Epidemiological survey of varicella-zoster infection in faisalabad city v/s various adjoining areas of faisalabad in 2017

Objective: To study the distribution and frequency of Varicella infection and the influence of socioeconomic status or facility of better health care on the outcome of infection in Faisalabad city and its periphery

Study Design: An Epidemiological Survey

Setting: It was carried out at Allied Hospital Faisalabad

Period: Cases presented from Faisalabad city and its peripheral areas, from January to October 2017 were included

Sample Size: Overall 323 patients, irrespective of the time of their presentation since the appearance of varicella rash, were included in this survey

Methodology: Data was analyzed and concluded in Statistical Package for the Social Sciences [SPSS] version 17

Result: Total of 323 cases was reported all over the district Faisalabad in 2017, out of which 206 [64%] cases were from Faisalabad city and remaining 117 [36%] were from adjoining areas [Tehsil] of Faisalabad. They were then distributed according to the day of their presentation in Teaching Hospital, which reveals that among 44 late presenters only 18 [41%] cases were reported from Faisalabad city while remaining 26 [59%] cases were from peripheral areas [Tehsils] of Faisalabad. Out of 279, those who presented to the hospital early, only 5 [1.8%] cases were expired, as compared to 4 [9.1%] cases among 44 late presenters

Conclusion: Varicella infection is more common in urban areas, which are more densely populated. While the proportion of deaths among infected people is higher among those who dwell in peripheries, away from the better healthcare facilities

Role of branched chain amino acids in hepatic encephalopathy

Introduction: Hepatic encephalopathy [HE] or portosystemic encephalopathy is a state characterized by disordered central nervous system functions because of failure of liver to detoxify nitrogenous agents originating from gut because of dysfunction of hepatocytes and portosystemic shunting. Patients with HE often present alteration of mental status varying from minor psychological abnormalities to deep coma. Multiple studies conducted worldwide suggest that the branched-chain amino acids [BCAAs] leucine, isoleucine, and valine may be useful in improving survival and reducing morbidity in patients with HE

Objectives: To compare the efficacy of branched chain amino acids in reversal of hepatic encephalopathy in patients with cirrhosis of liver with placebo

Study Design: Randomized control trial Setting: Medical Unit V, DHQ Hospital Faisalabad

Duration: Study was carried out over a period of 6 months from 1st July 2016 to 30 December 2016

Results: A total of 60 patients [30 in each group] were enrolled, majority of the patients were between 41-50 years in both groups, 36.67% [n=11] in Study and 43.33% [n=13] control group, mean and standard deviation of age was calculated as 43.56+/-5.21 in study and 45.78+/-4.98 years in control group, 70% [n=21]patients were male in study group and 63.33% [n=19] in the control group, 30% [n=9] patients in study group and 36.67% [n=11] in control group were females, comparison of efficacy of BCAAs in reversal of HE with placebo reveals 63.33% [n=19] patients in study group showed reversal of HE and 26.67% [n=8] patients in control group

Conclusion: The results of the study conclude that branched chain amino acids are significantly effective in reversal of hepatic encephalopathy when compared with placebo.

Diagnostic accuracy of cerebral CT perfusion in acute ischemic stroke

Objectives: to determine the diagnostic accuracy of CT Perfusion brain over Non contrast CT for patients presenting with stroke symptoms in the 12-hour window

Design: cross-sectional study

Setting: Department of Radiology Allied Hospital, Faisalabad

Period: from July 2014 to December 2014

Patients and Method: we studied 60 patients of 45-70 years of age of both genders [mean 55.13+/-5.54] [42 [70%] males and 18 [30%] females] with initial clinical symptoms suggestive of acute ischemic stroke. All patients had an initial non-contrast head CT, CT Perfusion [CTP], and follow up brain diffusion MRI at 7th day. The obtained CT perfusion images were used for image processing. Cerebral blood volume, cerebral blood flow and mean transit time were visually estimated and manually traced and the results were compared to diffusion MRI lesions

Results: follow-up DWI for confirmation of acute infarct revealed true recent infarcts in 36 patients. NCCT revealed 23 [38.3%] true acute infarcts, 10 [16.7%] false positive infarcts, 14 [23.3%] true negative and 13 [21.7%] false negative yielding diagnostic accuracy of 61.66%. CTP revealed 30 [50%] true positive acute infarcts with two [3.3%] false positive, 22 [36.7%] true negative and 6 [10%] false negative yielding sensitivity of 83.3%, specificity of 91.67%, PPV=93.75%, NPV=78.57% and diagnostic accuracy of 86.7%. CTP was significantly more sensitive [83.3 vs. 64.2%, p < 0.0001] and accurate [86.7 vs. 61.7%, p < 0.0001] and had a better negative predictive value [78.57 vs. 52.2%] than NCCT

Conclusions: dynamic PCT provides more sensitivity and accuracy than no enhanced CT in detecting acute strokes in the 12-hour window

