Frequency of various clinical and electrocardiac manifestation in patients with acute organophosphorous compound [OPC] poisoning

Background: worldwide, OPC are the most widely used insecticides in developing countries like Pakistan, where agriculture is the main occupation and easily available everywhere, therefore, the OPC poisoning is very common. WHO recently reports that pesticides poisoning occurs about 3 million/year with mortality > 3 lac/year and 99% belong to developing countries

Objective: to determine the frequency of various clinical and electro cardiac manifestation in OPC poisoning

Methodology: prospective observational study, conducted from Dec 2008 to April 2010 in Department of Medicine and Intensive Care Unit [ICU] at Liaquat University of Medical and Health Sciences, Jamshoro / Hyderabad

Results: out of 70 adult patients, 28[40%] were males and 42[60%] were females. The nature of OPC poisoning was suicidal in 58 [82.86%] and accidental/incidental in 12 [17.14%]. There were 43 [61.43%] farmers, 21 [30%] house-workers and 6 [8.57%] college students. There was a high ratio of insecticides [Melathion, Parathion, and Mite/rat House fly killer Carbamates] by ingestion/ inhalation route. The cardiac manifestations were Sinus Tachycardia in 20[28.6%], Non Cardiac Pulmonary Edema and Sinus Bradycardia 15[21.4%] each, Hypertension in 13[18.6%] and Hypotension in 07[10%]. Common ECG changes noted in our study were prolonged QTc - interval among 28[40%], prolonged P-R interval in 11[15.7%], atrial fibrillation, ventricular Tachycardia and extra systole were found as; 06 [8.6%], 05 [7.1%] and 05 [7.1%] respectively. Common neurological findings were flaccid paralysis in 28[40%] patients with respiratory muscle involvement in 10 cases, delirium in 11[17.5%], impairment of consciousness in 8[11.4%], and extrapyramidal features, fasciculation's, convulsions, and cranial nerve involvement were in 6 [8.6%], 5[7.1. %], 7[10%] and 5[7.1%] respectively

Conclusion: in routine hospital practice, the suicidal cases are very common due to acute OPC poisoning. Many cases are hospitalized with critical condition with predominant involvement of cardiac and neurological features. Early diagnosis with appropriate treatment with specific antidotes and ICU management can minimize the fatal consequences of OPC poisoning. It is further recommended that more studies are required to provide awareness regarding this important public health problem

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