Study on clinical presentation and etiological profile of atrial fibrillation patients

Background: Atrial fibrillation is one of most common arrhythmias observed in general practice. Atrial fibrillation may occur paroxysmal or may become established as permanent condition. The aim of the treatment of atrial fibrillation is either normalization of rhythm by cardioversion or control of ventricular rate by drugs. The present work was undertaken to study, clinical presentation, aetiology and complications in patients developing atrial fibrillation.Methods: A prospective study carried out at Department of Medicine V.M. Medical college and Shri Chhatrapati Shivaji Maharaj Sarvopachar Rungnalaya, Solapur, over the study period of two years. 100 patients of atrial fibrillation diagnosed by following clinical and ECG criteria were included. Detail study of aetiology complication and clinical presentation of atrial fibrillation was done in present study.Results: Commonest presenting symptom was breathlessness (70%) followed by palpitation (58%). Common signs elicited were irregular pulse, apex pulse deficit (92%). Congestive cardiac failure was present in 46% patient among those raised JVP was seen in 100% cases, oedema in 60.8% hepatomegaly 63.04% basal crepitations in 86.9% cases. ECG revealed coarse fibrillary waves (81.8%) in patients with rheumatic heart disease whereas fine fibrillary waves were seen in patients with IHD as cause of AF.Conclusions: Size of fibrillary was may be predicted etiology of AF as coarse waves are common in rheumatic and fine waves in non- rheumatic AF. The present paper would help in early diagnosis and prompt treatment of AF.

Novel role of topical diltiazem in reducing raised intraocular pressure in rabbits

Objective: The objective of the current study was to evaluate the IOP lowering of topical diltiazim which is a calcium channel blocker

Study Design: Observational / descriptive study

Place and Duration of Study: The study was conducted at the Department of Pharmacology, Khyber medical college Peshawar, KPK-Pakistan from November 2015 to February 2016

Materials and Methods: 40 healthy rabbits of a local strain weighing 1.50 to 2.00 kgs were obtained and kept at the animal house of the department of pharmacology, BMC Bannu. The study was conducted on both eyes of conscious rabbits. Three sets namely X, Y and Z were made. Topical diltiazim was injected to set X[made ocular hypertensive and glaucomatous through weekly injecting sub-conjunctival betamethasone suspension]. Ocular hypertensive control set Y was also established which gotsynthetic tears for a period of 28 days through the whole project. SetZ received no treatment during research and it act as normotensive control

Results: Our results indicated that topical diltiazim can reduce the intraocular pressure very efficiently and quickly. Topical diltiazim wielded IOP reducing outcome in a much transitory time retro. Marvelous animal's survival was also related to it

Conclusion: In future, topical diltiazim might be incorporated as a substitute anti-glaucoma drug in order to manageoptical hypertensive crisis, provided its safety in human

Surveillance report on endemic measles in district Bannu

Objective: The objective of the current study was to report the surveillance of endemic measles in district Bannu and its peripheries

Study Design: Observational / descriptive study

Place and Duration of Study: The study was conducted in Women and Children Teaching Hospital Bannu and various BHUs and dispensaries of countryside's of the district from Jan, 2016 to March, 2016

Materials and Methods: Patients up to 16 years old were screened for febrile rash illnesses at women and children teaching hospital district Bannu and BHUs/dispensaries. Active measles cases were classified as measles, measles with eye and mouth complications, or severe complicated measles using IMCI criteria.16 most critical patient's blood samples were sent to CMH hospital laboratory Peshawar, KPK for further confirmation where test was done by ELISA technique utilizing IgM antibodies

Results: Results showed that male children were highly infected than female. Children from 1-3 years were most affected, followed by children with 1 to 12 months. Least no of cases were reported in children from 4-8 years. Bannu city surrounded areas like mammashkhel, shiekhan, surrani were more affected from measles outbreak while nearby areas are at constant threat

Conclusion: It is concluded that the peripheries were more affected from measles outbreak while nearby areas are at constant threat. In light of our findings, it can be stated that proper steps should be taken by government and non- government organization to control the situation in affected areas and to prevent the nearby areas specially the city from the current outbreak

