Risk factors for decompensation of heart failure in patients with established left ventricular dysfunction

Objective: This study was aimed to identify the risk factors for decompensation of heart failure in patients with established left ventricular dysfunction

Study Design: Observational / descriptive / cross-sectional study

Place and Duration of Study: This study was carried out at Sandeman provincial hospital, Quetta from 15[th] March till 14[th] September 2015

Materials and Methods: One hundred fifty patients of decompensated HF with established left ventricular dysfunction [Ejection Fraction <40 %] were included in the study. Information about factors for decompensation of HF was collected from patients through a proforma during their hospital admission

The data was analyzed on statistical package for social sciences [SPSS] version 16

Results: Out of 150 patients, 59 % had ischemic heart disease while 41 % had non-ischemic heart disease. Non-compliance with diet and/or drug therapy [56.7% and 37.3%, respectively], cardiac arrhythmias [34%], lack of follow-up [26.7%], and intake of medications precipitating heart failure [20%] were the most common risk factors for decompensation of heart failure. Among other significant risk factors were infections [11.3%], anemia [10.7%] and myocardial ischemia [10.7%]. Pregnancy [2.7%] and thyroid disorders [2.7%] were less common risk factors

Conclusion: Majority of the risk factors for decompensation of heart failure appear to be preventable, and should thus be avoided with a better and more comprehensive control of heart failure in these patients

Prediction of large esophageal varices in patients with decompensated cirrhosis by child-pugh score, in medical unit-ii, chandka medical college hospital, larkana

To assess prediction of large esophageal varices in patients with decompensated cirrhosis by Child-Pugh score, in Medical Unit-II, Chandka Medical College Hospital Larkana. Cross sectional study. This study was carried out at Medical Unit II, Chandka Medical College and Hospital, Larkana from November 2011 to November 2012. In this study 88 consecutive cirrhotic patients with ascites [those Patients who fulfilled the inclusion criteria] were included; blood samples for Serum bilirubin, serum albumin, and INR ratio were sent to single laboratory. Then, child Pugh score were assigned to each patient on the basis of clinical and to laboratory parameter. The ultrasound of abdomen was carried out for size of liver and spleen, portal vein diameter, and quantification of ascits. Eligible patients were subjected for upper gastrointestinal endoscopy for the presence of esophageal varices and their grading. The data was analyzed using SPSS version 19. The mean age of enrolled patients was 43.19 +/- 7.1 years. Of 88 patients, 69 [78.4%] were male and 19 [21.6%] were female. Child Pugh class relation to number of patients were; 52, 20, and 16 in class A, B, and C respectively. While Child Pugh class relation to frequency of esophageal varices were; 6, 11 and 14 in class A, B, and C respectively. Frequency of grading of esophageal varices was; 4, 13, and 14 in grade one, two, and three respectively. Distribution of large esophageal varices [LEVX] in relation to child Pugh class is one in class A, two in class B and 11 in class C. It is concluded from this study that; as the child pugh score advances, the number and size of esophageal varices increases, and chance of absence of varices decreases

Experience of acute systemic lupus erythematosus in indoor and outdoor patients

The aim of this study was to determine spectrum of clinical and Laboratory diagnosis of Systemic lupus erythematosus at tertiary care unit. Descriptive type, [cross sectional]. This study was conducted at the Department of General medicine and Paediatric Medicine in indoor and outpatients CMC, Shaheed Muhatarma Benazir Bhutto University Medical Larkana from February 2010 to February 2012. We studied prospectively 44 patients with SLE who were seen consecutively either as inpatients or outpatients. All were met the American College of Rheumatology [formerly American Rheumatism Association, ARA] revised criteria for SLE and underwent medical interview as well as routine general physical examination by a researcher, and the laboratory investigations were carried out from single laboratory of Larkana, all these characteristics features of patients were collected in a protocol form. These investigations were includes the CBC, serology for ANA, anti dsDNA and urine for protienuria. X-ray chest and echocardiography was also done for pleural and pericardial effusion. Forty-four patients fulfilled the ACR criteria for SLE, most common presentation were cutaneous 30 [68.2%] cases, mucocutaneous ulceration 26 [59.1%] Fever 26 cases [59.1%], pallor 47 [67.14], cough 34 [48.57%], swelling of body 12 [17.14%], headache in 10 [22.7%] and Major physical signs were arthritis and arthralgia 30 [68.2%], Hepatosplenomegaly 20 [45.5%], generalized lymphadenopathy 12[27.3%], pleural effusion 08 [18.2%] and 02 [4.5%] patients had pericardial effusion, Raynaud's phenomenon 10 [22.7%], while direct comb test, ANA, anti dsDNA antibodies were found to be positive in 10 [22.7%], 42 [95.5%], 34[77.3%] cases respectively. Most patients presented almost universally with fever and arthralgias or arthritis in combination with malar rash or oral ulcers and in some patients a combination of all of the above was observed. A combination of positive anti nuclear antibody test, increased ESR and proteinuria were found to be a sensitive and cost effective set of laboratory findings for the diagnosis of patients suffering from SLE. The set of these clinical and laboratory features would help in the correct and early diagnosis of patients suffering from SLE, a relatively rare disease, in the busy medical outpatient and inpatient departments in our set up

frequency of impaired glucose tolerance in patients of essential hypertension in tertiary care Hospital, Larkana

