Frequency of medical complications in hospitalized stroke patients at Bahawal Victoria Hospital, Bahawalpur

Objective: To find out the frequency and nature of medical complications in hospitalized patients admitted to Bahawal Victoria Hospital, Bahawalpur with acute stroke

Study Design: Cross-sectional Study

Place and Duration of Study: This study was conducted at the Department of Medicine, Bahawal Victoria Hospital and Quaid-e-Azam Medical College, Bahawalpur from July 2015 to September 2015

Materials and Methods: 98 patients who fulfill the inclusion criteria and gave informed consent were enlisted in the study. These patients were regularly observed for any post stroke medical complications after the clinical evaluation and CT scan plain brain until they were discharged from the hospital

Results: The mean age of the patients was 57.15 +/- 15.42. Most of the patients suffering from stroke were female [68.4 %] and belonged from rural population [73.5 %]. Most of them were suffering from ischemic stroke [66.3 %]. Specified medical complications included: Recurrent Stroke [29.6 %], Epileptic seizures [12. 2 %], Urinary tract infections [30. 6 %], respiratory tract infections [31. 6 %], bed sores [15.3 %], shoulder pain [10.2 %], depression [53.1 %], falls [13.3 %], Venous Thromboembolism [7.1 %]. A total of 14 patients [14.28 %] died during the hospital stay due to severe disease

Conclusion: This study established the post stroke medical complications mainly the pressure sores, pain and infection. As a complication, depression was also identified among the stroke patients. The disability and mortality can be minimized by early identification and treatment of these likely avertable complications

Accidental phosphine gas poisoning with fatal myocardial dysfunction in two families

Aluminum phosphide is commonly used as a rodenticide and insecticide and is one of the most fatal poisons. The active ingredient is Phosphine gas which inhibits cytochrome oxidase and cellular oxygen utilization. The clinical symptoms are due to multiorgan involvement including cardiac toxicity which is the most common cause of mortality. Severity of clinical manifestations depends upon the amount of the gas to which a person is exposed. There is no specific antidote available. High index of suspicion and early aggressive treatment is the key to success. We report 2 cases of aluminum phosphide toxicity in 2 families due to incidental exposure after fumigation

clinical value of immediate second transurethral resection in patients with high grade non-muscle inasive bladder Cancer [HG-NMIBC]

Objectives: this study was designed to estimate the value of a second transurethral resection of bladder tumor in patients with initially diagnosed T1 High-grade bladder cancer

Material and Methods: between October 2008 and November 2015, a total of 350 patients were diagnosed with T1 high grade non-muscle invasive bladder cancer. These patients were divided into two groups. Group A: 150 patients who underwent an early reresection. Group B: 200 patients who did not undergo early re-resection. Data were collected retrospectively which included patient's history, physical examination, and investigation, histological parameters including presence of detrusor muscle at initial TUR and at second TUR, recurrences and progression rates

Results: the detrusor muscle was present in 90 patients out of 150 patients [60%] in Group A and in 158 patients out of 200 patients [79%] in Group B, at initial TUR. At early re-resection, detrusor muscles were present in 76.67% of patients. The residual tumor was present in 55% of re-resected patients. The overall incidence of tumor recurrence was 34.66% and 42% in Groups A and B, respectively. There was a significantly higher rate of tumor progression in patients who did not undergo early re-resection during follow up. [Group 14.28% v. s. Group 3.85% P<0.05]

Conclusion: a second TUR should be routinely advised in all patients with T1 high grade bladder cancer, to achieve a complete resection and to identify patients who may need to undergo radical cystectomy

To evaluate comparative values of HDL cholesterol among male and female patients of type 2 diabetes

Objectives: To assess and compare the HDL Cholesterol among male and female type 2 diabetics and to look for the blood pressure and glycemic stats between both genders

Study design: An observational comparative prospective study

Place and duration: The study was conducted in Medical Unit-2 of Bahawalpur Victoria Hospital over a period of 6 months from June 2012 to December 2012

