Diagnostic Accuracy of Different Bedside Clinical Methods in Evaluation of Peripheral Neuropathy in Patients of Diabetes: Experience at a Tertiary Care Center

Background and Objectives: At present, the gold standard for diagnosis of diabetic peripheral neuropathy is biothesiometry. Sincethe data are sparse comparing the biothesiometry with commonly used bedside tests, we conducted this study to evaluate theclinical accuracy of simple bedside clinical screening tools for evaluation of peripheral neuropathy in patients of diabetes mellitus.Materials and Methods: Atotal of 120 patients with diabetes mellitus referred from the endocrinology department, from August2014 to July 2017 were included in this study. A detailed clinical assessment including diabetic neuropathy symptom (DNS)score, diabetic neuropathy examination (DNE) score, ankle reflex, vibration sensation with a 128 Hz tuning fork, and 10 gSemmes-Weinstein monofilament, and biothesiometry was done in all the subjects.Results: The prevalence of peripheral neuropathy was 36% with biothesiometry. Only 33.33% of patients followed foot carepractices in the study population. Monofilament was the most sensitive and accurate of all the diagnostic tests for the evaluationof peripheral neuropathy in diabetes patients. On statistical analysis correlations observed between the biothesiometry andthe DNE score (r = 0.572, P < 0.00018) and DNS score (r = 0.436, P < 0.0004) and absent tuning fork sensation (r = 0.510;P < 0.0007), monofilament sensation (r = 0.713; P < 0.0002) and ankle reflex (r = 0.456, P = 0.0002) were significant.Interpretation and Conclusions: we concluded that simple bedside tests are useful for diagnosing peripheral neuropathy indiabetes patients including those in whom foot care practices are not followed.

Role of ultrasound guided biopsy of thoracic lesions

This prospective study is to evaluate and enhance the role of ultrasound in biopsy guidance of thoracic lesions. 55 patients were subjected for fine needle aspiration [FNA] and/or core needle biopsy [CNB] from peripheral chest lesions in Ribat University Hospital during the period from April 2011 and October 2012. Samples were analyzed and results were processed by the pathologist. 81 biopsies were successfully taken from 51 [92.7%] patients, while failed in 4 [7.3%]. 41 [50.6%] of the biopsies were taken using FNA and 26 [32.1%] by CNB, while 14 [17.3%] of the samples were aspirations from loculated pleural effusions. The diagnostic yield was 96.2% for CNB, 92.7% for FNA and 95.7% when both of them were taken. The mean duration of the procedures was 20.6 minutes. Immediate complications occurred in three patients, mild hemoptysis in two and chest pain in one. The results showed that US guided biopsies of intrathoracic lesions is safe, quick and the least expensive imaging guided biopsy. The procedure accuracy in obtaining sample is very high. Training chest physician on US will enable them to take active part in patient management and hence cut short waiting time for the procedure and the result, which will free the radiologist for more complex interventional procedures.

Reference spirometric values in a Sudanese cohort

To determine normal values of respiratory function for Sudanese, a randomized stratified crosssectional study was performed on 2250 healthy Sudanese aged 7-86 years in 2002-05. Data were obtained through a questionnaire, pulmonary function testing and taking anthropometric measurements. Lung function and anthropometric measurements were correlated and regression equations were derived. Sudanese of Arab ethnic background had significantly higher forced vital capacity [FVC], forced expiratory volume in 1 [first] second [FEV1] and peak expiratory flow rate [PEFR] than those of African ethnicity. In adults a positive correlation was found between lung function and height and a negative correlation with age. Gender and ethnic variations in Sudanese lung function were confirmed. Comparisons were made with data from other international studies. These values can be used as reference values in respiratory clinics in Sudan

