Systemic inflammatory response syndrome [SIRS]; patients with liver cirrhosis

Systemic inflammatory response syndrome [SIRS] is a generalized disorder, immune response to infection which results in disturbed microcirculation, visceral perfusion and ultimately visceral failure. Objectives: To determine the frequency of systemic inflammatory response syndrome in patients with liver cirrhosis. Design: Cross sectional descriptive. Period: Six months study. Setting: At Liaquat University Hospital Hyderabad. Patients and methods: All the patients with liver cirrhosis for 06 months duration admitted in the ward were further evaluated for systemic inflammatory response syndrome. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Results: During six months study period, total 100 cirrhotic subjects were studied for SIRS. The mean +/- SD for age in all [100] cirrhotic patients was 45.74 +/- 7.537. The mean temperatures was 40.42+/-0.32 where as it was 39.72+/-0.43 and 38.92+/-0.11 in male and female population respectively. The mean heart beat was 128.42+/-6.74 where as it was 115.83+/-8.93 and 120.62+/-5.53 in male and female population respectively. The mean respiratory rate was 25.31+/-3.52 where as it was 23.52+/-2.31 and 26.63+/-3.21 in male and female population respectively. The mean white blood cell count was 28.81+/-4.51 where as it was 23.74+/-4.73 and 30.83+/-5.73 respectively. The SIRS was observed in 70% subjects of which 47[67.1%] were males and 23[32.9%] were females [p=0.04]. Majority of SIRS subjects were 30-39 years of age and male population was predominant [p=0.03]. The gender distribution in relation to severity of liver disease was statistically significant [p=0.05] while the SIRS in relation statical analysis. Conclusions: The systemic inflammatory response syndrome occurs in patients with liver cirrhosis

C-reactive protein [CRP]; in patients with metabolic syndrome

To determine the frequency of raised C-reactive protein [CRP] in patients with metabolic syndrome. This cross sectional descriptive study of six months study was conducted at Liaquat University Hospital Hyderabad. All the patients of 20 to 60 years of age, of either gender presented with symptoms of metabolic syndrome for more than 01 year duration were admitted and evaluated for C-reactive protein. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Total one hundred patients [59 females and 41 males] with metabolic syndrome were evaluated for C-reactive protein. The mean waist circumference for males and female patients with raised CRP was 48.93 +/- 2.33 and 48.42 +/- 3.41 while the mean +/- SD of serum triglycerides level for male and female with raised CRP was 192.41 +/- 3.21 and 196.31 +/- 3.43 respectively. The mean +/- SD of serum HDL-C level for male and female with raised CRP was 28.32 +/- 1.22 and 25.31 +/- 1.42. The mean +/- SD of systolic and diastolic pressure for males and female patients with raised CRP was 150 +/- 3.42 and 100.51 +/- 4.42. The mean +/- SD of serum fasting blood sugar for male and female patients with raised CRP was 131.52 +/- 3.33 and 143.42 +/- 7.42 respectively. The mean +/- SD of CRP for male and female patients with raised CRP was 4.42 +/- 1.21 and 5.8 +/- 2.52. In relation to gender distribution, the majority of subjects from 40-49 years of age group with female predominance [p = 0.01] while the CRP was raised in 67% patients in relation to age [p=0.05] and gender [p=0.04] respectively. Out of 67 subjects with raised CRP 44 were females and 23 were males

Drug induced hepatitis; does hepatitis b and hepatitis c co-infection increases the risk during anti tuberculosis chemotherapy

We evaluated whether HBV +ve and HCV +ve patients are at high risk for developing drug induced hepatitis than control subjects during treatment for tuberculosis with standard short course regimens. Observational cohort study. This study was conducted at Department of Medicine, Liaquat University of Medical and Health Sciences Jamshoro from May 2008 to May 2011. All newly diagnosed active tuberculosis patients were included in the study population and they were further screened for hepatitis B surface antigen and HCV antibodies. All patients were divided into three groups. One having no co-infection with hepatitis B and Hepatitis C and was taken as control group, second group was co-infected with hepatitis B and third was co-infected with hepatitis C. short course anti tuberculous regimen was started and patients were followed for six months. One hundred and twenty eight tuberculous patients were divided into three groups. 92 in control groups without any co-infection with hepatitis B and C, 10 were HBV +ve and 26 were HCV +ve. During follow up 24 developed drug induced hepatitis, 8[38.33%, n = 24] in control group, 2[8.33%, n = 24] in hepatitis B group and 14[58.33%, n = 24] in hepatitis C group. These findings suggest that treatment for tuberculosis in HCV seropositive patients is a risk factor for the development of hepatitis exacerbation and HBV seropositive patients shows no any increased risk of hepatitis exacerbation

Serum lipoproteins and chronic hepatitis C infection; importance of inverse relationship

