Post esophageal variceal band ligation pain, another insult to injury

Objective: To measure and characterize pain in post esophageal variceal band ligation patients

Study Design: Cross sectional observational study

Place and Duration of Study: This study was carried out in Combined Military Hospital Kharian which is a tertiary care hospital, from Dec 2014 to Aug 2015

Material and Methods: All patients of esophageal varices due to any underlying pathology requiring esophageal variceal band ligation [EVBL] were included in this study. Patients unwilling for EVBL were excluded from the study

Their EVBL was done with the help of Upper Gastrointestinal Pentax High definition 90i series Video Endoscope and subsequently they were inquired about the details of pain till next session of banding

Results: Out of 86 patients 63 [73%] were males and 23 [27%] were females. Their mean age was 54 years with SD +/- 12. Pain was present in 47 [54%] patients and 39 [46%] were pain free. It was severe in 3 [7%], moderate in 34 [72%] and mild in 10 [21%] patients. Out of post EVBL pain group 30 [65%] patients experienced pain after first EVBL session, 12 [25%] in subsequent and 5 [10%] after all the sessions

Conclusion: Post EVBL pain is a common complication. Mostly it is mild to moderate in intensity and needs attention in almost half of the patients to relief the suffering

Vitamin d deficiency in patients with tuberculosis

To determine the frequency and association of Vitamin D deficiency in patients with tuberculosis. Case control study. Medical Department, Combined Military Hospital, Kharian, from July 2010 to June 2012. One hundred and five outdoor patients of tuberculosis were selected with 255 gender matched controls. Tuberculosis was diagnosed by presence of acid fast bacilli in sputum smears, positive culture for Mycobacterium tuberculosis or demonstration of chronic caseating granulomatous inflammation in tissue specimens. Controls were drawn randomly from general population. Serum 25 hydroxyvitamin D [25 [OH] D3] levels < 25 ng/ml was considered Vitamin D deficiency. The results were analyzed on SPSS version 17. Mean Vitamin D levels were 23.23 +/- 6.81 ng/ml in cases, 29.27 +/- 8.89 ng/ml in controls [p < 0.0001]. Vitamin D deficiency was found in 57% of cases and 33% controls [p < 0.0001]. Mean Vitamin D levels were significantly lower in females with tuberculosis [20.84 ng/ml] as compared to males [25.03 ng/ml, p = 0.002]. Mean BMI in patients of tuberculosis with Vitamin D deficiency were 19.51 +/- 1.77 kg/m2 and in patients with normal Vitamin D were 21.65 +/- 1.79 kg/m2 [p < 0.0001]. Mean Vitamin D levels in patients with multi-drug resistant tuberculosis was lower to a mean of 15.41 +/- 4.67 ng/ml [p < 0.0001]. There is significant deficiency of Vitamin D in patients with tuberculosis as compared to controls. This deficiency is more pronounced in females, individuals with low BMI, extra pulmonary and MDR tuberculosis.

Frequency of inter-atrial blocks in patients with ischemic stroke

To determine the frequency and association of Interatrial block in hospitalized patients with Ischemic Stroke. A case control study. Department of medicine, Military Hospital, Rawalpindi from 1st Jan 2009 to 30 December 2009. It included 64 patients, 32 cases of diagnosed ischemic stroke and 32 patients were taken as controls not suffering from ischemic stroke or ischemic heart disease. ECG findings of both selected groups were evaluated for presence or absence of interatrial block. Out of 32 ischemic stroke patients, 14 [43.85%] were found to have interatrial block on electrocardiogram [ECG]. Whereas only 6 [18.80%] controls were found to have interatrial block on ECG. Odds ratio was 1.66. Interatrial block is more frequent in ischemic stroke patients and may represent a risk factor for such stroke.

