Clinical profile and outcome of paraphenylene diamine poisoning

Objective: To determine the clinical presentation, complications, and outcome of paraphenylene diamine [PPD] poisoning in patients presenting to Nishtar Hospital, Multan. Study Design: Descriptive study. Place and Duration of Study: Medical Unit II and III, Nishtar Hospital, Multan, from April 2015 to September 2016

Methodology: All adult patients admitted with history of paraphenylene diamine ingestion were evaluated for clinical features, complications, and outcomes on a pre-designed proforma

Results: Out of 122 patients, 95 were females [77.9%] and 101/122 patients had ingested the poison with an intention of suicide or self harm [82.8%]. The mean age of presentation was 23.21 +/-8.2 years. Cervico-facial edema was the chief presenting complaint, seen in 116/122 [95%] of patients, with median of 2 [interquartile range=3] for time of onset after ingestion of poison. Tracheostomy was needed in 95/116 [82%] patients with cervico-facial edema. Other common complaints were dark urine in 95/122 [77.9%] and pain in limbs in 98/122 [80.3%] patients. Rhabdomyolysis was evident in 91/122 [74.5%] patients at admission. Acute kidney injury developed in 37/122 [30.3%] patients. Among these, 16 [43.2%] patients required haemodialysis. Myocarditis was diagnosed in 33/122 [27%] patients. The median for hospital stay was 9.50 days [interquartile range=6.25]. The mortality was 34/122 [28%]. Ventricular arrhythmias were the commonest cause of death in 25/34 [73.5%], followed by renal failure in 5/34 [14.7%], asphyxia in 2/34 [5.88%], and aspiration pneumonia in 2/34 [5.88%] patients

Conclusion: Paraphenylene diamine is an emerging domestic poison in Pakistan, with a high morbidity and mortality

Frequency of the metabolic syndrome in type 2 diabetic subjects attending the diabetes clinic of Nishtar medical college and hospital, Multan

Objectives: To determine the frequency of the metabolic syndrome in patients with type 2 diabetes mellitus who attended the diabetes clinic of Nishtar Medical College and Hospital, Multan

Methods: A cross sectional descriptive study was conducted at the diabetes clinic of Nishtar Medical College and Hospital, Multan from June 2010 to August 2010. 187 patients with type 2 diabetes were enrolled in the study. Frequency of metabolic syndrome was estimated according to the criteria proposed by American Heart Association/ National Heart, Lung and Blood Institute

Results: Total number of patients enrolled was 187 out of which, there were 67 male patients and 120 female patients. The mean age of the patients was 48 years and the range was 28 to 80 years. By applying American Heart Association criteria, metabolic syndrome was found in 65.2% type 2 diabetics, [43.31% women and 21.92% men]

Conclusion: The frequency of the metabolic syndrome was found very high in our study. This was especially high in type 2 diabetic women at a frequency of 43.31%

Hepatic cirrhosis association of platelet count, splenomegaly and esophageal varices in patients

To see the association of platelet count, splenomegaly and development of oesophageal varices. Observational study. One year from January 2010 to December 2010. Gastroenterology Department, Medical Unit III, Nishtar Hospital Multan. One hundred ten cirrhotic patients were included. The record of these patients was scrutinized and data collected was entered and analyzed through SPSS 11. The patients were divided into three groups according to platelet count. Group I with platelet count less than 50000/mm3, group II with platelet count of 50000 to 100000/mm3 and group III with platelet count of 100000 to 150000/mm3. Similarly patients were also divided into three groups according to splenic size. Group I with splenic size 11 - 13 cm, group II with splenic size 13-16 cm and group III splenic size more than 16 cm. In each group presence of esophageal varices along with grading was noted. The age of the patients varied from 15 to 80 years and mean age was 48.55 +/- 13.88 years. Sixty five [59.1%] were male and 45 [40.9%] were female. The hemoglobin level of these patients varied from 6.0 to 14.3 gm/100 ml with mean level of 9.23 +/- 2.11gm/100ml. The platelet count varied from 22000 to 385000/mm3. The splenic size varied from 9 to 18 cm with mean of 12.53 +/- 2.14 cm. Esophageal varices were detected in 102 cases. Seventeen cases were of grade I varices, 25 cases were of grade II varices, 40 cases were in grade III varices and 4 cases were in grade IV varices. Maximum number of grade-III [22 patients] and grade IV [3patients] esophageal varices occurred in patients having platelet count less than 50000/mm3. As the splenic size increases the grade of esophageal varices also increases. Maximum number of esophageal varices occur in grade II [25] followed by grade-III [37] in patients with splenic size in the range of 13 to 16 cm. A low platelet count and large splenic size are good non-invasive predictors of esophageal varices. These parameters can also accurately assess the presence of large varices. So a patient of cirrhosis with low platelet count and large spleen has an increased diagnostic yield of esophageal varices on upper GI endoscopy

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

Presence of anemia in different diseases in a medical ward of a tertiary care hospital

The objective of this study is to find out presence of anemia in patients admitted in medical ward of a tertiary care hospital. It is a retrospective, non interventional, observational, hospital based study. Fifty patients of anemia admitted in medical ward 12 of Nishtar Hospital Multan were included in the study. The patients admitted during July 2006 to August 2006. Fifty patients suffering from anemia were studied. The final diagnosis was as chronic liver disease 26%, chronic renal failure 16%, and heart diseases 10%. Lung diseases 10%, infectious diseases 10%, CNS diseases 8% and miscellaneous causes 20%. Miscellaneous includes patients with infections and snake bite. Due to commonly prescribed and easily available different hematinic preparations, deficiency anemias were not common in the hospital settings. In admitted patients presence of low Hb% levels mean a more sinister diagnosis which needs a chain of special investigations for proper diagnosis

Mortality rate in a general medical unit of Nishtar hospital, Multan

To determine the mortality rate in a general medical unit and variation in mortality with relevance to age, sex and disease. All patients admitted in a medical unit of Nishtar Hospital, Multan were included in this study over a period of one month, irrespective of clinical diagnosis. 340 patients were admitted during this period of one month, 181 were male and 159 were female. 30 patients died during hospital stay, 21 were male and 9 were female. Total mortality rate in one month was 8.8% out of which 30% of patients were less than 40 years of age and 70% above the age of 40 years. Cerebrovascular accidents accounted for 9 deaths, cardiac diseases accounted for 7 deaths and hepatic diseases accounted for 7 deaths. Mortality rate is high. It is significantly higher in men compared to women. Mortality rate rises steadily with increasing age and is significantly influenced by underlying disease prognosis. CNS, CVS and Liver diseases were the leading causes of death in our unit

Endoscopic evaluation of aetiology of upper gastrointestinal bleeding

Endoscope evaluation of upper gastrointestinal bleed [UGIB] to see the difference in aetiology in our population compared to that in the West. This retrospective, observational analysis of a time based study was carried out in the Department of Gastroenterology, Ward No. 10, Nishtar Hospital, Multan during the period from May2002 to April 2003. A total of 385 patients who presented with UGIB, were evaluated by endoscopic examination to determine the cause. A total of 385 patients were endoscoped, out of these 126 [32%] were females and 259 [78%] were males. of the total, oesophageal varices were found in 267[69%], no findings were observed in 48 [12%] gastntis 22 [5.7%], esophagitis in 20 [5%], duodenal ulcer 11 [2.8%] duodenitis in 6 [1.5%]. gastric ulcer 6 [1.5%] fundal varices in 3 [0.7%] and gastric carcinoma in 2[0.5%] patients. GI endoscopy, a reliable diagnosis and hence an adequate management of these patients can be done