Intra-articular distal radius fractures; functional outcome of percutaneous kirschner wire fixation and short arm cast in patients of 20-70 years

To determine functional outcome of percutaneous Kirschner wire fixation and short arm cast in intra-articular distal radius fractures in patients of 20-70 years. Descriptive case series. Department of Orthopedic Surgery, Dow University of Health Sciences / Civil Hospital Karachi. 1[st] April, 2013 to 30[th] September, 2013. A total of 62 patients with closed type III distal fractures according to Frykman classification were included in this study. Patient lying in supine position and after general anesthesia, closed reduction was done with the forearm in prone position, aiming to restore normal anatomical position. Two Kirschner wires were inserted from radial styloid process in parallel and oblique fashion to the medial cortex of the radius and one transversely from lateral to medial for intra-articular fragments. Final functional outcome was assessed after 12 weeks of surgery and recorded on pre-designed Proforma. Acceptable functional outcome of percutaneous Kirschner wire fixation and short arm cast in intra-articular distal radius fractures was observed in 80.65% [50/62] cases. It is concluded that functional outcome of percutaneous Kirschner wire fixation and short arm cast procedure is satisfactory in intra-articular distal radius fractures and it appears to be an easy, technically less demanding and effective method for stabilization, so this procedure can be applied for patients with these fractures

Pentalogy of fallot with a single coronary artery: a rare case report

Anomalies of origin, course, and distribution of coronary arteries, including single coronary artery, are well known in patients with Tetralogy of Fallot However, to the best of our knowledge, there is no published case report of Pentalogy of Fallot with a single coronary artery. Herein, we introduce a 22-year-oldfemale patient diagnosed via echocardiography and cardiac catheterization preoperatively as Pentalogy of Fallot with a single coronary artery arising from the left coronary sinus

Clinico-radiological profile of arrhythmogenic right ventricular dysplasia at a tertiary care center: two year experience

Arrythmogenic right ventricular dysplasia [ARVD/C] refers to fibro fatty infiltration replacement of ventricular myocardium especially that of right ventricle. The clinical presentation varies from asymptomatic state to ventricular tachycardia, heart failure and even sudden death. Diagnosis is established using modified ARVD/C taskforce criteria. Among all the various modalities of diagnosis, magnetic resonance imaging [MRI] gives most comprehensive evaluation of both morphological and functional abnormalities in this disease. MRI may not only obviate need for myocardial biopsy but also give insights into the nature of disease like presence of left ventricular myocardial involvement. We present our 2 years experience of ARVD/C patents who were admitted in our center and in whom diagnosis of ARVD/C was supported by excellent MR imaging. This study was conducted by Department of Radiology and Cardiology SKIMS, a tertiary care center for a period of 2 years. Patients with suspected ARVD/C based on clinical, electrophysiological and echocardiographic findings were subjected to MR imaging. Patients were excluded if they had history metallic implants, claustrophobia or were uncooperative. In this study stress was laid on diagnostic role of MRI in ARVD/C. The median age at presentation was 31 years [range 21-43 years]. 80% of patients were males. Most common clinical presentation was palpatations [40%]. Syncope was present in 27% and heart failure in 13%. EKG suggestive of ARVD was seen in 87%. Echocardiographic features suggestive of ARVD/C was seen in all 15 patients. Family history of premature sudden death less than 35 years old was present in one patient only. MRI evidence classical for ARVD/C was seen in 80%. Demographic features and mode of presentation of our patients is consistent with what has been rest of the world. We performed MRI in all patients to increase the specificity of our diagnosis. MR imaging allows a three-dimensional evaluation of the right ventricle and provides the most important anatomic, functional, and morphologic criteria for diagnosis of ARVD/C within one single study. MR imaging appears to be the optimal imaging technique for detection and follow-up of clinically suspected ARVD/C

Successful reductions of anterior shoulder dislocations using intra articular lidocaine injection

