ABSTRACT
Objective: To determine the frequency of prolonged corrected QT interval [QTc] in Child Pugh Class in patients of liver cirrhosis presenting to Combined Military Hospital Peshawar. Study Design: Cross sectional study. Place and Duration of Study: Department of Medicine, Combined Military Hospital Peshawar, from Dec 2013 to Jun 2014
Material and Methods: One hundred and thirty three patients with liver cirrhosis fulfilling the inclusion criteria were included in the study using non-probability consecutive sampling after taking informed consent. All patients were assigned their Child's Class either A, B or C. Electrocardiogram [ECG] was done and QTc was calculated using Bazett's formula. QTc of more than 0.44 seconds was taken as prolonged
Results: Out of 133 patients, QTc was prolonged in 78 patients yielding frequency of QTc prolongation in cirrhosis of 58.64%. Frequency of QTc prolongation was 61.18% in males and 54.17% in females. QTc prolongation was 15% in Child Pugh grade A, 54.76% in Child Pugh grade B and 73.24% in Child Pugh grade C. There was a statistically significant association between QTc prolongation and the severity of cirrhosis [p<0.001]
Conclusion: This study concludes that there was a statistically significant increase in frequency of QTc prolongation with worsening of Child Pugh Class thereby indicating an association between QTc prolongation and the severity of cirrhosis
ABSTRACT
Objective: To compare the efficacy of telmisartan and atenolol in management of patients with essential hypertension. Study Design: Randomized comparative trial. Place and Duration of Study: Department of Medicine Combined Military Hospital Peshawar, from Feb 2010 to Aug 2010
Material and Methods: One hundred and eighty patients diagnosed with essential hypertension fulfilling the inclusion criteria were included in study using consecutive non-probability sampling after taking informed consent. Patients were allocated to either telmisartan or atenolol group by using a table of random numbers. Follow up of patients was carried out in 4 visits with recording of sitting systolic and diastolic blood pressures
Results: Among total of 180 patients, 60% were females and 40% were males. Majority were between age group 56-75 years. Reduction of both systolic and diastolic blood pressures at the end of eight weeks was significantly greater with telmisartan as compared to atenolol [p-value=0.000 and 0.016 respectively]
Conclusion: At the end of eight weeks of treatment, telmisartan was more effective than atenolol in lowering systolic and diastolic blood pressure
ABSTRACT
Objective: To compare the efficacy of pregabalin and amitriptyline in alleviating pain associated with painful diabetic peripheral neuropathy [PDPN]. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Medicine, Pakistan Naval Ship [PNS] Shifa Karachi, from May 2014 to Nov 2014
Material and Methods: Six hundred and sixty patients [330 in each group] with PDPN fulfilling the inclusion/exclusion criteria were randomized into groups A and B through consecutive non-probability sampling. Baseline pain scores on visual analogue scale [VAS] from 0-10 were recorded. Group-A was given pregabalin and group-B was given amitriptyline. Response was assessed after 6 weeks using VAS. A reduction of >50% on VAS was labeled efficacious
Results: Out of 660 patients, 46.36% [n=153] in group-A and 57.88% [n=191] in group-B had effective relief of pain whereas 53.64% [n=177] in group-A and 42.12% [n=139] in group-B had persistent pain. A p-value was calculated as 0.003
Conclusion: Amitriptyline was significantly more effective for alleviation of pain associated with PDPN when compared with pregabalin
ABSTRACT
Background and Objective: Chronic obstructive pulmonary disease [COPD] is characterized by chronic incompletely reversible poor airflow and air trapping and usually this debilitating disorder limits the outside activities of the patients depriving them of sunlight which is a rich source of Vitamin D. The objective of this study was to determine the effect of vitamin D supplementation in reducing number of acute exacerbation in COPD patients
Methods: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore from January to December 2015 as exacerbations of COPD are season dependent. Diagnosis was confirmed by performing Pulmonary Function Tests [PFTs]. Basic demographical information was obtained and baseline PFTs of the patient was done. Only Group A patients was treated with oral vitamin D intake of 2000 IU daily for 6 months. Vitamin D level was measured at 0, 2, 4, and 6 months and exacerbation of COPD, FEV1 and FVC was measured weekly. Both the groups were given standard treatment for exacerbation of COPD. Spirometry was repeated at each visit. Blood samples were collected every 2 months for vitamin D. Supplementation was stopped if vitamin D level exceeded 100ng/ml
Results: The mean age of the patients was 46.28 +/- 8.83 years, the male to female ratio was 1.8:1. The mean 25[OH] level at baseline was 24.08 +/- 2.58 and at 6th month was 29.60 +/- 8.74. The mean FVC at baseline was 77.83 +/- 5.49 and at 6th month was 91.34 +/- 5.52. The exacerbation at baseline was present in all 120[100%] patients and at 6th month was reduced to 4[3.3%]
