ABSTRACT
Objective: To ascertain the effectiveness of immunosuppressants along with ACEI and /or ARBS in proteinuria in patients with solitary kidney post nephrectomy
Study Design: Prospective quasi-experimental study
Place and Duration of Study: Combined Military Hospital Peshawar and Multan, from 2010 to 2016
Subjects and Methods: The sample population comprised of 07 cases of post nephrectomy solitary kidney developing proteinuria from 2010-2016 reporting to hospitals. Patients were given initially ACEI and/or ARBS to lower proteinuria for three months. They were followed up to see for complete or partial remission. Deltacortil 1mg/kg max 60mg/day along with ACEI and /or ARBS was added to patients who didn't go into remission
Results: Out of 7 patients, 3 [42.9 percent] were males and 4 [57.1 percent] were female patients. Addition of deltacortil 1mg/kg max 60mg/day along with ACEI and /or ARBS reduced proteinuria to less than 1 gram in 3 patients [2 males and 1 female] and less than 300mg in 4 patients [1 male and 3 females].There was a reduction in the mean 24hrs urinary protein excretion as a whole from the baseline 2.33 +/- 0.84 g/24 hrs to 0.48 +/- 0.33 g/24 hrs. Remission was achieved on the average in three months and maintenance on tapering doses for 12 months. Cyclosporine was used in three cases who relapsed on tapering steroids and remission was achieved with 5-10mg steroids and 100-200mg of cyclosporine
Conclusion: Non respondent patients with solitary kidney developing proteinuria being treated with ACEI and/or ARBS had good chance to lower their proteinuria with steroids. Relapses even with steroids responded to cyclosporine
ABSTRACT
Objective: To determine frequencies of various acute complications in patients undergoing hemodialysis
Study Design: Descriptive cross-sectional study
Place and Duration of Study: Department of Nephrology Military Hospital [MH] Rawalpindi, from Jan 2016 till Mar 2016
Material and Methods: A total of 150 patients who underwent haemodialysis at MH were enrolled in the study after informed consent on justification of inclusion and exclusion criteria. The patients were evaluated for the frequency of various intra-dialytic complications and data were analysed using SPSS version 19
Results: Out of the 150 enrolled patients, males were 125 [83.33%] and females were 25 [16.67%]. A total of 2520 haemodialysis session were performed. Hypotension was the most frequently observed complication during 318 [12.62%] dialysis sessions, followed by hypertension in 208 [8.25%] and fever in 193 [7.66%] sessions. Other complications were muscle cramps in 116 [4.60%], shivering in 94 [3.73%], headache in 70 [2.78%], nausea/vomiting 60 [2.38%], itching 41 [1.62%], chest pain 37 [1.47%], hypoglycaemia 31 [1.23%], seizures 23 [0.91%] and arrhythmias in 13 [0.52%] dialysis sessions
Conclusion: Haemodialysis, one of the renal replacement therapies, is a life-saving treatment modality but it is not without complications despite the advances in technology. However frequency with which they occur is low and majority are not life threatening
ABSTRACT
Objective: To assess validity of platelet count/spleen diameter ratio in cirrhotic patients, as a non-invasive predictor of high risk esophageal varices [EVs]
Study Design: Cross sectional validation study
Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi
Material and Methods: A total of 160 cases with cirrhosis due to any cause were included in this study. The study included both male and female subjects and was restricted to age 35-70 years. Exclusion criteria were also applied to this group of patients. All these patients underwent blood test for platelet count and ultrasound abdomen for splenic diameter. For each patient calculation of platelet/splenic ratio was determined with a cut off value of 909 determined. Values greater than this cut off were supposed not to have high risk esophageal varices. Upper gastrointestinal endoscopies were performed on all patients and then on the basis of endoscopy results the patients were divided into two groups, first group in which high risk EVs [grade 2 and grade 3] were present and second group in which they were absent. Subsequently sensitivity, specificity, predictive values and accuracy were calculated, keeping in view the calculated cut off value and endoscopy findings
Results: In our study, 60% [n=96] were between 35-50 years of age and 40% [n=64] were between 51-70 years of age, mean +/- SD was calculated as 50.15 +/- 9.28 years, 55.63% [n=89] were male and 44. 37% [n=71] were females. Validity of platelet count/spleen diameter ratio in cirrhotic patients for diagnosis of high risk EVs, keeping endoscopy as gold standard was recorded which showed that 58.13% [n=93] were true positive, 5.63% [n=9] were false positive, 27.5% [n=44] were true negative and 8.75% [n=14] were false negative. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were calculated as 86.92%, 83.01%, 91.18%, 75.86% and 85.63% respectively
