Gastroesophageal reflux disease in patients with chronic obstructive pulmonary disease

Objective: To evaluate the gastroesophageal reflux symptoms in Chronic Obstructive Pulmonary Disease [COPD] patients and Upper Gastrointestinal [GI] endoscopy findings in these patients

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Dow University Hospital and Civil Hospital Karachi from January 2013 to December 2013

Materials and Methods: 100 of COPD were selected and assessed for presence of gastro esophageal reflux [GERD] symptoms. Data was analyzed on SPSS version 13

Frequency and percentage were computed for categorical variable like gender, gastro-esophageal reflux symptoms and upper GI endoscopy finding in COPD patients with gastro esophageal reflux symptoms. Mean standard deviation was computed for quantitative variables like age, smoking [pack year], solid fuel and tea consumption [cup/day]

Results: In this study of 100 patients 95 were males and 5 were female. Cough was the commonest symptom that was found in 85% patients followed by sputum production in 71% patients, retrosternal burning [68%], acid reflux [54%] and dysphagia [11%]

Gastro-esophageal reflux symptoms were observed in 54 patients. Out of these 54 patients who had GER symptoms, 33 [61%] patients had erosive gastro-esophageal reflux disease while 21[39%] patients non-erosive gastro esophageal reflux disease on upper GI endoscopy

Conclusion: Our study shows that higher proportion of Gastro esophageal reflux symptoms is present in COPD patients. Moreover, upper GI endoscopy can be normal in COPD patients with significant GERD symptoms

Frequency of impaired glucose tolerance test in patients with active tuberculosis

Objective: To determine the frequency of impaired glucose tolerance in patients presenting with active pulmonary tuberculosis in tertiary care hospital, Karachi

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Dow University Hospital [Dow University Health Sciences Karachi] from 1stJune 2014to 30thNovember 2014

Materials and Methods: A total of 110 diagnosed adult cases of active pulmonary tuberculosis on the basis of sputum smear positivity were included in this study. Blood samples were drawn for investigations and sent to the same reference laboratory to minimize bias.Data was collected on a pre-tested self administered Performa

Results: There were 59.1% were male and 40.9% were female. Frequency of impaired glucose tolerance in patients presenting with active pulmonary tuberculosis was observed in 20.9%. Rate of impaired glucose tolerance was highly associated with above 40 years of age patients and with family history of diabetes

Conclusion: In Pakistan DM is on the rise and TB has one of the highest incidence in the world. There is emerging evidence that one disease is fuelling the other. The interest in diabetes and TB is mounting rapidly, so the clinician and researchers should prepare themselves to meet the challenges of the two diseasecombined

observe the role of angiotension receptor blocker losartan in treating prehypertension

The primary objective of the present study was to determine whether in patients with prehypertension six months of treatment with an angiotensin II, type I receptor antagonist [at a dose of 8mg once a day] reduces the incidence of hypertension in borderline patients Randomized, open-labeled, prospective study. This study was conducted in the department of pharmacology and therapeutics, Basic Medical Sciences institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi, from July 2007 to January 2008. This study involved eighty untreated participants between 30 to 60 years of age of either sex with blood pressure on study entry in high-normal range i.e. systolic blood pressure of 130 to 139 mmHg and diastolic blood pressure of 85 to 89 mmHg, according to the classification developed by Joint National Committee on prevention, Detection, Evaluation, and Treatment of high blood pressure [JNC-VI]. All participants were randomized and enrolled in study after baseline investigations and informed written consent. All values have been expressed in standard error of mean [ +/- SEM]. Forty patients were treated with DRI and DR2 from day 0 to day 90[th] of study period respectively. InDRI group the mean systolic BY was decreased from 138 mmHg to 125.8 mmHg from day 0 to day 90[th] In DR2 group an increase was observed in systolic BY from 128 mmHg to 136 mmHg from day 0 to day 90[th]. An average percentage decrease of 8.21% in case of DR] while, 5.52% was increased in DR2 group. In same way a decrease of 11.82% in DR] group, while, an increase of 11.5% was observed in case of DR2 group in mean diastolic blood pressure respectively from day 0 to day 90[th] of study duration. Treatment of prehhypertension with an angiotension receptor antagonist May decreases incident hypertension. Additional studies will be needed to ascertain whether this or other strategies involving early pharmacological treatment of prehypertension would positively affect clinical outcomes

Hemodialysis patients profile at Dow university of health sciences, Karachi, Pakistan