Methodology: A sample size of hundred diagnosed cases of type 2 diabetes was collected. Those who had hyperlipidaemia due to secondary causes like nephrotic syndrome, hypothyroidism and drugs were excluded. Fasting blood samples were collected for sugar and lipid profile. All collected data was analyzed through software SPSS version 10

Results: Female patients were found to be overweight and hypertensive and they had uncontrolled hyperglycemia as well. The mean values of lipoprotein were deranged in females as compared to males. By applying NCEP ATP III criterion, lipid level were classified into different risk categories. In female patient the mean concentrations of HDL-C was 32+2.4mg/dL [T-Value = -23.57 very highly significant] and was in high risk category while LDL-C was 191+31.81mg/dL [T-Value = -2.01 significant] and was in borderline risk. LDL: HDL ratio was 6.0 and significantly raised. Triglycerides were within normal range. In male patients the mean concentration of LDL was borderline risk 174+41mg/dL [T-Value = 13.2] while HDL-C was 40mg / dL [T-Value = -6.53], both in borderline category. LDL: HDL ratio was also in acceptable range in males. Triglycerides values turned out to be within normal range in both gender

Conclusion: HDL cholesterol was frequently reduced and was in high risk category in female diabetic patients as compared to male counterparts and LDL values were borderline. Hence they are at more risk of complications as they were hypertensive and had more uncontrolled hyperglycemia as well

Pulmonary arteriovenous malformation in cryptogenic liver cirrhosis

The cause in 10 - 20% cases of liver cirrhosis [LC] cannot be elucidated, and are thus termed cryptogenic. Pulmonary arteriovenous malformations [PAVMs] are relatively rare, but the most common anomaly involving the pulmonary tree. Although the rare correlation between LC and PAVM is well-known, there have been no reports of PAVMs occurring in cryptogenic LC. We report a case of PAVM that occurred in cryptogenic liver cirrhosis in a 3 years old male child. The child presented with complaints of malena, hematemesis and variceal bleed. The examination revealed a child with respiratory distress, irritability, tachycardia, clubbing and abdominal distention. He was worked up for recurrent variceal bleeding secondary to portal hypertension but the oxygen saturation during hospital stay kept deteriorating. The diagnosis of hepatopulmonary syndrome as the cause of persistent hypoxemia in the absence of other cardio-pulmonary causes was then made by enhanced echocardiogram using agitated saline. He improved significantly after liver transplantation performed abroad. At a 6 months follow-up, the child was stable with no evidence of intrapulmonary shunting on repeat echo

Epidemiological survey of helminths of goats in southern Punjab, Pakistan

The main purpose of this study was to investigate the prevalence of helminths of goats such as Fasciola hepatica, Haemonchus contortus, Paramphistomum cervi, Oesophagostomum columbian, Cotylophoron cotylophorum, Monezia expansa, Oestertagia oestertagi and Oestertagia circumcincta. The overall prevalence of all species of helminthes was 52% in goat. The study was designed to investigate the factors of helminths prevalence on the basis of sex and age of goat with the help of Chi-square. All the results obtained were non-significant due to some factors which directly affects the prevalence of helminths.

Etiological determinants of pericardiocentesis in children

To look at etiology of pericardial effusion and association between etiology and need for pericardiocentesis. This retrospective study was conducted at the Department of Pediatrics at Aga Khan University Hospital Karachi from January 2002 - December 2010. It included children [age < 15 years] who were admitted with diagnosis of pericardial effusion. Relevant information regarding history, clinical examination, investigations and treatment were noted on a performa. Data was analyzed by using SPSS [statistical package for social science for window version 16.0]. Thirty six 36 patients admitted with moderate to large pericardial effusion were included in the study. Mean age of the patients was 79 +/- 10 months with male: female ratio of 3:1. Infections, postpericardiotomy syndrome, malignancy and connective tissue disorders were the most common causes of pericardial effusion. Seventy five percent [75%] patients required pericardial effusion drainage. Pericardial effusions secondary to infections and postpericardiotomy syndrome are more likely to require pericardiocentesis [p value 0.04]. There were two deaths in the study group which were unrelated to pericardial effusion. Infections and postpericardiotomy syndrome are the most common etiologies of pericardial effusion in our study group. Pericardial effusion secondary to infection and postpericardiotomy syndrome are more likely to require pericardiocentesis

