comparative analysis of hyperhomocysteinemia in hemodialysis patients versus normal controls

To compare the mean homocysteine level of ESRD patients undergoing regular hemodialysis with normal age and gender matched controls. This observational study was conducted at Dialysis Unit of Fauji Foundation Hospital, from January 2011 to October 2012. Cases included patients from 12-65 years age of either gender who were on regular hemodialysis for more than three months at a frequency of three times a week. Controls were chosen from the healthy relatives and hospital employees who had normal renal functions and were matched for age and gender. Total homocysteine in plasma was measured by HPLC and fluorescence detection. We included 55 hemodialysis patients and 55 controls. The mean age of cases and controls was 45.67 +/- 10.68 and 45.94 +/- 10.50 years respectively. There were a total of 24 [21.8%] males. The two groups were similar in respect to age and gender distribution. The mean homocysteine level of cases and controls was 17.69 +/- 5.17 and 12.85 +/- 3.27 micro mol/L respectively [p =0.00]. Plasma homocysteine levels are significantly higher among homodialysis subjects as compared to normal controls

comparative analysis of the association of chronic inflammation versus no inflammation on the nutritional status of patients on chronic maintenance hemodialysis

To assess the association of chronic inflammation on the nutritional status of patients on Chronic maintenance hemodialysis. This cross-sectional comparative study was performed at department of Medicine Fauji Foundation Hospital Rawalpindi. Patients having chronic renal failure who were on regular maintenance hemodialysis for more than 6 months were included in the study. Ultrasound examination was done to confirm the presence of renal parenchymal disease and shrunken kidneys. The level of C-reactive protein was measured as indicator of inflammation and serum albumin, cholesterol level, mid-arm circumference, triceps skin fold thickness, subscapular skin fold thickness and body mass index [BMI] were used as the assessment tools to evaluate the influence of inflammation on the nutritional status in patients. Patient in two groups with positive or negative CRP were compared regarding the effects of inflammation on nutritional parameters. Out of 30 patients, 13 [43.3%] had evidence of inflammation with positive CRP and a mean BMI of 19.2 +/- 3.3 whereas the CRP negative group had a mean BMI of 24.9 +/- 1.5. Regarding nutritional parameters, Triceps Skin Fold Thickness, Subscapular Skin Fold Thickness, mid-arm circumference and serum albumin were also statistically low in CRP positive patients although serum cholesterol levels did not differ significantly in our study. The CRP positive patients therefore were malnourished as compared to the CRP negative group. Patients with end stage renal disease on chronic dialysis with evidence of inflammation are more at risk of malnutrition. Although there is no standardized strategy for the treatment of chronic inflammation in these patients so far but this area needs further research to improve outcome in these patients

Her-2/neu gene overexpression in breast carcinoma and its association with clinicopathological characteristics of the disease

To assess the frequency of Her-2/neu gene amplification in breast cancer and its association with clinicopathologic characteristics of the disease. Cross-sectional comparative study. Study was carried out at Surgical Unit I, Holy Family Hospital, Rawalpindi, from January 2005 to December 2006. A total of 50 patients diagnosed of having breast cancer on biopsy of breast lump were included in the study. All patients underwent mastectomy and samples were submitted to AFIP [Armed Forces Institute of Pathology, Rawalpindi] for histopathology and determination of estrogen and progesterone receptors and Her-2/neu gene amplification. Moreover, association of Her-2/neu amplification to other characteristics like tumor size, node involvement, histological grade and presence of estrogen and progesterone receptors were also studied. Out of 50 patients, 18 [36%] were positive for Her-2/neu over expression. Among the various prognostic factors, age showed a statistically significant relation to Her-2/neu positivity [p=0.001]. The Her-2/neu positive cancers were larger in size [mean size of 7.9 +/- 3.615 and 5.4 +/- 1.906 cm in Her-2/neu positive and negative cases respectively; p=0.002]. Her-2/neu positive cases had statistically significant relation to number of involved lymph nodes [mean number of 9.9 and 4.4 lymph nodes in Her-2/neu positive and negative cases respectively; p=0.001]. Tumor grade and nuclear grade had no statistically significant relation to Her-2/neu status [p=0.19 and 0.434 respectively]. Both estrogen and progesterone receptors are inversely related to Her-2/neu positivity [p=0.028 and 0.006 respectively]. The pathological and clinical characteristics of Her-2/neu positive and negative subsets differ, and Her-2/neu over. expression was associated with other poor prognostic factors of age, tumor size and number of nodes involved. There was an inverse relation of Her-2/neu status and hormone receptor