Conclusion: Our results suggest that the platelet count/spleen diameter ratio may be a useful tool for detecting EVs in patients with hepatic cirrhosis but some-other trials in our local population are required to further authenticate its accuracy
ABSTRACT
Objective: To determine seroprevalence of hepatitis B and C among blood donors in 2009 and comparing with the seroprevalence in 2014
Study Design: Cross sectional study with retrospective data collection
Place and Duration of Study: Foundation University Medical College and Fauji Foundation Hospital, Rawalpindi. Data in 2009 and in 2014 were collected
Material and Methods: The blood samples collected from individuals from Province of Khyber Pakhtunkhawa, Azad Kashmir and Northern Punjab including Rawalpindi-Islamabad and comprised 3776 [in the year 2009] and 6740 [in the year 2014] adults ranging from 18 to 60 years who reported to Fauji Foundation Hospital, Rawalpindi voluntarily or as a compulsion to donate blood for their patients
Results: During 2009, there were 71 [1.88%] and 113 [2.99%] donors positive for hepatitis B surface antigen [HBsAg] and anti hepatitis C virus [Anti HCV] respectively out of a total of 3776 donors whereas during 2014 there were 106 [1.57%] and 174 [2.58%] donors positive for HBsAg and anti HCV respectively out of a total donors of 6740. There was no statistical significant difference between the year [2009 and 2014] and seroprevalence of HBsAg [p=0.239] and HCV positive donors [p=0.215]
Conclusion: There is no significant change in seroprevalence of hepatitis B and C among blood donors during 2014 as compared to 2009 in Northern Pakistan
ABSTRACT
Objective: To assess the subjective sleep quality and its relationship with the presence of psychiatric morbidity in the patients suffering from chronic kidney disease [CKD] and undergoing the procedure of hemodialysis [HD]; and analyze the associated socio-demographic factors
Study Design: Cross-sectional descriptive study
Place and Duration of Study: Nephrology Department, Military Hospital, Rawalpindi, from July to December 2016
Methodology: Patients of CKD undergoing the HD were included in the final analysis. Quality of sleep was determined by using the Pittsburgh Sleep Quality Index [PSQI]. Psychiatric morbidity was determined by the General Health Questionnaire 12 [GHQ-12]. Relationship of education, BMI, gender, age, duration of dialysis, dialysis count per week, marital status, level of family income, psychiatric morbidity, occupation, biochemical markers [urea, creatinine, BUN, albumin, calcium, phosphorous and hemoglobin], tobacco smoking, and use of naswar was determined with the sleep quality
Results: One hundred and forty patients were screened through the PSQI; 44 [31.4%] had good quality of sleep while 96 [68.6%] had poor sleep quality. Statistical analysis revealed that presence of psychiatric morbidity, increasing age, female gender, being unmarried, low family income, and low frequency of dialysis had significant association with the poor sleep quality
Conclusion: Poor sleep quality was highly prevalent among the patients of CKD receiving the hemodialysis. The patients with low family income, more age, and with two or less dialysis sessions per week should be screened thoroughly for the sleep problems. Presence of psychiatric morbidity emerged as an independent factor responsible for the poor sleep quality in our target population
ABSTRACT
Objective: To compare short term mortality in non-diabetic ischemic stroke patients with or without stress hyperglycemia
Study Design: Cohort study
Place and Duration of Study: This study was carried out at Neurology Department of Military Hospital, Rawalpindi from Jan 2010 to Jul 2012 for a total duration of six months
Material and Methods: Non-diabetic ischemic stroke patients were included in the study and they were divided in two groups. Each group had 75 patients. Group 'I' [Normoglycemic or control group] had normal blood glucose level while group 'II' [Hyperglycaemic or cohort] had hyperglycaemia on presentation or over next 72 hours. Prognosis in terms of patient either being dead or alive was determined within or at 4 weeks of admission in both groups. Data were entered and analysed using Statistical Package for Social Sciences SPSS version 10. Descriptive statistics were calculated for both qualitative and quantitative variables. For comparison of short term mortality in hyperglycaemic and normoglycemic stroke patients, chi-square test was applied. p-value <0.05 was considered statistically significant
Results: Short term mortality was higher in cohort [hyperglycemic] group as compared to control [normoglycemic] group [34.7% vs. 14.7%]. Relative risk was 2.36. The groups had a statistically significant difference in the short term mortality within four weeks with a Chi-Square 'p' value of 0.004 [p=0.004]
Conclusion: Short term mortality in non-diabetic ischemic stroke patients with stress hyperglycemia is higher than those patients who do not have stress hyperglycemia