Desarda repair - a new method of tension free repair for inguinal hernia - experience of 77 cases at DHQ hospital Abbottabad

To determine the frequency of patients with inguinal hernia in whom Desarda repair can safely be accomplished and study the morbidity and mortality in such cases. Inguinal hernia is a common disorder in males which requires corrective surgery to lead a comfortable life. Tension free surgery is aim of the surgeon to avoid recurrence of the disorder. Mesh repair has been the most widely performed surgery for inguinal hernia. A new technique of inguinal hernia repair has been developed which utilizes the normal tissue of the patient to create a tension free repair. A prospective study. This study was conducted at DHQ Hospital Abbottabad from September 2009 -June 2011. A prospective study was conducted at DHQ Hospital Abbottabad on 77 patients having inguinal hernia. All patients above the age of 15 years were included. Patients having recurrent inguinal hernia were excluded from study. Most common age group was [56-65 yrs]. Out of 77 patients 64% were of indirect inguinal hernia while 36% were of direct inguinal hernia. Common age group with direct hernia was above 50 years. Post operative complications, hospital stay and return to routine activities were evaluated. Hematoma formation and wound infection in two cases were only complications noted. Patients were free of post operative pain. Desarda repair is simple, very safe technique of inguinal hernia repair free from any complications

Management and outcome of chronic subdural haematoma

To analyze overall outcome in chronic subdural haematoma and study the results of different surgical methods employed to treat this condition. This prospective, descriptive observational study was carried in the Department of Neurosurgery, Nishtar Medical College and Hospital, Multan from October 2007 to April 2008. A total of 60 patients were included in the study. Out of 60 patients, 44 [73%] were male and 16 [27%] were female. 60% patients presented with history of minor trauma to he head in road traffic accidents, falls and slips in bath rooms of different durations, usually more than 2 weeks. The chronic subdural haematoma is a surgical lesion. The burr-holes aspiration under local anesthesia is the perfect surgical method in most of the cases

Microsurgical aneurysmal clipping based on computed tomography angiography

To evaluate the efficacy of Microsurgical Aneurysmal Clipping Based on the computerized tomographic angiography [CTA]. This study was carried out in Neurosurgery Department, Nishtar Hospital, Multan from June 2009 to December 2009. A total of 10 patients who were operated upon for craniotomy and clipping of the aneurysms. All the patients presented with spontaneous sub-arachanoid hemorrhage were worked up for the cause of their intracranial bleed. Computerized tomographic angiography was the initial investigation Patients with ruptured aneurysm wee considered for surgery. Ten patients were operated upon during a time span of six months and showed excellent compliance in their follow up visits. There was no mortality in any of the surgically operated cases. Only three [33.3%] patients suffered from minor morbidity which recovered in a short period of time with the steroids and physiotherapy. Preoperative angiographic studies were compared with the postoperative angiographic studies and the isolation of the aneurysm was assessed independently by a radiologist who was not the member of study team. CTA being a non invasive and quick method to visualize the angioarchitecture of the brain in an alternative method for the planning of the aneurismal surgery. The sensitivity of the CTA for the aneurysms of the brain in 80-85% with a specificity of 90-97% compared with the digital sub-traction angiography [DSA]

Psychosocial factors associated with symptoms of depression and anxiety following acute myocardial infarction

