Frequency of acute complications of Hemodialysis in adult age group at a tertiary care center

Objective: To determine the frequency of acute complications of hemodialysis in adult age group at a tertiary care centre

Study Design: Descriptive study

Place and Duration of Study: Department of Medicine, Combined Military Hospital Lahore, from Apr 2012 to Oct 2012

Patients and Methods: We included 100 consecutive patients of chronic kidney disease on hemodialysis with age more than 12 years. Personal profile, comorbidities, intravenous access type and duration, hemodialysis parameters were recorded for each patient. Monitoring of blood pressure, temperature, pulse and history of palpitations, headache, nausea, vomiting, muscle cramps, fever, shivering, chest-pain, bleeding, fits, itching was recorded before and up till one hour post hemodialysis session

Results: In our study population fever was the commonest complication with frequency of 37 percent, followed by nausea and vomiting in 36 percent, muscle cramps in 28 percent, hypotension in 24 percent, headache in 23 percent, shivering in 22 percent, chest Pain in 15 percent, itching in 14 percent, hypertension in 10 percent, cardiac arrhythmias in 8 percent, hemorrhage in 7 percent and Seizures in 7 percent of patients

Conclusion: Infection related complications were more common in our set up as compared to international statistics which depicts that we should improve our antiseptic techniques

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

Sodium Intake Prediction with Health Promotion Model Constructs in Rural Hypertensive Patients.

Background: Hypertension is the most common cause of cardiovascular disease, and the growing epidemic is a serious warning to pay more attention to this disease. The aims of this study were to examine the relationships between the health promotion model (HPM) constructs and sodium intake, and to determine the predictive power of the HPM constructs as the possible mediators of sodium intake in rural Iranian hypertensive patients. Materials and Methods: This cross-sectional study was conducted on 671 hypertensive patients in Ardabil, Iran in 2013. The data were obtained during a 25-40 min face-to-face conversation by validated and reliable instruments. The nutritional data were assessed with Nutritionist version 4 (N4) software. Descriptive statistics, Spearman’s correlations were calculated using SPSS Statistics version 18.0. Structural equation modeling was conducted using AMOS version 18. Results: Sodium intake was negatively correlated with perceived benefi ts (r = -0.707; P < 0.01), perceived self-effi cacy (r = -0.719; P < 0.01), situational infl uences (r = -0.590; P < 0.01), interpersonal infl uences (r = -0.637; P < 0.01), commitment to action (r = -0.605; P < 0.01), affects related behavior (r = -0.499; P < 0.01), and positively associated with the perceived barriers score (r = 0.563; P < 0.01). The structural equation modeling showed that the model explained 63.0% of the variation in sodium intake. Conclusions: HPM constructs were signifi cantly associated with sodium intake and dietary perceptions based on HPM constructs can predict acceptable rate of the variation of sodium intake. Therefore, we suggest using this model constructs to improve the effectiveness of nutritional interventions.

Horner's syndrome following double lumen dialysis catheter insertion in right internal jugular vein

Horner syndrome is characterized by ptosis ,miosis and anhidrosis. We describe a case of Horner Syndrome as a possible but rare complication of internal jugular vein catheterization

Diseases causing acute renal failure in a tertiary care hospital

This study was done to evaluate frequency of acute renal failure [ARF], its causes and out come of the patients. Descriptive analytic study. March to Dec 2007 at Combined Military Hospital Lahore. All patients, admitted in different wards of the hospital, who developed acute renal failure [doubling of serum creatinine measured on two occasions 12 hours apart], were included in this study. A total of 39 patients were included in the study. Males were 19 [48.71%] and 20 [51.28%] were female. Mean age of patients was 40.2 years [SD=18.0]. The major cause was acute Gastroenteritis seen in 23 [58.97%] cases. Others developed ARF due to, Abruptio Placentae 5 [12.82%], Postoperative 5 [12.82%], Eclampsia 3 [7.69%] and Drug induced 3 [7.69%]. Oliguric phase developed in 28 [71.79%] patients and lasted for 8.45 +/- 4.16 days. Of these 17 [60.71%] patients had acute gastroenteritis. Gastroenteritis is the most common and important cause of ARF though gynaecological and surgical etiologies must be kept in mind. It is evident that the gynaecological and surgical patients need critical peri-partum and peri-operative monitoring to prevent development of ARF. Early institution of therapy will prevent subsequent morbidity associated with this disease

