Diabetic patients; clinical profile with endstage renal disease on haemodialysis

To study the clinical profile of diabetic patients on haemodialysis with a view to identify common clinical features and the trend of compliance with treatment and follow up. Haemodialysis unit Fatima Memorial Hospital, Lahore, from January to August 2011. Method: Data collected from all patients above 14 years of age through medical history, record, examination and fundoscopy. Out of total 76 patients on haemodialysis 50[65.7%] had DM and of these 42[84%] also had hypertension. Among diabetics 28 [56%] were male and 22 [44%] female. Mean age was 56.68 +/- 9.09. Among these 15[30%] were illiterate and 27 [54%] belonged to lower social class. Ever smokers were 18[36%]. Mean duration of diabetes since diagnosis was 10.9 +/- 5.99. Mean duration of hypertension 8.28 +/- 8.07, Duration of onset of dialysis 6 months to 8 years with mean 2.16 +/- 1.47. Retinopathy was found in 29[58%], 18[36%] had diabetic and 11[22%] had hypertensive changes. Both fasting and random blood sugar levels were monitored by 28 [56%]. None had regular follow up with HbA1c levels or urine for protienuria prior to onset of haemodialysis. Compliance with dietary advice and treatment claimed by 24[48%] and 36[72%] respectively. History of intake of Hakeem and homeopathic medications was found in 16[32%] and 10[20%] respectively. 65.7% of ESRD were diabetics. Majority were in 6th decade of life. Retinopathy was present in 58%. Low trend was observed towards compliance with treatment and follow up

Hepatitis C; validity of alanine aminotransferase levels in predicting histological changes in young asymptomatic patients

Liver biopsy the gold standard for the histological assessment in chronic hepatitis C is an invasive procedure with certain limitations. It was to evaluate the relation of serum ALT levels with the histological changes in healthy blood donors screened positive for HCV. This cross sectional comparative study. It was conducted at department of medicine Combined Military Hospital Lahore, from January to August 2004 It was to evaluate the relation of serum ALT levels with the histological changes in healthy blood donors screened positive for HCV. 76 apparently healthy blood donor soldiers age 20 - 49 years positive for HCV antibodies by third generation ELISA test, evaluated by medical history, physical examination, serum ALT levels, PCR test for HCV RNA and ultrasound abdomen were enrolled. Liver biopsy was done through percutaneous route and histology was graded according to Knodell scoring system. Serum ALT levels showed a skewed distribution with mean of 130.9+96.9 IU/L and median of 8.5IU/L. Eleven patients had normal ALT [<40 IU/L].On histological analysis of liver biopsy specimen 17 had Knodell score 8. Patients with score > 8 were older than the former groups. The difference was significant [p=0.047]. Relation of ALT levels with stage of fibrosis and grade of inflammation was estimated using ANOVA it showed no statistical significance. Patients with stage 1 fibrosis had highest mean serum ALT levels [p=0.108]. No association found between the ALT level and liver biopsy histological score. However patients with normal ALT levels usually had mild necroinflammatory changes

Thrombocytopenia and platelets transfusion in Dengue fever

This study was done to see how much prevalent is thrombocytopenia and need and indications of platelets transfusion in patients with dengue fever in our community hospitals, This study was done from I[th], September 2010 to 15[th], November 2010 in three different hospitals, two were urban and one was rural and all three were tertiary care hospitals, Our study was based on 200 patients who were serologically confirmed cases for Dengue fever [IgM +ive] and had symptoms and signs of dengue fever for more than four to seven days at the time of admission. Clinical data reports of hematological investigations, platelets requirements, and data obtained from daily follow up, were analyzed. There were 200 serologically confirmed Dengue fever patients, among them 176 were males, 24 females, 183 patients were urban and 17 were rural patients. Thrombocytopenia was found in 174 [87%] on the day of admission. Among them 48 [24%] patients had platelets count in between 20, 000 to 40, 000/cumm, 46 [23%] had platelets count <20, 000/cumm, and 4 [2%] had platelets count <10, 000/cumm. Patients having platelets count <20, 000/cumm all have hemorrhage manifestations. Out of 48 [24%] patients having platelets count in between 20, 000 to 40, 000/cumm, 21[43%] had hemorrhagic manifestations. 98[49%] patients were given platelets transfusion. None of these patients got platelets transfusion with platelets count above 40, 000/cumm. 27 patients received platelets therapy inappropriately [platelets count < 40, 000/cumm with no hemorrhagic manifestations. There was only 2 mortality in these patients. Our study suggests that bleeding occurs more often in patients with severe thrombocytopenia [platelets count <20, 000/cumm] and these patients need urgent platelets transfusion. Patients having platelets count in between 20, 000-40, 000/cumm are at moderate risk and these patients require platelets transfUsion if they have hemorrhagic manifestation. Platelets count above 40, 000/cumm are at low risk and no need of platelets transfusion in these patients, only these patients need careful monitoring

Liver biopsy percutaneous liver biopsy by surecut needle

To study the safety and efficacy of Surecut needle in obtaining the liver tissue by percutaneous liver biopsy. Design: Single centered prospective hospital based study. Department of Internal medicine [Unit-1] and Family ward, Combined military hospital Lahore for more than one year from August 2002 to March 2004. One hundred and fifty patients of either gender having asymptomatic hepatitis C carrier state, healthy blood donors, with positive HCV-PCR were included in study. The patients liver biopsy was done with Surecut needle 16G with patient breath suspended in expiration from the periphery of right lobe of liver. Majority of patients, 135 [90%] were male and 15 [10%] were female. The mean age was 30.3 years with range of 25-55years. In 146[97.31%]patients successful biopsy was done while the biopsy was non-diagnostic in 4[2.69%] patients. Mean core length of liver tissue obtained was Mean+sd[1.2+0.42cm] and histopathologic diagnosis was made in 97.31% cases. Total number of attempts were 1-2. In 99% single attempt was done. No major complications related to procedure was seen. liver biopsy with Surecut needle is safe and effective in establishing the diagnosis of Chronic hepatitis

Training of non-physician practitioners to identify and refer diabetic patients

To improve the practices of non-physician practitioners on early diagnosis and referral of patients with diabetes mellitus. Study will be conducted in a peri-urban village community in Lahore, Pakistan, during 2007 - 2008. Quasi - experimental study, one group before and after design was used to document the effect of training of non-physician practitioners on improving their diabetic patient identification practices and referral to the hospital for diagnostic and treatment facilities. Fasting blood glucose test was used to identify hyperglycaemics out of those referred by the NPPs. Patient referral was increased by 48.44% after training. Identification of hyperglycaemic patients on the basis of signs and symptoms was 47% before and 48% after training and the difference between two proportions was not significant. increased number of referral showed motivation of NPPs towards the task however more prolonged and structured training program is required to utilize their services in community as part of our health care delivery system