Pancytopenia; study for clinical features and etiological pattern at tertiary care settings in Abbottabad

Pancytopenia is an important hematological problem encountered in our day-to-day clinical practice. The aim of our study was to evaluate clinical features and etiological pattern of pancytopenia at tertiary care settings in Abbottabad. This prospective study was conducted at Northern Institue of Medical Sciences [NIMS] and Ayub Teaching Hospital Abbottabad from 25th August 2009 to 31st July 2010. A total of 85 patients fulfilling the criteria of pancytopenia were randomly selected by time-based sampling. Pancytopenia was diagnosed by anemia [hemoglobin

Frequency and pattern of retinopathy in newly diagnosed type 2 diabetic patients at tertiary care settings in Abbottabad

Retinopathy is one of the most frequent and serious complication of diabetes mellitus and leading cause of blindness worldwide. The objective of this study was to determine frequency and pattern of retinopathy in newly diagnosed type 2 diabetic patients at tertiary care settings in Abbottabad. This was a descriptive cross-sectional comparative study being conducted at Ayub Teaching Hospital and Northern Institute of Medical Sciences Abbottabad. It included 100 newly diagnosed type 2 diabetic patients who were attending diabetic clinics of these tertiary care hospitals. Already diagnosed type 2 patients taking anti-diabetic medication, type 1 diabetes mellitus, hypertension, retinal vasculitis, retinal vessel occlusion, and sickle cell retinopathy were excluded. After pupillary dilatation, detailed fundoscopic examination was carried out via direct ophthalmoscopy and further confirmed by an ophthalmologist. According to fundoscopic findings, retinopathy was graded into background, pre-proliferative and proliferative types. Total 100 patients were included, with mean age 45.1 +/- 3.2 years, 60% of them were females. Overall, 17% of type 2 diabetic patients had retinopathy within one month of diagnosis. Background retinopathy was predominant [12%] followed by pre-proliferative [4%] and proliferative [1%] lesions. Frequency of retinopathy in newly diagnosed type 2 diabetic patients seems to be higher than previous reports and background lesions were predominant. Detailed fundoscopic examination of all newly type 2 diabetic patients at the time of diagnosis is of paramount importance.

Knowledge, attitudes and practices of general practitioners towards diabetes mellitus in Hyderabad, Sindh

Objectives: To ascertain the knowledge, attitude and practice of general practitioners towards diabetes mellitus

Study Design: Cross sectional study

Duration of Study: From July 2009 to October 2009

Place of the study: The cases were collected from various areas of Hyderabad like Latifabad, Qasimabad, Hussainabad, Pretabad and Tando Jam, Hosrri

Material and Methods: One hundred general practitioners were selected in this study were excluded. A written questionnaire was filled by each doctor that included the 4 questions of each domain of knowledge, practice and attitudes. The knowledge was assessed by levels of blood glucose, random and fasting, practices assessed by treatment options and attitudes by advising to their patients for obesity, diet and pregnancy. The frequencies were taken of known or unknown

Results: out of 100 participants 35 belonged to periphery and 65 to major areas of Hyderabad. The mean +/- SD age was 41+/- 3.5 years and means +/- SD duration of practice was 10.4+/- 5.7 years. Each doctor had seen 10 diabetic patients per day. Out of 100 doctors, 55 answered correctly and 45 were poor to all domain

Conclusion: This study explored the knowledge, attitudes and practices regarding diabetes in Hyderabad among general practitioners and identified the need for improvement in managing diabetes. Awareness and education regarding diabetes is recommended to improve the health-care services provided by general practitioners

Frequency and clinical presentation of dengue fever at tertiary care hospital of Hyderabad/Jamshoro

Objectives: The aim of this study is to observe the clinical presentation and frequency of dengue as a cause of fever in our setup

Methods: This retrospective study comprising of clinically suspected dengue infection, admitted to Liaquat University Hospital Hyderabad, during an epidemic from August 2006 to August 2007. Only adults with acute febrile illness were evaluated for clinical features of dengue fever, dengue hemorrhagic fever and dengue shock syndrome

