Incidence of right ventricular infarction in patients with acute inferior wall infarction

Objectives: to find out the frequency of right ventricular infarction [RVI] in patients with acute inferior wall myocardial infarction and also to see its clinical correlation and prognostic value

Methods: 198 consecutive patients with acute inferior wall myocardial infarction [MI] were enrolled. Elevated ST segments in V4R or V3R to V6R were used to diagnose RVI. We assessed the incidence of ST-segment elevation in these leads and their correlation on clinical ground

Result: in 96 patients [48.5%], RVI was present. Clinical correlation showed that raised JVP was present in 58.5% and raised JVP with hypotension in 34.5% of patients. Normal JVP was present in 41.5% of patients in which 22% of patients were with hypotension and 20% of patients were without clinical findings. Hypotension observed in 53% of patients. Complications were higher in patients with elevated ST segments in V4R [51%] in contrast to those without RVI [21%]. In-hospital mortality was more than double in RVI Group

Conclusion: RVI in acute inferior MI is common. Elevated ST segments in V4R or V3R to V6R can be used to diagnose RVI. Clinical correlation can help but may not be diagnostic and it has higher mortality compared to inferior MI alone

Type 2 diabetes mellitus; dental caries in patients

To determine the frequency and pattern of dental carries in patients with type 2 diabetes mellitus. Cross sectional descriptive study. Patients with history of type 2 diabetes mellitus for >/=02 years duration with >/=35 years of age and of either gender with dental pain visit at medical and dental outpatient department [OPD] of Liaquat University Hospital Hyderabad. The detail history was taken and the blood samples were taken for haemoglobin A1c [HbA1c] to assess the glycemic status. The existence of dental carries and its pattern was diagnosed through dental examination by consultant dentist had clinical experience >/=05 years. The data was collected on pre-designed proforma, entered and analyzed in SPSS version 11.00. A total of 137 type 2 diabetic patients were selected for this study, out of these 82 were males and 55 females. The dental carries was found in 98 [71.5%] patients. Out of these ninety eight, 53 [54.08%] were males and 45 [45.92%] were female. Upper molar teeth involvement was present in 46 patients and lower molar teeth were involved in 52 patients. Dentine carries was seen in 35 patients, enamel carries in 19, white spot carries in 20 patients, pulpitis in 16 patients, and pulp capping in 8 patients. Involvement of individual teeth was also assessed, the upper molar involvement was present in 32 patients, premolar involvement was present in 11, incisor involvement in 03 patients. The lower molars were involved in 28 patients, lower pre molar in 21 and lower incisors in 03 patients. Dental carries was present in 43 [43.9%] patients in patients whose duration of diabetes was between 5-10 years, whereas those patients having duration >10 years had 31.6% frequency of dental carries, while regarding duration of <5 years only 24 [24.5%] patients had dental carries. The diabetic patients are more prone to acquire dental caries

Efficacy of peg-interferon based treatment in patients with hepatitis C refractory to previous conventional interferon-based treatment

To determine the efficacy of peg-interferon-based therapy in patients refractory to previous conventional interferon-based treatment and factors predicting sustained viral response [SVR]. Analytical study. Medical Unit IV, Liaquat University Hospital, Jamshoro, from July 2009 to June 2011. This study included consecutive patients of hepatitis C who were previously treated with conventional interferon-based treatment for 6 months but were either non-responders, relapsed or had virologic breakthrough and stage >/= 2 with fibrosis on liver biopsy. All eligible patients were provided peg-interferon at the dosage of 180 micro g weekly with ribavirin thrice a day for 6 months. Sustained Viral Response [SVR] was defined as absence of HCV RNA at 24[th] week after treatment. All data was processed on SPSS version 16. Out of 450 patients enrolled in the study, 192 were excluded from the study on the basis of minimal fibrosis [stage 0 and 1]. Two hundred and fifty eight patients fulfilled the inclusion criteria and 247 completed the course of peg-interferon treatment. One hundred and sixty one [62.4%] were males and 97 [37.6%] were females. The mean age was 39.9 +/- 6.1 years, haemoglobin was 11.49 +/- 2.45 g/dl, platelet count was 127.2 +/- 50.6 10[3]/mm[3], ALT was 99 +/- 65 IU/L. SVR was achieved in 84 [32.6%]. The strong association was found between SVR and the pattern of response [p = 0. 001], degree of fibrosis and early viral response [p = 0.001]. Peg-interferon based treatment is an effective and safe treatment option for patients refractory to conventional interferon-based treatment