Conclusion: Vitamin D supplementation has significant effect in reducing number of acute exacerbation in COPD patients when it is given for prolonged period
ABSTRACT
Objective: To study the effect of Vitamin D supplementation on reduction in level of HbA1 in patients recently diagnosed with diabetes mellitus Type II having asymptomatic Vitamin D deficiency
Methods: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore for 6 months from January 01 2016 to June 30, 2016. 114 Patients were included through non probability purposive sampling technique. Informed consent and demographic information was collected. Patients were divided in two groups by randomization through tossing a coin. GroupA patients received Metformin tablet alone at 500 mg after dinner and Group-B patients were treated with same dosage of Metformin along with oral vitamin D at 200,000 ILJ monthly for three months. Blood sample was obtained at baseline, 3 months and 6 months of initiation of therapy. All samples were sent to the laboratory for complete blood count, blood sugar fasting, serum calcium, serum phosphorous, serum alkaline phosphatase, HbA1c and serum 25 Hyroxy Vitamin D [S-25[OH] D] levels and iPTH. Data entry and analysis was done by using SPSS 20
Results: The mean age of patients in metformin group was 42.37+/-4.59 years while mean age of patients in combination group was 43.33+/-4.86years. Males were 45.6% and females were 54.4% in metformin group while in combination group, 36.8% were males1 and 63.2% were females'. At baseline, in metformin group, mean Vitamin D level was 17.09+/-1.73mg/dl and in combination group, mean Vitamin D level was 16.49+/-n D was 29.04+/-3.96mg/dl. At baseline, 1[st] and 2[nd] visit, in metformin group, mean HbA1c was 7.59+/-0.47%, 7.46+/-0.25% and 7.30+/-0.29%. At baseline, 1[st] and 2[nd] visit, in combination group, mean HbA1c was 7.71 +/-0.19%, 7.57+/-0.21% and 7.43+/-0.26%. The difference was insignificant [p>0.05] at baseline while significant on later follow-ups [P<0.05]
Conclusion: Vitamin D supplementation improved the glycemic control but substantial reduction in HbA1c was statistically insignificant in both groups
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Vitamin D/physiology , Glycated Hemoglobin , Metformin , Vitamin D DeficiencyABSTRACT
Objectives: To estimate the range of hepatic involvement in dengue infections by assessing clinical and biochemical profile of adult dengue infected patients
Methods: Serologically confirmed 220 adult cases of dengue infections admitted to Mayo hospital from June 2013 to November 2013 were classified as having dengue fever, dengue haemorragic fever and dengue shock syndrome. The frequency and range of bilirubin, liver enzymes derangement and presence of liver enlargement in each group was calculated and further stratified according to age and gender. Patients with positive viral serology, chronic liver disease, malaria and typhoid were excluded from the study
Results: About 60% of DHF patients had hepatomegaly compared to 40% of DF patients. Liver dysfunction was more common in DF compared to DHF [38.15 vs 18.6%]. Hyperbilirubinemia was noted in 40 [18.2%] patients, 28 [12.7%] in DF and 12[5.5%] in DHF. The mean serum bilirubin was higher in DHF [0.87+0.33] compared to DF [0.74+0.27]. Bilirubin was higher in male patients and in younger [<20 years] age group. ALT was elevated more frequently in male patients in age group of 31-40 years and in DF patients as compared to DHF [72[32.7% vs 40[18.2%]]. The mean serum ALT level was 103.7 U/l in DHF and 69.2U/I in DF. AST was raised in all DHF patients as compared to DF in which 40% patients had normal AST levels. Alkaline Phosphate was high in all DHF patients with a mean of 278.7. It was raised in most of the DF patients as well and majority of patients were in age group of 31-40 years
Conclusion: Liver involvement is very common in dengue infections and is not limited to elevation of transaminases only. Bilirubin and Alkaline phosphatase are also raised in considerable number of patients. Therefore in adults with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic
Subject(s)
Humans , Female , Male , Adolescent , Adult , Middle Aged , Adult , Severe Dengue , Transaminases , Endemic Diseases , HepatomegalyABSTRACT
Objectives: To determine the accuracy of first morning void urine specimen for Albumin to Creatinine Ratio [ACR] comparing with 24-hour urinary albumin excretion in detecting trueroalburninuria in type 2 diabetics
Study Design: Cross Sectional study
Place and Duration of Study: Military Hospital Rawalpindi, from Apr 2013 to Oct 2013
Patients and Methods: One hundred and twenty patients with type 2 Diabetes Mellitus [DM] fulfilling the inclusion criteria were included in study using consecutive non-probability sampling. A standard protocol was followed for specimen collection. Urine collection was started from the next day of admission
