Endoscopic management of common bile duct stones experience at military hospital, Rawalpindi

To determine the characteristics of patients presenting with common bile duct [CBD] stones, to know the type of endoscopic therapy employed and to see procedure related complications. A descriptive study Palace and Duration of Study: The study was conducted in the Department of Gastroenterology of Military Hospital, Rawalpindi from Jan 2007 to Dec 2007. Adult patients with common bile duct stones who underwent endoscopic retrograde cholangiopancreatography [ERCP] enrolled in a consecutive manner. The procedure was done under sedation with midazolam and meperidine after informed and written consent. Patients data was obtained from the department and entered on a spread sheet to calculate percentages and frequencies .The data was analyzed using Statistical Package for Social Sciences [SPSS] version 10 to document the endoscopic procedures done and the procedure- related complications. Two hundred and twenty five patients underwent ERCP for evaluation and treatment of CBD stones. Mean age was 45 years with female to male ratio of 1.9: 1. Out of 225 patients, cannulation failed in 4 cases due to duodenal stenosis and 154 [70%] out of 221 cases of CBD stones mandated endoscopic treatment with balloon trail, basket extraction, placement of plastic biliary stent temporarily or use of mechanical lithotriptor. Duct clearance was achieved in 67% cases. Complication rate has been 9% with bleeding being the most common complication with no mortality. A duct clearance rate of over 67% was achieved with sphincterotomy combined with balloon trail, basket extraction and lithotripsy. Bleeding was the most common procedure- related complication. Very large CBD stones/ Mirrizi syndrome cases were referred for surgical intervention

Comparative efficacy of intravenous methylprednisolone versus intravenous hydrocortisone in acute severe asthma

To compare the efficacy of intravenous methylprednisolone versus intravenous hydrocortisone in acute severe asthma It was a quasi-experimental interventional study, conducted on 60 patients of acute severe asthma, presenting to the emergency department of MH Rawalpindi. Military Hospital Rawalpindi from Jan 2001 to Dec 2002. Patients fulfilling the criteria were divided into two groups of 30 patients each by convenience sampling. Group-I received intravenous methylprednisolone sodium succinate 125 mg as a single dose within half an hour of admission while group-2 received intravenous hydrocortisone 200 mg bolus followed by three doses of 100mg at six hours interval for next 24 hours. In addition, both the groups received nebulized salbutamol 2.5 mg diluted with 5 ml of distilled water at an interval of 30 minutes for first hour then 4 hourly along with oxygen at a rate 4-5 liters /minutes. Pulse rate and peak expiratory flow rate [PEFR: best of three attempts] were recorded on admission and subsequently at interval of six, twelve, eighteen and twenty-four hours of admission. Significant improvement in pulse rate was defined as its fall below 100 per minute and that of PEFR as its rise above 65% of predicted. Out of sixty patients, 41 were males and 19 were females. Their mean age was 38 years [range 19-50 years]. Significant improvements in pulse rate and PEFR were noted at interval of 24 hours in both groups, and this improvement was more marked in gropu-2. Target reduction [< 100/minute] in mean pulse rate was seen in 70% of patients in group-2 versus 26.7% in group-1. Target mean PEFR [> 65% of predicted] was achieved in 86.7% [group-2] and 40% [group-1]. The differences of mean pulse rate and PEFR at 24 hours were statistically significant. Intravenous hydrocortisone is more effective than intravenous methylprednisolone, at the dosages selected, in setting of acute severe asthma

Cigarette smoking among Pakistan army soldiers

To evaluate frequency, intensity and other characteristics of cigarette smoking in army soldiers. Various army units stationed at Multan Garrison. This is descriptive cross sectional study, in which one thousands male soldiers from various army units [both fighting and supporting arms] were randomly selected to fill the questionnaire. Nine hundred and eighty six responses were included in study and rests were discarded in view of inappropriateness. Among responders, 470 [47.6%] were smokers. Frequencies of occasional, mild, moderate and heavy smoking were 11.9%, 14.8%, 10.7% and 10.2% respectively. Twenty one percent were smokers prior to joining army while 26.6% picked up this habit after induction. According to age 84.3% were less than 40 years of age while remaining 15.7% were above 40. The respective frequencies of smoking in these two age groups were 49.3% and 38.9% [p<0.05]. The 56.7% of under-metric soldiers were smokers in comparison with 35.8% of over-metric [p<0.05]. Frequency of smoking was 52.2% among unskilled soldiers while it was 33% in skilled soldiers [p<0.05]. It was slightly higher among fighting units [52.3% vs. 47.7%]. The job related stress and peer pressure were major risk factors for initiation of smoking. Almost all smokers wanted to quit and significant number of smokers reported that had tried to quit smoking at least once in the past. Smoking frequency is quite high among army soldiers particularly among unskilled and less educated and there is strong need to address this issue