Urinary tract infection frequency and pattern in patients with diabetes mellitus

To determine the frequency and pattern of urinary tract infection in patients with diabetes mellitus. Descriptive case series study. February 2009 to July 2009. Department of medicine at Liaquat University Hospital]. All patients >/= 18 years of age, of either gender were known diabetes for >/= 2 years duration. The infection was labeled when>5/hpf leukocyte in urine and growth of organism on urine for C/S. The blood sugar and hemoglobin A1C [HbA1C] was also advised to evaluate the status of their diabetes i.e. control or poorly control. During study period total 150 diabetic patients were evaluated for urinary tract infection, of which 92[61%] had UTI. Out of ninety two 80[87%] had diabetes type 2 and 12[13%] were diabetes type 1. The female gender was predominant. The mean +/- SD for age of patients with type 2 and type 1 diabetes mellitus was 53.52 +/- 10.74 and 20.77 +/- 1.65 whereas the mean random blood sugar level in patients with type 2 and 1 diabetes was 232.85 +/- 5.87 and 288.99 +/- 7.87. The mean +/- SD for duration of diabetes type 2 and 1 was 4.77 +/- 2.31 and 2.56 +/- 1.42. The isolated microorganism were Staphylococcus aureus, Escherichia coli, Proteus, Pseudomonas aeruginosa, Klebsiella, Enterobacteriaceae and C.albicans. The urinary tract infection is more prevalent in patients with diabetes mellitus

Oral lichen planus: a clinical study

To evaluate the clinical characteristics, predisposing/aggravating factors and malignant potential of oral lichen planus [OLP]. Case series. Department of Dermatology and Oral Pathology, Liaquat University Hospital, Hyderabad, from January 2006 to November 2007. Patients of either gender aged above 12 years, fulfilling the diagnostic criteria for OLP were enrolled for study. Patients not willing to participate or suspected to have drug-induced lichenoid reactions were excluded. History regarding the onset and duration, symptoms, addictions was elicited followed by oral, cutaneous and systemic examination. Biopsy was taken when the diagnosis was doubtful or malignancy was suspected. The data were analyzed using SPSS software version 11.0 for frequency and percentage. A total of 95 patients [40 male and 55 female], aged between 17 and 62 years were enrolled. Diabetes [n=05] and hypertension [n=04] were the accompanying comorbidities. Family history was positive in 3 patients only. Reticular form was the most common clinical type seen in 52 [54.7%], followed by erosive in 31[32.6%] and atrophic/erythematous types in 12 [12.6%] patients. The disease caused pain, burning and other symptoms in 72 [75.7%] patients. Buccal mucosa was the chief site of involvement [n=31]. Other sites involved were tongue [n=20], lips [n=28], palate [n=9] and floor of mouth [n=03]. Stress, spicy foods and poor oral hygiene aggravated disease in most [n=77] of the patients. OLP is a chronic disease with diverse clinical manifestations and multiple site involvement. Associated pigmentation of surrounding mucosa was unique finding of this study. Long-term follow up is needed to assess the malignant potential. Stress was the most important factor aggravating the disease

Discoid lupus erythematosus: a profile

To determine the demographic data, clinical pattern and therapeutic outcome in patients with discoid lupus erythematosus [DLE]. Case series. The Department of Dermatology, Liaquat University of Medical and Health Sciences, Jamshoro, from January 2004 to December 2008. Patients of either gender aged above 18 years diagnosed with DLE were enrolled for the study. Those with evidence of systemic lupus erythematosus were excluded. Apart from the onset, duration, symptoms, lesion's location, size and dimensions were noted. Biopsy was taken when the diagnosis was in doubt. Apart from routine investigations serum anti-nuclear factor was determined in every patient. The data were analyzed using SPSS software version 11.0 for frequencies and percentages. There were 110 patients [38 males and 72 females], with ages between 18 and 62 years. Family history was positive in 3 patients. The plaque form was the most common clinical type seen in 68 [61.8%] patients, followed by tumid [n=20, 18.2%], panniculitis [n=10, 9.1%] and ulcerative [n=8,7.3%] types. Face was the most common site affected [n=60, 54.5%]. Antinuclear antibody was present in 19 [17.3%] patients. Fatigue and joint pains were the commonest symptoms [n=52, 47%]. Pigmentation and scarring were the usual outcome. DLE is a chronic disease with multiple presentations, which usually ends with pigmentation and scarring

Serum zinc level in patients with liver cirrhosis

To determine the serum zinc level in patients with liver cirrhosis. This descriptive cross sectional study was conducted at Liaquat University Hospital Hyderabad Sindh, Pakistan. All patients above 12 years of age, of either gender and known [diagnosed] cases of liver cirrhosis were further evaluated for their serum zinc level. The data was analyzed in statistical software [SPSS] and the p value <0.05 was considered as statistically significant. One hundred twenty seven cirrhotic patients with means age 42.7559 +/- 15.8894 were evaluated and assessed. The serum zinc was low in 69% patients. According to Child-Pugh classification 72% zinc deficient cirrhotic subjects were in class C, 16% in class B and 12% in class A. 94% subjects had hepatitis C virus infection, 4% had hepatitis B virus infection and 2% had history of alcoholism. The serum zinc level was low in patients with liver cirrhosis

