Frequency of persistent intradialytic hypertension in patients undergoing hemodialysis

Objective: To determine the frequency of persistent intradialytic hypertension in Pakistani end stage renal disease patients on hemodialysis

Methods: A total of 150 patients undergoing hemodialysis were included in the study after informed consent. After enrollment, pre- and post-dialysis systolic blood pressurewas measured using standard techniques. Persistent intradialytic hypertension was labeled. All data was collected on predesigned proforma. Anti-hypertensive medicines being used and duration of dialysis in months were used as effect modifier

Results: From one hundred and fifty patients the minimum age was found as 18 years and maximum age was found as 60 years with mean + standard deviation as 47.04 +10.64 years. There were 56 % male patients and 44% patients were female. Persistent intradialytic hypertension was found in 12% patients. 84% patients used anti-hypertensive. By using chi-square test, there was no significant association between age and presence of persistent intradialytic hypertension with p-value = 0.546. Significant association was not found between gender and presence of persistent intradialytic hypertension with p-value = 0.139. Usage of Anti-hypertensive was significantly associated with presence of persistent intradialytic hypertension with p-value = 0.048. Duration of dialysis was not significantly associated with presence of persistent intradialytic hypertension with p-value = 0.706

Conclusion: The frequency of persistent intradialytic hypertension was found in 12% end stage renal disease patients on hemodialysis. Effect modifiers were not significantly associated with presence of persistent intradialytic hypertension except usage of Anti-hypertensive

Frequency of dyslipidemia in normotersive non diabetic obese patients

Objective: to determine the frequency of dyslipidemia in normotensive, non-diabetic obese patients

Methods: it was a cross sectional study including admitted patients and patients visiting outdoor. After obtaining informed consent, demographic information such as name, age, gender was collected .This study included 200 normotensive, non-diabetic obese patients. Serum lipid profile was checked in all patients. The frequency and pattern of dyslipidemia was assessed which was described in frequency distribution tables

Results: the mean total Cholesterol, mean LDL C, HDL and Triglyceride levels were 211.59 +/- 42.39 mg/dl, 131. 39 +/-17.21 mg/dl, 36.46+/-7.93 mg/dl and 164.69 +/- 11.80 mg/dl, respectively. The dyslipidemias were found in 87 [43.5%] patients

Conclusion: the frequency of dyslipidemias is high among normotensive non diabetic obese patients. So, every patient with obesity should be screened with lipid profile

Efficacy of rifaximin in treatment of hepatic encephalopathy

Objective: to compare the efficacy of rifaximin vs control group in addition to lactulose for treatment of hepatic encephalopathy with constipate

Methods: a total 100 patients were enrolled in this study. After taking an informed consent the demographic data was collected. Patients were well informed regarding the treatment and its possible effect. The patients were examined for the confirmation of hepatic encephalopathy with constipation. Patients were randomly divided into two groups. Group A received additional rifaximin with lactulose and Group B received only lactulose. The treatment was continued for four months and then patients were observed

Results: in our study, 18% [n=9] in Group-A and 24% [n=12] in Group-B were between 18-30 years of age while 82% [n=41] in Group-A and 76% [n=38] in Group-B were between 31-60 years of age, mean+/-sd was calculated as 47.7+/-10.44 and 46.1 +/-10.77 years respectively. Comparison of efficacy in both groups shows 68% [n=34] in Group-A and 58% [n=29] in Group-B while 32% [n=16] in Group-A and 42% [n=21] in Group-B had no findings of efficacy

Conclusion: we concluded that the efficacy of rifaximin is significantly better when compared to control group in addition to lactulose for treatment of hepatic encephalopathy with constipation

Prediction of oesophageal varices in cirrhotic patients by prothrombin time as a non-invasive marker

Objective: the objective of the study was to determine the diagnostic accuracy of prothrombin time for the non-invasive diagnosis of esophageal varices keeping upper gastrointestinal endoscopy as Gold Standard

Methods: the study was conducted in Medical unit 4, Services Hospital Lahore over a period of 6 months. It is a cross-sectional study

Results: in our study, 43.5%[n=87] were between 12-30 years and 56.5%[n=113] were between 31-60 years, mean+/-sd was calculated as 39.90+/-12.29 years, 43.5%[n=87] were male and 56.5%[n=113] were females, frequency of esophageal varices keeping upper gastrointestinal endoscopy as gold standard was recorded in 57%[n=114] while 43%[n=86] had no findings of the morbidity, diagnostic accuracy of prothrombin time for the non-invasive diagnosis of esophageal varices keeping upper gastrointestinal endoscopy as gold standard 53%[n=106] true positive, 2%[n=4] false positive, 4%[n=8] false negative and 41 %[n=82] as true negative. Whereas specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy was calculated as 92.98%, 95.35%, 96.36%, 91.11 %, and 94% respectively