To determine the frequency of diseases contributing to End Stage Renal Failure [ESRF] and to determine the frequency of seropositivity for hepatitis B and hepatitis C in our patients. This is an observational study of two years duration from January 2012 till December 2013, done at Dow university of Health Sciences. Sample size is 189 by convenient method. Data collection is retrospective. Inclusion criteria includes all patients ever hemodialysed at DIMC with age 14 or above. Exclusion criteria is age below 14. Data maintained and analyzed on SPSS version 16. All categorical data in percentages and numeric data is given in frequencies and mean with Standard deviation. Total number of patients included in study were 189, Males were 94/189 [49.7%], females were 95/189 [50.3%], Male to female ratio was 0.98:1.0. Mean age was 51.88 +/- 15.2, range was 14-86 years. Patients started on Hemodialysis were found to have hypertension in 40.2%, both diabetes and hypertension was present in 42.8%, diabetes alone in 3.1% of patients as likely etiology of renal failure. Seropositivity for HBV was found 4/189[2.1%] and HCV in 31/189[16.4%] at initiation of Hemodialysis. Hypertension alone is an important disease found in patients with renal failure as likely cause followed by diabetes. Hepatitis C positivity at start of hemodialysis is 16%

Repetitive nerve stimulation test, an investigation that helps in confirming diagnosis in seronegative myasthenia gravis

To assess the effectiveness of Repetitive Nerve Stimulation Test in the diagnosis of Seronegative Myasthenia Gravis. Descriptive Observational. This study was conducted at Dow University of Health Sciences and Jinnah Postgraduate Medical Centre during the period of three years from 2010 to 2013. A total 129 cases, both out patients as well as inpatients, who were diagnosed as a case of Myasthenia Gravis clinically and by other investigations including, Edrophonium Test, Chest Radiology, and Acetylcholine Receptor antibodies were studied. Out of 129 cases, of Myasthenia Gravis, who were admitted or came in outpatient department, 55 subjects are male. On Repetitive Nerve Stimulation study at 3Hz, significant decrement was found in trapezius in 16 [88%] patients who are Seronegative and in 90 [81%] seropositive patients. Repetitive Nerve Stimulation Test is a promising tool in the diagnosis of Myasthenia Gravis and should be a part of investigations used to diagnose this neuromuscular junction disorder especially in Seronegative cases, for confirming the diagnosis

Correlation between clinical severity and eosinophillic count in asthmatic patients

To determine the correlation between the blood eosinophil count and the severity of symptoms in asthmatic patients. Prospective observational study. This study was carried out in Dow General Hospital, Dow University of Heath Sciences from l[st] January 201 1 to 31[st] December 2011. Asthmatic patients who were admitted in Dow General Hospital, Dow University of Heath Sciences, and those who fulfilled the inclusion criteria were enrolled in the study. Physical examination was carried out and the severity of the symptoms was gauged by using Peak Expiratory flow meter and absolute eosinophil count. The data thus collected was analyzed using SPSS Version 15. Among 56 patients who were enrolled in the study 29[51.8%] were male and 27[48.2%] were female. Ages were between 13 and 70 years. The absolute eosinophil count ranged between 70/mm[3] and 1400/mm[3]. Based on the definition of asthma severity, 20 patients [35.7%] had mild asthma, 17[30.4%] had moderate and 19[33.9%] patients had severe asthma. Statistical analysis showed that no relationship exist between blood eosinophil count and the severity of asthma, [p < 0.003]

To assess vitamin d levels in patients diagnosed as fibromyalgia in patients attending dow university hospital

To assess the Vitamin D levels in patients diagnosed as fibromyalgia in patients attending Dow University Hospital Karachi. Descriptive study. This study was conducted at Dow University Hospital, Karachi from 21[st] January 2013 to 30[th] December 2013. 83 patients were selected from the outpatient department of medicine OPD. among 83 patients who were enrolled in the study 60 [72.71%] were male and 23were [27.71] were females ages were between 7 and 70 years, the vitamin D levels ranged between 2 and 58with mean vitamin D level found to be 12,58 which is counted as moderate deficiency. 83 patients with fibromyalgia were included in study. Among them who were enrolled in the study 60 [72.28%] were male and 23 [27.71%] were females .The subjects included in study age between 17 and 70 with mean age of 39.69 years. The fibromyalgia was gauged on clinical assessment. Vitamin D levels were classified. Vitamin D levels ranged between 2 and 58 with mean 12.58. As objective of study to assess vit D levels in diagnosed fibromyalgia patients in our population it was found that relationship between two parameters in significant. Vitamin D deficiency is frequently diagnosed in patients with fibromyalgia and nonspecific musculoskeletal pain in study population