Frequency and psychosocial impact of acne on university and college students

Objectives of the study were to describe the frequency of acne in late adolescent and adult students and to evaluate psychosocial impact of the disease. It was a cross-sectional study conducted in four institutions, from June to August 2008. Questionnaires with Cardiff Acne Disability Index [CADI] were filled by 950 students. They were examined for presence and severity of acne. Age ranged from 17 to 28 years. Frequency of facial acne was 74.6%. Difference between the genders was not statistically significant. Mean ADI score was 2.67 + 5.35, and range was 0-13. The disease had a greater psychosocial impact on females as compared to males

Hyperkalemia - frequency in a group of hypertensive diabetics

To evaluate the frequency of hyperkalemia in a cohort of hypertensive diabetic patients. A prospective analytical cohort study. The study was carried out in department of medicine [nephrology] Military Hospital [MH] and Armed Forces Institute of Urology [AFIU] Rawalpindi from Jun 2007 - Jun 2009. A total of 110 hypertensive, middle aged diabetic patients attending medical OPD in MH and AFIU. Rawalpindi were followed over two years from Jun 2007 - Jun 2009 for development of hyperkalemia and monitored for changes in eGFR, Serum Urea, creatinine and blood glucose random besides changes in blood pressure and ECG findings. SPSS version 13 was employed for statistical analysis. During the course of study 9 patients were lost to follow up. There were 7 deaths among study subjects before the end of study after about ten to twelve months. Out of the 94 patients followed up mean Serum Urea at the end of study was 13.50 mmol/l against a serum creatinine level of 2.26mmol/l and an estimated GFR of 21.08 ml/ min. The frequency of raised serum Potassium of 5.1-6.0 mmol/l was 46.08% and 26.59% of the patients had serum Potassium of 6.1-7.2 mmol/l at the end of study. This was against an initial level of 4.5-5.0 mmol/l in 100% of the study subjects. Paired sample t-test revealed significant changes in each variable studied but a borderline positive correlation of 0.619 was observed only between serum potassium and change in eGFR at the end of study. The mean blood glucose random dropped from 16.14 mmol/l to 10.41 mmol/l. at the end of study mean systolic BP was 122mm Hg and diastolic BP 80.2mm Hg. The ECG revealed tall T waves in 64.9% of cases while at the start of study all subjects had their electrocardiograms within normal limits. There was a trend of increase in frequency of tall T waves with the rise of serum potassium levels. Raised serum potassium is a significant potential complication among long standing diabetics with covert nephropathy treated with ACE inhibotrs, ARBs, potassium sparing diuretics or a combination of these drugs. Co morbidities and development of this complication must therefore be considered by physicians when dealing with such patients

Primary prophylaxis in preventing 1st bleed in oesophageal varicies

To study the efficacy of oesophageal band ligation versus use of beta -blockers for primary prophylaxis of 1st variceal bleed in portal hypertension Randomized controlled trial Place and duration of study: At department of Medicine and Gastroenterology, Combined Military hospital Rawalpindi, during June 2006 to June 2007 Sixty eight patients with portal hypertension were included in the study after screening endoscopy. All the patients were divided in two groups, A and B. Group A patients underwent oesophageal band ligation and patients in group B were given beta -blockers for primary prophylaxis. Each group contained equal number of 34 patients to start with but in the very first week, 6 patients in group B could not tolerate beta blockers. They were switched to group A treatment. These patients were followed up for next one year Group A patients who underwent band ligation had significantly reduced incidence of 1st variceal bleed[p value=0.020] as compared to group B who received beta -blockers. As far as mortality is concerned there was no significant difference [p=0.067] was noted between the two groups. The oesophageal band ligation is superior to beta -blockers in preventing 1st oesophageal variceal bleed but no difference in mortality was noted whichever prophylaxis was used in this study