Conclusion: we concluded that the predictive value of prothrombin time for presence of oesophageeal varices is a higher and it is a useful non-invasive diagnostic modality

Frequency of thyroid dysfunction in patients of chronic hepatitis C treated with interferon alpha 2B and ribavirin

Objective: to determine the frequency of thyroid dysfunction in patients of chronic hepatitis C treated with Interferon alpha 2b and Ribavirin

Methods: a total of 120 cases having active hepatitis C assessed by HCV RNA PCR as per operational definition for at least 3 months between 15 years to 60 years of both gender were included in the study from outdoor of Services Hospital Lahore after a written informed consent. All the demographics including name, age, gender and address were entered in a pre-defined questionnaire. Patients were treated with Interferon alpha 2b [dose] three million international units subcutaneously three times a week and Ribavirin [dose] 1200 mg oral dailyfor24 weeks. As per hospital routine Thyroid dysfunction was evaluated as per operational definitions bycollecting4ml of blood in a 5cc syringe at 0 [baseline] and 12 week. Presence or absence of thyroid dysfunction at 12 weeks was labelled as per operational definition

Results: in our study, out of 120 cases, 42.5% [n=51] were between 15-40 years while 57.5% [n=69] were between 41-60 years of age, mean +/-sd was calculated as 42.49+/-11.54 years, 59.17% [n=71] were male while 40.83% [n=49] were females, frequency of thyroid dysfunction in patients of chronic hepatitis C treated with interferon alpha 2b and ribavirin was recorded in 21.67% [n=26]

Conclusion: we concluded that the frequency of thyroid dysfunction in patients of chronic hepatitis C treated with Interferon alpha 2b and Ribavirin is not very high but reaches at a considerable level and necessary steps should be taken for the management of this morbidity while interferon therapy is given to the Hepatitis C virus cases

Pattern of torso-trauma in road traffic accidents in KSA

To study the pattern and severity of abdominal injuries due to road traffic accidents [RTA] in KSA. Retrospective descriptive. This study was conducted in the Department of Surgery, King Fahad Hospital Al-baha, Kingdom of Saudi Arabia during one year from 2012 to 2013. Materials and Methods: This is retrospective study of all patients admitted with torso-trauma in Department of Surgery KFH Al-Baha from the period of Aug. 2012 to Aug. 2013. In the 01 year period, 2520 patients were admitted following an RTA. Out of these, 537 were admitted due to torso trauma.120 patients were admitted in SICU, 280 in intermediate dependency unit while remaining 137 admitted in surgical ward. 27 patient died due to torso trauma with multiple injuries. 3 patients died of pure liver trauma while 2 patients died of splenic injury. Lot of burden over the hospital because of RTA related injuries. There was very severe and fatal injuries faced because of accidents happened in youth and male preponderance

Prevalence of congestive gastro and doudenopathy in patients with portal hypertension

The aim of this study was to determine the prevalence of congestive gastropathy/ duodenopathy in portal hypertension. A cross sectional study of 100 patients with portal hypertension undergoing upper gastro-intestinal endoscopy in Medical Unit IV was carried out in which their history, clinical and endoscopic examination was done. Congestive gastropathy was seen in 88% of the patients, while congestive duodenopathy was seen in 19% of the patients. The study data analysis leads to the conclusion that the congestive gastropathy can by included as one of the common complications of advanced liver cirrhosis

Postural hypotension in male diabetics with autonomic cardiovascular dysfunction and impotence

Objective: to find out frequency of postural hypotension in male diabetics with autonomic cardiovascular dysfunction and impotence

Material and Methods: a total of 200 male diabetic patients, attending Diabetes Management Centre Services Hospital Lahore, were enrolled in the study. All the diabetic patients between ages 14-60 years, having fasting blood sugar level more than 126 mg/di, were included. A detailed history was taken and all patients underwent relevant physical examination; blood pressure was taken in supine and standing position and investigations like random blood sugar levels were checked. The diagnosis of autonomic cardiovascular dysfunction was documented by heart rate response to Valsalva maneuver. The ratio of longest R-R to shortest R-R is< 1.2 during Valsalva in patients with autonomic cardiovascular dysfunction. The postural hypotension in diabetic patients was calculated after recording the postural drop in all the patients. Before assessing blood pressure variation with postural change, 20 min supine rest was mandatory

Results: the age range was from 14-60 years. The percentage of patients with postural drop was 32 percent in the presence of parasympathetic dysfunction. The mean age of patients with parasympathetic dysfunction was 50.65+/-5.53 years

