ABSTRACT
Objective: to determine the preventive role of interferon in Hepatocellular carcinoma [HCC] in patients of chronic hepatitis B and C who didn't respond virologically to interferon therapy
Methodology: this comparative retrospective study was performed in the Medical Unit Hayatabad Medical Complex Peshawar from Jun2014 to April 2015. Patients of cirrhosis liver due to hepatitis C and B virus infection from the wards and hospital OPD were entered. Hbs Ag and Hepatitis C antibodies test was performed on ELISA method. Patients with liver mass on ultrasound and CT scan with raised alpha feto protein were labeled hepatocellular carcinoma were divided in the Child Class A, B or C. They were divided in to two groups, one who used interferon and the other who did not. We noted the reasons for not using interferon and the duration from the earliest evidence of Hepatitis B and C positive status to the diagnosis of HCC
Results: we collected 500 cases of cirrhosis liver due to hepatitis B and C. Seventy eight percent [n=390] were anti HCV while 22% [n=110] Hbs Ag positive. Fifty three percent [n=265] were male and age range was 45 to 80 years with a mean of 68 +12 years. Their average duration from the diagnosis of hepatitis B and C to cirrhosis liver or HCC was few days to 15 years with a mean of 7.5 + 7 years. Interferon was used in past by 16% [n=80] while 83% [n=415] have not and 1% [n=5] used interferon incompletely. We compared the different parameters between the two groups as shown in [table-1-2] which shows that despite not achieving sustained virological response [SVR] the treated group had significantly lower prevalence of HCC and longer duration from diagnosis to the development of HCC than the untreated cases
Conclusion: interferon therapy can delay or prevent HCC in patients of chronic liver disease due to Hepatitis B and C virus even if the patient has not achieved the SVR
ABSTRACT
To estimate the clinical outcomes of hypoglycemia in elderly diabetic patients, its associations with the different antidiabetic drugs and some predisposing factors or comorbid conditions. Both type 1 and type 2 diabetic patients with age 60 years or above fulfilling Whiple's criteria for hypoglycemia were included in this study. They were collected from the medical unit Hayatabad Medical Complex Peshawar from November 2010 to July 2011. The patient's history, clinical examination and investigations were recorded on a proforma. Patients with abnormal CNS findings on CT or MRI scan and those who didn't give any partial or complete response to the IV glucose, were excluded from the study. Eighty five patients with mean age of 75+6 years were included in this study. The average hospital stay was 10 days. Sixty-five percent [n=55] of these patients were using sulfonylureas, 20% [n=17] were using metformin alone and in combination, while 25% [n=21] were using insulin [combination of regular and intermediate acting]. Impaired renal function in 40% [n=34], impaired liver functions in 20% [n=17] and neglected elderly in 30.6% [n=26] were the most common predisposing factors. Diabetic treatment related hypoglycemia is more severe in the elderly population with a poor prognosis. Sulfonylureas are the most frequently associated drugs with poorer outcomes. Predisposing factors like impaired renal functions, liver functions and neglected elderly increase the frequency of hypoglycemia. HbA1c is not a good predictor of hypoglycemia in elderly population
Subject(s)
Humans , Aged, 80 and over , Middle Aged , Aged , Male , Female , Hypoglycemia/etiology , Hypoglycemia/drug therapy , Prevalence , Risk Factors , Treatment Outcome , Diabetes Mellitus , Sulfonylurea CompoundsABSTRACT
Stroke is rapidly developing phenomena of symptoms and signs of focal, and at times global, loss of cerebral function with no apparent cause other than that of vascular origin. The Objective was to know the frequency of cerebral infarction and haemorrhage in one hundred patients of stroke in a period of one year. Data was collected by consecutive sampling technique. Total one hundred patients of stroke were collected for the study. They were assessed through a detailed history of hypertension, diabetes mellitus, smoking, previous stroke, transient ischemic attack [TIA], previous myocardial infarction, angina, atrial fibrillation, alcohol intake, drugs used for hypertension/diabetes mellitus. Blood pressure was recorded at arrival and 24 hours after admission. There were 70% males and 30% females. Twenty percent of the patients were in the age range of 51-60 years, 26% of the patients were in the age range of 61-70 years and 18% were in the age range of 71-80 years. Cerebral infarction was present in 72% patients while cerebral haemorrhage was present in 28% patients. Hypertension was the most common risk factor among these stroke patients. Average blood pressure was 180/100 mmHg. Cerebral infarction is the commonest form of stroke. Hypertension is the leading risk factor in stroke patients
ABSTRACT
Objectives: to compare the lipid profile in glycemic uncontrolled type 1 diabetes mellitus [DM] with type 2 glycemic uncontrolled diabetes mellitus [DM] and with matched controls
Study design: comparative study
Place and duration: diabetic Clinic Ward-7, Jinnah Postgraduate Medical Centre, Karachi- Pakistan, from March 2007 to June 2007
Methodology: total 120 adult subjects of either sex were included with set criteria in study and were distributed into three groups of 40 subjects. Group 1 glycemic uncontrolled diabetes type 1 using insulin regularly, Group 2 glycemic uncontrolled diabetes type 2 using oral hypoglycemic drugs regularly, and Group 3 non-diabetic controls. Lipid, lipoproteins, fasting serum sugar and HbA1c were analyzed and compared between both groups of diabetes as well as control group
Result: fasting serum glucose, HbA1c, total cholesterol, triglycerides, and LDL cholesterol were significantly increased whereas HDL cholesterol levels were found to be significantly decreased in both groups of diabetes than in control group. There was no significant difference between type 1 diabetics [group 1] and type 2 diabetics [group 2] in any parameter except that HDL cholesterol levels were increased significantly in type 2 glycemic uncontrolled diabetics, compared to type 1 glycemic uncontrolled diabetics
Conclusion: patients with glycemic uncontrolled diabetics type 2 have greater disturbance in lipid and lipoprotein metabolism as compare to type 1 glycemic uncontrolled type 1 as well as to controls
ABSTRACT
To determine the diagnostic yield of pleural biopsy in exudative pleural effusion. This prospective observational study comprising 50 patients of exudative pleural effusion, was conducted in department of Medicine, Hayatabad Medical complex [HMC], Peshawar. All were included from the hospital OPD. Patients, who were having transudative pleural effusion and those, who were very emaciated, were excluded from the study. History, clinical examination and baseline investigations like FBC, X-Ray chest PA view, Mantoux test, Renal functions and pleural fluid analysis were performed. Pleural biopsy was performed through Abram's pleural biopsy needle. Out of 50 patients, 33 were males and 17 were females. Regarding the presenting symptoms, 86% presented with nonproductive cough, 66% presented with chest pain, 36% with breathlessness and 44% with fever. In 45/50 [90%] patients an adequate pleural tissue was obtained. Out of 45 patients, 40 [89%] patients were having positive yield and 5 [11%] cases had nonspecific inflammation. Out of 40 patients, 27 [67.5%] were having granulomatous inflammatory changes presumptive of tuberculosis, 10 [25%] patients had malignancy and 3 [7.5%] had miscellaneous conditions like Para pneumonic effusion etc. The most common complication was biopsy site pain in all cases. Only 3 [6%] patients developed pneumothorax during the study period. Pleural biopsy has a high diagnostic yield. It is safe, simple and clearly differentiates between malignant and tuberculous effusions