Clinical registry for rheumatoid arthritis; a preliminary analysis

Objective: To establish a clinical registry for Rheumatoid Arthritis and delineate the most common symptoms that rheumatoid arthritis [RA] patients experience in our set up

Study Design: Cross sectional study

Place and Duration of Study: Study was carried out at Military Hospital [MH] Rawalpindi at Rheumatology Department during the period of Jan 2013 to Jun 2015

Material and Methods: A clinical registry for Rheumatoid Arthritis was developed as per criteria jointly developed by American College of Rheumatology [ACR] along with European League against Rheumatism [EULAR] [2010]. Fifty-eight patients were registered after their informed consent and approval by Military Hospital [MH] Rawalpindi ethical committee. Age, gender and relevant clinical parameters of RA patients were recorded on case report forms and stored for analysis in the RA registry in Excel 2010. The figures were reported in frequencies and percentages

Results: Multiple joint pains [48.28%], fever [24.14%], morning stiffness of joints [22.41%] were the most common symptoms in RA patients. Other clinical manifestations included painful bilateral swollen joints [13.79%], pain in different parts of the body [10.34%], Raynaud's phenomenon [10.34%], malaise [8.62%], swollen body parts [8.62%], ulcers [8.62%], fatigue [6.90%], nodules on skin/elbow/interphalangeal joints [6.90%], deformities of fingers/ hand [3.45%], redness of eyes [3.45%], body rash [3.45%], inability to walk [3.45%], cervical lymphadenopathy [1.72%], stiffness of spine [1.72%] and myalgias [1.72%]

Conclusion: It is concluded that multiple joint pains, fever and morning stiffness of joints are the most common symptoms of RA patients

Diagnostic accuracy of echocardiography in determining left anterior descending artery occlusion

Objective: To determine the diagnostic accuracy of echocardiography in left anterior descending artery occlusion proximal to first diagonal [Dl] branch in acute anterior wall myocardial infarction [AWMI] by comparing it with angiography

Study Design: Cross sectional validation study

Place and Duration of Study: Department of cardiology, Pakistan Institutes of Medical Sciences [PIMS], Islamabad from May 2011 to Nov 2011

Material and Methods: This was a cross sectional study which included 200 patients with left anterior descending myocardial infarction [LADMI]. All the patients had 12-lead ECG followed by coronary angiography [gold standard] for the detection of LAD occlusion proximal to Dl. Diagnostic accuracy of 12-lead ECG was detected by determining sensitivity, specificity and accuracy

Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 12-lead ECG for diagnosis of LAD occlusion proximal to Dl was 91%, 70.45%, 91.61%, 68.88% and 86.50%, respectively

Conclusion: Twelve-lead ECG is a reliable test for detection of LAD occlusion proximal to Dl and should be done in every patient with AWMI

Obstructive jaundice; diagnostic role of ERCP

Objective: To determine the efficacy of Endoscopic Retrograde Cholangiopancreatography [ERCP] in patients presenting with obstructive jaundice. DESIGN: Prospective study. Place and Duration of Study: This study was conducted at Military hospital Rawalpindi from 2000 to 2001, which is a tertiary referral centre for armed forces

Patients and Methods: 50 patients were selected of both sexes for ERCP. Subjects of this study were patients who were diagnosed to have obstructive jaundice on the basis of laboratory investigations and sonography. Patients with less than 15 years of age and with conditions other than obstructive jaundice were not included. ERCP was carried out in left lateral position with the left arm held behind the back of the patient. The results were then prepared and analyzed by Fisher Exact test to find out significance between the ultrasound and ERCP

Results: Successful ductal pacification was achieved in 45 cases. The gross pathological findings included 18 cases with stones, 11 cases with stricture and 12 cases with carcinoma. Only one case had choledochal cyst

Conclusion: ERCP is a useful diagnostic tool, providing direct and non-surgical imaging of pancreatic and biliary ducts. It has improved the diagnostic yield and has proved to be more safe and economical mean of pre-operative assessment of obstructive jaundice without the need for more expensive CT scan / MRI or more invasive Per cutaneous Transhepatic Cholangiography [PTC]