Diversity of presentations in decompensated chronic liver disease due to HCV

Background: An estimated 170 million people worldwide suffer from HCV infection. Chronic hepatitis C virus [HCV] infection is often a clinically silent infection presenting many years after with complications related to decompensation, so

Objective: To emphasize the role of early detection and intervention in preventing complications of HCV related chronic liver disease

Materials And Methods: Newly diagnosed decompensated chronic liver disease [CLD] due to HCV infection presenting to respective hospitals during 2010

Study design: observational multicentre study

Results: Out of 340 new cases of decompensated chronic liver disease due to hepatitis C virus. 190 [56%] were females and 150 [54%] were male. In terms of presentation, patients were having overlapping symptoms and signs like ascites, jaundice, upper GI bleed and encephalopathy. 220 [64.7%] had clinical ascites, 70 [20.5%] had spontaneous bacterial peritonitis, 130[38.2%] had altered conscious level and150 [44.1%] had upper GI bleed. It was inferred from history that 170[50%] patients with Hepatitis C were detected while being investigated for complaints other than liver disease. Other presentations included jaundice in 10[2.9%] 50 [14.7%] with previous upper GI bleed, 80 [23.5%] with CLD, 10 [2.9%] with epigastric discomfort and 20 [5.8%] had altered conscious level. 235 [69.1%] with Child's Score B and 105[30.4%] with Child's Score C

Conclusion: Majority of patients become aware only when complications set in. Early detection and interventions should be stressed because the available treatment options for the complications are beyond the reach of majority of patients and don't have a permanent solution

Hypoglycemia; experience in diabetics

Hypoglycemic symptoms are a very common experience for diabetics ranging from an innocent increased appetite to dreadful unconsciousness. This study was designed to assess the patient's awareness about the symptoms, experience of individual symptoms and their ability to recognize and to respond accordingly. All diabetic patients were assessed for the awareness of different symptoms of hypoglycemia, their experience of individual symptoms in last six months and ability of the patient and family members to recognize and to respond accordingly to these symptoms on a prescribed proforma with the help of trained staff. We had 1260 new cases of DM during the study period with valid diagnosis and taking either sulphonylurea or Insulin who were enrolled in the study. 280 patients had no idea of the symptoms. 564 patients knew no more than three symptoms. Palpitation and sweating were the most commonly known 80% and experienced 65% symptoms. Hunger and epigastric discomfort were the next best known 73% and experienced 58% symptoms. Loss of consciousness was the next in the list in terms of knowledge 52% and experience 23%. Coldness of body 28%, severe weakness 24%, blurred vision 12%, abnormal behavior 12% and altered consciousness 6% were the next in the list of experience. Early morning headache, night terror and frequent awakening were the least known 3% and recognized1% symptoms. Abnormal behavior and altered consciousness were not known to any patient as a symptom. Of those who knew or experienced the symptoms, eating anything available was the most common response, only 35% responded by eating rapidly available food items like sugar, honey, candies, beverages, fruit juice or jams. 3% of patients even resorted to taking diet colas initially and only later took other food after waiting for some time. In the event of patient getting unconscious, 80% of the times attendants did not consider hypoglycemia initially at home at first such experience. Patient must be properly educated about these symptoms before prescribing these agents and shall be repeatedly evaluated at each visit. Failing to recognize early and mild symptoms may lead to a terrifying experience

Metabolic syndrome frequency in patients presenting with acute myocardial infarction

To determine the frequency of metabolic syndrome in patients presenting with acute myocardial infarction [MI]. Cross -sectional, observational, multi center study. Allied Hospital Faisalabad from 01-01-2009 to 30-06-2010. Any patient fulfilling the criteria of acute myocardial infarction were admitted and enrolled in the study during the study period. Demographic details, history and clinical examination of the patients were recorded on prescribed performa after securing an informed consent. Blood Pressure was recorded in lying posture from right arm and waist circumference measured at umbilical level in lying position. Blood sample was collected in fasting state for estimation of plasma glucose, serum HDL-cholesterol and serum triglycerides levels. Out of 690 patients, 420[60.86%] were male and 270[39.14%] were females with average age 55.90 +/- 10.19. 40% males and 44% females had metabolic syndrome and incidence increased with age. Waist circumference was increased in 46.85% participants followed by increased fasting blood sugar [42%] levels. Frequency of metabolic syndrome was high among the patients with acute myocardial infarction. It supports the potential for preventive efforts in persons with high risk for acute myocardial infarction

Use of metered dose inhalers; Patient's fears and objections, errors in their techniques. A reflection of poor patient education in asthmatics

Inhalational bronchodilators and anti-inflammatory therapy is the ideal treatment for asthmatics. Successful management depends on active and continuous interaction between the clinician and a well-educated patient. Detailed interview of patients were carried out to determine the patients' fears about MDI and the errors in technique were recorded. This would highlight the common deficiencies in the management in our own socioeconomic setup. Any patient with a diagnosis of Bronchial Asthma was assessed for the competency of diagnosis. A specially trained nurse interviewed the eligible patients on a prescribed performa who were using MDI to determine their fears and objections on its use. They were asked to demonstrate their technique of MDI use and errors were noted. The physician checked all the information and confirmed that technique has been corrected and the fears addressed, Patients below the age of 16 or over the age of 60 were excluded. Seriously sick patients and patients of COPD were excluded. Asthmatics presently not using MDI were excluded. Study was carried out from January to December 2003. 192 patients were enrolled during one-year period, from January to December 2003, in this study. There were 112 males and 80 females 46% of patients rejected MDI considering it as the last resort, 54% perceived it as costly, for 58% it was a complicated way to use medicine, 54% considered it in-effective, 50% feared life long dependency, 54% disliked it as MDI would incite cough, 29% objected on the oral thrush and 13% on dysphonia associated with them and for 21% it was socially un-acceptable to use MDI in public. When inhalation technique for MDI was checked, all checked for empty canister by shaking. 92% could find out if the demo canister was empty. All removed the cap properly. 92% shaked the MDI before use while 8% failed to do so. 79% used it in proper upside-down position. Hand-Lung co-ordination was proper in only 29% of patients. 49% held their breath for adequate time. 38% made proper slow exhalation. 38% performed actuation with open mouth and 63% with mouth closed on MDI mouthpiece. 33% swallowed the drug after actuation, leakage from mouth was seen in 29% and leakage of fumes from nose was seen in 54% of patients. Multiple actuations were done by 50% of patients. Bronchial Asthma is a common clinical disorder requiring long-term treatment. Inhalational delivery systems like MDI are the ideal mode of therapy. Use of MDI is stigmatized, partly contributed by patients' dissatisfaction from results due to improper technique and partly attributed to the social inhibitions attached to its use. We defined, addressed and made effort to correct their technique. More emphasis on different aspects of patient education is the only way to improve our standard of Asthma care