cross sectional survey

Place and Duration of Study: Combined Military Hospital Lahore Pakistan, from Jul to Aug 2016

Material and Methods: For this descriptive observational study attendants of patients admitted in the hospital for more than 24 hours were administered a questionnaire. Only one family member per patient was surveyed

Results: Three hundred attendants were interviewed for the study of which 162 were males. One hundred and twenty eight 128 [42.7 percent] came from within the city. One hundred and eighty seven [62.3 percent] intended to stay with the patients till the time they were discharged. A total of 185 [61.7 percent] patients had only one attendant whereas 59 [19 percent] of patients had no attendants available. Two hundred and thirty one [77 percent] attendants were blood relatives. The hospital canteen served food to 140 [46.7 percent] attendants. Only 25 [4.3 percent] attendants were satisfied with their existing eating arrangements. One hundred and seventy eight [59.3 percent] of attendants slept inside the hospital wards whereas 54 [18 percent] slept within hospital premises. One third of them were satisfied with their sleeping arrangements whereas the remaining desired more comfortable residential facilities or [Sarais] which were affiliated with the hospital. Sixty four [52 percent] attendants experienced difficulties in affording their boarding and lodging expenses

Conclusion: Patients and families bear the emotional and financial cost of illness. Findings suggest that attendants are not satisfied with their existing sleeping

Role of antenatal checkup on caesarean section rate - study at CMH Attock

Objective: The present study was designed to study the role of antenatal check upon caesarean section [C-Section] rate in patients reporting to labour room

Study Design: Prospective cohort study

Place and Duration of Study: The study was carried out at Combined Military Hospital [CMH] Attock, from Oct 2014 to Mar 2015

Material and Methods: A total of 447 patients who underwent treatment in CMH Attock were included in this study. Patients were divided into two groups: 1] Booked patients - the ones who consulted obstetrician regularly during pregnancy, 2] Unbooked patients - These patients do not consult obstetrician for ante-natal checkup during the pregnancy. The data was collected on a proforma and was statistically analyzed

Results: About 77.85% of the total recruited patients in the study were booked while 22.15% were un-booked. A 37.6% of the booked patients had to undergo caesarian section [c-section] while 62.4% patient underwent spontaneous vaginal delivery [SVD]. Whereas 51.5% un-booked patients had c-section while 48.5% patients underwent SVD. Point two percent and 2.5% of the overall patients had gestational diabetes and anaemia respectively. Three percent of the total pregnant patients were diagnosed as being hypertensive. Patient history revealed that 3% patients had bad obstetrics history and 76.9% of them attended ante-natal clinic

Conclusion: In our set up overall C-section rate was 42.6% but in the booked group the rate was 37.6% as compared to the much higher 51.5% in the un-booked group thus indicating that high C-section rate in the unbooked group contributed in a major way to the overall C-section rate

Lipid profile in non-obese and non-diabetic: hypertensive patients

To find out the frequency and pattern of lipid abnormalities in non-obese and non-patients suffering from essential hypertension. This is the cross sectional descriptive study. The study was conducted at the Department of Medicine and its OPD, Jinnah Hospital, Lahore from July 2009 to February 2010. 100 patients were included in the study. Patients were taken randomly. Blood samp were checked in Pathology laboratory of the hospital. Increase in total serum cholesterol was seen in majority of patients. Increase in total cholesterol showed an increasing trend with the time duration of hypertension. Highly atherogenic LDL-cholesterol was increased in majority of patients. One patient of familial combined hyperlipidemia was also detected. Physicians should be careful while treating hypertensive patients. Lipid profile should be advised not only in obese and diabetic but also in thin lean non-diabetic, hypertensive patients. If we treat dyslipidemia in -0 hypertensive patients we can decrease the coronary artery disease risk to an appreciable level

