Efficacy of Vitamin D supplementation in achieving an early sputum conversion in smear positive Pulmonary Tuberculosis

Objective: To determine the efficacy of Vitamin D supplementation in achieving an early sputum conversion in vitamin D deficient smear positive pulmonary tuberculosis patients

Methods: This randomized clinical trial was done at Mayo hospital Lahore from November 2015 to August 2016. One hundred twenty patients with sputum smear positive pulmonary tuberculosis were selected and randomized to Group-A [taking anti-tuberculous therapy [ATT] only] and Group-B [taking ATT with Vitamin D supplementation]. Four doses of100,000 IU of Vitamin D injection intramuscularly were given after every 14 days during intensive-phase. Sputum examination was repeated at 2nd, 4th, 6th, 8th, 10th and 12th weeks. Efficacy of treatment in terms of early sputum conversion between both groups was tested using Chi square and independent sample t-test was applied to compare mean values of serum vitamin D before and after treatment. P-value . 0.05 was considered as significant

Results: The mean age of patients was 37.18 +/- 6.81 years in Group-A and 39.02 +/- 7.56 years in Group-B. There were 63 [52.50%] males and 57 [47.50%] females. The mean serum Vitamin D was 17.07 +/- 1.44 in Group-A and 17.23 +/- 2.37 in Group-B at baseline and at 12th week, the levels were 21.77 +/- 2.23 in Group-A and 29.24 +/- 0.72 in Group-B. In Group-A, 7 [11.7%] patients showed positive sputum examination and in Group-B, only one [1.7%] patient had positive sputum examination at 12th week. The difference was statistically significant [p-value= 0.028]

Conclusion: Four doses of intramuscular vitamin D given after every 14 days corrected vitamin D deficiency and improved the rate of sputum smear conversion in patients of pulmonary tuberculosis

Correlation between serum calcium level with blood pressure level in patients presenting with type 2 diabetes mellitus

Objective: To study the relationship between serum calcium level and blood pressure level in patients presenting with type 2 diabetes mellitus

Methods: This cross sectional study was conducted at East Medical Ward, Department of Medicine Mayo Hospital Lahore. This study was done in six months period from March 10, 2015- Sep 10, 2015. The non-probability consecutive sampling technique was used in this study. Informed consent and demographic information like name, age and address was recorded. Systolic and Diastolic Blood pressure was measured by using standard and absolute sphygmomanometer. 3ml Blood sample of each patient was taken with informed consent and was sent to the laboratory of the hospital to assess serum calcium level [as per operational definition). Reports were assessed and calcium level was recorded. Pearson correlation coefficient was calculated to measure the relationship between serum calcium level and systolic and diastolic blood pressure. pvalue

Results: In our study the mean age of the patients was 59.42 +/- 11.02 years, 30% patients were males and 70% patients were females. The mean SBP value of the patients was 140.56 +/- 11.35 mmHg and mean DBPvalue was 87.98 +/- 6.11 mmHg. In this study the mean value of calcium level of the patients was 8.22 +/- 1.24 mg/dl. The negative correlation was observed in our study between the calcium level and SBP, DBPof the DM patients i.e. r= -0.665 and -0.401 respectively

Conclusion: The study concluded that negative correlation was observed between the serum calcium level and the blood pressure level in patients presenting with type 2 diabetes mellitus

Frequency of Type-2 diabetes mellitus in Nephropathic patients and comparison of mean magnesium levels in Nephropathic patients with and without Type-2 diabetes mellitus

Objective: The objective of this study was to determine the frequency of Type 2 diabetes mellitus [T2DM] in patients with nephropathy [i.e. Chronic Kidney Disease Stage 1 to 3] and to compare the mean magnesium levels in diabetic nephropathic patients and non-diabetic nephropathic patients

Methods: This cross-sectional study was conducted in department of Medicine, Mayo Hospital Lahore from August 2014 to February 2015. Using non-probability purposive sampling 200 nephropathic [Chronic Kidney Disease Stage 1 to 3] patients were selected. Patients were assessed for T2DM and divided in two groups on the basis of presence or absence of DM. Magnesium levels were recorded in both groups. Percentages, mean, standard deviation and unpaired t-test was used to assess the data. SPSS was used for analysis of information

Results: Total number of cases were 200, 43.5% [n=87] out of them were between 25-50 years of age while 56.5% [n=113] patients were between 51-70 years. The Mean+SD was calculated to be 51.38+11.51 years, The male patients were 48.5 %[ n=109] while 51.5 %[ n=91] were females. The frequency of DM in patients with nephropathy was 25.5% [n=51]

Comparison of mean magnesium levels in nephropathic patients with and without diabetes was done. The results showed nephropathic patients having diabetes had 1.54+0,301 mg/dL magnesium levels while cases without diabetes had 1.92+0.313 mg/dL levels of magnesium, p value was calculated as 0.001 showing a significant difference between the two groups

Conclusion: The frequency of diabetes mellitus is higher among patients with nephropathy while on comparison of mean magnesium levels, nephropathic patients with diabetes had significant lower levels of magnesium as compared to without diabetes

Association of progression of pulmonary fibrosis with severity of liver cirrhosis

Background: it has been found that frequency of pulmonary fibrosis increases in patients with cirrhosis of liver. We hypothesized that as the stage of cirrhosis advances, the frequency of pulmonary fibrosis should increase. We used child's pugh classification to stage the cirrhosis of liver

Material and Methods: fifty five patients of age range 16 to 80 years, both males and females having established cirrhosis of Fiver on ultrasonography, regardless of etiology, visiting the outpatient and inpatient department for treatment were selected. Patients were divided into three groups according to child's criteria i.e. group A, group B, and group C. HRCT of chest was performed on patients in all three groups to look for pulmonary fibrosis

Results: 27 [49%] patients were found to have pulmonary fibrosis on HRCT. The frequency of pulmonary fibrosis in different groups of child's classification was also assessed and it was found that class C and class B, are affected more than A

Conclusion: pulmonary fibrosis progresses with severity of liver cirrhosis

Assessment of severity of esophageal varices by splenic index in cirrhotic patients

Objective: to determine the relationship between the splenic index and the severity of esophageal varices in cirrhotic patients

Material and Methods: fifty patients who had coarse echotexture of liver on abdominal ultrasound and clinically .palpable spleen were selected. Splenic index was calculated using abdominal ultrasound as a product of longitudinal length and transverse width across the hilus of the spleen. These patients were then subjected to upper gastrointestinal endoscopy and esophageal varices were noticed and severity was assessed using grades from 0-3

Results: relationship was observed between the splenic index and the severity of esophageal Varices

Conclusion: splenic index can be a useful noninvasive method to determine the severity of esophageal varices in patients suffering from hepatic cirrhosis