To determine the serum lipid profile in patients with chronic HCV infection and correlation between serum lipid levels and liver histology. Descriptive study was carried out in Medical Unit I of Liaquat University Hospital Jamshoro Hyderabad, from September 2007 to August 2009. Convenience sampling was used and 30 patients were selected. Positive PCR test for HCV, non diabetic patients and non cirrhotic patients were included in this study. All the patients were selected from the medical OPD. Clinical examination performed and then blood tests were done. Serum lipid profile were determined in all participants after an overnight fast of 12 h. TC, TG, and HDL-C was measured enzymatically with commercial kits [Olympus System Reagent, Hamburg, Germany] by the use of an automated analyzer. The body mass index [BMI] was calculated in accordance with the formula of weight [kg] divided by height2 [m2]. Selected patients were called in the ward and biopsy was done via Trucut needle and the specimen was fixed in formalin. The biopsies were used to calculate the degree of steatosis [0-3] and fibrosis by METAVIR score. A total of 30 patients were selected for this study. Out of these 19 were males and 11 females. The patients were divided in three groups. Patients with chronic HCV infection were found to have significantly lower levels of serum TC, HDL-C and LDL-C than normal adults values. Steatosis was present in significant number of patients [36.67%]. However, steatosis was not correlating with fibrosis [p>0.005]. Hypolipoproteinemia and steatosis are important factors which are associated with chronic hepatitis C

Hemorrhagic stroke; frequency of hypertension, diabetes and smoking in patients

To identify the frequency of risk factors in hemorrhagic stroke at Liaquat university of medical and health sciences. This Descriptive case series study of six months was carried out in the department of medicine, Liaquat University of Medical and Health Sciences. Patients aged 20-70 years of age with hemorrhagic stroke on CT were enrolled in the study after taking consent from caretaker of patients. Detailed history focusing on hypertension, diabetes and smoking and their duration was taken. Blood pressure was recorded and fundoscopy was done to find out diabetic or hypertensive retinopathy. Thorough neurological examination and fasting / random blood glucose level was evaluated while the data was done was analyzed using SPSS version 16. A total of 100 patients were included in the study during study period. 61% of patients were in > 50 years of age group with mean age of 53.4+/-11 years. A total of 66 [66%] were male; with male to female ratio was 2:1. Hypertension was present in 63% of cases, Diabetes was found in 24% cases and 44 patients were cigarette smokers. It was concluded that high blood pressure, diabetes mellitus and smoking are associated with hemorrhagic stroke

Standard antituberculosis drug induced hepatotoxicity: Do the risk factors matter?

Objective: To determine the frequency of hepatotoxicity with standard antituberculosis drug therapy and its risk factors

Method: This prospective cohort study was conducted at Muhammad Medical College Hospital, Mirpurkhas and Liaquat University Hospital Jamshoro, from July 2007 to August 2008. A total of 350 cases of active pulmonary tuberculosis with normal pretreatment liver function test [LFT] were selected through probability sampling. Patients were started first line antituberculosis drug therapy [ATT]. The liver function derangement was monitored. If any hepatotoxicity noticed, the time duration for toxicity occurrence and time taken for normalization of LFT were recorded. ATT was altered as needed, with exclusion of toxic drug. Data were collected on proforma and analyzed by using SPSS version 10.0

Results: ATT induced hepatotoxicity developed in 91 [26%] patients with minor, moderate and severe alanine transaminase [ALT] rise noted in 48 [52.75%], 40 [43.95%] and 3 [3.3%] cases respectively. Hepatotoxicity for individual drugs were noted as; Isoniazid [INH] 53 [58.24%], rifampicin 32 [35.16%] and pyrazinamide [PZA] 6 [6.59%] [p=0.01]. Malnutrition, low albumin, acetaminophen, female sex, older age and low serum cholesterol were noted as the risk factors [p=0.05]

Conclusion: Hepatotoxicity occurs significantly with anti-TB drugs, usually reversible and rarely fulminant. It is more frequent in patients with malnutrition, low albumin, acetaminophen, female sex, older age and low serum cholesterol

Chloroquine resistant plasmodium falciparum

The study was conducted to determine the frequency of Chloroquine-resistant Plasmodium falciparum. This was a descriptive case series study conducted at Muhammad Medical College Mirpurkhas and Liaquat University Hospital Hyderabad/ Jamshoro, from January 2007 to December 2007. Total 160 patients with acute attack of fever were selected and studied who fulfilled the inclusion criteria. The WHO extended test was done by giving 25 mg/kg body weight of Chloroquine base over 3 days. The interpretation of the test was done as per criteria laid down by WHO. Out of one hundred sixty, 110 [68.75%] were males and 50 [31.25%] were females with ratio of 2.2:1. The age range 16-45 years with mean 28_12 years. Seventy one patients [44.375%] were Chloroquine sensitive. Chloroquine-resistance [CQR] Rl, Rll and both Rl Rll noted were 28.125%, 15.645% and 43.75% respectively. The CQR- R III was not observed in our study. In view of this situation, more organized and thorough studies must be conducted to elucidate the epidemiology, geographic-distribution and degree of Chloroquine resistance. And the local strategies be made to overcome this problem and to assess the need for changing the first line drug

Cardiac autonomic neuropathy [CAN] in type-1 diabetes, mellitus patients and its association with the duration of disease and glycemic control

