Comparison of 12-hour with 72-hour terlipressin therapy for bleeding esophageal varices

Objective: To determine the efficacy of 12-hour of Terlipressin therapy as compared to 72-hour therapy in preventing rebleeding after endoscopic therapy

Study Design: Interventional study

Place and Duration of Study: Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital, Lahore, from January to March 2016

Methodology: Cirrhotic patients presenting to our hospital with Gl [gastrointestinal] bleeding received Terlipressin 2 mg intravenous bolus, followed by 1mg 6-hourly until undergoing endoscopy.;Those with esophageal varices as the source of bleeding underwent band ligation and were recruited. Of the 93 enrolled patients, 90 remained and were randomized into 25 [27.8%] in control Group-A and 65 [72.2%] in test Group-B. Group-A received 72-hour of Terlipressin while Group-B received it for 12-hour. Both groups were monitored for rebleeding for 5 days

Results: Rebleeding occurred in 1 [4%] patient in Group-A and 3 [4.6%] in Group-B during the 5-day period. All 4 [4.4%] underwent repeat endoscopy. The Group-A patient and 2 [3%] of 3 Group-B patients showed ulcers over band ligation sites as source of bleed. The third Group-B patient showed varices requiring repeat banding. One [4%] patient [Group-A]

died due to persistent encephalopathy. No drug related adverse effects were seen

Conclusion: A 12-hour duration of Terlipressin as an adjunct to endoscopic band ligation shows similar results to 72-hour therapy

Changes in doppler ultrasound indices of hepatic circulation after treatment with beta blockers: a pilot study

Background: Portal hypertension is a serious complication of liver cirrhosis. Doppler ultrasound assessment may be a non-invasive and cost-effective means of evaluating portal hemodynamics in patients with portal hypertension

Aims and objectives: To assess efficacy of Doppler ultrasound in detecting changes in hemodynamics of hepatic circulation after beta-blocker administration

Methodology: 11 patients with liver cirrhosis and portal hypertension were included. All underwent Doppler assessment of portal vein velocity [PVV], spleno-portal index [SPI], congestive index [CI], liver vascular index [LVI], dampening index [DI], hepatic artery velocity [HAV], splenic artery velocity [SAV], hepatic artery resistive index [HARI] and splenic artery resistive index [SARI]. They were started on beta-blocker carvedilol 6.25 mg once daily and recalled after two weeks for repeat assessment

Results: Out of 13 enrolled, 4 were lost to follow up and one stopped carvedilol. 8 remained. The changes in parameters were: PVV: reduction in 3 [37.5%], no change in 1 and increase in 4[50%] patients; SPI: reduction in 3 [37.5%] and increase in 5 [62.5%]; CI: reduction in 3 [37.5%], no change in 1 and increase in 4 [50%]; LVI: decrease in 3 [50%], no change in 1 and increase in 2; DI: decrease in 5 [62.5%] and increase in 3 [37.5%]; HAV: increase in 4 [50%], no change in 1 [12.5%] and decrease in 3 [37.5%]; SAV: decrease in 4 [50%] and increase in 4 [50%]; HARI: increase in 7 [87.5%] and decrease in 1 [12.5%]; SARI: reduction in 3 [37.5%] and increase in 3 [37.5%]. 3 patients achieved reduction in 5 [PVV, LVI, DI, SARI and SAV] parameters. DI had the largest number of patients with observable reduction and HARI with the largest number showing observable increase in measured parameters

Conclusion: Doppler ultrasound represents a cost effective means of assessing the hemodynamics of hepatic circulation and any associated changes due to diseases and drugs

Patient satisfaction with electroconvulsive therapy in a tertiary care hospital

To determine the frequency of satisfied patients with ECTs in a public sector tertiary care hospital. Cross-sectional, descriptive study. The study was carried out in the in-patient department of Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, a tertiary care public sector hospital, from October 2010 to June 2011. A consecutive sample of 163 inpatients of both genders, excluding acutely disturbed patients was recruited. Proforma regarding the socio-demographic details was filled by the participants. ECT satisfaction Questionnaire was orally administered in Urdu to each participant for the assessment of their satisfaction with ECT. Data was analyzed using SPSS 10.0. Using the ECT satisfaction Questionnaire, 62.6% patients were satisfied while 37.4% were dissatisfied with ECT. Majority of patient was satisfied with Electroconvulsive therapy. However there is a need to explore specific reasons for satisfaction/dissatisfaction with this treatment modality in order to improve the delivery of this treatment in accordance with the patients' expectations for better treatment adherence and improved outcomes

Prevalence of obesity in school children of Hazara division

Limited data is available in Pakistan regarding prevalence of obesity in school going children. The objective of this study was to find out obesity prevalence in school going children in Hazara division. It was descriptive study. Data of 3200 students was collected over six month period, from Hazara Division. Four schools were selected in each district two for boys and two for females. District Kohistan was excluded from study as female education is not permitted beyond primary education. Children 5-14 year age group were included in the study. Initial 20 students of each class were selected for study. Anthropometric data [weight, height] for each student was collected and entered on Performa structured for this purpose. BMI was calculated and values were compared with standard BMI charts of National Health Centre for health statistics. Prevalence of obesity was 4.78%. Out of 3,200 children enrolled 153 [4.78%] were obese. Male to female ratio was 1:1.2. The prevalence of obesity was high in private school students than government schools [66.66% and 33%]. The prevalence was high in both sexes in 12-14 years and 6-7 years age groups [49% and 20.26%]. Prevalence of obesity in present study is similar to the results from developing countries in the region but prevalence is lower than developed countries. Problem of obesity also exists in developing countries and there is need to create awareness about obesity and related complications

Mushroom poisoning in children: clinical presentation and outcome

A variable clinical picture characterizes mushroom poisoning. The Amatoxin, the main toxic component of these fungi, are responsible for gastrointestinal symptoms as well as hepatic and renal failure. As acute gastroenteritis is extremely common in our set up, so every patient presenting with these symptoms is treated as gastroenteritis of viral aetiology. The authors present the clinical picture of the phalloid syndrome, its treatment and immediate outcome. All children age less than 16 years admitted in Saidu Hospital Swat from January to December 2006 with mushroom poisoning were included in the study. Patients with doubtful history or with associated illness were not included. The diagnosis was based on the clinical picture of the patient, history and the laboratory data. In addition to maintenance of fluid and electrolyte balance and treating sepsis, oral Silymarin and intravenous penicillin was started. Liver function tests, renal functions tests, serum electrolytes and coagulation profile was done in all the patients. The severity of poisoning was graded according to hepatic transaminase elevations and prolongation of prothrombin time. Of the 18 patients, fifteen were above five years of age. Female were twice in number. Fifteen patients developed hepatic failure and three patients developed renal failure. Thirteen patients expired. To start timely management, Mushroom poisoning should be considered in the differential diagnosis in patients presenting with food poisoning particularly coming in groups. Delay in diagnosis is associated with high mortality