Lower gasrtointestinal bleeding; etiologic spectrum in Nishtar Hospital Multan

To determine the etiology of lower GI bleeding based on colonoscopic findings Retrospective study. This study was conducted at gastroenterology unit of Nishtar Hospital Multan from Feb 2013 to August 2014. Two hundred and fifty four patients, >/= 14 years old who presented with history of lower GI bleeding to the gastroenterology unit of Nishtar Hospital Multan out of 254 patients, 59.05% were males and 40.95% were females. Mean age of patients was 37.22 +/- 10.68 years. Most common findings were haemorrhoids [40.9% cases], ulcerative colitis [35.4%], no abnormality [8.2%], solitary rectal ulcer [7.5%], growth [7.1%], proctitis [3.5%], polyps[2%], rectal varix [1.2%], infective colitis [0.8%], uremic colopathy [0.8%], rectal prolapse [0.8%], multiple polyposis coli [0.8%], petechiae [0.8%], stricture [0.8%], diverticula[0.4%]and fissure [0.4%]. Colonoscopy is the investigation of choice for patients of lower gastrointestinal bleeding. More common colonoscopic findings in our study were haemorrhoids, ulcerative colitis, solitary rectal ulcer, malignancy and proctitis. Polyps and diverticula which are common in the west were uncommon in our patients. Rectal prolapse, petechiae, stricture, uremic colopathy and multiple polyposis coli were rare causes

Risk factors of hypoglycemia in diabetics

To find the frequency of risk factors of hypoglycemia in diabetics in our setup. Prospective observational study. This study was conducted at Emergency and Medical Wards Nishtar Hospital Multan from January 2010 to December 2013. One hundred and eighteen patients presented with hypoglycemia to Nishtar Hospital Multan. One hundred and eighteen diabetic patients above the age of 16 years admitted with hypoglycemia were included in the study. Written informed consent was taken from the patients or the attendants in case of patients with altered state of consciousness. Approval was taken from hospital ethical committee. Mean age of patients was 60.46 +/- 14.20. Forty two patients [35.6%] were males and 76 [64.4%] were females. Mean duration of diabetes was 6.4 +/- 6.04years. Mean blood glucose level at the time of presentation was 36.25 +/- 12.49mg/dl. Thirty four [28.8%] patients had only neuroglycopenic symptoms without autonomic symptoms while 4[3.4%] hadautonomic symptoms alone. Eighty [67.8%] presented with both adrenergic and neuroglycopenic symptoms. Regarding risk factors, 77[65.25%] had renal failure, 66[55.93%] had missed meal, 37[31.35%] had vomiting, 23[19.49%] had recent increased dose of hypoglycemic agents, 19[16.10%] had delayed meal, 16[13.55%] had diarrhea, 14 [11.86%] had liver dysfunctionand 2[1.69%] had excessive physical activity. Hypoglycemia is common in old patients with long history of diabetes. Patients usually present late when they develop neuroglycopenic symptoms. Renal failure and missed meal are most common risk factors followed by vomiting and increased dosage of hypoglycemic agents. Patients need education about early symptoms of hypoglycemia, common risk factors and remedial steps to avoid this serious complication

Causes of acute renal failure in Nishtar hospital Multan

To identify the common causes of Acute Renal Failure [ARF] in Nishtar Hospital Multan. Prospective observational study. This study was conducted at Medical Wards, Nishtar Hospital Multan from September 2012 to March 2013. One hundred and thirty six [136] patients presented with Acute Renal Failure to Nishtar Hospital of ages 15 and above. Fifty three patients [39%] were males and 83[61%] were females. Mean age of patients was 40.43 +/- 18.56 years. Our study showed that common causes of ARF were diarrhea with or without vomiting [22%], septicemia [22%], obstetric causes like septic abortion and APH/PPH [19.11%],obstructive uropathy [11%], hair dye ingestion [9.6%], glomerulonephritis [7.35%], nephrotoxins [5.9%], hemolysis [4.4%] and cardiac failure [3.7%]. Diarrhea with/without vomiting,sepsis, post-partum and ante-partum hemorrhage, septic abortion, obstructive uropathy, hair dye, glomerulonephritis, nephrotoxic drugs, hemolysis and cardiac failureare the common causes of acute renalfailure in our setup. ARFis associated with high morbidity and mortality. So all these causes should be managed aggressively to avoid this life threatening complication

Frequency of risk factors in acute coronary syndrome

To measure the frequency of risk factors in patients of ACS, Observational descriptive study. It was conducted in the'emergency department of Nishtar Hospital Multan from January 2008 to January 2009. Consecutive 400 patients who presented with history of chest pain were enrolled in the study. These patients underwent clinical examination, ECG and Trop T testing, Patients were inquired about the risk factors by the help of a Proforma. STEMI was the most common diagnosis [66.7%]. One or more risk factors were present in each patient; Hypertension [37.2%], Smoking history [50.1%], Diabetes Mellitus [29.2%], Family history [41.5%] and sedentary habits [33.2%].Hypertension and smoking are most common risk factors in patients with ACS

Non endoscopic predictors of esophageal varices in cirrhotics

To identify non-invasive predictors of esophageal varices in patients in Liver Cirrhosis. First Medical Unit, Nishtar Hospital Multan from January 2004 to December 2005. Sixty five patients diagnosed as Cirrhosis of liver and without any history of hematemesis and/or melena were included in this study. These patients underwent complete clinical, biochemical and ultrasonographic evaluation. Four variables selected to predict the presence of esophageal varices were platelet count, spleen diameter, portal vein diameter and platelet count/spleen diameter ratio. Upper GI endoscopy was done in all these patients to see esophageal varices. Thirty three patients had esophageal varices while varices were not found in 32 patients. Best cut off values of spleen diameter [160 mm, p-value <0.001] and portal vein diameter [13.5 mm, p-value of <0.001] were statistically significant for prediction of presence of varices. Positive and negative predictive values for spleen diameter were 90% and 81% respectively. Positive and negative predictive values for portal vein diameter were 74% and 77% respectively. Best cut off values of platelet count [145 X 10[3]/micro L, p-value-0.486], and platelet count/spleen diameter ratio [1200, p-value-0.153] were statistically not significant for prediction of presence of varice. Spleen diameter [cut off value 160 mm] and portal vein diameter [cut off value 13.5 mm] have very good predictive values [positive and negative] and can be used as predictors for presence of varices in patients of cirrhosis with no past history of bleeding

Dyspepsia and upper gastrointestinal endoscopy; Multan experience

To find out causes of dyspepsia on upper gastrointestinal endoscopy. Endoscopy unit of Nishtar Hospital Multan. May 2005 to August 2007. Patients suffering from dyspepsia were referred by consultants of Nishtar Hospital Multan and doctors working in the periphery for endoscopy. 502 patients were scoped for dyspepsia; 254 [50.6%] were male and 248 [49.4%] were female. Mean age was 42.5 years and age range was 7-95 years. Most common lesion was gastroduodenitis [20% cases] followed by gastric ulcer [5.4% cases]. Ratio of duodenal ulcer to gastric ulcer was 1:2.56% patients had no pathology; females were more likely to have normal endoscopy. Gastroduodenitis is the most frequent organic cause of dyspepsia. Functional dyspepsia is more common among females