To find out the frequency of successful reductions in acute anterior shoulder dislocations after the use of intra-articular lidocaine injection. This study [case series] was conducted in Emergency Department of Civil Hospital Karachi from July 2009 to January 2010. Patients with acute anterior shoulder dislocation [diagnosed with examination and X-Rays] were reduced in emergency department by Hippocratic method after infiltration of 1% Lidocaine in the affected shoulder joint. Reduction was confirmed by post reduction shoulder X-Rays. Frequency of successful reduction and complications were recorded. Majority of the patients [34.3%] were between 18-30 years of age group with mean age of 40.14 [ +/- 15.14] years. Males were affected more than females with male to female ratio being 2.9:1. They commonly had predominant right shoulder dislocation [71.4%]. Successful reduction was achieved in 32 [91.4%] patients after infiltration of 1% lidocaine injection. No complication was recorded. Use of intra-articular lidocaine for reduction of shoulder joint appears to be a safe and effective method and associated with successful reduction in majority of cases

Radiological outcome of type ii open diaphyseal fractures of tibia with interlocking intramedullary nailing

To determine the fracture healing [callus formation] with the use of interlocking intramedullary nailing in type II open diaphyseal fractures of tibia. Forty patients with open type II tibial diaphyseal fracture of tibia were included in this case series study conducted in Orthopaedic Unit-1 of Civil Hospital Karachi from August 15, 2008 to August 14, 2009. All patients underwent fracture stabilization by reamed locking intramedullary nail within three days of injury. The main outcome measure was fracture healing [i.e. adequate callus formation] on X-ray at twenty four weeks. The SPSS version 13 was used to analyze data for descriptive statistics. Majority of the patients [42.5%] were between 18-30 years of age group with mean + SD age was 36.50 [12.89] years. Males were affected more than females with male to female ratio being 4:1. Adequate callus formation was achieved in 35 [87.5%] patients radiographically at the end of six-months. Intramedullary interlocking nail can be safe and effective in management of open type II diaphyseal fracture of tibia as it is associated with satisfactory healing

Presentation and precipitating factors of diabetic Ketoacidosis in children

Diabetes mellitus is a metabolic disorder caused by absolute or relative deficiency of insulin. It is the most common metabolic disorder of childhood and is caused by deficiency of insulin [type 1]. Its prevalence is 1 per 500-600 children. The incidence is 1.2-1.9 cases per 1000 children. The complications of diabetes are multiple and severe. Immediate complications include Diabetic Ketoacidosis [DKA] and Coma. 10-30% children present with DKA. The main contributing factor is relative lack of insulin. This occurs when there is increased requirement for insulin due to increased physiological stress as seen in infection, trauma, surgery and psychological stress, etc. [1] To identify the frequency of various presentations of DKA in children. [2] To identify the frequency of various precipitating factors of DKA in children. [3] To correlate the incidence of DKA with age and socioeconomic conditions. A cross-sectional study. JMDCH, January 2004 - October 2004. The convenient sample of 50 histories was collected from pediatric departments of various public and private sector hospitals of Karachi. Results were analyzed using MS Excel 2000. A total of 50 cases were analyzed out of which most of the cases were undiagnosed [64%] and belonged to low socioeconomic group [58%]. Mean age of male patients was significantly lower as compared to females [5.5 +/- 2.31 vs. 7.54 +/- 3.05, p<0.05], while status of hydrogen ion concentration [pH] was significantly lower in females [7.16 +/- 1.46 vs. 7.26 +/- 0.08, p<0.05]. Most frequent presenting complaints were vomiting, abdominal pain, dehydration and respiratory distress [34%]. The most frequent precipitating factor was fever in 17[34%] cases. More than half of the cases are undiagnosed and belong to low socioeconomic group. The level of awareness towards diagnosis of disease increases with the socioeconomic conditions. DKA affects both the genders equally; males being affected at an earlier age group. Most frequent presenting complaints are vomiting, abdominal pain, dehydration and respiratory distress while fever is the chief precipitating factor