Frequency of spontaneous bacterial peritonitis in hospitalized patients with cirrhosis and hypoalbuminemia

Background: Spontaneous bacterial peritonitis [SBP] is one of the complications in patients of cirrhosis. These patients when exposed to infection are likely to develop SBP. Various studies refer its frequency to around 30%, yet no study has estimated its frequency in hospitalized cirrhotic patients with serum albumin <3.5 g/dl

Objectives: To find out the frequency of SBP in hospitalized patients with cirrhosis and hypoalbuminemia

Methodology: This cross sectional study was conducted in Medical wards of Mayo hospital, Lahore from August 2010 to January 2011. A total of 110 cirrhotic patients recently hospitalized and having serum albumin < 3.5 g/dl in their initial investigations were investigated. Relevant history, examination and investigations were carried out and recorded in the proforma

Results: Of 110 patients under study, 60 were males[54.5%] and 50 were females[45.5%]. Total 54 patients [49.1%] had SBP. Patients having SBP were older [52.6 +/- 12.8 years] compared to others [45.4 +/- 10.2 years]. Among those having SBP, 38[70%] patients were > 40 years of age. The mean ascitic fluid white cell count in SBP patients was 884 +/- 260 cells/uL versus 236 +/- 108 cells/uL. The mean neutrophil count in ascitic fluid was 643 +/- 181 cells/uL versus 137 +/- 65 cells/uL. HCV was the commonest etiology of cirrhosis 59 [54%], HBV in 29 [26%], combined HBV and HCV in 10 [9%], and non-viral in 12 [11%]

Conclusion: SBP is a common complication of cirrhosis and its frequency is higher in those cirrhotic patients who also have hypoalbuminemia [<3.5gm/dl]

Evaluation of performance of basic life support and clinical skills among interns in mayo and allied hospitals of king Edward medical university, Lahore

Training of medical students on basic life support and clinical skills is an important part of under graduate medical education. Teaching hospitals can provide these skills efficiently. To compare the performance of basic life support and clinical skills among trained and non-trained medical graduates, working as interns in Mayo and Allied Hospitals of King Edward Medical University. Study type settings and duration: Cross sectional study conducted in the Department of Medical Education, King Edward Medical University, Lahore from May 2010 to April 2011. A total of 227 medical graduates [academic year of 2010] were trained for basic life support of child and adult, neonatal resuscitation, airway opening maneuvers, endotracheal tube insertion and aseptic techniques. They were divided into two groups; group A consisted of 125 King Edward Medical University graduates who, as students were trained in above mentioned skills and now as interns, were working in emergency and intensive care units of Paediatrics, Neonatology, Medicine, Surgery and Gynecology and Obstetrics of Mayo and Allied Hospitals of King Edward Medical University. Group B consisted of 125 interns who graduated from other medical schools, and had not learnt above mentioned skills as undergraduate students. Interns of both the groups were interviewed using a structured questionnaire for importance of learning the skills at undergraduate level and performance of above mentioned skills as an intern. Study group A was also interviewed about grading the skills that they learnt as undergraduate students. Data was entered in SPSS 17. Chi square test was applied to compare the performance of the skills while, logistic regression analysis was done to calculate odds ratio and 95% confidence interval. In group A, 74[59%] interns performed basic life support for child and adult well. Almost 79[63%] performed neonatal resuscitation, 63[50%] airway opening maneuvers, 37[30%] endotracheal tube insertion and 91[73%] aseptic techniques well. In group B, 98[78%], 120[96%], 104[83%], 117[94%], and 81[65%] interns were unable to perform above mentioned skills respectively. The difference between the groups was statistically significant for all the skills. Training of basic life support and clinical skills' courses at undergraduate level can result in better performance of these skills in their practical life

Validity of rockall scoring system in determining in-hospital rebleeding among cirrhotic patients with acute esophageal/gastric variceal hemorrhage using endoscopy as gold standard

The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Rockall scoring system primarily developed for patients with non variceal source of bleeding

Objective: To determine the validity of Rockall scoring system in determining in-hospital re-bleeding among cirrhotic patients with acute esophageal/gastric variceal haemorrhage using endoscopy as gold standard. The study was conducted in Allied hospital and Liver Centre Allied/DHQ Hospitals, Faisalabad

Study Period: Study was carried out from 28-06-2010 to 27-12- 2010

Patients and Methods: Total 176 cases were include in this study. The subjects were scored using Rockall scoring system and placed under observation for re-bleed in 10 days

Results: The mean age of patients was 50.99 +/- 12.47 years. Out of 87 positive cases on Rockall score, 82 cases were true positive. Out of 89 cases, that were negative, 81 were true negative. Sensitivity, Specificity and diagnostic accuracy of Rockall score was found to be 91.1%, 94.1% and 92.6%, respectively. Positive predictive value [PPV] of Rockall score was 94.2% and negative predictive values [NPV] was 90.0%

Conclusion: The risk scoring system developed by Rockall and coworkers is a clinically useful scoring system among cirrhotic patients with acute esophageal/gastric variceal haemorrhage

Effect of fluvastatin on dyslipidaemia associated with type 2 diabetes mellitus

Type-2 diabetics suffer from lipid abnormalities. Even though these are mild in most patients, they contribute to the increased cardiovascular morbidity and mortality seen in this disease, especially in South Asians. We report the effect of HMGCoA reductase inhibitor, FLUVASTATIN in lowering lipid levels in type 2 diabetes mellitus in urban Pakistanis from Punjab. Such data does not exist before. Type 2 diabetes with stable disease were entered into the study if the level of lipids remained elevated following period of 8 weeks on diet placebo oral medications. They entered into the next phase [week 0] only if they demonstrated a persistently raised total cholesterol [250 mg/dl] despite the lipid lowering diet. In phase 2, the subjects received FLUVASTATIN 40 mg per day for twelve weeks, lipid levels were estimated at week 0, 6, 12. Monitoring for side effects both clinical and biochemical, was carried out. 50 out of 85 patients were found to have a total cholesterol of less than 250 mg/dl after 8 weeks on a lipid-lowering diet. 35 patients [9 male, 26 female] entered phase two. Their mean age was 46.7 years and mean body mass index 28.6 kg/m[2]. After 12 weeks of treatment with FLUVASTATIN there was no change in fasting blood glucose. However mean total cholesterol was reduced from 313.3 mg/dl to 233 mg/dl [-34.3%]; LDL cholesterol fell from 185.2 mg/dl to 160.6 mg/ dl [-15.4%]. The mean HDL cholesterol level increased from 46.6 mg/dl to 56.1 mg/dl [+17.2%]. Side effects were insignificant. FLUVASTATIN effectively and safely lowers total cholesterol, LDL cholesterol, triglycerides in urban Pakistanis suffering from type 2 diabetes mellitus, presenting at Mayo Hospital, diabetic clinic. It also increases the level of HDL cholesterol