Lung function and airways responsiveness during pregnancy

The changes in forced vital capacity [FVC], forced expiratory volume in the first second [FEV[1]], peak expiratory oral pressure [PEFR] and abdominal birth pregnancy and in the postpartum period were found. A randomized prospective longitudinal study was performed in Rabak city in central Sudan in January to November 2002. 48 normally pregnant women were included [26 in the 3[rd] trimester, 19 in the 2[nd] trimester and 3 in the 1[st] trimester]. The microplus spirometer was used to measure FVC, FEV[1] and PEFR during pregnancy then 1-2 months after delivery. The abdominal girth was measured concurrently with lung function parameters. Paired T-test was used to compare lung function during pregnancy and in postpartum period. The results show that there was significant increase in both FVC and FEV[1] after delivery [P<0.01] with insignificant increase in PEFR. The abdominal girth had decreased significantly in the postpartum period [P<0.01]. In spite of the steady drop in FEV[1] from the 1[st] to the 3[rd] trimester, PEFR values showed some what steady increase. There was no significant correlation between abdominal girth and lung function during pregnancy. Some pregnant women had reported dyspnea. It was concluded that there was significant reduction in FVC and FEV[1] values during pregnancy compared to postpartum period which can not be only explained mechanically, because this decrease had occurred from the 1[st] trimester even before any increase in the abdominal girth. The improvement in PEFR values from the 1[st] to the 3[rd] trimester can be explained by the rise of plasma cortisol and this improves asthma severity during pregnancy. The reported dyspnea during pregnancy can be explained by the hyperventilation during pregnancy caused by progesterone and not mechanically, because it frequently occurred before any increase in the abdominal girth

Occupational pulmonary hazards due to chronic exposure to benzene

This was a cross-sectional study performed in Khartoum state on 79 workers at petrol stations in October 2003. The population was divided into two groups, one exposed to benzene for 5 years and more and another exposed for less than 5 years, then both groups were compared to a control of unexposed subjects. Lung function was evaluated by a questionnaire and lung function testing using the microplus spirometer. Provocation and reversibility tests were performed using benzene and salbutamol respectively and a full history before and after exposure to benzene was taken. Benzene provocation test was performed in some unexposed subjects. Both restrictive and obstructive pulmonary trends were evident by the reduction of FVC, FEV1 and PEFR in benzene exposed groups which was directly proportional to the duration of the exposure. The results showed significant reduction in FEV1 and PEFR in benzene exposed workers minutes after benzene inhalation [benzene provocation test] while the reductions were insignificant in benzene unexposed control indicating an increase in airways sensitivity to benzene in chronically exposed subjects than non-exposed. 21% of the workers had reported respiratory problems following work at petrol stations

Peripartum hysterectomy

To find out the frequency, indication and its associated morbidity in our setup. Prospective cross-sectional observational study for the period one year [from June 2003 - May 2004] carried out in the Department of Obs / Gynae, Lahore General Hospital Lahore. During the study there were 26 cases of peripartum hysterectomy, of which 14 case were of caesarean hysterectomy, while 10 cases were following normal vaginal delivery and 2 cases followed by instrumental delivery. Uterine atony was the most common indication for peripartum hysterectomy in 12 cases [46.15%]. Uterine rupture including instrumental delivery tear was 2nd most frequent cause in 4 +2=6[23.07%] of cases. In 19.2% [5] of cases abnormal placentation was the cause. In 2[7.6%] of cases sepsis was the cause leading to secondary PPH followed by hysterectomy. A subtotal hysterectomy was carried out in 10 [38.46%] and total hysterectomy was performed in 16 [61.53%] cases. there were 4 maternal deaths. Urinary tract injuries occurred in 3[11.53%] cases, fever, chest infection and wound infection were common morbidity. Anemia was found in almost every case. Intra and post operative Blood transfusion s were given in all cases. Reloparotomy was done in one patient for continues vaginal bleeding. Despite its morbidity and mortality emergency Obstetric hysterectomy remains an essential life saving tool. Uterine atony, uterine rupture and abnormal placentation were mast common indications, reflecting under utilization of existing antenatal, family planning services. Injudicious use of oxytocin, lack of transportation facilities, poverty and delayed referral all contribute to morbidity and mortality associated with emergency Obstetric hysterectomy