Pattern of skin disorders among adolescent female students at Hyderabad, Sindh

To determine the pattern and severity of skin disorders among female adolescent students at Hyderabad, Sindh, Pakistan. This observational study was conducted at Hyderabad, Sindh, Pakistan, from August, 2007 to October, 2007. Four intermediate and degree colleges of the Hyderabad city were randomly selected and visited. The students were examined with regard to the type and severity of skin disorders. The findings were recorded on a pre-structured proforma. A total of 1350 students were examined. Their ages ranged from 16-24 years. Acne was the most common disorder seen in 59.5% of subjects followed by hair loss [59%], pigmentary disorders [36.3%], dandruff [26.1], hirsutism [20.9%], ephelides [6.4%], xerosis [2.9%], pityriasis versicolor [2.9%], pruritus [2.3%] and eczema [2.1%]. There were very few cases of pyoderma, tinea corporis and scabies. Skin disorders are common among adolescent college girls. The most prevalent group of skin disorders at this age is cosmetic one. Their proper management at earlier stages with education of patients is important to prevent late disfiguring complications and psychological sequelae

Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital

Nosocomial infection is defined as an infection which develops 48 hours after hospital admission or within 48 hours after being discharged. The objectives were to assess the frequency of nosocomial infection in patients admitted to intensive care unit [ICU] and to determine the etiological factors in such patients. It was an Observational Study and conducted in Intensive Care Unit, Liaquat University Hospital Hyderabad Sindh Pakistan from January 2008 to November 2008. All patients above 16 years of age admitted in the ICU for more than 48 hours and developed clinical evidence of infection that did not originate from patients' original diagnosis at the time of admission, were included in the study. Data was entered in a proforma and analyzed using SPSS version 10.0. During the study period, 97 out of 333 patients acquired nosocomial infection. The frequency of nosocomial infection was 29.13%. Respiratory tract infection was seen in 29 [30.1%], urinary tract infection in 38 [39.1%] and blood stream infection in 23 [23.7%] patients. Other infections we identified were skin, soft tissue, wound and gastrointestinal tract infections. Patients admitted in intensive care unit are at more risk of acquiring nosocomial infection from different sources. It is suggested that proper nursing care, sterilization and disinfection of instruments and equipment and careful handling of invasive procedures are the best tool to control these life threatening infections

Treatment of extensive alopecia areata with oral prednisolone mini-pulse regimen

Systemic steroids in mini doses have been reported effective in the treatment of alopecia areata. To evaluate the efficacy of oral prednisolone in mini pulse regimen in the treatment of severe forms of alopecia areata. This open uncontrolled study was conducted at the Department of Dermatology and Medicine, Liaquat University Hospital, Hyderabad from June, 2007 to July, 2008. All adult patients of both genders not receiving any topical or systemic treatment were enrolled in study. Non-probability convenience technique was used for sampling. After recording personal data and short history regarding the onset, duration and treatment received; thorough cutaneous and systemic examination was done. The patients were assessed clinically and with photographs at all visits. All patients received 30 mg oral prednisolone for 3 consecutive days in a week for 6 months. They were assessed for response and side effects at monthly intervals. The post treatment follow-up was done for 6 months. The findings were recorded on close ended proforma. The data were analyzed using SPSS software version 11.0. Fourteen male and 8 female patients aged between 16 and 40 years [mean 25.5 years] were enrolled for study. The duration of the disease at the time of presentation was from 6 months to 10 years [mean 3.6 years]. Fourteen patients had extensive alopecia of scalp, 6 alopecia totalis while 2 alopecia universalis. Eight [15.7%] patients showed excellent response and 5 [9.8%] good response. The response was satisfactory in 7 [13.7%] and unsatisfactory in 2 [3.9%] patients. Low dose steroids in mini-pulse regimen are an effective treatment modality for treating AA

Pattern of spinal tuberculosis at Liaquat University hospital, Hyderabad/Jamshoro

To find out the pattern of spinal tuberculosis [TB] presenting as paraplegia/ paraparesis in our set up. A descriptive study. Department of Medicine, Liaquat University Hospital Jamshoro/Hyderabad - Sindh from July 2003 to August 2004. In this study, 44 patients having TB spine presenting as paraplegia/paraparesis were evaluated by haematology, sputum examination, urine analysis, biochemistry and imaging. These patients also underwent a detailed history and clinical examination. Patients having non-tubercular cases of paraplegia and children were excluded from the study. Age range of the patients was 18-62 years. Among study participants, there was male dominance [61.36%] as compared to females [38.64%]. Pott's disease was present in 26 [59.09%] cases, paravertebral abscess with vertebral body destruction in 2[4.54%] cases, without body destruction in 4[9.09%] cases and spinal stenosis in 2[4.54%] cases. Arachnoiditis was seen in 10[22.73%] cases while spinal ischaemia in 2[4.54%] cases. In region-wise distribution, thoracic was involved in 20[45.45%]cases, lumbar 12[27.27%] cases, diffuse 10 cases [22.73%] and cervical 2[4.54%] cases. Thirty [68.18%] cases improved neurologically after medical and surgical treatment while 14[31.82%] cases did not improve because of delay in the diagnosis and treatment. In our set up, TB spine is more common in males than females and mostly presents with history of fever and backache resulting into paraplegia and paraparesis. Thoracic region is more common area of involvement. Most common pattern of TB spine is Pott's disease. Recovery among these patients is remarkable if diagnosed earlier