To determine the frequency of impaired glucose tolerance in patients of essential hypertension. Descriptive Cross sectional study. This study was conducted at the Medical Outpatient department of Chandka Medical College Hospital Larkana, over one year period from February 2012 to February 2013. Total 171 patients of age 40-70 years having hypertension more than 2 years were purposively selected, while Known cases of DM, secondary hypertension and metabolic syndrome were excluded. Oral glucose tolerance was performed on selected patients of essential hypertension and plasma glucose was measured 2 hours after giving 75 g of glucose to each patient. Patients with [2 hours plasma glucose] level of 140-199 mg/dl were considered impaired glucose tolerance. Frequency was calculated for gender, number and type of medication and impaired glucose tolerance. The mean and SD were calculated for age, height, weight, BMI and duration of HTN. Stratification of age, gender, BMI and duration of hypertension done while applying Chi-Square with p value <0.05 as significant. One hundred and seventy one [171] patients met the inclusion criteria with mean age of 53.42 +/- 8.059 among those 104 were males [60.81%] while 67 were females [39.19%]. Duration of hypertension ranged 3-15 years with a mean duration of 7.47 +/- 3.26 years. Mean Body mass index [BMI] was 25.95 +/- 4.32, minimum BMI 17.88 and maximum BMI was 39.91. Frequency of IGT was 39.2% [n=67]. Mean serum glucose level at 2 hours in these patients was 159.33 +/- 27.937 grams/dL. Males were more affected while age has little effect on IGT frequency. More the duration of hypertension more was the prevalence of IGT. BMI was significant effect modifier for IGT; in overweight and obese patients the frequency of IGT was much higher [40.58% in overweight and 69.23% in obese] than normal weight patients [27.78%]. [p value <0.003]. IGT is much frequent in essential hypertension. Hypertensive males, elder age, longer duration of hypertension, high BMI and use of more than one antihypertensive medicine are associated with higher rates of IGT. This study suggests that all the patients with essential hypertension should be scrutinized for blood glucose levels

Pancytopenia; study of 40 patients at cmc hospital larkana

Pancytopenia is said to exist in an adult when the hemoglobin level is less than 13.5gm/dl in males and 1l.5gm/dl in females, white cell count less than 4x10[9]L[1] and platelet count less than 150x10[9]/L[1]. The causes of pancytopenia are aplastic anemia, subleukemic leukemia, myelodysplasia [2] multiple myeloma, nutritional deficiencies leading to megaloblastic anemia, hypersplenism, paroxysmal nocturnal hemoglobinuria, AIDS, infections such as miliary tuberculosis, leishmaniasis, brucellosis etc. To determine the frequency of various causes of pancytopenia in gender at Chandka Medical College, Larkana. Cross Sectional Study. OPD and Medical Ward-ll, Chandka Medical College Hospital Larkana. 01 years study from February 2007 to February 2008. Patients of either sex, who attended medical ward-ll of Chandka Medical College Hospital Larkana, either as inpatient or out patient department, from February 2007 to February 2008 and fulfilled the inclusion criteria, were included in this study. Pancytopenia was considered as hemoglobin value less than 13.5gm/dl in males or 11.5gm/dl in females, a white cell count less than 4x10[9]/L and Platelets count less than 150x10[9]/L. Patients of less than 12 years and pregnant females were excluded from the study. Out of 40 patients, 29 [72.5%] were males and 11 [27.5%] were females. Female to male ratio was 1:2.6. The mean ages of males were 29.10 +/- 16.46 years whereas of females 36.14 +/- 15.6 years [P = 0.22]. Aplastic anemia was the most common pathology encountered and was diagnosed in 13 cases [31.5%], followed by hypersplenism 09 [22.9%], Megaloblastic anemia 06 [15%] and hodgkin's lymphoma in 04 [10%] cases. Other less common causes detected were multiple myeloma 02 [5%], drug induced 02 [5%] and malaria, milliary tuberculosis, myelodysplastic syndrome, emophagocytic syndrome was 01 [2.5%] case in each. We concluded that aplastic anemia was the most common cause in our patients and more than 2/3rd patients were young males. We think the causes of aplastic anemia in this study may be misuse of drugs, kushtas, exposure to chemicals and viral infections

Prevalence of hepatitis-C virus infection in Khairpurnathan Shah and Shahdakot: a city based screening program

The world health Organization estimates that approximately 3% of the world population is infected with hepatitis-C virus [HCV] and there are more than 170 million individuals with chronic HCV infection who are at risk of developing liver cirrhosis, decompensated liver disease and hepatocellular carcinoma while in Pakistan according to a safe estimate, approximately 10 million people are infected with HCV. To observe the prevalence of HCV infection in our remote areas and to find out the possible causes for the spread of HCV infection, among the individual of Khairpur Nathan Shah and Shahdadkot. One day city based HCV screening program was conducted in the two cities i.e. Khairpur Nathan Shah and Shahdadkot. Cable and papers were used to invite subjects to come in for free HCV screening. The over all seropositivity among 406 subjects was 30.29%. The prevalence of HCV infection was higher in males [76.1% as compared to females [23.9%] and it was highest in subjects between 31-40 years of age [34.2%]. In this city based screening program, we found a high prevalence of HCV infection among the residents of Khairpur Nathan Shah and Shahdadkot. Broader based studies for HCV screening program are suggested in the remote areas of Pakistan