Amoebic liver abscess; needle aspiration after 96 hours of medical treatment

Amoebic Liver Abscess [ALA] is a serious problem in Pakistan Its management includes antimicrobial drugs, needle aspiration and surgical drainage. To determine if amoebic liver abscess can be treated conservatively or requires needle aspiration as well in selected cases. A prospective hospital based study. Nishtar Hospital Multan. 18 months. Thirty six consecutive adult patients with a right lobe liver abscess were included. All patients received metronidazole 800mg orally for 10-14 days and were clinically observed. Patients who did not show any clinical improvement in 96 hours had an ultrasound guided needle aspiration performed. Patients having an ALA less than 10cm in size respond to medical treatment. If patients continue to have toxic symptoms, needle aspiration should be performed. Most patients having ALA of >10cm will end up having a needle aspiration but should be given a trial of medical management

Distorted thyroid hormone status in hospitalized and ambulatory sick patients

To review all the thyroid test results of the hospitalized and ambulatory sick patients whom blood sample were sent for thyroid function tests to pathology lab and to evaluate non interpretable thyroid test results reported at Pathology department LRH during a period of one year. This is a retrospective study of thyroid test results performed at pathology department PGMI/LRH Peshawar from April 2007 to April 2008. More than 2000 blood samples were received during the period mentioned for thyroid function tests. All the tests were performed on the instrument immulite using chemiluminecent assays. Thyroid test panel was included TT4, TT3 and TSH. Estimation of thyrotrophin was performed by using 3rd generation assay. Results of the neonates and children have not been included because of incomplete requisition forms lacking relevant clinical details specially age of the patient. A total of 1457 adults patients test results were searched for thyroid dysfunction. Out of the total 1066 were female and 391 male. Test results were interpreted according to NACB guidelines. Distorted hormone status was observed in 117 individuals which is 8% of the total thyroid function test reports. This fact should be realized that some thyroid tests are inherently non interpretable in severely sick patients and those who are receiving various medication. Therefore the assessment of thyroid function in ill patients are best to be postponed until the illness has resolved except when a diagnosis should affect patient outcome

Chronic anal fissure; a randomised, double blind, placebo controlled trial of 0.5% glyceryl trinitrate ointment

Topical application of glyceryl trinitrate [GTN] ointment heals anal fissures, providing an alternative to the traditional first line treatment of surgical sphincterotomy. Tathlith General Hospital Saudi Arabia. January 2001 -April 2003. To determine the effectiveness and safety of topical 0.5% glyceryl trinitrate [GTN] in the management of chronic anal fissure. Individual Patients were randomized to receive 0.5%GTN paste or placebo three times per day for six weeks in addition to oral senna and/or lactulose. Patients took laxatives alone for further 6 weeks. Patients were followed every week for six weeks and then fortnightly for another six weeks to assess pain scores and were given advice. Fifty patients were recruited in this study and 44 patients completed the trial [23 in the GTN group and 21 in the placebo group], patients who could not complete the study were excluded. At 6 weeks, 74% of patients had no pain in the GTN group as compared to the 29% in the placebo group. In 26% of cases treatment was unsuccessful. At three month follow up there was no early recurrence. The prevalence of headaches was 65% in GTN group [reported by 15 patients] and 24% in placebo group [reported by 5 patients]. Mean pain scores were lower in the GTN group as compared to the placebo group. The use of 0.5% GTN induces healing of chronic anal fissures and may be used as a first line of treatment in patients with chronic anal fissure. Successful treatment may come at the expense of a high incidence of headaches

Basic haematological derangements in heroin addicts

Basic haematological derangements are not uncommon in drug addicts. This study was carried out on ninety heroin addicts and thirty normal healthy control subjects to observe the changes in simple haematological parameters including haemoglobin concentration, total leukocyte count, differential leukocyte count and erythrocyte sedimentation rate. The study revealed a significant reduction in haemoglobin, an increase in total leukocyte count and raised ESR. However, the differential leukocyte count did not differ significantly. The possible mechanisms of such derangements in haematological parameters are discussed in heroin addicts

Liver function in heroin addicts

To ascertain whether non-parenteral heroin ingestion would have undesirable effects on liver in persons with no previous history of liver disease, tests for liver function were carried out in 90 heroin addicts. The tests were normal but alkaline phosphatase was found significantly elevated. This study shows that heroin has no direct toxic effect on hepatocellular function