Frequency of urological carcinomas presenting as gross Haematuria in Punjab Pakistan and recommendation for its early diagnosis

Objective: To determine the frequency of various causes of gross Haematuria presenting in our hospital and recommend a working protocol to young doctors. Study Design: Prospective descriptive study. Place and Duration of Study: Urology Department, District Headquarter and Teaching Hospital, Sargodha Medical College, from Mar 2012 to Mar 2014

Material and Method: All fresh patients reporting to the hospital with complaints of 'blood in urine' were included in the study, while patients presenting with Microscopic haematuria were excluded. The patients, after being managed by the urology registrar, were given a questionnaire to fill, assisted by a resident, a reference number allotted for follow-up. A request for urine routine examination and urine microscopy/cytology was made to confirm haematuria and exclude malignant cells. Followed by ultrasound, X-Ray KUB, cystoscopy and IVU/CTU scan, as required. The results obtained were recorded and analyzed

Results: A total of 391 patients presented with complaints of 'blood in urine'. Trauma: was the most frequent cause seen in 21.7% [n=85], followed by Urinary tract infections [21.0%, n=82], Urolithasis [20.2%, n=79] and Urological tumors seen 19.4% [n=76] cases. About two thirds of the patients [56.6%, n=43] with urological tumors were not investigated, at primary health care level, to ascertain the cause and presented with advanced disease

Conclusion: General practitioners should be encouraged to request ultrasound scan for patients presenting with gross haematuria, as urothelial tumours, if detected early, can be managed effectively with better long term outcome

Expression analysis of matrix metalloproteinase-9gene in rheumatoid arthritis patients on disease modifying anti-rheumatic drugs

Objective: to evaluate matrix metalloproteinase-9gene expression in rheumatoid arthritis patients on disease modifying anti-rheumatic agents with the objective to further modify the current treatment regimen if indicated in order to prevent progression to deforming rheumatoid arthritis

Study Design: cross-sectional comparative study

Place and Duration of Study: cream Lab [Centre for Research in Experimental and Applied Medicine] and Department of Biochemistry and Molecular Biology, Army Medical College, in collaboration with Rheumatology Department at Military Hospital Rawalpindi from November 2015 to November 2016

Methodology: a total of 60 patients of both genders were taken, among which 30 were patients and 30 were controls. Non-probability purposive sampling technique was used. RNA was extracted from respective blood sample and cDNA was synthesised and after optimisation, expression analysis of matrix metalloproteinase-9gene was seen on real time PCR

Results: mean age of rheumatoid arthritis patients and healthy controls was 49.27 +/- 12.11and 42.10 +/- 9.02 years, respectively. Among controls, 50% were males [15] and 50% were females [15]; whereas, among patients, 30% [9] were males and 70% [21] were females. The mean cycle threshold [Ct] value of MMP-9expressions in patients was 27.9147 +/- 2.953; whereas, mean Ct of controls was 23.84 +/- 2.845. Down regulation of this gene was found in patients in comparison to controls

Conclusion: downregulation of matrix metalloproteinase-9was observed in patients as compared to controls indicating that current treatment regimen did not require further modification

Comparison of acute phase reactants in rheumatoid arthritis patients and healthy adults

Objective: To analyze the acute phase reactants in patients suffering from rheumatoid arthritis [RA] and compare them to healthy controls

Study Design: Cross-sectional comparative study

Place and Duration of Study: This study was conducted at the department of Biochemistry and Molecular Biology Army Medical College, Rawalpindi in collaboration with Rheumatology department Military Hospital [MH] Rawalpindi and Military Hospital Laboratories, from Jan 2016 to Jun 2016

Material and Methods: Approval of this study was given by Ethical Review Committee, Army Medical College [AMC] Rawalpindi. Two groups i.e., group I: normal healthy subjects [n=100] and group II: rheumatoid arthritis patients [n=100] were included in the study. Demographic data: age, gender, ethnicity and marital status of the healthy subjects as well as RA patients was recorded on proforma. Blood sample was collected and patients were monitored for acute-phase response i.e. by evaluating the levels of C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]

Results: In this study 100 RA patients with 29 males and 71 females were enrolled. Hundred healthy controls included 50 males and 50 females. The mean CRP value of RA patients was 8.44 +/- 4.28mg/l i.e. higher as compared to that of controls whose mean CRP value was 6.2 +/- 4.6mg/l [p<0.001]

Among RA patients, the mean ESR value was 29.0 +/- 16.9mm/ hr of and among controls, the mean ESR value was 20.0 +/- 9.42 mm/hr [p<0.001]

