Diagnostic validity of leukocyte esterase dipstick test for diagnosis of spontaneous bacterial peritonitis in cirrhotic patients

Spontaneous bacterial peritonitis [SBP] is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis [SBP] is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate, so early diagnosis and treatment of SBP is therefore necessary for survival. Leukocyte esterase dipstick test can rapidly diagnose the SBP. Objectives were to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis. This cross-sectional, validation study was conducted from January 2009 to June 2009 at Medical Unit-II, Chandka Medical College Hospital Larkana. All the Patients with cirrhosis and ascites of either gender were included in this study. Paracentesis were performed on admission. The ascitic fluid obtained at bedside was immediately tested with reagent strip Multistixregistered 10 SG. Ascitic fluid was then analysed for PMN cell count. The result of reagent strip was compared with ascitic fluid PMN cell count for determination of sensitivity, specificity, PPV and NPV of the test, while taking ascitic fluid PMN count >/= 250/mm[3] as standard for diagnosis of SBP. Leukocyte esterase dipstick read positive from +1 to +3 reaction while negative and trace reaction regarded as negative test result. Total ninety four patients were enrolled in this study. Ninety-four Ascitic fluid samples were obtained. SBP was diagnosed in 52 [55.3%] patients, 42 [44.7%] patients were negative for SBP by manual cell count. The sensitivity, specificity, PPV, NPV of leukocyte esterase dipstick test to diagnose SBP were 92%, 95%, 96%, 90% respectively. The leukocyte esterase dipstick test can be used as rapid test for diagnosis of SBP due to its high diagnostic validity

Ethambutol induced histological changes in optic nerve of rabbit

Objectives: Ethambutol [EMB] induced ocular toxicity The current study was designed to check the ethambutol [EMB] induced histological changes in optic nerve of rabbit

Study Design: An experimental Randomized Control Trial [RCT]

Place and Duration: The study was conducted in the experimental research Laboratory of University of Health Sciences, Lahore from January 2009 to December 2009

Material and Method: Ten, New Zealand white, albino rabbits of either sex, 6-12 month old, weighing 1- 2 kg were randomly divided in to two groups comprising five animals in each. Group A served as control, while Group B was given ethambutol 100 mg/kg/day for four weeks. At the end of experimental period, each animal was sacrificed under chloroform and both optic nerves along with chiasma were taken out and preserved. In this way, twenty optic nerve specimens [ten for each group] were collected from ten albino rabbits

Results: The histological study showed that optic nerves of group A were quite normal, while the histological preparation of group B showed decrease diameter of optic nerves and cytoplasmic vacuolations. Statistical analysis was done using Independent "t" test for measurement of diameter of optic nerve and counting the number of vacuoles. The results showed an immense vacuolations [p < 0.05] and decrease in diameter of optic nerve [p > 0.05] in the sections from group B as compared with that in the group A. However, there was no evidence of inflammatory changes and myelin-like structure in any preparation from the two groups

Conclusion: Ethambutol [EMB] induced histological changes produce vacuoles, representing damage to the optic nerve

Cornell product index for left ventricular hypertrophy. Does it perform better?

To determine the sensitivity and specificity of Cornell product index for left ventricular hypertrophy with reference to echocardiography. Descriptive study. Medical Unit 111, Jinnah Post-graduate Medical Centre Karachi. June 1998- February 1999. 50 patients with echocardiographic left ventricular hypertrophy [LVH] and 25 normal healthy persons without echocardiographic LVH were included in this study. All patients and control subjects were examined clinically and their ECGs were taken on that same day. Echo LVH was defined if Left Ventricular Mass Index exceeded 118 g/m2 in males and 104 g/m2 in females. Data was preserved and now it is analyzed for Electrocardiographic LVH in view of Cornell voltage and Cornell product index. Sensitivity and specificity was calculated by standard formula and P value derived by chi square test. 50 patients which were included in the study, 21[42%] were male and 29 [58%] were females; while 25 healthy persons without LVH, 12 [48%] were males and 13 [52%] were females. Cornell voltage criterion was having sensitivity of 48% as over-all, 48% in males and also 48% in females. It was 96% specific. Cornell product index was the higher sensitive criteria by scoringing 57% in males, 62% in females and 60% in all patients. Although electrocardiography is less sensitive than echocardiography, but can perform better in certain groups and with improved criterion. Cornell product criterion has the highest sensitivity as compared to other criteria

Frequency of aspirin resistance in patients with coronory artery disease in Pakistan

Aspirin resistance is an emerging clinical entity. However the data available on aspirin resistance in Asian population is scarce. This study was initiated to prospectively evaluate the frequency of aspirin resistance in patients with stable coronary artery disease [CAD] in Pakistan. A cross sectional prospective study was conducted in cardiology and hematology departments at Shifa International Hospital, Islamabad from January to December 2007. Two hundred and fifty patients were enrolled from cardiology out patient department having met the specific inclusion criteria. Details were entered on a pre-designed questionnaire and aspirin response assay was performed on IMPACT-R [Dia Med AG 1785 Cressier Morat, Switzerland]. Data was analyzed using SPSS V12. Aspirin resistance was observed in 12% of patients. 73.2% of study population were male and 26.8% were female, with a mean age of 57.2 years. There was no significant correlation of aspirin resistance with traditional risk factors like Diabetes Mellitus [DM], Hypertension or Dyslipidemia. 84% of Aspirin non responders were taking 75mg per day and 16% were on 150mg per day. A positive trend was noted between aspirin resistance and cigarette smoking. Aspirin resistance is a real phenomenon in Pakistani population with an estimated frequency of 12%. Large scale prospective randomized trials with long term follow up are needed to assess the impact of different doses and the clinical significance of this biochemical entity