Risk of development of chronic kidney disease in patients with type 2 diabetes having metabolic syndrome

To measure the relation of creatinine clearance in type-2 diabetic patients with different components of metabolic syndrome and to quantify the relationship of frequency of incident CKD with increasing number of metabolic syndrome components while controlling for age, gender and duration of diabetes. Cross-sectional descriptive study. Diabetes Clinic, Fauji Foundation Hospital, Rawalpindi, from January to August 2006. Patients having type-2 Diabetes for more than 5 years were enrolled. Information regarding age, gender, duration of diabetes, type of diabetes, treatment taking, complete fasting lipid profile, fasting blood glucose, Body Mass Index [BMI], 24 hours urinary proteins and creatinine clearance, co-existent risk factors like hypertension and ischemic heart disease was taken. Patients were divided into groups having one to all five metabolic syndrome traits. Progressive increase in the metabolic syndrome traits was compared with decline in creatinine clearance. Pearson correlation test and multiple logistic regression were applied to determine correlation with significance at 'r' and 'p'

Leiomyoma of the urinary bladder with bladder stone

Leiomyoma of the urinary bladder is a rare benign mesenchymal tumour. We describe here a case of leiomyoma of the urinary bladder in a 65-year-old gentleman who presented with haematuria, passage of clots and combined obstructive and irritative urinary symptoms. The investigations revealed a vesical calculus and a mass on the left lateral wall of the urinary bladder. Cystolitholapaxy and transurethral resection of the tumour was performed. Histopathological report of the resected tumour revealed a leiomyoma of the urinary bladder. So far, a leiomyoma of the urinary bladder and a concomitant vesical calculus have not been described in literature

Evaluation of risk factors of non alcoholic fatty liver disease [NAFLD] in a tertiary care hospital at Rawalpindi, Pakistan: a local experience

To document the frequency of risk factors for nonalcoholic fatty liver disease, such as gender, diabetes mellitus, hypercholestrolemia, hypertriglyceridemia, obesity and metabolic syndrome. This descriptive study was carried out at Department of Medicine Fauji Foundation Hospital Rawalpindi from January 2007 to December 2007 One hundred nonalcoholic patients with elevated ALT and negative viral serology and diagnosed as having fatty liver on ultrasound were evaluated for the presence of diabetes, hypercholestrolemia, hypertriglyceridemia, obesity and metabolic syndrome. Patients with suspected autoimmune hepatitis, hemochromatosis and Wilsons disease were excluded. The mean age was 45.39 years. Out of 100 patients, 63% were females and 37% were males. Sixty six percent patients were obese. Other risk factors included hypertriglyceridemia in 48%, diabetes mellitus in 34%, hypercholesterolemia in 28% and metabolic syndrome in 28% cases. Nonalcoholic fatty liver disease is associated with a high prevalence of obesity, hypertriglyceridemia, hypercholestrolemia, diabetes and female gender

Evaluation of knowledge and practices of foot care in patients with chronic type 2 diabetes mellitus

To evaluate the knowledge and practices of foot care in patients with diabetes mellitus and to stress upon the importance of such knowledge and practices in decreasing morbidity associated with diabetic foot disease. One hundred patients of either sex from three tertiary care hospitals with a 5 year history of Diabetes Mellitus were selected in this study and were asked to fill out a questionnaire about their knowledge and practices about daily foot inspection, foot cleaning, appropriate nail care, and use of footwear in the form of shoe material, open or closed forepart and nature of heel. Out of 100 patients [36 males and 64 females], 34% patients inspected their feet daily and 78% of the respondents knew about care of callosities, minor injuries and cuts, 52% of patients didn't know about correct technique of cutting nails. Eight [22.2%] male and 28 [43.8%] female patients were using open shoes while 24 [66.7%] male and 38 [59.4%] female patients had shoes with narrow forepart. Ten [27.8%] males were using shoes made of hard material as compared to 20 [31.3%] of female patients. Twenty two [34.4%] of our female diabetic patients were using shoes with high heel. Only 68% of the patients were on regular follow up. This simple quality initiative concludes the notion that patients with diabetes who are at risk for the development of diabetic foot ulcers should receive ongoing foot-specific patient education