To study factors associated with symptoms of depression and/or anxiety following acute myocardial infarction [AMI]. This Cross-sectional analytical, non-interventional, hospital based study was carried out at Punjab Institute of Cardiology [P.I.C] and Services Hospital, Lahore. One hundred consecutive inpatients with AMI diagnosed using WHO criteria, with the age range of 30-60 years [who were without physical complications] were included in the study. The Urdu version of Hospital Anxiety and Depression Scale [HADS] was administered to each patient during the period of 5-7 days following AMI. A semi structured clinical interview was also conducted which included demographic information, psychiatric assessment and risk factors related to AMI especially psychosocial factors. Results were analyzed using Statistical Package for Social Sciences [SPSS]. Out of 100 subjects, 80 [80%] were males and 20 [20%] were females. The age range was between 30-60 years [50.92 +/- 8.53]. Over all, symptoms of depression and/or anxiety were found in 50 [50%] patients. More particularly, symptoms of depression were found in 14%, symptoms of anxiety in 18%, and mixed symptoms [depression and anxiety] in 18% of the patients. A significant association was found between symptoms of depression and/or anxiety following AMI and family history of AMI [p < .007], type A behavior traits [p < .001], job stress [p < .01] and lack of confiding relationships [p < .002]. However, no significant association was found between symptoms of depression and/or anxiety following AMI and past history of AMI. The findings highlight the critical need to assess symptoms of depression and/or anxiety following AMI along with the factors leading to these. This would be particularly important in patients who have a family history of MI, job related stress, lack of confiding relationships and type A behavior traits

Dyspepsia and upper gastrointestinal endoscopy; Multan experience

To find out causes of dyspepsia on upper gastrointestinal endoscopy. Endoscopy unit of Nishtar Hospital Multan. May 2005 to August 2007. Patients suffering from dyspepsia were referred by consultants of Nishtar Hospital Multan and doctors working in the periphery for endoscopy. 502 patients were scoped for dyspepsia; 254 [50.6%] were male and 248 [49.4%] were female. Mean age was 42.5 years and age range was 7-95 years. Most common lesion was gastroduodenitis [20% cases] followed by gastric ulcer [5.4% cases]. Ratio of duodenal ulcer to gastric ulcer was 1:2.56% patients had no pathology; females were more likely to have normal endoscopy. Gastroduodenitis is the most frequent organic cause of dyspepsia. Functional dyspepsia is more common among females

Urological injuries

To find out the mechanism of injury and urological organ involved. Prospective study. two years [from 1996 to 1998] West Surgical Ward Mayo Hospital Lahore. A total numbers of 30 patients were included in the study. All the patients above the age of 12 years having injury to kidney, ureters, bladder, and combination were included. Penetrating injuries due to firearms were the dominant cause i.e. in kidneys and ureters [100%] and in urinary bladder [50%]. Kidney was the most common urological organ injured [56.66%] followed by the ureters [20%] and Urinary bladder [13.33%]. Urological injuries account for 10% of abdomen injuries. The vast majority are penetrating injuries due to firearms. The injuries may better be prevented than treated by strict maintenance of law and order

Vogt-koyanagi-harada syndrome: a case report and review of literature

Vogt-Koyanagi-Harada [VKH] syndrome is a rare multisystem disorder in which cell-mediated autoimmunity against melanocytes affects the eyes, inner ears, central nervous system and skin. Alopecia, poliosis and vitiligo are the cutaneous manifestations. Visual and hearing loss is the important complications which can be prevented by early diagnosis and aggressive systemic therapy. We report a case of VKH syndrome in which alopecia was the only cutaneous manifestation and early diagnosis and prompt systemic corticosteroid therapy prevented the visual loss and reduced the morbidity

Electrophoretic analysis of serum proteins in prostate cancer

Objective: This work was undertaken to analyse qualitatively serum proteins separated by SDS-PAGE and stained with Coomassie Brilliant Blue R-250, to detect novel proteins, which could possibly serve as markers for the early detection of prostate cancer

Design: This study [carried out on subjects who were confirmed by biopsy as cancer prostate [CaP] patients] was a preliminary step towards the detection of some new protein markers for CaP

Place and Duration of Study: This study was conducted at the Institute of Biochemistry and Biotechnology University of the Punjab Lahore, from January to March 2003

