Frequency of different infections in patients with hepatic encephalopathy due to cirrhosis liver

Objective: To determine frequency of different infections in patients with hepaticencephalopathy due to cirrhosis liver

Study Design: Cross sectional descriptive study

Place and Duration of Study: The study was conducted in the Department of Medicine, Combined Military Hospital, Peshawar over six months from April to October 2013

Patients and Methods: All patients with cirrhosis of liver of more than 18 years of age, manifesting signs of hepatic encephalopathy [HE] were included in the study. Detailed history, clinical examination and thorough investigations were done to look for different infections and the findings were recorded on a proforma. Descriptive statistics were used for data analysis

Results: One hundred and eighty five patients [70.81% males and 29.19% females] were enrolled. The mean age of the study subject was 49.2 +/- 3 years. Frequency of infections in the studied population was, spontaneous bacterial peritonitis [31.94%], UTI [25.00%], pneumonia [20.83%], sepsis [8.33%] and others infections [13.90%] like cholangitis, bronchitis, endocarditis, meningitis, and gastroenteritis

Conclusions: This study concluded that a substantial number of patients with hepatic encephalopathy due to cirrhosis liver have infections

Frequency of hypertriglyceridemia in newly diagnosed type 2 diabetics

Objective: To determine the frequency of hypertriglyceridemia in newly diagnosed type 2 diabetics presenting to tertiary care hospital

Study Design: Cross sectional descriptive study

Place and Duration of Study: This study was carried out at Department of Medicine, Military Hospital Rawalpindi from Nov 2010 to May 2011

Material and Methods: A total of 193 patients were recruited in this study from medical outpatient department and medical wards. Patients aged more than 30 years and of both sexes who were diagnosed diabetics in the past 6 months were included in the study

Results: Mean age of the patients was 49.1 +/- 7.3 years. Regarding gender distribution, 135 patients [70.0%] were male while remaining 58 patients [30.0%] were female. Out of total 193 patients, hypertriglyceridemia was present in 112 patients [58.0%]. Mean fasting blood glucose was 8.29 +/- 0.69 mmol/l, 2 hours post-prandial blood glucose 14.59 +/- 1.71 mmol/l, fasting serum triglyceride level was 2.27 +/- 0.35 mmol, 2 hours postprandial serum triglyceride level was 3.17 +/- 0.54 mmol

Conclusion: Frequency of hypertriglyceridemia in type 2 diabetics was found to be reasonably high in present study

Diagnostic accuracy of clinical methods for detection of diabetic sensory neuropathy

Objective: To determine the accuracy of clinical methods for detection of sensory neuropathy as compared to biothesiometry

Study Design: Cross-sectional analytical study

Place and Duration of Study: 1 Mountain Medical Battalion, Azad Kashmir, from October 2013 to September 2014

Methodology: Patients with type 2 diabetes were enrolled by convenience sampling. Exclusion criteria included other identifiable causes of neuropathy, extensive ulceration of feet, amputated feet, those on treatment for neuropathy and unwilling patients. Average of 3 vibration perception threshold values measured with a biothesiometer on distal hallux was calculated. Ten gm monofilament was used to examine touch sensation over dorsal surfaces of great toes. Vibration sensation was checked over the tips of great toes using 128Hz tuning fork. Ankle jerks were checked bilaterally

Results: Neuropathy [vibration perception threshold > 25 volts] was present in 34 [21.12%] out of 161 patients and 93 [57.76%] were symptomatic. Measures of diagnostic accuracy for monofilament, tuning fork and ankle jerks were: sensitivity 41.18%, 55.88% and 64.71%; specificity 92.91%, 93.70% and 80.31%; positive predictive value [PPV] 60.87%, 70.37% and 46.81%; negative predictive value [NPV] 85.51%, 88.81% and 89.47%; and, diagnostic accuracy 81.99%, 85.71% and 77.02%, respectively. Values for any 1 positive sign, any 2 positive signs or all 3 positive signs were: sensitivity 35.29%, 14.71% and 32.35%; specificity 81.89%, 93.70% and 99.21%; PPV 34.29%, 38.46% and 91.67%; NPV 82.54%, 80.41% and 84.56%; and, diagnostic accuracy 72.05%, 77.02% and 85.09%, respectively

Conclusion: Clinical methods are high accurate and specific diagnosis in picking up symmetric sensory neuropathy in patients with type 2 diabetes, particularly when multiple signs are combined

Herpes Zoster involving penis and scrotum: an unusual occurrence

Herpes zoster is an infectious vesicular skin rash in a dermatomal distribution caused by Varicella zoster virus. It occurs very uncommonly in sacral dermatomes. We describe a case with rash on penis and scrotum due to involvement of S2 dermatome in a young male. The disease followed an uneventful course and the patient recovered completely without any sequelae or complications. This case is being presented to highlight its unusual location and to discuss differentiation from another viral infection commonly seen at this site