Frequency of carotid artery stenosis in ischemic stroke

Stroke continues to be a significant cause of morbidity and mortality throughout the world. According to the world health organization, 15 million people suffer stroke worldwide annually. Despite maximal medical management, carotid artery atherosclerosis leading to stenosis continues to portend a poor prognosis. Conservative management frequently fails in this disease, leaving patients at high risk for cerebral infarction and death

Objective: To determine the frequency of carotid artery stenosis in patients with stroke using Doppler Ultrasonography

Study design: cross-sectional analytical study

Setting: outpatient and emergency department of Medical Unit-I, Allied Hospital, Faisalabad

Duration of study: Study was carried out over a period of seven months from 01-03 2014 to 30-09-2014

Subjects and methods: A total of 100 cases were included in this study. Every patient was undergone a list of investigation including lipid profile, electrocardiography [ECG], X-ray chest [PA], computed tomography [CT] scan brain and echocardiography to rule out any cardiac source of embolism

Results: Out of 100 cases, 12 patients [12%] were between 18-40 years old, 34 patients [34%] were 41-60 years of age while 54 patients [54%] were 61-80 years old. Mean age of the patients was 51.9 +/- 5.1. Regarding gender distribution, 62 patients [62%] were male and 38 patients [38%] were female. Of 100 patients, 56 patients [56%] had carotid stenosis on color Doppler Ultrasonography of carotid arteries. 29 patients [51.8%] had mild stenosis, 17 patients [30.3%] had moderate stenosis and 10 patients [17.9%] severe stenosis

Conclusion: It is concluded that carotid artery stenosis is strongly associated with ischemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke

Non contrast CT evaluation of lumbar pain presenting in medical emergency

Objective: To evaluate the value of non contrast CT in patient with lumbar pain

Methods: 1432 patient with lumbar pain, presenting in Medical emergency of Allied Hospital were taken, all of them under went Ultrasound abdomen and CT Abdomen. CT abdomen was conducted on optima 660, 128 slice CT scanner

Results: CT showed that out of 1231 patients 998 had either of multiple renal, ureteric and / or vesicle stones. 110 had normal scan and 123 had alternate or incidental diagnosis. Patient with multiple pathologies were excluded from the study which was 201 patients

Conclusion: In comparison with ultrasound CT was superior in detecting Ureteric stones and more correct in renal stones. CT was also superior in detecting alternate or incidental diagnosis

Prolongation of QTc duration and increased heart rate in patients with cirrhosis of liver

Objective: To compare QTc duration and increasedheart rate in patients with cirrhosis with noncirrhoticcontrols

Design: Cross-sectionalanalytical study

Place and Duration of Study:Medical Unit 1 Allied Hospital Faisalabad between1st March 2011 to 30th August 2011

Patients andMethods: 50 patients of cirrhosis were selected inGroup-I. An equal number of non-cirrhotic patientswere taken as control and were included in Group-II. ECG was recorded and Heart rate[HR] and QTcinterval was calculated in both the groups.Comparison of increased prolongation of QTc andHeart Rate were done using independent samples ttest with significance level at 0.05

Results: Fiftypatients of cirrhosis of liver were inducted in Group-I with same number of non-cirrhotic patients ascontrol in Group-II. The mean +/- SD of QTc ofGroup-I was 0.472 +/- 0.012 sec and that in Group-IIwas 0.434 +/- 0.014 sec and that for HR in Group-Iand II were 79.26 +/- 10.08 and 74.24 +/- 7.58beats/min respectively. The mean QTc and HRvalues were significantly more in Group-I ascompared to Group-II with p value = 0.0001

Conclusion: Means of both HR and QTc weresignificantly higher in cirrhotic patients as comparedwith non-cirrhotic controls

Arterial phase CT for early detection of HCC in cirrhotic patients

Objective: To know the effectiveness of EarlyArterial phase CT in detecting the small focusof HCC in Cirrhotic Patient

Material andMethods: 135 patient of Cirrhosis werescanned on a Multislice CT scanner with boluschase contrast tracking. All the patient had amass lesion on Ultrasound. Inclusion criterionwas a solitary lesion in the liver. The patientwere scanned in arterial phase, Portal venousphase and delayed phase CT. The scans weredone with an injector using a 100 ml of contrastvolume with the flow rate of 3.5ml / sec

Findings Total lesions identified on scans were210 on early arterial phase of the imaging. 145in portal venous phase and 142 in delayedphase. 43 patient showed multiple lesions -31.8%. That is to suggest that ultrasoundpicked less lesions as compared to CTMaximum number of 210 lesions wereappreciated in early arterial phase of the CT

Conclusion: Early Arterial phase CT is betterfor early detection of smaller sized HCC

CT guided transthoracic Needle Aspiration biopsy; effect of size of the lesion on the rate of pneumothorax