Malnutrition assessment of chronic obstructive pulmonary disease patients

To assess the prevalence and severity of malnutrition among COPD patients along with the effect of dietary intervention on the disease outcome. This was an interventional, Quasi- experimental study. The study was conducted at Department of Medicine and Department of Chest Diseases, Jinnah Hospital, Lahore. Total duration was one year from April 2009 to March 2010. Sample Size: 100 patients with COPD were investigated. Purposive Non-probability sampling. Majority of the patients were in the age range 50 - 70 years with more males than females. 97% patients had a positive tobacco smoking history. 57 - 78% of the patients included in the study were found to be malnourished, out of which 65 - 68% were moderately malnourished and 10% were severely malnourished according to SGA rating and BMI. There was a strong correlation between COPD staging and malnourishment. 54% patients with stage III COPD were malnourished while 90% patients with stage IV were found to be malnourished. Malnutrition is invariably observed in COPD patients and is more frequent and more severe in patients with advanced stage disease. Patients with COPD might benefit from a dietary intervention both in terms of pulmonary functions and nutritional state, which might have beneficial effects on prognosis

Comparison of pulmonary function tests in smokers and non-smokers

To compare the lung function tests in healthy non-smoker with age and sex matched smokers who are asymptomatic of respiratory impairment. This cross sectional analytic study was carried out from June 2009 to November 2009 in Department of Medicine and Pulmonology, Jinnah Hospital, Lahore. A total of 200 subjects were included in the study. All individuals were selected from healthy general public visiting Jinnah hospital Lahore as attendants of the patients.FVC, FEV1 and FEV1/FVC were measured and recorded in Performa. Data was entered and analyzed in SPSS 10. Mean age was 36.77+6.58 years. It was 34.11+7.38 in smokers and 33.43+5.39 in non-smokers group. Mean FEV1 was 2.55+0.79 in smokers and 3.52+0.55 in non-smokers. Mean FVC was 3.94+0.69 in smokers and 4.35+0.69 in non-smokes. Smoking causes significant reduction in lung functions in asymptomatic smokers which can be prevented by quitting smoking

Breast diseases; spectrum in Wah Cantt; POF hospital experience

To find out the magnitude of breast diseases and their distribution in different age groups among the patients attending surgical OPD for surgical consultation at POF Hospital Wah Cantt. This is a retrospective observational type of study. Patients attending surgical OPD for breast problem from January 2000 to December 2007 were included. They were assessed clinically and their diagnosis was confirmed by cytological [FNAC] or histopathological [biopsy] examination. Records were taken from pathology and surgery department and the patients were retrospectively reviewed. 954 cases of breast disease were diagnosed. These include 905 female and 49 male patients. Benign breast diseases [BBD] were the most common lesions of the breast found in this study [71.5%] whereas malignant lesions were on the rise with each passing year [28.5%]. Among BBD, the most common lesion was fibroadenoma [49%] followed by breast abscess [13%], Fibrocystic disease [9.3%] and gynecomastia [6.8%]. 271 cases [28.5%] were malignant lesions. This includes 269 female and 2 male cases. The common ages for BBD were, 12-30 years for fibroadenoma, 15-40 years for breast abscess, 18-40 years for fibrocystic disease and 15-29, 50-59 for gynecomastia respectively, whereas carcinoma breast was seen in the age group of fifties initially, getting more common in forties, in the later part of study. We conclude from this study that BBD is the most frequent breast ailment. Among the BBD, fibroadenoma was the most common lesion. Breast carcinoma cases were becoming more frequent but reached hospital at a late stage of the disease. Infiltrating ductal carcinoma was the most common malignancy noted

Surgical management of peptic ulcer disease in proton pump inhibitor era

To evaluate the important risk factors involved in complications of peptic ulcer disease and the need, timing, extent and outcome of surgery with the evolution of proton pump inhibitors. Descriptive study. POF Hospital Wah Cantt, from December 2006 to December 2008. All the patients presenting with complications of peptic ulcer disease [perforation, bleeding duodenal ulcers and gastric outlet obstruction] were included in this study. A total of 46 patients were included in this study. Thirty five patients had peptic ulcer perforation, 8 patients presented with bleeding peptic ulcer that failed to respond to medical and endoscopic treatment and 3 patients presented with gastric outlet obstruction. Smoking was the most common risk factor followed by the use of non streroidal anti inflammatory [NSAID] drugs and steroids. Ramadan fasting was also a factor in patients with history of dyspepsia. Peptic ulcer perforation was more common in patients in second and third decade of life as compared to bleeding which was more prevalent in fourth decade. Modern medical and endoscopic therapy has caused a decline in complications of peptic ulcer disease but they are still prevalent in developing world. Smoking is one of the most common and important risk factors