Conclusion: postural hypotension does not seem to be a good marker for autonomic neuropathy. The proportion of patients having postural hypotension in the presence of parasympathetic dysfunction was not significant in the study population. However significant correlation of postural hypotension with duration of diabetes was found

Bone mineral density in patients with metastatic prostate cancer with or without androgen deprivation therapy

Prostate cancer commonly metastatize to skeletal sites. Androgen deprivation therapy [ADT], the primary treatment of metastatic prostate cancer, may result in osteoporosis. Bone mineral density evaluation during androgen deprivation therapy can detect patients at risk of osteoporotic fractures

Objectives: 1-To determine BMD [T-score] in patients with metastatic prostate cancer with or without androgen deprivation therapy. 2-To compare BMD in metastatic prostate cancer patients with age matched controls

Study Design: case-control study

Setting: Urology Department, Allied Hospital Faisalabad

Materials and Methods: BMD of patients with metastatic prostate cancer [30 with ADT, 30 without ADT sampled with nonprobability convenience method] were compared with age matched control group of 60 subjects. Inclusion criteria. Group-I: 60-80 years aged consecutive patients of carcinoma prostate who have been taking anti androgen therapy at least six months. Group-II: 60-80 years consecutive patients with metastatic prostate cancer who have not started any antidrogen deprivation therapy. Group-III: 60-80 years aged healthy men from general population [preferably from patient's family] without prostate cancer. Exclusion criteria: From all groups, men taking for any reason, chemotherapy, radiation thyroxin, warfarin, corticosteroids, methrotrexate, anticonvulsants, post organ transplant therapy, chronic heparin, antipsychotic medications, long term lithium therapy and calciuretic diuretics were not included in the study

Results: Out of 120 subjects, 31% had normal BMD, 27% osteopenia, 42% osteoporosis. In metastatic prostate cancer patients taking ADT [n=30], 7% subjects had normal BMD, 37% osteopenia and 56% osteoporosis. In metastatic prostate cancer patients without ADT [n=30], 13% subjects had normal BMD, 63% osteopenia, 24% osteoporosis. In healthy controls [n=60], 52% subjects had normal BMD, 33% osteopenia, 15% osteoporosis

Conclusions: BMD is affected by prostate cancer and its treatment. Bisphosphonates use should be rationalized according to the patients need

Etiological determinants of congenital pelviureteric junction obstruction

Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases

Outcome of retrograde ureteroscopy for the management of ureteric calculi: four years experience

To ascertain the efficacy of transurethral Ureteroscopy [URS] and Pneumatic Lithoclasty for the management of ureteral stones. This retrospective study was conducted from December 2005 to December 2009 at the Department of Urology and Renal Transplantation, Allied Hospital/Punjab Medical College, Faisalabad and Hospitals in Private sector. Patients with stones of different sizes and at different levels in the ureter were included in the study. Patients of less than 12 years of age and also patients with ureteric stones more than 3 cm were not included in the study.Such stones were managed by open Ureterolithotomy. A total number of 540 patients with ureteric calculi were included in the study. Cause of ureteric obstruction was stones in all cases. Among these 450 patients, 209 [38.6%] patients presented with lower ureteric stones, 266 [49.20%] patients presented with stones in the mid ureter, 65 [12.2%] patients presented with stones in the upper ureter. Bilateral ureteric calculi were present in 95 [17.5%] cases. Out of 540 cases 57 [10.62%] patients presented with anuria and they were initially treated by Percutaneous Nephrostomy PCN to relieve the obstruction followed by URS and Lithoclasty. Overall, ureteric stones at different levels and of different sizes were treated successfully in 480 [89.0%] patients and in remaining 60 [11.0%] patients stones could not be broken. Stones were successfully fragmented and cleared in the 198 [94.73%] of 209 patients with stones in the lower ureter, in 253 [95.11%] of 266 patients with stones in the mid ureter and in 29 [44.61%] of 65 patients with stones in the upper part of ureter. Stones were successfully fragmented in 347 [98.21%] out of 354, 92 [85.18%] out of 108 and 41 [52.56%] out of 78 patients with stone sizes of <1 cm, 1-2 cm and 2-3 cm respectively. DJ stents were inserted in 426 [78.81%] cases. Procedure was not successful in 60 [11.0%] patients. Stones were migrated up in to renal pelvis in 31 [5.73%] patients, stone fragmentation failure was in 13 [2.40%] patients, failure of URS insertion up to stone was in 6 [1.10%] patients and ureteric avulsion was in 1 [0.18%]. Transurethral rigid Ureteroscopy is still an acceptable procedure in the treatment of ureteric calculi of different sizes at different levels and it can be used safely with very good results in expert hands