Pattern of upper gastro intestinal malignancies in northern Punjab

To record the number of cases of carcinoma of stomach, geographical location and histological diagnosis presenting to a hospital in northern Punjab. This study was conducted at the department of medicine [GI unit] Fauji Foundation Hospital Rawalpindi. All the patients who underwent upper GI endoscopy and were found to have an upper GI malignancy on histopathology were reviewed for part of the gut involved. Patient demographics including age, sex, and place of residence, clinical presentation, and subsequent histologic diagnosis were recorded. During the study period, 302 cases of upper GI malignancy were seen at our institution, 83 [14.8%] were in patients 40 years of age or younger. Mean patient age was 58 years. The lesion was distal in 43%, proximal in 20% and 7% involved the entire stomach. In 9.8% of the cases, lesser curve was the site. The tumor was located in the upper third, middle third and lower third in 33, 22 and 34.6% respectively. The common presenting symptom in case of carcinoma of stomach was pain epigastrium. Dysphagia was the major subjective complaint in cases of esophageal carcinoma. The common malignant tumor in males was carcinoma of stomach and in females carcinoma of esophagus. Endoscopic screening in subjects suspected of upper gastrointestinal malignancy results in a significant yield of carcinoma. The gastric tumor in distal location [non cardia cancer] is still more common. Asian race is no different from other races as far as the ca stomach is concerned

Risk of development of chronic kidney disease in patients with type 2 diabetes having metabolic syndrome

To measure the relation of creatinine clearance in type-2 diabetic patients with different components of metabolic syndrome and to quantify the relationship of frequency of incident CKD with increasing number of metabolic syndrome components while controlling for age, gender and duration of diabetes. Cross-sectional descriptive study. Diabetes Clinic, Fauji Foundation Hospital, Rawalpindi, from January to August 2006. Patients having type-2 Diabetes for more than 5 years were enrolled. Information regarding age, gender, duration of diabetes, type of diabetes, treatment taking, complete fasting lipid profile, fasting blood glucose, Body Mass Index [BMI], 24 hours urinary proteins and creatinine clearance, co-existent risk factors like hypertension and ischemic heart disease was taken. Patients were divided into groups having one to all five metabolic syndrome traits. Progressive increase in the metabolic syndrome traits was compared with decline in creatinine clearance. Pearson correlation test and multiple logistic regression were applied to determine correlation with significance at 'r' and 'p'

Evaluation of risk factors of non alcoholic fatty liver disease [NAFLD] in a tertiary care hospital at Rawalpindi, Pakistan: a local experience

To document the frequency of risk factors for nonalcoholic fatty liver disease, such as gender, diabetes mellitus, hypercholestrolemia, hypertriglyceridemia, obesity and metabolic syndrome. This descriptive study was carried out at Department of Medicine Fauji Foundation Hospital Rawalpindi from January 2007 to December 2007 One hundred nonalcoholic patients with elevated ALT and negative viral serology and diagnosed as having fatty liver on ultrasound were evaluated for the presence of diabetes, hypercholestrolemia, hypertriglyceridemia, obesity and metabolic syndrome. Patients with suspected autoimmune hepatitis, hemochromatosis and Wilsons disease were excluded. The mean age was 45.39 years. Out of 100 patients, 63% were females and 37% were males. Sixty six percent patients were obese. Other risk factors included hypertriglyceridemia in 48%, diabetes mellitus in 34%, hypercholesterolemia in 28% and metabolic syndrome in 28% cases. Nonalcoholic fatty liver disease is associated with a high prevalence of obesity, hypertriglyceridemia, hypercholestrolemia, diabetes and female gender

Intrabiliary rupture of hepatic hydatid cyst: role of ERCP

We report a case of hepatic hydatid cyst presenting with obstructive jaundice following cholecystectomy. ERCP showed intrabiliary cyst rupture with biliary obstruction due to cyst remnants. Endoscopic sphincterotomy was performed and cyst debris removed with complete resolution of symptoms

Evaluation of knowledge and practices of foot care in patients with chronic type 2 diabetes mellitus

To evaluate the knowledge and practices of foot care in patients with diabetes mellitus and to stress upon the importance of such knowledge and practices in decreasing morbidity associated with diabetic foot disease. One hundred patients of either sex from three tertiary care hospitals with a 5 year history of Diabetes Mellitus were selected in this study and were asked to fill out a questionnaire about their knowledge and practices about daily foot inspection, foot cleaning, appropriate nail care, and use of footwear in the form of shoe material, open or closed forepart and nature of heel. Out of 100 patients [36 males and 64 females], 34% patients inspected their feet daily and 78% of the respondents knew about care of callosities, minor injuries and cuts, 52% of patients didn't know about correct technique of cutting nails. Eight [22.2%] male and 28 [43.8%] female patients were using open shoes while 24 [66.7%] male and 38 [59.4%] female patients had shoes with narrow forepart. Ten [27.8%] males were using shoes made of hard material as compared to 20 [31.3%] of female patients. Twenty two [34.4%] of our female diabetic patients were using shoes with high heel. Only 68% of the patients were on regular follow up. This simple quality initiative concludes the notion that patients with diabetes who are at risk for the development of diabetic foot ulcers should receive ongoing foot-specific patient education

