Gall stones: a fundamental clinical review

Formation of stones in the gall bladder is known as cholelithiasis. About 10% to 20% of Western population are suffering from gall stones and this percentage is increasing day by day. Biochemically gall stones are classified into black pigment stones, brown pigment stones and cholesterol stones. Gall stones can be anatomically located at two possible sites; in the gall bladder known as cholelithiasis and in the common bile duct known as choledocholithiasis. Gall stones may present with symptoms known as symptomatic gallstones or without symptoms known as asymptomatic gallstones. The major causes of gallstones are high cholesterol diet, low bile salt levels, decreased gall bladder motility etc. Obesity, female gender, family history, rapid weight loss and vitamin B12 or folic acid deficiency are considered as important risk factors in the development of gall stones. The clinical presentations include acute cholecystitis and febrile illness with pain and tenderness in the right upper quadrant (Murphy sign). Generalized body weakness and weight loss are considered as generalized symptoms of gallstones. The complications include cholangitis, empyema of gall bladder, pancreatitis, abscess formation, porcelain gall bladder and gall bladder perforation. The differential diagnosis of gall stones is carried out based on endoscopy, ALT and AST serum levels. Non-surgical treatment for gall stones is oral dissolution therapy. The standard surgical treatment for gall stones is cholecystectomy.

Duration of in-hospital cardiopulmonary resuscitation and its effect on survival

Objective This study aims to determine the correlation between the duration of cardiopulmonary resuscitation (CPR) and the return of spontaneous circulation (ROSC) in an in-hospital cardiac arrest cohort. Methods All patients (age ≥ 17 years) who underwent CPR at our institution from 2015 to 2017 were included. The primary endpoint was ROSC or death. A total of 88 patients were included in the study. The Pearson correlation of CPR duration with the establishment of ROSC was calculated using the IBM SPSS, version 25. Results In all, 88 patients who received CPR, 55% (n = 48) experienced ROSC and survived. The remaining 45% (n = 40) of the total and 56% (n = 27) of those with ROSC died during the same hospitalization (Fig. 1). Among the 48 patients with ROSC, the documented duration of their CPR was about 10 min on average in comparison with 27.5 min CPR for patients who did not achieve ROSC (Fig. 2). Among all the patients, there was a negative correlation between the duration of the CPR and the establishment of ROSC. This is shown in Fig. 3. Conclusion Our study shows that CPR duration is inversely associated with the establishment rates of ROSC. Most of the benefits of CPR can be achieved in the first 15 min, and a further increase in the duration of CPR provides a minimal gain. Still, survival was achievable till 38 min in some cases, and the ideal duration of resuscitation should remain a bedside decision taking into consideration the whole clinical picture.

Prevalence of diabetic retinopathy in Pakistan: a systematic review

Objectives: Primary aim was to review the literature on the prevalence of diabetic retinopathy [DR] and Vision threatening diabetic retinopathy [VTDR] in Pakistan

Methods: A search of the bibliographic databases [Medline, Pub med, and Google scholar] was conducted from 1990 to March 2017. Articles about prevalence of DR and VTDR in Pakistan were retrieved and scrutinized. The studies satisfying the inclusion/exclusion criteria were considered for detail review

Results: Forty one articles on prevalence of DR were traced out. Exclusion and inclusion criteria were met in 29 studies. In selected studies [29], pooled Prevalence of DR was found to be 28.78% with a variation of 10.6% to 91.3%. Out of 29 studies, DR was classified in 19 studies. Pooled Prevalence of VTDR in these 19 studies was found to be 28.2% [variation of 4% to 46.3%] of patient with retinopathy and 8.6% of all diabetics

Conclusion: A great variation in the values of DR and VTDR was observed in this study. Researchers suggest a community based study with uniform methodology to find out a comparable value of prevalence of DR and VTDR in all provinces of Pakistan

Frequency of atrial fibrillation in chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease [COPD] is a common disease reported to Pulmonology wards and outdoors. Cardiac complications especially atrial fibrillation are common and add to overall morbidity and mortality

Objective: To determine the frequency of atrial fibrillation in patients of chronic obstructive pulmonary disease [COPD]

Methodology: This was a cross sectional study carried out at pulmonology ward of Sheikh Zayed Hospital, Medical College Rahim Yar Khan from 1[st] July 2016 to 28[th] February 2017. In this study, 111 patients having COPD were included. Detailed demographic and co morbid conditions like DM and HTN was taken. These cases then underwent ECG and atrial fibrillation was identified. The data was entered and analyzed by SPSS version 21

Results: In this study, total 111 patients were enrolled out of which 94 [84.7%] were males and 17 [15.3%] were females with mean age of 58.16+/-9.94 years. There were 7 [6.3%] cases that has DM and 22 [19.8%] cases has Hypertension. Atrial fibrillation was observed in 16 [14.41%] patients. Atrial fibrillation was seen in 4 [25%] out of 16 cases with DM [p= 0.07]. Among hypertensive patients it was seen in 8 [50%] out of 16 cases with significant p value of 0.001. There was no significant difference in terms of gender and different age groups with p value of 0.27 and 0.17