Spectrum of complications of snake bites - a tertiary care hospital experience

To highlight the spectrum of haematological, central nervous system complications and treatment outcome in cases of ophitoxaemia. This descriptive analytical study was carried out at Combined Military Hospital, Kharian. All cases of ophitoxaemia admitted in Combined Military Hospital [CMH] Kharian cantonment from June 2007 to November 2008. During the study period a total of fifty cases of snake bites were admitted in CMH Kharian. These cases reported between June 2007 to Nov 2007 and then between June 2008 to Nov 2008. No case of snake bite reported from December 2007 till May 2008. There were 33 [66%] male and 17 [34%] females. The mean age was 34.8 years. The mean hospital stay was 5.06 days [maximum 13 days]. There were 34 events of haematological complications and nine patients developed central nervous system [CNS] complications including respiratory failure in seven patients warranting mechanical ventilator support. Antivenom [AV] was administered to 32 patients only. Dose of AV ranged from 40-200 ml with a mean value of 37.29 ml. The administration of AV was associated with allergic febrile reactions in twenty five patients [78.1%]. In this study four patients died with mortality rate of 8%. The bite to needle time in the patients with fatal outcome was > 24 hours. Snake bites are still associated with fatal outcome, mainly because of late administration of AV. Successful management of haematological and central nervous complications requires the availability of facilities for mechanical ventilator support and blood components

comparative study between conventional open and mini cholecystectomy in the treatment of gall stone disease regarding postoperative pain, and hospital stay

To compare the conventional open and mini-cholecystectomy. This comparative, cross-sectional study was conducted in Nishtar Hospital, Muhan during the period of 6 months October 1998 to March 1999. A total Of 50 patients were include in the study. Among 50 patients of gall stone, .8 [16%] were male and 42[84%] were female. As regards age, 16 [32%] were of<40 years, 14 [28%] between 41-50 years and remaining 20 [40%] were of>50 years Out of 50 patients, 32 [64%] patients presenting with pain right hypochondrium, in 14 [28%] patients presenting complaint was pain epigastrium. In 25 patients of group A, who were treated conventional open cholecystectomy, the average hospital stay was 8.66 days with shortest stay of 6 days and longest stay of 10 days Out of 25 patients [16 [64%] patients were discharged after 8[th] day while 4 [16%] patients were discharged after patients were discharged after 6 days In the 25 patients of group-B who were treated by mirncholecystectomy, the mean hospital stay was 3.33 days with shortest of 2 days and longest of 5 days. Eight [32%] patients were discharged on 2[nd] postoperative day, while 14 [56%] were discharged on the 3[rd] postoperative day. Mini-cholecystectomy is associated with less patients discomfort and decreased incidence of postoperative complications

Comparison of etiology and rate of infection in different surgical wounds

To recommend the steps to decrease the wound infection and improve the health care facilities by comparing the incidence of infection in different surgical wounds and to see the causes of these infections. Cross-sectional, comparative prospective study. Al-Noor Specialist Hospital, Holly Makkah, KSA. 1-06-2005 to 30-5-2006. This is a prospective study, which includes 520 patients above the age of 12 years including both males and females. All the patients under went surgery either elective or emergency. Patients were divided in to 04 groups according to the standard surgical wound classification. All the 520 patients were admitted in general surgery department of Al-Noor specialist Hospital, Makkah, KSA. Out of these 340 patients [65.38%] underwent emergency surgery and 180 patients [34.6%] underwent elective surgery. These patients were divided in to four groups according to the standard wound classifications i.e. clean, clean contaminated, contaminated and dirty wounds. In elective surgery, we can avoid the 'wound infection by stopping smoking at least 2 weeks before surgery, good control of diabetes mellitus, lung and cardiovascular disease before surgery, antibiotic prophylaxis on induction o anesthesia and avoid excessive blood loss during surgery. In emergency surgery, we can avoid wound infection by making the arrangement that patients can reach the hospital in early course. of their disease, early diagnosis, good antibiotic cover, less operative time, experienced surgeon and peroperatively good peritoneal lavage