Fetal and maternal out come in eclampsia

To Study the fetal and maternal complication of patient developed eclampsia. Prospective study. Department of Obs. and Gynae Lahore General Hospital Lahore. This Study way conducted from Aug 04 to Aug 05. All the patients presenting with eclampsia to the labor ward were included in study. A total of 3850admission were made in labour word. During Period and out of them 58 Cases were of eclampsia out of them 20 were Primigravida 22 multi gravida and 16 grand multi gravida. Out 58 patients 31 patient developed the complication of eclampsia, 15, IUGR., 6 abruptio Placenta, 4 PPH, 4 Pulmonary edema and 2 Cerebral in Farcts. Among the new born prematurity was found to be major cause of Perinatal mortality. Eclampsia is a dreadful complication of Preeclampsia associated with high perinatal and maternal mortality. An improvement in pre-natal consultation should make it possible to reduce its incidence

Comparison of maternal complication in elective Vs. Emergency caesarean section

To compare the maternal complication in elective vs emergency caesarean section. Prospective study. Department of Obstetrics and Gynaecology, Lahore General Hospital, The study was conducted from August 2004 to August 2005. During this period all women underwent elective or emergency caesarean section included. A total of 920 caesarean sections were performed, 770 were emergency and 150 were elective. Intraoperative and postoperative complications were 76, 70 in emergency and 6 in elective group. Postoperative complications were 120, 110 in emergency and 10 in elective cases. In emergency caesarean section maternal mortality and morbidity is high

Effect of chronic exposure to cotton dust on lung function in Khartoum, Sudan

The aim of this article is to compare forced vital capacity [FVC], forced expiratory volume in the first second [FEV1] and peak expiratory flow rate [PEFR] values in cotton dust exposed textile workers with those obtained from non-exposed control. A randomized cross-sectional study was performed in June 2004 on 101 adult subjects in Khartoum city. 37 were textile workers [19 males and 18 females]. 10 males were exposed to cotton dust for >10 years and 9 for < 10 years, while 18 females were exposed for more than 10 years. 40 non-exposed subjects of similar ages and heights [20 males and 20 females] were used as control. The subjects were examined for pulmonary function using microplus spirometer and their respiratory history was investigated by questionnaire. Results showed that Males exposed for > 10 years showed a highly significant reduction in FEV1 and PEFR compared to the control [p<0.01] while the reduction in FVC was statistically insignificant [p=0.071]. Statistically significant reductions in FVC and FEVl compared to the group exposed for < 10 years were detected, but still the reduction in PEFR was statistically insignificant [p=0.042]. In female textile workers, reductions in FVC, FEV1 and PEFR were statistically insignificant compared to the control as females worked at less exposed sections. Some subjects in the exposed groups had experienced chronic cough and shortness of breath following exposure. It is concluded that chronic exposure to cotton dust is associated with respiratory tract allergy and obstruction more than restriction owing to the significant reductions in PEFR and FEV1 compared to the insignificant reduction in FVC. Proper health safety precautions should be taken in textile factories with continuous check up of the workers

Lung function at high altitude

High altitudes are characterized by low barometric pressure and so low PO2. Inhabitants of such areas must adapt to such environment. In this study the effect of chronic exposure to high altitude on lung function through measuring forced vital capacity [FVC], forced expiratory volume in the first second [FEV1] and peak expiratory flow rate [PEFR] in school children was investigated. A cross-sectional study was performed on 72 male school children in Nyertete village [1160 meters above see level] at Jebel Marrah, western Sudan. The apparently healthy volunteers had completed a questionnaire included personal data and disease history. Anthropometric measurements and pulmonary function tests were performed using the microplus spirometer. The obtained data was compared with the predicted norms of male Sudanese children[1]. Anova test was used for comparing the means. FVC was found to be 2.81 L, FEV1 2.71L and PEFR 403L/min, which were higher than the predicted normal values for these children. It was concluded that high altitude male children showed significant increase in lung function values [FVC, FEV1 and PEFR] compared to low altitude male children predicted normal values

Uterine rupture: an audit to analyze management options, maternal and fetal outcome