Conclusion: Both CRP and ESR are important disease assessment biomarkers. They were significantly elevated among RA patients as compared to healthy subjects in our study. Moreover due to cost effectiveness these [CRP and ESR] are preferred tests for routine assessment. CRP and ESR provide the much desired information about RA activity and severity that cannot be provided by either of them alone

Anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis patients

Objective: To detect the anti cyclic citrullinated peptide [Anti-CCP] antibody in rheumatoid arthritis [RA] patients to determine its diagnostic value in Pakistani patients

Study Design: Cross sectional study

Place and Duration of Study: Military Hospital [MH] Rawalpindi, from January 2013 to June 2015

Material and Methods: A total of 58 patients with complications of rheumatoid arthritis were recruited in the study using convenient sampling technique after their informed consent. Age and gender of the patients were recorded. Blood was collected from the patients subjected to ELISA based detection of anti-CCP and latex agglutination test for detection of Rheumatoid Factor [RF]. Data obtained were analyzed using Microsoft excel 2010

Results: Among the fifty eight RA patients, 40% were males and 60% were females. Age ranged between 12 to 80 years [mean age 49.74 +/- 16.81 years] of the males RA patients and was higher as compared to females [mean age 43.2 +/- 16.70 years]. ELISA based detection of anti-CCP antibody showed that about 91 percent of RA patients were positive for anti CCP antibody. About 72% were positive for anti CCP antibody alone, 19 percent were positive for both anti-CCP and RF and 9 percent were positive for RF

Conclusion: The results concluded that a higher percentage of the RA patients are positive for anti-CCP antibody marking its importance as a diagnostic marker. Anti-CCP has more sensitivity as compared to RF in RA patients

Clinical registry for rheumatoid arthritis; a preliminary analysis

Objective: To establish a clinical registry for Rheumatoid Arthritis and delineate the most common symptoms that rheumatoid arthritis [RA] patients experience in our set up

Study Design: Cross sectional study

Place and Duration of Study: Study was carried out at Military Hospital [MH] Rawalpindi at Rheumatology Department during the period of Jan 2013 to Jun 2015

Material and Methods: A clinical registry for Rheumatoid Arthritis was developed as per criteria jointly developed by American College of Rheumatology [ACR] along with European League against Rheumatism [EULAR] [2010]. Fifty-eight patients were registered after their informed consent and approval by Military Hospital [MH] Rawalpindi ethical committee. Age, gender and relevant clinical parameters of RA patients were recorded on case report forms and stored for analysis in the RA registry in Excel 2010. The figures were reported in frequencies and percentages

Results: Multiple joint pains [48.28%], fever [24.14%], morning stiffness of joints [22.41%] were the most common symptoms in RA patients. Other clinical manifestations included painful bilateral swollen joints [13.79%], pain in different parts of the body [10.34%], Raynaud's phenomenon [10.34%], malaise [8.62%], swollen body parts [8.62%], ulcers [8.62%], fatigue [6.90%], nodules on skin/elbow/interphalangeal joints [6.90%], deformities of fingers/ hand [3.45%], redness of eyes [3.45%], body rash [3.45%], inability to walk [3.45%], cervical lymphadenopathy [1.72%], stiffness of spine [1.72%] and myalgias [1.72%]

Conclusion: It is concluded that multiple joint pains, fever and morning stiffness of joints are the most common symptoms of RA patients

Status of glycemic control in patients of type 2 diabetes mellitus

To determine the status of glycemic control in patients of type 2 diabetes mellitus. Cross sectional descriptive study. Medical out-patient/ in -patient departments at Military Hospital Rawalpindi from January 2011 to December 2012. Six hundred and fifty patients of type 2 DM fulfilling the required criteria were included in the study. Glycemic control of these patients was determined by estimation of blood glucose [fasting and random] and glycosylated haemoglobin [HbA1c]. The patients were grouped in three categories good, fair and poor diabetic control having their HbA1c values of being 6-7%, 7.1-8% and more than 8.1% respectively. Statistical package for social sciences [SPSS] version 15 was used for analysis. Out of 650 patients 377 [58%] had poor glycemic control with mean HbA1c of 9.5% +/- 0.95, 78 [12%] patients had fair control of glycemic control with mean HbA1c of 7.8 +/- 0.25, and 195 [30%] patients had good glycemic control with mean HbA1c of 6.4 +/- 0.17. Majority of patients had poor control of their glycemic status which is an important indicator and predictor of both micro and macrovascular complications