Results: Patients with acute febrile illness were evaluated during this study. Fifty [5%] patients presented with typical features of dengue fever. Age of the patients ranged between 13 and 70 years. All patients were males with mean age of 35 years. Only 20/50 [40%] were dengue proven while 30/50 [60%] were dengue suspected. Out of dengue proven, 18 patients had dengue fever and 2 had dengue hemorrhagic fever. Typical clinical features included chills and rigors in 16 [80%], myalgia in 14 [70%], vomiting in 12 [60%], headache in 10 [50%], rash in 5 [25%]. Unusual clinical features were pharygitis in 7 [35%] and bleeding manifestations in 5% of patients. Laboratory investigations showed leucopenia [<4.0x10[9]/L] in 80%, thrombocytopenia [<150x10[9]/L] in 90%, and serum ALT was elevated [>40 U/L] in 40% cases

Conclusions: Fever associated with chills and rigors, bodyaches, bone pain, headache, myalgia, rash, low platelet count, decreased total leukocyte count, raised serum ALT, and hemorrhagic manifestations are satisfactory and important parameters to screen the cases of suspected dengue virus infection; however the diagnosis cannot be confirmed unless supported by molecular studies or dengue specific IgM

Study of snake bite cases at Liaquat University Hospital Hyderabad/Jamshoro

Envenoming resulting from snakebites is an important public health hazard in many regions. It is common in rural areas not to delay access to life saving anti-venom. The objectives of this study were to know about common types of snakes in local areas, clinical features in snakebite victims, complications in snakebite case, and mortality rate in snakebite victims in rural Sindh. This descriptive study was conducted at 4 medical wards of Liaquat University Hospital Hyderabad/Jamshoro, Sindh from 1st January 2006 to December 2006. One hundred cases with history of snakebite were analysed. Both genders were included in study. Patients with history of trauma, insect bite or thorn prick were excluded from the study. Clotting time [CT] was the main bedside procedure, to assess the degree of envenomation. One hundred [100] cases from both genders, from 8 to 55 years age were reviewed. There were 57 [95%] viper bites [haemotoxic] having haemostatic abnormalities and 3 [5%] elapid [neurotoxic] bites presented with neuroparalytic symptoms. Most cases were from Tando Mohammad Khan and Hyderabad [rural] districts of Sindh. All victims had localized oedema at the site of bite. Fang/teeth marks were noted in [90%] cases. Majority [80%] were bitten on the legs below knee. Some 40% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.5 and male to female ratio was 4:1. Mean time to arrival at our hospital after the bite was 3 hours and mean duration of hospital stay was 4 days. One patient had acute renal failure [ARF] and disseminated intravascular coagulation [DIC], 3% cases of elapid bites were shifted to ICU for assisted ventilation, 4 patients [5.5%] had adverse effects after anti-venom administration and needed intravenous hydrocortisone, promethazine and subcutaneous adrenaline. The average dose of anti-venom was 60 vials for viper bites and 10 vials for elapibites. Overall mortality rate was 4%. Snakebites are common in the rural population of developing countries. There is need to educate the public about the hazards of snake bite, early hospital referral and treatment

Left ventricular ejection fraction [LVEF] determination in post myocardial infarction patients. A comparison of gated blood pool [GBP] ventriculography and contrast ventriculography

To compare the efficacy of gated blood pool versus contrast ventriculography [Gold standard] for determination of ejection fraction in post myocardial infarction patients. Patients and Gated blood pool imaging [BPI] was performed by gated blood pool radionuclide ventriculography or MUGA in 30 patients within 48 hours after single plane [RAO-30] contrast ventriculography. Statistical analysis was done by student "t-test" [unpaired] and by Pearson's correlation co-efficient. Result: There was no significance difference in their mean ejection fraction [44.04 +/- 11.93 Vs 48.46 ' 12.78%, P = NS] and has statistically significant correlation [r=0.86, P=0.171] GBP ventriculography can therefore be utilized accurately for determination of ejection fraction for prognostic and diagnostic evaluation of post myocardial infarction patients