Study Design: An analysis of 14 cases of ruptured uterus was done during January 2003 to December 2003 in Obstetrics and Gynae Department of Lahore General Hospital, Lahore. The purpose of this Audit was to analyse the different management options, maternal and fetal outcome in uterine rupture. Material and Total no of births in 2003 was 4840. Total number of ruptured uterus found to be 14 [2.9%/1000] deliveries. Among these incomplete rupture were 3 [21.4%] and complete rupture were 11 [78.4%]. Regarding the common sites of uterine rupture lower uterine segment interior surface = 11 [78.4%]. Lower uterine segment posterior surface = 2 [14.2%] and upper uterine segment rupture was = 1 [7.14%]. The most common cause of uterine rupture was found to be multiparity and injudicious use of oxytocin by TBA in 5 cases. [35.7%] and previous uterine surgery in 5 cases [35.7%]. 2 cases [14.21] were due to cephalopelvic disproportion due to hydrocephalus and 2 [14.2%] cases were of malpresentation [transverse lie] mostly handled at home by TBAs. Hysterectomy, total or sub total was done in 7 cases [50%]. Repair of uterus was done in 5 cases [35.7%], in 2-cases [14.2%]. Bladder repair alongwith uterine repair was done. In two cases [14.2%] of scar dehiscence, repeat cesarean section was done. The maternal mortality was found to be zero, while intrauterine death were 10[71.4%] and alive babies were 4 [28.5%] high perinatal mortality of 71% were found. Ruptured uterus is avoidable catastrophe by proper education, training of patients and TBA's and by providing effective family planning services, transportation, diagnostic facilities and by reducing the unnecessary caesarean section

Frequency of placenta praevia with previous caesarean section

Two hundred Cases of Previous Caesarean Sections were Studied. 130 were associated with Placenta previa. The aim of Study was to evaluate the frequency of Placenta previa with Previous Caesarean Section. Out of 130 Patients 73% were Symptomatic and 27% were asymptomatic. The most Common ante-natal Complications were anemia 40% and repeated Warning haemorrhages 64%. Out of 130 Patients 35 Patients had Previous one Caesarean Section 27%, 80 Patient had Previous two Caesarean Section 61.5% and 15 Patients had Previous three Caesarean Section 11.5%

Does sweeping of membranes in nulliparous women reduce the need for formal induction of labor?

To evaluate the effectiveness of sweeping of the membranes in nulliparous women to reduce the need for a formal induction of labor. A randomized controlled clinical trial. The study was conducted in the Gynae unit 1 of Jinnah Hospital Complex. Lahore, from April 2001to March 2003. 100 nulliparous women attending the antenatal clinic at 39 weeks of gestation were randomly allocated for the study. 50 women were randomized to sweeping of membranes and 50 to control group. Their outcome measures in terms of proportion of women achieving spontaneous labor, duration of labor and bishop score at the time of admission to the hospital were assessed. Spontaneous labor occurred more often in the sweeping of the membranes group than in the control group [38/50[76%] vs. 19/50[38%] P = 0.002]. In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labo r ward [25/50 [49%] vs. 8/50 [16%] P = 0.005. Women allocated to sweeping showed a trend towards having a shorter randomization-delivery interval: 9.4 days vs. 10.6 days in the controls P = 0.087. The need for induction of labor was significantly reduced in those women who underwent sweeping [11% vs26% P = 0.004]. Sweeping of membranes in nulliparous women at 39weeks of gestation significantly decreases the number that will reach 41 weeks of gestation

Ligation of inferior thyroid arteries in subtotal thyroidectomy and postoperative parathyroid function

The study included 48 patients with non-toxic multinodular goitre. In 24 patients [group A] truncal ligation of inferior thyroid arteries was performed and in other 24 [group B] ligation of branches of inferior thyroid arteries at the capsule of the gland was done. The two groups were compared regarding the effect of the procedure on postoperative parathyroid function. Serum total calcium, albumin, and parathormone [PTH] levels were measured before operation and at 6, 24, 72 hours after operation and finally at 3-5 months follow-up. Only 40 patients reported for follow-up. None of the patients in either group had clinical tetany. All the patients had a fall in serum total calcium and albumin level during the first 24-48 hours after operation. Temporary hypocalcaemia occurred in 15 patients [31%]; 7 belonged to group A and 8 belonged to group B. Overt hypocalcaemia occurred in 7 patients; 3 belonged to group A and 4 belonged to group B, whereas subclinical hypocalcaemia occurred in 8 patients [16.5%], 4 from each group. Parathyroid function recovered in 96% of patients by 3 months. Two patients one from each group, had prolonged hypocalcaemia and were still having low corrected serum calcium and PTH levels at two months follow-up. They however, recovered fully by 5 months. No statistically significant difference was found between the two groups of patients studied regarding total calcium, corrected serum calcium and parathyroid hormone levels. The results confirmed that truncal ligation of inferior thyroid arteries during subtotal thyroidectomy does not cause hypoparathyroidism