Prevalence of metabolic syndrome in patients present with unstable angina

The main objective of this study was to determine the frequencyof metabolic syndrome in patients presesnting with unstable angina at DUHS. Cross-sectional observational study. This study was carried out at all medical wards of a DUHS from January 2012 to July 2012. 81 patients with Unstable Angina [UA] presented in medical ward that fulfilled the inclusion and exclusion criteria and gave informed consent were enrolled for the study. Metabolic syndrome was defined according to ATPIII criteria. Patients were evaluated for obesity, diabetes, hypertension, hypertriglyceridemia and low HDL. Total 81 patients with unstable angina were included in this study Out of them 43 [53.1%] were male and 38 [46.9%] were female. Mean age was 60.23 +/- 8.7. Majority of patients [49.4%] were lying in 51 to 60 years age group. The frequency of metabolic syndrome was thirty nine [48.1%]. Among them twenty three [53.5%] were male and sixteen [42.1%] were females, hence it shows insignificant p value of 0.018. Metabolic syndrome is common with high frequency in our population. This study provides a quantitative estimate of the frequency of metabolic syndrome and suggests Diabetes, low HDL, hypertension, hypertriglyceridaemia and obesity strongly correlates with unstable angina

Radiographic patterns in HIV associated pulmonary tuberculosis

To compare the radiologic patterns in HIV positive patients with pulmonary tuberculosis with non-HIV positive patients of pulmonary tuberculosis. Descriptive study. The study is a carried out in the Department of Medicine at Dow University Hospital from July, 2010 to July, 2011. The admission records of 54 HIV-positive patients were analyzed. A total of 30 patients out of 54 presented with pulmonary symptoms, which were further evaluated by sputum smear for acid-fast bacilli and chest radiographs. These 30 patients were compared with 30 non-HIV, smear positive for acid-fast bacilli patients. Out of 30 HIV seropositive patients, 29 were male and 1 was female with the mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 10 patients [33.3 %]. Frequent radiographic patterns included normal 12[40%] and apical infiltrates 5[16.6%]. Cavitatory lesion was observed in 1 patient. Dominant symptoms were weight loss 29[93.3%] and fever 24[80%]. Out of the 30 non-HIV seropositive pulmonary tuberculosis patients, 20 were male and 10 were female of mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 30 patients [100%]. Frequent radiographic patterns were apical cavitations 12[40%], apical infiltrates 5 [16.6%], bronchopneumonia 6[20%], interstitial infection3 [10%].Dominant symptoms were weight loss 29[93.3%] and fever 24[80%]. Majority of HIV seropositive patients with pulmonary tuberculosis were male. Common radiographic patterns were normal radiographs and apical infiltrates. Atypical radiographic presentation is particularly related in advance stages of immunosuppresion. Cavitatory lesions and pleural effusion were rare findings. Non HIV seropositive pulmonary tuberculosis patients were both male and female. Common radiographic patterns were apical cavitatory lesions, bronchopneumonia, interstitial infiltrations and pleural effusion. This radiographic presentation is particularly related to delayed hypersensitivity reaction

Sensitivity pattern of causative microorganisms in septicemia

The study was conducted to find out the various etiological organisms in septicemia and their sensitivity to different antimicrobial drugs. Observational study. This study was conducted in Medical units of Civil Hospital Karachi from January 2010 to December 2010. A total of 90 patients between the ages of 15 years to 80 years, irrespective of gender with septicemia were included in this study. Total number of patients was 90. There were 47 [52%] male and 43 [48%] were female. Staphylococcus aureus and Salmonella Typhi were the most common organisms isolates in 26% cases. Regarding the sensitivity pattern of bacteria to different antimicrobial drugs, the results showed that Staph. Aureus had good sensitivity to Augmentin, Imipenem and Tazobactum and marked resistance to Ciprofloxacin. No MRSA was isolated in the study. Salmonella Typhi showed good sensitivity to Quinolones and Ceftriaxone and marked resistance to Chloramphenicol, Co-trimaxazole and amoxicillin [Table 4]. Klebsiella showed good sensitivity to Amikacin, Ceftriaxone, Imepenem and marked resistance to Ampicillin and Carbencillin, Pseudomonas aeuroginosa had good sensitivity to Tazobactum, Amikacin and Ceftriaxone. Septicemia is a major cause of death worldwide and the random use of antibiotics has considerably increased the resistance to commonly used antibiotics. Blood culture should be sent immediately to know the spectrum of microorganisms, and their sensitivity pattern, however this may not delay the empirical use of antibiotics to hasten recovery