Chronic suppurative otitis media; empiric quinolones in children

The aim of the study was to determine the most prevalent organisms in chronic otitis media in children and their susceptibility to various antibimicrobials so that an appropriate empiric antibiotic can be started promptly while awaiting the results of the culture and sensitivity. Prospective observational study. The study was conducted at Combined Military Hospital Lahore from Jan 2006 to Dec 2007. A total of 156 patients less than 15 years of age who were having discharge from one or both ears for at least 1 week with tympanic membrane perforation were included in the study. A sample of the ear discharge was collected on the swab and cultured on appropriate media. The Gram positive organisms were identified on the basis of Gram staining, catalase and coagulase test, the Gram negative organisms were identified by API 20e. A total of 156 patients were included in the study of which 96 [61.5%] were males and 59 [37.8%] were females. The organisms isolated were Staphylococcus aureus in 79 [50.6%], Pseudomonas-aeruginosa in 45 [28.8%] patients and Proteus mirabilis 17 [10.9%], Escherichia coli, Acinetobacter sp and streptococi were isolated in occasional patients. Staphylococcus aureus was the commonest organism isolated followed by Pseudomonas aeruginosa and Proteus mirabilis fifty four. [34.6%] of Staphylococcus aureus were sensitive to gentamicin, fifty two [33.3%] to ciprofloxacin and 42 [26.9%]% to both ciprofloxacin and gentamicin. Among the Pseudomonas aeruginosa isolates 40 [25.6%] were sensitive to gentamicin, 27 [17.3%] to ciprofloxacin and 22 [14.1%] to both ciprofloxacin and gentamicin. Out of 156 patients 91 [58.3%] had isolates which were sensitive to ciprofloxacin and 62 [39.7%] were resistant to it. One hundred fourteen patients [73.1%] had isolates which were sensitive to gentamicin whereas 33 [21.2%] were resistant. Similarly 35 isolates [22.4%] were sensitive to sulphamethoxazole/trimethoprim whereas 66 [42.3%] were resistant. Among Proteus mirabilis isolates 12 were sensitive to gentamicin, 11 were sensitive to ciprofloxacin and 11 were sensitive to both ciprofloxacin and gentamicin. Ciprofloxacin ear drops can be recommended to be given empirically in children with chronic discharging ears. The initial therapy can be modified and appropriate therapy started if the result of the culture and sensitivity report shows the isolate to be resistant to the antibiotic started empirically

Peri-operative Pulmonary Edema a manifestation of Peripartum Cardiomyopathy

A 20 years primigravida presented in emergency with history of pulmonary edema after caesarean hysterectomy under spinal anesthesia, complicated by cardiac arrest. On examination, the patient was conscious, anxious and restless, pale, cyanosed, had edema face and feet, distended neck veins and was orthopnoeic. X-ray chest showed diffuse homogenous opacities in both lung fields. A provisional diagnosis of over transfusion pulmonary edema was made. She was placed on ventilatory support on synchronized intermittent mandatory ventilation [SIMV] along with positive end expiratory pressure [PEEP]. Her endotracheal suction had to be performed quite frequently due to exuberant amount of edema fluid. She was given diuretics, antibiotics and analgesics

Fat embolism syndrome: a case report

A young motorcyclist, who had met a road traffic accident resulting in multiple fractures, later developed fat embolism syndrome. He had to be instituted mechanical ventilation for hypoxemia and deteriorating levels of consciousness and was rendered vigorous management for his critical general condition

Endoscopic assessment of dyspepsia

This study was conducted to identify the spectrum of diseases causing dyspepsia and to find out relative prevalence of individual diseases in our society. A number of 510 patients between ages of 10-70 years with dyspepsia were selected after fulfilling a definite criterion for the study. The results indicated that 261 [51.17%] had no endoscopic abnormality suggesting that a large majority of patients suffer from non-ulcer dyspepsia. The prevalence of peptic ulcer was 10%. About 20% had esophagitis and 13% suffered from gastritis/duodenitis. It was concluded that majority of patients with dyspepsia had no peptic ulceration, though they may present with ulcer like symptoms