To determine the frequency of Cardiac Autonomic Neuropathy [CAN] in type-1 Diabetes mellitus patients and its association with the duration of disease and glycemic control. Descriptive study. Department of Medicine, Liaquat University Hospital, Hyderabad/Jamshoro, from December, 2004 to April, 2005. Fifty patients of type-1 Diabetes Mellitus [DM] of >/= 10 years duration were selected. CAN was evaluated in terms of presence of resting tachycardia, loss of sinus arrhythmia and heart rate response to Valsalva maneuver by electrocardiogram [ECG]. An R-R variation with respiration of >15 beats per minute was taken normal, while 10-15 beats and <10 beats per minute were taken as borderline and definitive CAN respectively. QTc intervals were measured. Patients with HbA1c levels <7% were considered as well-controlled. The associations between CAN, the duration of diabetes and the diabetic control were determined. The mean age was 35.16 +/- 10.58 years with 32 males and 18 females. The mean values for the known duration of diabetes and HbA1c were 13 +/- 7.3 years and 9.36 +/- 2.5 mg/dl respectively. Definitive and borderline CAN were noted in 20% and 24% respectively. Variability of heart rate with respiration was significantly related to the duration but not to the control of the diabetes [p < 0.05]. QTc showed a significant correlation with the known duration of diabetes and heart rate variability with respiration [p < 0.05]. Most of the patients had uncontrolled glycemic status. Cardiac autonomic neuropathy is common in long standing type-1 diabetics. CAN resulted in prolonged QTc interval that may result in cardiac arrhythmias and even death. Intensive glycemic control improves the cardiac autonomic nerve functions

Diabetic foot ulcers; common isolated pathogens and in vitro antimicrobial activity

To determine common pathogens isolated in diabetic foot ulcers and in vitro antimicrobial activity. Muhammad Medical College Hospital, Mirpurkhas and Liaquat University of Medical and Health Sciences Jamshoro. 1st November 2007 to 30th June 2008. Pus samples for bacterial culture were collected from 60 patients admitted with diabetic foot infections. Anti-microbial susceptibility testing of aerobic isolates was performed by the standard disc diffusion method as recommended by the National Committee for Clinical Laboratory Standards. Microbroth dilution test was arranged for susceptibility of anaerobic organisms to metronidazole and amoxicillin/clavulanate. A vancomycin screen agar [6 micro g/ml] was used to detect vancomycin intermediate isolates of Staphylococci. Clinical grading and bacteriological study of 60 patients revealed, 44 [73.33%] patients had gram-negative organisms, and Pseudomonas aeruginosa was the most common. While 16 [26.66%] patients had gram-positive organisms and Staphylococci was the most common organism. Infection with anaerobes was observed in one patient [1.66%]. Both gram-positive and -negative organisms were seen in 8 [13.33%]. Pseudomonas aeruginosa and S.aureus exhibited a high frequency of resistance to the antibiotics tested. All the isolates were uniformly susceptible to fosfomycin, levofloxacin, amikacin and vancomycin. Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis and Proteus were the most common causes of diabetic foot infections in this study. And the rate of antibiotic resistance was 66.66% among the isolates. All the isolates were uniformly susceptible to fosfomycin, levofloxacin, amikacin and vancomycin

Frequency of skin manifestations in 120 type 2 diabetics presenting at tertiary care hospital

Objectives: to determine" the frequency of skin manifestations in patients with type 2 Diabetes mellitus"

Study design, place and duration: this was a descriptive case series study, carried out at Dep't of Medicine, Muhammad Medical College Hospital, Mirpurkhas and Liaquat University of Medical and Health Sciences, Jamshoro from November 2007 to April 2008

Subjects and Methods: one hundred and twenty type 2 diabetics; both male and female, were included in this study. All patients were asked about any skin problems they might have and subsequently all were examined regardless of their response. Age, sex, duration of diabetes, mode of treatment whether on oral hypoglycemic agents or insulin, and skin manifestations were noted

Results: age varied from 33 to 76 years [54 +/- 17 years] and known duration of diabetes varied from 10 to 27 years [15 +/- 9 years]. The overall prevalence of one or more skin disease was 96 [80%]. Diabetic dermopathy was seen in 36 [30%], rubeosis facies in 6 [5%], skin tags in 22 [18.33%], acanthosis nigricans in 7 [5.8%], eruptive xanthomas in 8 [6.66%], Vitiligo in 6 [5%], diabetic bullae in 8 [6.66%], diabetic xerosis in 6 [5%], lichen planus in 4 [3.33%], loss of hair in legs in 24 [20%], nail changes in 24 [20%], gangrenous diabetic foot in 29 [24%], thick skin in 60 [50%], and hyperhidrosis in 36 [30%] patients. Pruritis was noted in 48 [40%] patients. The skin infections were noted in 84 [70%] cases; including bacterial infections in 60 [50%], fungal infections in 20 [16.66%] and viral infections in 04 [3.33%] cases

Conclusions: we conclude that the skin is involved in diabetes quite often and whenever patients present with multiple skin manifestations; their diabetic status should be checked and controlled