Clinical presentation and CT scan findings in patients of ischemic and hemorrhagic strokes

To compare the weighted clinical score and computed tomography scan brain of patients of ischemic and hemorrhagic strokes. This descriptive non-interventional study was conducted on 100 consecutive patients of all ages and both sexes presenting with stroke within 48 hours of the onset of the symptoms due to hemorrhage or infarction but not due to transient ischemic attack, reversible ischemic neurologic deficit, sub-arachnoid hemorrhage, tumors or trauma. The patients were admitted and examined, Siriraj Stroke Score was applied to make the clinical diagnosis and this score was compared with CT scan of the brain as gold standard. Out of 100 patients, eight were excluded due to invalid Siriraj Stroke Score between+1 to-1. Among 92 patients, 58.7% [54] were male and 41.3% [38] were female with a mean age of 61.8 +/- 7.8 years. Mean diastolic blood pressure was 94.78 mm Hg with range of 50 to 160. Hypertension was the most prevalent risk factor being present in 57.1% of ischemic and 54.4% of hemorrhagic patients. Clinically 72.8% [67] patients had ischemic and 27.2% [25] patients had hemorrhagic stroke. CT scan showed 76.1% [70] patients had ischemic and 23.9% [22] patients had hemorrhagic stroke. For ischemic strokes, Siriraj Stroke Score is 87%sensitive and 73% specific having a positive predictive value of 91%. For hemorrhagic stroke, Siriraj Stroke Score is 73% sensitive and 87% specific with a positive predictive value of 63%. Yule's coefficient using Chi-square test showed a high comparability between clinical and CT scan diagnoses. Siriraj Stroke Score needs to be further modified to be more objective and it should be compared with diffusion weighted magnetic resonance imaging as gold standard and not with computed tomography of the brain

Fat embolism syndrome: a case report

A young motorcyclist, who had met a road traffic accident resulting in multiple fractures, later developed fat embolism syndrome. He had to be instituted mechanical ventilation for hypoxemia and deteriorating levels of consciousness and was rendered vigorous management for his critical general condition

Injection Sclerotherapy versus Electrocoagulation in the management outcome of early haemorrhoids

To study the symptomatology of early hemorrhoids and to compare injection Sclerotherapy [IS] with electrocoagulation [EC] in the management outcome of early haemorrhoids with respect to pain during the procedure, reduction in bleeding per rectum, and overall patient satisfaction score. A total of 102 patients were included in this experimental study at the POP Hospital, Wah Cantt from October 2004 to June 2005. A detailed history was taken and proctoscopic examination was performed. Patients were then randomly divided into two groups [Lottery method]. One group was subjected to EC and the other to IS. In the EC, using the EC machine [Wieda, China], direct current of 10-20 mA was applied in the submucosal plane of each pile core for 5-7 minutes. In the IS 1-2 ml of 5% phenol in almond oil was injected in the same plane in each pile core. Pain during the procedure, reduction in bleeding per rectum and overall patient satisfaction, were studied as outcome measures. The mean age of the patients was 44 years, 86 were males and 16 were females. Two thirds of the patients were having symptoms for more than 6 months. A third of patients had associated local pain while another third had associated mucous discharge. Chronic constipation was present in 81% patients. Only 24.5% of the patients had a positive family history of haemorrhoids. Patients in the electrocoagulation [EC] group experienced more pain during the procedure than the injection Sclerotherapy [IS] group [P<0.000], but EC was significantly more effective than IS in terms of reducing the bleeding per rectum [P= 0.039], and also significantly higher number of patients were fully satisfied with EC than with IS [P<0.04]. EC, although more painful, is a safe, more effective and a highly satisfying procedure for treating early hemorrhoids