Conclusion: Atrial fibrillation is commonly seen in cases of COPD and is significantly higher in cases that has concomitant hypertension

Aggravating factors of hepatic encephalopathy in patients with chronic liver disease: our experience at teaching hospital in southern Punjab, Pakistan

Background: Multiple aggravating factors can complicate a case of chronic liver disease, leading to hepatic encephalopathy

Objective: To enlist aggravating factors of hepatic encephalopathy in patients with chronic liver disease

Methodology: This cross sectional study was carried out at Sheikh Zayad Hospital Rahim Yar Khan, from 1[st] April to 31[st] December 2016. Convenient sampling technique was used in this study and 50 patients with hepatic encephalopathy who came for consultation included in this study. The detailed medical history was asked to fill in specially designed forms

Results: 50 patients with hepatic encephalopathy were included in this study. 35 [70%] were men and 15 [30%] women. The patient's age ranged from 35-65 years. Mean age of the study subjects was 46.45 +/- 5 years. The most common aggravating factor was infection in 42 [85%] of cases; Spontaneous bacterial peritonitis [SBP] in 33[65%] and 9 [19%] patients with urinary tract infections [UTI]. Other causes were dehydration 19[37%], constipation 15 [30%] and 13 [26%] patients with gastrointestinal bleeding. Two or more risk factors were present among 29 [58%]

Conclusion: Infection, especially spontaneous bacterial peritonitis, is a commonest aggravating factor of hepatic encephalopathy; followed by dehydration, constipation and gastrointestinal bleeding in this study

Knowledge and practices among mothers regarding weaning practices, visiting pediatric outpatient department Bahawal Victoria Hospital Bahawalpur

Background: Weaning is defined as addition of foods in the infant's diet other than mother's milk and slowly lessing mother's milk. WHO recommends and emphasize on breast feeding for the first four to six months for full term healthy child by a healthy mother

Objective: To evaluate the knowledge and practices of lactating mothers of infants regarding weaning

Methodology: This cross-sectional study was conducted at pediatric outpatient department of Bahawal Victoria Hospital Bahawalpur from 1[st] February to 30[th] April 2016.The non - probability convenience sampling method was used to get data from 75 lactating mothers attending outpatient department with their infants, and data regarding weaning knowledge and practices was noted. Data was analyzed by SPSS 21 and all results were shown in the form of tables, frequencies and percentages

Results: In the present study, 70% of mothers were 20 to 29 years of age, all were housewives, 30% were educated at 10[th] grade, and 75% lived in the combined family system, age range was 4-6 month, in 65% of mothers. Overall 48% used home-made weaning diet, 34% used mixed homemade and commercially refined diets, while 18% used only commercially prepared diets. Breastfeeding was sustained during and after weaning, in 68% mothers

Conclusion: This study showed that only two third mothers started weaning at 4-6 months, and half of mothers used home mad diet. Mothers must be educated about the importance and effectiveness of weaning, age at which weaning starts and the types of weaning diets. This can be achieved through the use of LHWs, LHVs and mass media as communication. The importance of continued breastfeeding after weaning should be emphasized

Comparison of exercise tolerance tests and thallium 201/MIBI scan in the diagnosis of ischemic heart disease

Coronary artery disease is one of the commonest causes of death throughout the world. Despite impressive study in diagnosis and management over the last three decades acute myocardial infarction [AMI] continues to be a major public health problem in the industrialized world. To compare the sensitivity and specificity of ETT alone and stress MIBI scan for the diagnosis of coronary artery disease. The study was started in year 2000. Fifty patients were randomly selected. They were referred from the outpatient departments of general medicine and cardiology of Nishtar Hospital, Multan. Fifty patients were included in my study. Out of these 37 [74%] were males and 13[26%] were females. Out of 50, 37[74%] patients showed positive ETT. Among these patients, 30[81%] were male and 7 [19%] were females. Among 21 hypertensives, 17 [81%] patients showed positive ETT. Out of these 17 patients, 14 [82%] patients were male and 3[18%] were females. It is concluded the same observation that radiopharmaceutical scans is better tool for the diagnosis of coronary artery disease

Prevalence of Hepatitis B surface antigenaemia amongst nursing staff of tertiary care hospital

The main object of study was to find out the number of positive cases of hepatitis B virus amongst nursing staff working in Nishtar Hospital Multan. This descriptive study was conducted in Nishtar Hospital, Multan. A total 136 staff nurses were included in the study. The prevalence of Hepatitis B among staff nurses of Nishter Hospital Multan According top the study was [2.20%]. The prevalence of Hepatitis B antigenemia in staff Nurses of Nishtar Hospital Multan According to the above study was 2.20%. 18 of the total 154 staff nurses were vaccinated against Hepatitis B infection. The prevalence rate was lower in comparison with the other studies