Various clinical presentations of falciparum malaria and outcome: a study of 100 patients

Various clinical presentations of falciparum malaria and outcome. Malaria is an important disease worldwide, result in estimated 300-500 million new cases and 1.5-2.7 million deaths per year. Most deaths occur due to Plasmodium Falciparum infection. Falciparum malaria is a major community problem in our country. Presentation of falciparum malaria with paroxysms of fever chills and rigors are easy to diagnose and treat. Case series study. This study was conducted at DUHS from January 2011 to December 2011. 100 patients above 12 years of age with any gender, presenting with high grade fever and diagnosed as a case of Falciparum malaria on thick and thin film are included in this study. Among 100 patients 69 were male and 31 females. Clinically all patients presents with fever, while 69 with headache, 39 with vomiting and 28 with altered level of consciousness. The most common sign was anemia i.e. in 40 patients, splenomegaly in 37, and jaundice was found in 35 patients. 7 patients were expired during the study. Falciparum malaria is a notorious for various presentations which may mimic like upper and lower respiratory tract infection, acute gastroenteritis and bacterial meningitis. The treating physician should be aware of the various presentations because early detection and treatment may reduce the morbidity and mortality associated with falciparum malaria

Comparison of hemodynamic responses of intrathecally placed hyperbaric 0.75% bupivacaine hydrochloride in different height groups of patients undergoing caesarean section

To compare the Hemodynamic response of intrathecally placed 1.5 ml of 0.75% hyperbaric bupivacaine hydrochloric in different height groups of patients undergoing caesarean section in spinal anesthesia. Quasi experimental study. This study was carried out in the Department of Anesthesia, Sindh Govt, Lyari General Hospital, Dow Medical College, Dow University of Health Sciences from July 2009 to December 2009. In this study patients enrolled for elective caesarean section, were divided into two groups. In Group-A the height of the patients was equal or less than 60 inches [5 feet] and the height of the patients of Group-B was between 60 -66 inches [5 - 5.5 feet]. Hypotension was observed in 67 patients. 46 patients belonged to Group-A and 21 patients from Group-B. The study showed that height of the patients influenced the hemodynamic response of local Anesthetics given during spinal anesthesia

Radiographic patterns in HIV associated pulmonary tuberculosis

To evaluate Radiographic patterns in HIV associated PULMONARY TUBERCULOSIS. Observational, retrospective, descriptive study. This study was conducted in the Department of Infectious Diseases, Civil Hospital, Karachi between July 2008 to April 2009. This study is conducted by reviewing the admission records of 54 HIV diagnosed patients. A total of 30 patients presented with pulmonary symptoms were evaluated by sputum smear for acid fast bacilli [AFB] and chest radiographs. Out of 30 HIV seropositive patients, 29 were male and 1 was female of mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 10 patients [33.3%]. Frequent radiographic patterns were 12 [40%] normal, 5 [16.6%] apical infiltrate, cavitatory lesion was observed in 1 patient. Dominant symptoms were weight loss 29 [93.3%], fever 24 [80%]. Majority of HIV seropositive patients with pulmonary tuberculosis were male, common radiographic patterns were normal radiograph, apical infiltrates atypical radiographic presentation is particularly related in advance stages of immunosuppressant. Cavitatory lesions and pleural effusion were rare findings

To compare the efficacy of rocuronium bromide and succinylcholine in elective surgery for endotracheal tube

To compare the efficacy of rocuronium bromide and Succinylcholine in elective surgery for endotracheal tube. Randomized, double blind study. This study was conducted in the Department of Anesthesia and Surgical ICU, Civil Hospital Karachi over a period of six months i.e. January 2009 to August 2009. This study was conducted on sixty patients. They were aged between 20-60 years. Patients were divided into two groups following inclusion i.e. Group A and Group B. Patients in Group A were given inj. Rocuronium 0.9mg / kg and group B received inj. Succinylcholine 1.5mg / kg. In group A which was received rocuronium bromide 0.9mg / kg, showed excellent intubating conditions in 83.33% of patients as compared to group B which was given Succinylcholine 1.5mg / kg, showed 96.66%. The intubating conditions were significantly better in group B which received inj. Succinylcholine 1.5mg / kg as compare to group A was given inj. Rocuronium 0.9mg / kg

