Non-invasive investigations in heroin users and non-users - a case control study

Objective: To compare heroin users with their age and gender matched relatives as regards non-invasive investigations like chest x-ray, electrocardiography [ECG] and 2D-echocardiography

Study Design: Case control study

Place and Duration of Study: Armed Forces Institute of Cardiology-National Institute of Heart Diseases, Rawalpindi, from Feb 2010 to Jul 2010

Material and Methods: Sixty one heroin users [cases] and their 100 non-substance abuser age and gender matched relatives [controls] were included through non-probability consecutive sampling. Chest x-ray [CXR], 12-lead electrocardiography [ECG] and two-dimensional echocardiography [2D-ECHO] were done of each one and the result was interpreted by respected consultants. The data were analyzed on SPSS version 15. Descriptive statistics of mean and standard deviation [SD] were described for quantitative variables while frequency and percentages for qualitative variables. Independent samples t-test compared quantitative variables while for qualitative variables chi-square test was used. Ninety five percent confidence intervals were calculated for all variables

Results: Statistically significant differences were noted between cases and controls as regards chest X-ray. A total of 10% cases had findings consistent with tuberculosis [TB] as compared to 3% controls [p=0.045]. There was however no cardiac abnormality in any study subject. Significant 12-lead ECG findings other than normal were noticed in 12 [19.7%] heroin users as compared to 10 [10%] controls [p=0.083]. In 12 lead ECG, the predominant finding was t wave inversion in leads AVF and III. According to 2D-echocardiography [2D-echo] reports, 15 [24.6%] heroin users [cases] and 17 [17%] controls had abnormal findings [p=0.242]. We report no vegetations on any cardiac valve

Conclusion: On radiological and cardiac parameters, heroin users are a different population as compared to the non-heroin users. The knowledge about variations on non-invasive investigations not only helps the healthcare workers to optimize treatment regarding rehabilitation but also facilitate diagnosis and treatment

Research design and statistical error of articles submitted in a public sector medical journal - a retrospective survey

Objective: The objective of this study was to identify the quality of statistical procedures used, the accuracy of study design, sampling and relevant statistical analysis

Study Design: Retrospective Survey study

Place and Duration of Study: Army Medical College from June 2014 to Jan 2015

Methodology: Three hundred and forty two original research articles published in Pakistan Armed Forces Medical Journal were reviewed. The selected research articles were all original articles. Case series and case reports were excluded

Results: Among 342 articles, the major error was that the objectives, results and conclusion were not in accordance with each other in 115 [33.6%] articles. In 48 [14%] articles study design was incorrect and does not matched with the objectives. In 26 [7.6%] articles sample size was not appropriate as per the guidelines of journal. In 12 [3.5%] articles sampling technique used for sample selection was not mentioned. In 62 [18.1%] articles type of variables was incorrectly defined. In 6 [1.8%] articles descriptive statistics were not given at all. In 13 [3.8%] articles inferential statistics were not given articles. In 60 [17.5%] articles figures and tables were either not given or if given were incorrect. The pattern of statistical errors was almost similar in different years with a little bit difference but that difference could not attained any statistical significance [p = 0.460]

Conclusion: In order to maintain the standards of the medical writing in research with authentication the teaching of statistical methods should be enhanced

Validation of the Seattle heart failure model [SHFM] in heart failure population

To determine the effectiveness of Seattle Heart Failure Model [SHFM] in a Pakistani systolic heart failure cohort in predicting mortality in this population. Cohort study. The Armed Forces Institute of Cardiology - National Institute of Heart Diseases, Rawalpindi, from March 2011 to March 2012. One hundred and eighteen patients with heart failure [HF] from the registry were followed for one year. Their 1-year mortality was calculated using the SHFM software on their enrollment into the registry. After 1-year predicted 1-year mortality was compared with the actual 1-year mortality of these patients. The mean age was 41.6 A +/- 14.9 years [16 - 78 years]. There were 73.7% males and 26.3% females. One hundred and fifteen patients were in NYHA class III or IV. Mean ejection fraction in these patients was 23 A +/- 9.3%. Mean brain natriuretic peptide levels were 1230 A +/- 1214 pg/mL. Sensitivity of the model was 89.3% with 71.1% specificity, 49% positive predictive value and 95.5% negative predictive value. The accuracy of the model was 75.4%. In ROC analysis, AUC for the SHFM was 0.802 [p < 0.001]. SHFM was found to be reliable in predicting one-year mortality among patients with heart failure in the Pakistani patients

Validity of total leucocytes count and neutrophil count [differential leucocytes count] in diagnosing suspected acute appendicitis

To compare the diagnostic accuracy of Total Leucocytes Count [TLC] with Neutrophil count; Differential Leucocytes Count [DLC] in diagnosing cases of suspected acute appendicitis. Validation study. Department of Surgery, Combined Military Hospital [CMH] Rawalpindi, from April 2008 to October 2008. A total of 100 patients of Pain right iliac fossae who underwent appendicectomy were included. Detailed history of all the patients was taken for pain in right lower abdomen, its severity, its nature, relieving or provoking factors. Clinical examination was done in detail. Total and Differential Leucocytes Count was done. Every patient's appendix was examined grossly after appendicectomy for evidence of appendicitis. Diagnostic measures of TLC and DLC were calculated by standard formulas. Sensitivity and specificity of TLC is 86.9% and 81.25% respectively and that of DLC is 82% and 68.75% respectively. Accuracy was 86% for TLC and 80% for DLC. TLC is more sensitive, specific and accurate test as compared to DLC and it should be used as diagnostic aid for suspected acute appendicitis cases.