To analyze the rate of Pneumothorax after CT guided TNAB of lung masses, and correlating it with the size of the lesion. Descriptive study. Department of Radiology Mayo Hospital, Lahore. From June 2002 to April 2003, Seventy patients underwent CT guided FNA of the chest masses. Out of Seventy, 18 patients i.e.; 26% developed Pneumothorax. Lesion less than 1 cm, out of 6 patients 3 developed pneumothorax [50%], lesions 1-2 cm 5 out of 11 developed pneumothorax [45%], lesions with size of 2-3 cm 5 out of 14 patients developed pneumothorax [35%], lesions between 3-4 cm 2 out of 8 developed pneumothorax [25%], lesion sized 4-5 cm 1 out of 15 developed pneumothorax [6%], and lesion with more than 5 cm size 1 out of 16 developed pneumothorax [6%]. The study shows that the rate of Pneumothorax after CT guided TNAB of Lung Masses increases as the size of the lesion decreases

Multi-detector ct findings in abdominal tuberculosis

To know the findings of MDCT in cases of Abdominal Tuberculosis. Fifty eight patients with suspicion of abdominal tuberculosis were scanned and the findings were evaluated. All the patients received IV and oral contrast. The patients were referred from the medical and surgical departments of Shalamar Hospital, Lahore. Toshiba 4 Slice Aquilion was used for scanning. The exclusion criterion was patients on Anti tuberculous drugs and urogenital tuberculosis. Following 6 findings were observed in 47 abnormal scans, Out of other 11 scans 9 had other diseases like diverticulitis, Appendicitis and Bowel Lymphoma. 2 were normal. Close medical and Surgical follow up was obtained in all cases. Ascites = 35, Omental / Mesenteric Thickening / Involving = 27, Small Bowel wall thickening = 07, Large bowel wall thickening including Caecal wall thickening = 06, Abdominal Lymphadenopathy= 26, Solid Organ Involvement, Liver=01, Spleen=02. Ascites was the most common finding in Patients with Abdominal Tuberculosis and Involvement of liver being the least common finding amongst the group

Diagnosing gossypiboma of abdomen

1. To analyze the imaging findings of Gossypiboma [Retained intra abdominal post operative sponge]. 2. To propose the surgeons with a solution. Five proven patients, from June 2001 till June 2006 with intra abdominal sponge after various operation were retrospectively evaluated for the findings on plain x ray, ultrasound and CT scans. Findings found on various modalities are as under Simple X-ray findings were normal in one patient [20%], showed haze in one patient [20%] and specks of contained air in three patients [60%]. Ultrasound findings were of a mass with echogenic area having acoustic shadowing, three patients had surrounding thickened walls and two had surrounding free fluid. T showed air filled mass in four patients with unusual pattern of air in 1 patient and all five of them had surrounding fat stranding surrounding the air filled mass. Among imaging modalities CT is the best modality if there is suspicion of retained sponge/guaze. It is highly recommended that during surgical procedure such things should be slightly soaked with aseptic iodinated contrast so that imaging features are readily accepted by all, including the surgeons or newer version of guaze piece with small internal metallic strip should be used

CT evaluation of craniocervical junction

The purpose of the study was to evaluate the effectiveness of CT in diagnosing craniocervical junction pathologies. Six consecutive patients who presented with symptoms related to craniocervical junction were evaluated by CT. Two of the patients had history to trauma, two had congenital problems with cervical spine, one had tuberculosis and one had craniocervical junction tumor. CT was found to be extremely helpful in all the cases with superior definition of bone detail when compared to plain films or MRI.

Hepatitis B and C virus and nephrotic syndrome

Nephrotic syndrome is a common disorder that affects all age groups. Etiology is variable ranging from infection to malignancy. Lately Hepatitis B and C viruses have been found to have high correlation with Nephrotic syndrome. The microscopic renal picture is different depending upon age groups

Objectives: objective of this study was to determine how prevalent is HBV and HCV in adults with Nephrotic syndrome in this region of Pakistan

Period: jan 1997 to Oct 1998

Setting: allied Hospital PMC, Faisalabad

Material and methods: all patients between age 14 and 60 years who were having Nephrotic syndrome with all known secondary causes having been ruled out, underwent Percutaneous Renal Biopsy

Results: among 50 patients 34 were positive for HCV and 3 were positive for HBV. Commonest microscopic lesion was Membrano-Proliferative Glomerulonephritis

Conclusions: there is high prevalence of HCV in adult Nephrotic syndrome like some other countries

Acute myocardial infarction; study of in-hospital complications in patients treated with streptokinase versus control

Objectives: to evaluate the benefits of early streptokinase therapy in patients with acute myocardial infarction

Settings: district Headquarters and Allied Hospital, Faisalabad

Period: 1st January, 1997 to 30th May, 1997. Results: Out of 102 patients included in this study male to female ratio was 1.6 to 1.Forty seven percent received streptokinase therapy and 53% were denied due to any contraindication. The mean age was 52 years with 82.5% above the age of 40 years. 66.7% in both groups were in Killip Class-I, while 8.3% in streptokinase group and 3.7% in control group were in Killip Class-IV. The overall mortality was 17.6% but 29.8% in control group and only 4.2% in streptokinase group expired. The rhythm disturbances were more in streptokinase group. 66.7% presented late, and mechanical complications were more in the control group

Conclusion: the early streptokinase therapy lowers the in-hospital mortality but more public awareness is required for early reporting and efforts should be made for the availability of streptokinase for the poor community