Results: Mean random plasma glucose level was 174.54 +/- 33.06 mg/dL, mean HbAlc was 8.5 +/- 1.32%, mean urinary albumin 130.26 +/- 47.25 mg/24 hour and mean ACR was 104.30 +/- 51.56 mg/g. Area under ROC curve was 0.964 for microalbuminuria by ACR. Spearman's rank-order coefficient [rs] was 0.696 for ACR and 24 hour albumin excretion
Conclusion: ACR in first morning void urine accurately detected early microalbuminuria in type 2 diabetics
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Creatinine , Diabetes Mellitus, Type 2 , Cross-Sectional Studies , Urine Specimen CollectionABSTRACT
Objectives: The main objectives of this study were to evaluate the complications of tracheostomy in IDPs patients who were admitted in DHQ teaching hospital Bannu and further the study of complications in relation with tracheostomy types, age and tracheostomy tubes types
Study Design: Observational / analytic / cross sectional study
Place and Duration of Study: The study was conducted at the ENT Unit, DHQ Teaching Hospital, Bannu from April 2015 to December 2015
Materials and Methods: 60 patients undergoing tracheostomy, having an age group of 3 to 65 and fulfilling inclusion and exclusion criteria were selected. Elective and emergency tracheostomy was included in the study period. "Open surgical technique" was done. Metallic and portex cuffed rubber tubes ware used. To record any possible complication, a pre-designed proforma was used
Results: The study comprised 42 males and 18 females. The mean age of the patients was 30 years[SD+18.20]. Elective tracheostomy was done in 10% while emergency tracheostomy was done in rest of the 90% patients. Metallic tubes were used in 20% and portex cuffed rubber tubes in 80% of the patients. The recorded complication rate was 40% overall. There was an 18% immediate, 11% intermediate and 11% late complications. Complication rate was somewhat elevated in early age. Bleeding was commonest complication [20%] among all followed by emphysema, dysphagia and aspiration [4% each]. Complication rate of emergency tracheostomy was higher than elective one. Similarly, complication rate with portex cuffed rubber tubes was greater than metallic tubes
Conclusion: Rate of complication in emergency tracheostomy was higher than elective tracheostomy where as in elder patients; it was lower than in younger patients. Similarly, complication rate was greater with portex cuffed rubber tubes. From the study, it is concluded that post op care can minimize the chances of post tracheostomy complications
ABSTRACT
Acute renal failure is one of the important complications of acute gastroenteritis. Early intervention and proper fluid replacement may lessen this risk. We conducted this observational study to see the renal involvement and its outcome in patients with acute gastroenteritis. Observational study. This study was done in three different hospitals which are tertiary care and teaching hospitals. May 2009 to September 2009. A total of 200 patients were included in this study who presented with acute gastroenteritis. All patients were assessed properly for their clinical examination and laboratory tests including renal functions, electrolytes and other routine tests were done and evaluated. These patients were treated either in Emergency department or indoor departments. Only those patients were included in our study who met our inclusion criteria which was set before conducting study. A total of 200 patients were included in our study, among them 160 were male patients and 40 were female patients. At presentation 32 [16%] patients had deranged renal functions, 18 [09%] patients had urea in range of 50-100 mg/dL and creatinine in the range of 1.4-2.0 mg/dl. 10 [05%] patients had urea in range of 101-150mg/dL and creatinine 2.1-3.Smg/dl. 04 [02%] patients had urea in range of 151-200 mg/dl and creatinine 3.6-7.0mg/dL. 12 patients were received in hypovolemic shock at presentation. After one week of follow up most of these patients improved but 04 patients were deteriorated and put on renal replacement therapy. Patients who had their renal functions in normal range were discharged from hospital and follow up of all these patients were continued for 6 months. lt was observed that those patients which presented late had more chances of renal involvement. Early referral and timely management with fluids and antimicrobials may reduce risk of renal failure in patients with acute gastroenteritis.
ABSTRACT
To correlate the total area of Acanthosis Nigricans with total cystic area of ovaries in women with polycystic ovaries. Thirty young females with polycystic ovaries were selected and in them total cystic area and total area of Acanthosis Nigricans was measured. Mean total cystic area was 92.0 [SD 35.12] and mean total area of Acanthosis Nigricans was 224.46 [SD 234.90]. The relationship between total cystic area [TCA] and total area of Acanthosis Nigricans [TAAN] was statistically significant with p of 0.007. There is a significant correlation between total cystic area and total area of Acanthosis Nigricans in subjects with PCOS. So Acanthosis Nigricans could be a useful cutaneous marker for PCOS and the extensiveness of the cysts presents