Cerebral salt wasting: a report of three cases

Hyponatremia secondary to the Syndrome of Inappropriate Anti-Diuretic Hormone [SIADH] secretion is commonly observed in patients with various neurological disorders. Cerebral Salt Wasting [CSW] resulting in hyponatremia is also an infrequent occurrence in some patients with neurological disorders. Confusion in differentiating CSW from SIADH may arise since both results in similar electrolyte disturbances. Herein, we report three cases of CSW with intracranial afflictions. CSW was diagnosed on the basis of fractional excretion of urinary sodium and uric acid along with extremely low serum uric acid. Improvements in serum sodium levels after saline hydration and fludrocortisone administration further supported the diagnosis

Etiology and epidemiology of patients presenting with liver disease during pregnancy

We conducted this study to elaborate the etiology and epidemiology of liver diseases presenting during pregnancy. It was a prospective, observational study. This study was conducted in the Department of Gastroenterology, Fatima Memorial Hospital in collaboration with the Department of Obstetrics and Gynaecology from June 2011 -May 2013. 73 patients were evaluated. Data was evaluated for quantitative and qualitative variables. Outcome of mother, pregnancy and neonates was also recorded were available. During the study period 73 pregnant patients were evaluated for the presence of liver disease giving an incidence of 3.6%. The mean age of the patients was 26.3 +/- 3.8 [median: 26, range: 16 - 45] years. The patients presented at a mean gestational age of 5.8 +/- 2.4 [median: 6, range: 1- 9] months. The mean STB and ALT levelswere 11.5 +/- 8.5 [median: 9.3, range: 1.4 - 48] mg/dL and 943.5 +/- 887.4 [median: 765, range: 13 - 4810] IU/Lrespectively. The mean duration of jaundice and mean hospital stay were 6.82 +/- 5.32 [median: 5, range: 2 - 30] days and 5.6 +/- 2.7 [median: 5, range: 1-18] days. Fulminant hepatic failure was seen in 6.8% of the patients. Acute Hepatitis E was the most frequent diagnosis in our population. Maternal deaths were seen in 8.2%, foetal deaths were seen in 12.3% and neonatal deaths in 6.5%. Liver diseases during pregnancy can have multiple causes and may predict poor outcomes for the patients and neonates

Diabetic patients; clinical profile with endstage renal disease on haemodialysis

To study the clinical profile of diabetic patients on haemodialysis with a view to identify common clinical features and the trend of compliance with treatment and follow up. Haemodialysis unit Fatima Memorial Hospital, Lahore, from January to August 2011. Method: Data collected from all patients above 14 years of age through medical history, record, examination and fundoscopy. Out of total 76 patients on haemodialysis 50[65.7%] had DM and of these 42[84%] also had hypertension. Among diabetics 28 [56%] were male and 22 [44%] female. Mean age was 56.68 +/- 9.09. Among these 15[30%] were illiterate and 27 [54%] belonged to lower social class. Ever smokers were 18[36%]. Mean duration of diabetes since diagnosis was 10.9 +/- 5.99. Mean duration of hypertension 8.28 +/- 8.07, Duration of onset of dialysis 6 months to 8 years with mean 2.16 +/- 1.47. Retinopathy was found in 29[58%], 18[36%] had diabetic and 11[22%] had hypertensive changes. Both fasting and random blood sugar levels were monitored by 28 [56%]. None had regular follow up with HbA1c levels or urine for protienuria prior to onset of haemodialysis. Compliance with dietary advice and treatment claimed by 24[48%] and 36[72%] respectively. History of intake of Hakeem and homeopathic medications was found in 16[32%] and 10[20%] respectively. 65.7% of ESRD were diabetics. Majority were in 6th decade of life. Retinopathy was present in 58%. Low trend was observed towards compliance with treatment and follow up

Morbidity associated with obesity in pregnancy

Obesity is associated with increased risk of illness and disability. It is one of the leading preventable causes of death in the World. Major maternal complications associated with obesity include diabetes mellitus, hypertension, deep vein thrombosis, respiratory diseases, infections and birth defects and even decreased fertility. Economic consequences of obesity are operative delivery and its complications, prolonged hospital stay. 1. To review maternal and fetal morbidity associated with obesity. 2. To observe the mode of delivery in obese pregnant female. Observational study [cross section]. This study was conducted at Khair-un-Nisa Hospital affiliated with Fatima Memorial Hospital from April 2011 to October 2011. 60 patients were enrolled in this study. Women with BMI more than 30 were included in our study. BMI was calculated by pre-pregnancy weight or weight during first trimester at booking within outpatient department. Patients with history of chronic hypertension, diabetes mellitus were not included in the study. The prevalence of obesity is increasing in our young population. In this study mean age is 30 years +/- SD 91.25. Most of the patients had BMI 33 +/- SD 2.80. Hypertension, diabetes, urinary tract infection 18.33%, congenital abnormalities 16.7%. Most of the patients ended on LSCS 30.5%, wound infection noted in 11 patients 18.3%. During normal vaginal delivery 4 patients 6.7% had third degree prenieal tear and 11 patients had post-partum hemorrhage. Fetal complications were birth asphyxia in 8 [13.3%] neonates and shoulder dystocia in 2 [3.3%] babies. Obesity is a public health problem because of its prevalence, cost and health effects. Maternal obesity carries significant risk for mother and fetus. Risk increases with degree of obesity. Feto-maternal morbidity associated with it, can be prevented by creating awareness and preventing overweight and obesity in adults and children