Clinical pattern and outcome of organophosphorus poisoning

Objectives: to determine the clinical presentation and outcome of acute organophosphorus Poisoning

Methods: this case series included 100 cases from various medical wards of Civil Hospital Karachi from February 2008 to December 2008. We included all patients of organophosphorus poisoning who showed either signs of muscarinic or nicotinic involvement. However we excluded those patients in which organophosphorus poisoning was doubtful and who were intoxicated with poisoning other than organophosphates

Results: hundred patients of organophosphate poisoning were admitted among these 68% was males and 32% were females. Modes of poisoning were suicidal in 65% of cases, accidental in 27% and 8% were homicidal. Though the clinical presentation of acute poisoning was variable however the most consistent feature was miosis [98%]. According to W.H.O. classification for severity of organophosphorus poisoning; 60% cases were moderate, 28% were severe and 12% were mild. The mortality rate was 20% and mostly among patients who presented with severe symptoms and presented late

Conclusion: pesticides are the major chemical agents which pose a health threat particularly to young people, depressed individual and farm worker so this fetal condition needs rapid diagnosis and early treatment

Effect of pregnancy on the disease activity in ulcerative colitis

To study the effects of pregnancy on the disease activity in ulcerative colitis. This experimental study was conducted at department of Medicine at Sultan Qaboos University Hospital Oman from July 2002 to December 2004. A total 60 diagnosed cases of ulcerative colitis proven on colonoscopy and biopsy and fairly well controlled disease at the time of enrollment were included in the study. Those who conceived and delivered during the study period were inducted as experimental group [total 30 patients], and those who did not conceive during the study period were inducted as control group [total 30 patients]. Out of total 60 patients, 30 patients who were included in the study group, 24 remained well with mild exacerbation requiring only increased dose of mesalamine, four patients had moderate disease exacerbation requiring oral steroids along with mesalamine. Two patients had severe exacerbation that was controlled on parental steroids. Among control group, 25 had mild exacerbation, 4 had moderate exacerbation and 1 had severe exacerbation during the study period. The eventual out come was good in all patients. It is thus concluded that a planned pregnancy when the disease is well controlled minimizes the risk of complications in patients of ulcerative colitis and also has got favorable outcome of pregnancy

Extra-intestinal manifestations of ulcerative colitis in Omani population: a study of 100 cases

Object: to identify the extra intestinal manifestations of Ulcerative Colitis in Omani population

Study design: observational study

Place and duration of study: Sultan Qaboos University Hospital, Oman from January, 2002 to January, 2006

Patients and Methods: inclusion Criteria: All patients seen in Gastroenterology out patient's clinic with bleeding per rectum and diagnosis of ulcerative colitis by colonoscopy and subsequent confirmation by biopsy. Exclusion Criteria: All patients with other systemic illness

Results: total 100 Patients were included in the study, among them 61 were males. Extra intestinal manifestations were observed in 6 males and 5 females. Among 6 male patients 2 had more than one complication while 4 had only one complication. Among 5 female patients 2 had more than one, while 3 had only one complication

Conclusion: it is thus concluded that incidences and severity of extra intestinal manifestation is much less in the Omani population as compared to the Western population

Spectrum of complications in post liver transplant patients: a study of 30 cases

Objective: To study the complications encountered in post liver transplant patients performed due to different etiologies leading to end stage liver disease. Study Design: Cohort and observational study. Place and Duration of Study: Sultan Qaboos University Hospital, Oman. From Dec 2001- July 2006

Patients and Methods: The study was conducted on all patients having cadavaric liver transplantation outside Oman. All patients were followed up for at least 18 months after enrolling in the study. They all had certain routine tests at the start of the study and were repeated according to the requirement of the individual patients. All patients had tacrolimus as an immunosuppressive agent. Patients with hepatitis B had hepatitis B immunoglobulin, alongwith lamivudine for relapse prophylaxis

Results: Complications of liver transplantation was observed in 21 patients, out of total 30 patients. Thirteen patients developed new onset diabetes mellitus, among them 7 had other complications as well. Eight patients had different hepatic complications and 7 had non hepatic problems. Total 5 patients expired during our follow up

Conclusion: The complications of liver transplantation can be controlled and managed if diagnosed promptly and treated early