Community education and downward trend in maternal deaths due to eclampsia

To study the effects of Mother and Child Health programme on Maternal Mortality and morbidity due to eclampsia. Study of all the births recorded during January-December 1994 and cases of eclampsia. Dept. of Obstetrics and Gynaecology, Allied Hospital, Faisalabad. 2579 births recorded during January to December 1994 which included 44 cases of eclampsia. Main outcome measures: To evaluate the number of cases admitted in Allied Hospital, recognition of avoidable factors and improvement of existing practices to reduce maternal mortality, morbidity due to eclampsia. During the study period total number of deliveries conducted in the department were 2579 which included 44 patients admitted with eclampsia. The eclampsia incidence was 1.7%, deaths due to eclampsia were three, maternal mortality being 9.0% which decreased from 20%, 17%, 14.2% and 10.3% FROM 1990-1993 respectively. Eclamptic patients from rural areas were 24 and urban areas twenty, which shows that eclampsia patients were now coming to the hospital as a result of community education programme by the MCHWA. Eighteen eclampsia patients were primigravida while 26 were multigravida quite contrary to the pattern send during 1990-1993. With effective community education programmes maternal mortality and morbidity due to eclampsia can be reduced considerably

Endometriosis in diagnostic laparoscopy

To test the wisely accepted but no well supported impression that endometriosis is much more common in the Caucasian than in Asian women. We assessed prospectively the prevalence of endometriosis in 200 consecutive diagnostic laparoscopies in our department. Twenty-five [12.5%] cases of endometriosis were found. Of these 200 cases 160 cases [70%] underwent laparoscopy for infertility. In 17 [68%] out of 25 patients with endometriosis infertility was the indication for laparoscopy. In the remainder of the patients laparoscopy was performed because of other indications. Half of the patients with endometriosis showed moderate and severe degrees of endometriosis. Two third of the patients were below the age of 29. According to these findings, the presumption that endometriosis is uncommon in Asian women is considered to be erroneous

Genitourinary fistulas: a two year experience with vicryl on 20 cases

Twenty cases of Vesico Vaginal fistula were admitted and repair was done in Allied Hospital / Punjab Medical College, Faisalabad during January, 1992 to December, 1993. Most of the women were in age group between 20-30 years. The major cause leading to VVF was obstructed labour [60%]. The majority 50% of women developed VVF between 2-10 days after the obstetric or gynaecological truam. All [100%] were repaired by using vicryl 3/0, 2/0. The repair was successful in 100% cases

Prevalent characteristics of a community regarding maternal and child health: a base line study

This study was conducted by Mother and Child Welfare Association Faisalabad [MCW AF] before launching a mother and child health programme in two slum areas of the city in 1993. It was found that out of 2080 parous women who were included in the study only 92 [4.4%] were presently practicing family planning whereas only 325 [15.6%] practiced. it previously. 1720 [82.71%] were uneducated, only 154 [7.4%] had primary education and 206 [9.9%] had secondary education. Majority of these women i.e., 1079 [51.9%] were grand multipara and most of the primigravidas 1954 [93.9%] were delivered by TBAs. Exclusive breast feeding was quite commonly practiced and full immunization of the first child was carried out in [47.1%] cases. Early marriage trend was predominant with most i.e., 1728 183.2%] got married between the age of 16-20 years, few i.e., 214 [9.8%] between 21.25 years and fewer i.e., 140 [6.7%] between 12-15 years of age

Faisalabad obstetric flying services and analysis of 1992

Faisalabad flying squad has played a major role in decreasing the rate of maternal mortality in Faisalabad city during 1992 which has been recorded as 0.68/1000 live births. During this period 103 flying squad calls were received and 91 [88.3%] patients were shifted to Allied Hospital, one [1%] delivered at home, 3 [2.9%] were shifted to other hospitals before arrival of flying squad services. Six patients received first aid treatment at home. Most of the calls 34 [33%] were made by the relatives of the patients for utilization of flying squad services