Malignant hypertension in a patient with end of stage renal disease [ESRD] treated by renal transplant

Control of hypertension is often a problem in the management of end stage renal disease [ESRD]. Multiple modalities of treatment are required to prevent cardiovascular and cerebrovascular mortality and morbidity. These include fluid and salt restriction, multidrug regimes and dialysis. We report a case of young 25 years old patient, admitted with chronic renal failure, complicated by malignant and refractory hypertension, not responding to hemodialysis and antihypertensive agent. During stay in hospital, patient also had intracerebral hemorrhage, fits due to uncontrolled hypertension requiring ventilatory support followed. Renal transplant was considered to be the final therapeutic modality. After gradual recovery, a successful live-related renal transplant was performed. As soon as good graft was established, the blood pressure settled and 4 of the 5 antihypertensives were withdrawn. After 2 weeks, patient was discharged in a stable condition with a total stay of about 2 months

Acute confusional state; etiological spectrum

Objectives: The study was planned to work out the important organic causes of Acute Confusional State [ACS] in our population, so as to help in pointing out important and common causes of ACS in our setup thus helping to keep in mind different diseases while we are confronted with a patient of ACS. Study Design: A descriptive study was conducted at Military Hospital Rawalpindi to evaluate patients admitted with a provisional diagnosis of acute confusional state. One hundred adult patients were consecutively included in the study

Place and Duration: The study was conducted at Military Hospital, Rawalpindi. It spanned over the period of 07 months from Oct 2000 to Apr 2001

Subject/Methods: One hundred adult patients of both genders admitted with a provisional diagnosis of ACS, presenting within 48 hours of the onset of symptoms were consecutively included in the study. Patients were assessed on Diagnostic and Statistical Manual, 4[th] Edition [DSM-IV] classification of American Psychiatric Association [APA] and level of consciousness was assessed according to Glasgow Coma Scale. Detailed neurological and systemic examination was done. All the relevant investigations were done immediately including biochemical profile, Blood CP, Urine RE, ECG and Chest X-Ray Other important investigations like lumbar puncture, CT scan head and MRI etc were done where indicated

Results: The study showed that neurological lesions and metabolic encephalopathies accounted for about 70% of the cases followed by infections [10%] and drugs/toxins [8%] Amongst the neurological diseases stroke is the most common while in metabolic encephalopathies, hepatic encephalopathy is the commonest followed by ureaemic encephalopathy

Conclusion: The study has highlighted the epidemiology of the organic causes of ACS encountered in the patients of the Military Hospital, Rawalpindi, helping us to conclude that neurological and metabolic disorders are the most common organic cause of ACS

Donor selection in renal transplantation

Renal donors of 194 renal transplants performed at Armed Forces Institute of Urology [AFIU] were studied retrospectively with an aim to assess the state of kidney donation by different family members alongwith their age and sex distribution. Kidneys were donated by relatives in 87.6% cases while 12.4% cases donors were unrelated. Siblings donated kidneys in most of the cases [55.9%], followed by parents [24.7%], cousins [10.6%] and children [8.8%]. Most of our donors were young between 18-30 years of age [43.3%] followed by 31-40 years group [32.5%], 41-50 years age [15.5%] and 5160 years age [8.2%]. Only one donor was more than 60 years age

comparative study of peritoneal dialysis versus haemodialysis as an emergency procedure and a review of peritoneal dialysis

A short term study was conducted in Military Hospital, Rwp in the Nephrology Department, to study the biochemical effects of peritoneal dialysis of 18 hours duration and hamodialysis of 4 hours duration. Twenty patients admitted to the unit were randomly allocated to either hamodialysis [HD] or Peritoneal Dialysis [PD] unless a contra-indication to one or the other modes of therapy existed. Patients were assessed clinically and a biochemical profile was taken before and after the procedures. From this study it appears that peritoneal dialysis is as effective as hamodialysis as a life saving manouver in restoring biochemical status quo and improving symptoms in acute renal failure. PD has not been used alone as a modality of treatment in chronic renal failure, in this unit

Disseminated intravascular coagulation complicating typhoid fever

Disseminated intravascular coagulation occurring as a complication in three patient suffering from typhoid fever are described and the subject is reviewed

Resistant plasmodium falciparum malaria [a case report and review]

Plasmodium Falciparum causes the manifestations' of malignant tertian malaria which carries a high mortality rate. Resistance of PI falciparum to Chloroquine is being increasingly reported from East and Equatorial Africa, and recently from Thailand. A case of cerebral malaria from Rawalpindi is described in which the protozoan was resistant to Chloroquine and the clinical manifestation and complications of falciparum malaria are reviewed

Mitral valve prolapse [a case report]

A case of mitral valve prolapse is described in a young man, discovered incidentally during the course of an unrelated illness. There was no associated mitral valve regurgitation or any haemodynamic disturbance. In retrospect the patient described symptoms which appeared to be those of a cardiac neurosis