Thrombocytopenia and platelets transfusion in Dengue fever

This study was done to see how much prevalent is thrombocytopenia and need and indications of platelets transfusion in patients with dengue fever in our community hospitals, This study was done from I[th], September 2010 to 15[th], November 2010 in three different hospitals, two were urban and one was rural and all three were tertiary care hospitals, Our study was based on 200 patients who were serologically confirmed cases for Dengue fever [IgM +ive] and had symptoms and signs of dengue fever for more than four to seven days at the time of admission. Clinical data reports of hematological investigations, platelets requirements, and data obtained from daily follow up, were analyzed. There were 200 serologically confirmed Dengue fever patients, among them 176 were males, 24 females, 183 patients were urban and 17 were rural patients. Thrombocytopenia was found in 174 [87%] on the day of admission. Among them 48 [24%] patients had platelets count in between 20, 000 to 40, 000/cumm, 46 [23%] had platelets count <20, 000/cumm, and 4 [2%] had platelets count <10, 000/cumm. Patients having platelets count <20, 000/cumm all have hemorrhage manifestations. Out of 48 [24%] patients having platelets count in between 20, 000 to 40, 000/cumm, 21[43%] had hemorrhagic manifestations. 98[49%] patients were given platelets transfusion. None of these patients got platelets transfusion with platelets count above 40, 000/cumm. 27 patients received platelets therapy inappropriately [platelets count < 40, 000/cumm with no hemorrhagic manifestations. There was only 2 mortality in these patients. Our study suggests that bleeding occurs more often in patients with severe thrombocytopenia [platelets count <20, 000/cumm] and these patients need urgent platelets transfusion. Patients having platelets count in between 20, 000-40, 000/cumm are at moderate risk and these patients require platelets transfUsion if they have hemorrhagic manifestation. Platelets count above 40, 000/cumm are at low risk and no need of platelets transfusion in these patients, only these patients need careful monitoring

Renal outcome in patients with pre-eclampsia and eclampsia at presentation, three and six months postpartum

To assess the natural history of Renal Disease in patients with Pre-eclampsia or Eclampsia. It was an observational study. This study was conducted simultaneously at two tertiary care hospitals: Fatima Memorial Hospital, l.ahore and Bhatti International leaching Hospital, Kasur from March 2009 to January 2011 women presented with pre-eclampsia or/ and eclampsia were consectively selected for the study fulfilling the inclusion criteria. A total number of 220 patients were eniolled in this study. All parameters required f'or the study were done carefully as blood pressure, proteinurla, renal function tests, urinary creatinine, weight, primary or multiparous, any previous history of pre-eclampsia. These parameters are checked at three and then six months post delivery. Among 220 patients, 140 [63.6%] were primigravida and 80 [36.4%] were multigravida. Blood pressure was from 140/90 to 210/110mmHg average blood pressure was 175100. 195 [8863%] patients had deranged renal function tests and 215 [97%] patients had protelnuria >2+. At Three months post-delivery 151[68.6%] patients achieved normal blood pressure and 190[86.3%] had normal serum creatinine i-e < 1.4. At six months 161 [73.8%] got adequate control of blood pressure, 59 [26.81%] had blood pressure > 140/90. Serum creatinine became in normal range in 195 [88.63%]. Acute renal failure was observed in 6 patents who weie put on renal replacement therapy

Training of non-physician practitioners to identify and refer diabetic patients

To improve the practices of non-physician practitioners on early diagnosis and referral of patients with diabetes mellitus. Study will be conducted in a peri-urban village community in Lahore, Pakistan, during 2007 - 2008. Quasi - experimental study, one group before and after design was used to document the effect of training of non-physician practitioners on improving their diabetic patient identification practices and referral to the hospital for diagnostic and treatment facilities. Fasting blood glucose test was used to identify hyperglycaemics out of those referred by the NPPs. Patient referral was increased by 48.44% after training. Identification of hyperglycaemic patients on the basis of signs and symptoms was 47% before and 48% after training and the difference between two proportions was not significant. increased number of referral showed motivation of NPPs towards the task however more prolonged and structured training program is required to utilize their services in community as part of our health care delivery system