ABSTRACT
Objectives: To evaluate the effect of low dose Albumin i.e. 4 grams per litre of ascitic fluid after large volume paracentesis [LVP] for the prevention of paracentesis induced circulatory dysfunction [PICD] related renal impairment in cirrhosis. Methods: Case records of all patients with cirrhosis who underwent LVP from January 12th, 2011 till December 29th, 2013 were reviewed. Patients were excluded if they had spontaneous bacterial peritonitis, creatinine >1.5 mg/dl, hepatoma or if volume of ascitic fluid removed was <5 litres. Data including age, gender, cause of cirrhosis, CTP score and volume of ascitic fluid drained were noted. In addition serum creatinine and serum sodium at baseline and one week post paracentesis were recorded. Results: Two hundred and fourteen patients with cirrhosis underwent LVP during the study period. One hundred and thirty nine patients met the inclusion criteria and were analyzed. Patients were divided into two groups based on the amount of albumin given. The amount of albumin given was 25 grams and 50 grams while the volume of ascitic fluid removed were 6.2+/-1 litres and 10.4+/-1.5 litres in groups A and B respectively. One hundred and eight patients were in group A while thirty one patients were in group B respectively. Both groups received albumin at a dose of 4 grams per litre of ascitic fluid removed. Mean age in both groups were 53 years. Hepatitis C was the commonest etiology in both the groups, followed by Hepatitis B. More than 70% patients in both the groups were in child class C. Serum creatinine at baseline and one week post LVP was 1.04+/-0.24 mg/dl and 1.07+/-0.35 mg/dl in GROUP A while 1.11+/-0.23 mg/dl and 1.41+/-0.94 mg/dl in GROUP B. [P value 0.35]. Similarly, serum sodium at baseline and one week post LVP was 130 +/-5.6 meq/lit and 129.6+/-5.9 meq/lit in GROUP A while 127.6+/-5.8 meq/lit and 128+/-6.2 meq/lit in GROUP B respectively. [P value 0.14] Conclusion: This study suggests that 4 grams of albumin per litre of ascitic fluid drained is effective in preventing the PICD related renal impairment following large volume paracentesis in cirrhosis
ABSTRACT
Dog bite accounts for a significant number of traumatic injuries, which often needs medical treatment .Although agent, host and environment characteristics of dog bite have been well documented internationally but it is not done in Pakistan. A study was planed to find Agent, host and environment characteristics of dog bite in local population.The study setting was Emergency Department of Abbasi Shaheed Hospital. Patients were enrolled in July 2004,on a Performa designed to get different features of epidemiologic triad. Performa contain features of agents [type of animal, nature of attack and vaccination status of animal]host features [Age .gender, body part involved in bite and vaccination] environmental features [Time of bite and site of accident].Performa was filled by Doctors after interviewing each patient individually. Total 81 cases were registered in this study. Male were dominating with 80% [66] cases .Children and adolescent were the main target 65% [53] of the dog bite victims were less than 15 year of age .Mostly lower limbs were involved in the accident and it accounted for 68 % [55] cases.The highest frequency of dog bite were reported from Orangi town 31 % [25], a thickly populated area belonging to very low socioeconomic group