Subjects and Methods: Serum samples, 36 cases of cap and 36 controls of similar age group were separated by SDS-PAGE on a 12% gel, and then stained using Coomassie Brilliant Blue R-250. Protein fractions were analyzed using the computer software program "GeneGenius Gel Documentation and Analysis System"

Results: The appearance and relative raw volumes of 14 major protein fractions ranging in molecular weight from 0.23-157 kD in each group were studied. It was seen, on the whole, that the raw volume of most of the protein fractions decreased in the CaP cases as compared to the controls. Furthermore, the protein fractions of 1.27, 100, 114, 122 and 140 kD were absent in a significant number of the cases. However, it was seen that the protein fraction of 0.23 kD was absent in all the control samples while it appeared in most of the cases

Conclusion: A number of proteins were found to have been lost during malignant transformation. Further investigations are warranted to identify these novel proteins using 2D-PAGE followed by immunoblotting

Symptoms of deperession and anxiety in post-myocardial infarction patients

To assess the frequency of symptoms of depression and/or anxiety following acute myocardial infarction [AMI] and to analyse their association with demographic variables. Design: A cross-sectional analytical, non-interventional hospital based study. Place and Duration of Study: The study was carried out at Punjab Institute of Cardiology [PIC], Lahore, from January 2000 to January 2001. Patients and A total number of 100 inpatients suffering from AMI were studied. After a careful selection of the subjects the Urdu version of Hospital Anxiety and Depression Scale [HADS] was administered to each patient during the period of 5-7 days following AMI to assess symptoms of depression and anxiety. A semi-structured clinical interview was also conducted which included demographic information, psychiatric history and other variables. Results were analyzed by using Statistical Package for Social Sciences [SPSS version 8.0]. Out of 100 subjects, 80 [80%] were males and 20 [20%] were females. Their ages ranged from 30-60 years [mean age, 50.92+8.53]. Overall, symptoms of anxiety and/or depression were found in 50 [50%] patients. More specifically, symptoms of depression were found in 14%, anxiety symptoms in 18% and mixed symptoms [anxiety and depression] in 18% of the patients. Results revealed that patients above 45 years of age [i.e. 46-60 years] were more likely to experience symptoms of depression and/ or anxiety following AMI. A significant association was also found between female sex [p <0.02], lower socioeconomic status [p <0.05] and symptoms of depression and/ or anxiety in these patients. However, no significant association was found in relation to educational status, marital status and origin [urban/rural]. The high proportion of patients with AMI found to be suffering from symptoms of depression and/ or anxiety one week after AMI highlights the essential need to assess these symptoms in all such patients during the post-MI period as they merit appropriate treatment alongwith the other complications of AMI

Morphological pattern of male infertility - an experience at Lahore General Hospital, Lahore

This is a retrospective study carried on fifty patients undergoing testicular biopsy for work up of male factor infertility in the Department of Urology Lahore General Hospital, Lahore. The objective was to determine the predominant histopathological patterns in testicular biopsies .A clinically relevant classification was utilized. Of the total 50 patients studied, normal spermatogenesis was found in 38 percent of cases. Hypospermatogenesis was found in 12 percent of cases, maturation arrest in 10 percent, germinal aplasia in 18 percent and end stage testis in 22 percent of cases. A higher percentage of germinal cell aplasia and end stage testis was seen in this study. The sample size, design of different studies and criteria used for patient selection explain the cause of observed differences

Laser trabeculoplasty in pakistani patients

Argon laser trabeculoplasty [LTP] was performed on one eye each of 13 phakic patients with bilateral open angle glaucoma. Initial results of a 10-month follow-up showed it effective in lowering of intraocular pressure and, hence, in reduction or discontinuation of other antiglaucoma medication in eight [61.5%] patients. One patient [7.6%] showed no change and four [30.8%] needed filtering procedure following LTP. However, the long-term efficacy of laser trabeculoplasty in these Pakistani patients in the first group remains to be fully determined