Malignant hypertension in a patient with end of stage renal disease [ESRD] treated by renal transplant

Control of hypertension is often a problem in the management of end stage renal disease [ESRD]. Multiple modalities of treatment are required to prevent cardiovascular and cerebrovascular mortality and morbidity. These include fluid and salt restriction, multidrug regimes and dialysis. We report a case of young 25 years old patient, admitted with chronic renal failure, complicated by malignant and refractory hypertension, not responding to hemodialysis and antihypertensive agent. During stay in hospital, patient also had intracerebral hemorrhage, fits due to uncontrolled hypertension requiring ventilatory support followed. Renal transplant was considered to be the final therapeutic modality. After gradual recovery, a successful live-related renal transplant was performed. As soon as good graft was established, the blood pressure settled and 4 of the 5 antihypertensives were withdrawn. After 2 weeks, patient was discharged in a stable condition with a total stay of about 2 months

Renal transplant in a patient with augmentation cystoplasty

A 20 years old girl, had undergone surgery for meningocele six weeks after birth, suffered from neurogenic bladder dysfunction. She underwent an augmentation ileocystoplasty and was trained to perform clean intermittent self catheterization [CISC]. After two years she developed renal failure secondary to recurrent urinary tract infections and she was started on chronic hemodialysis. On account of repeated line sepsis, a live related donor renal transplant was performed. About three months after renal transplantation she reported in emergency with an episode of graft rejection secondary to severe infection and later on complicated by leakage of urine from the renal pelvis of the allograft into the peritoneal cavity suggestive of a rent. A percutaneous nephrostomy of the allograft was performed which facilitated healing of the rent in the renal pelvis. The nephrostomy was withdrawn and patient started voiding through urethral catheter and gradually returned to CISC

Electrocoagulation versus suture-ligation of lymphatics in kidney transplant recipient surgery

To compare electrocoagulation versus suture-ligation of the lymphatics in kidney transplant operation of the recipient in terms of operating time, cost effectiveness, drainage from renal bed and incidence of lymphocele. This prospective comparative study was conducted at the department of Urology and Kidney Transplantation, Hearts International Hospital Rawalpindi during a period of two and a half years [January 2003 to July 2005] by a single surgical team. All patients who underwent kidney transplant during this period and did not fall into exclusion criteria were included in the study. Ninety Cases of End-stage Renal Disease undergoing kidney transplant were randomly divided into two equal groups. Patients in the group A had their lymphatics electrocoagulated and divided in the preparation of external iliac vessels for allograft anastomoses, while the patients in group-B underwent suture-ligation and division of the lymphatics covering the external iliac vessels. The average operating time was reduced in group-A. Also, no suture material was used for this step. Over all anesthesia time was also less. There was no significant difference in the quantities of postoperative drainage from the wound. There was no incidence of lymphocele development in group-A [0%]. While one patient [2.2%] in group-B had a moderate lymphocele which was aspirated and there was no recurrence. Cut off point of the study was six months from the day of surgery. Electro-coagulation and division of lymphatics coursing over the external iliac vessels is an attractive procedure. It saves time, is cost-effective, the postoperative wound drainage is not a problem and the procedure is not associated with increased incidence of lymphocele

Adverse effects of smoking in the flyers of Pakistan air force

This study was carried out to assess the adverse effects of smoking on pilots at PAF Base Sargodha. 73 Aircrew were included in the study. 28 pilots, 28/73 [38.35%] were found to be smokers. 57% of pilots reported high frequency of upper respiratory tract problems per year. 100% reported altered taste sensation. 78% reported dyspepsia/heartburn. The study recommends that all aircrew who smoke must quit smoking as it affects almost all body systems