Role of Pancreatic Stent placement in prevention of post Endoscopic retrograde Cholangiopancreatography Pancreatitis: experience at a tertiary care hospital in Pakistan

Objective: To determine the frequency of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis [PEP] in patients who underwent prophylactic pancreatic duct stenting

Study Design: Descriptive case series

Place and Duration of Study: This descriptive case series was conducted at the department of Gastroenterology, Pak Emirates Military Hospital Rawalpindi, from Jul 2017 to Feb 2018

Material and Methods: One hundred and twenty consecutive patients were enrolled after they met inclusion and exclusion criteria. Endoscopic Retrograde Cholangiopancreatography Pancreatitis [ERCP] was performed by Olympus duodeno scope [TJF Q180V] by an endoscopist having at least 3 years experience of performingindependent ERCPs. An additional 4, 6, or 7cm long 5FrGeenen[registration sign] pancreatic plastic stent [Cook Medical] was placed in all cases where pancreatic duct was accidentally cannulated. Primary outcome variable was post ERCP pancreatitis. Data was recorded on a pre-designed proforma and analyzed by SPSS version 21.0

Results: Out of total 120 cases, PEP was found in 4 [3.3 percent] patients. All the 4 patients had mild pancreatitis

Conclusion: PEP is not an uncommon complication following ERCP. The rate of PEP appears to be lower with prophylactic pancreatic duct stenting

Vitamin d deficiency in patients with tuberculosis

To determine the frequency and association of Vitamin D deficiency in patients with tuberculosis. Case control study. Medical Department, Combined Military Hospital, Kharian, from July 2010 to June 2012. One hundred and five outdoor patients of tuberculosis were selected with 255 gender matched controls. Tuberculosis was diagnosed by presence of acid fast bacilli in sputum smears, positive culture for Mycobacterium tuberculosis or demonstration of chronic caseating granulomatous inflammation in tissue specimens. Controls were drawn randomly from general population. Serum 25 hydroxyvitamin D [25 [OH] D3] levels < 25 ng/ml was considered Vitamin D deficiency. The results were analyzed on SPSS version 17. Mean Vitamin D levels were 23.23 +/- 6.81 ng/ml in cases, 29.27 +/- 8.89 ng/ml in controls [p < 0.0001]. Vitamin D deficiency was found in 57% of cases and 33% controls [p < 0.0001]. Mean Vitamin D levels were significantly lower in females with tuberculosis [20.84 ng/ml] as compared to males [25.03 ng/ml, p = 0.002]. Mean BMI in patients of tuberculosis with Vitamin D deficiency were 19.51 +/- 1.77 kg/m2 and in patients with normal Vitamin D were 21.65 +/- 1.79 kg/m2 [p < 0.0001]. Mean Vitamin D levels in patients with multi-drug resistant tuberculosis was lower to a mean of 15.41 +/- 4.67 ng/ml [p < 0.0001]. There is significant deficiency of Vitamin D in patients with tuberculosis as compared to controls. This deficiency is more pronounced in females, individuals with low BMI, extra pulmonary and MDR tuberculosis.

Hypomagnesemia; frequency in patients with type 2 diabetes mellitus

To determine frequency of Hypomagnesaemia in patients of type 2 diabetes mellitus in our population. Random selection of DM II patients from Outpatient Department CMH, Kharian.: Cross sectional study. Combined Military Hospital Kharian, Department of Medicine. January 2011 to December 2011. We selected outdoor patients of DM-2 from both gender between 40 to 70 yrs of age by random sampling. Those selected, were subjected to blood fasting and random glucose measurements as well as serum magnesium levels. Blood samples were collected using full aseptic measures and vtfthin one hour, samples were transported to Armed Forces institute of Pathology [AFIP] for analysis. Serum magnesium level estimation was done by timed endpoint method using calmagite dye. DXC 600 automated analyzer was used. The results were verified by Pathologist. The overall frequency of Hypomagnesemia was 32.2% [124 out of the 385 subjects] using the cutoff value of less than 0.6mmol/l for Hypomagnesaemia, whereas 67.8% [261 out of the 385 individual] had normal serum magnesium levels. Significant number of patients with type 2 diabetes mellitus suffers from Hypomagnesaemia. These patients have increased risk risk of poor Glycemic control and diabetic complications due to Hypomagnesemia. Therefore, it is recommended that serum magnesium levels should be checked regularly in patients with type 2 diabetes mellitus and oral magnesium replacement should be done