Comparative analysis of cerebrospinal fluid Ada levels in Tuberculous and Non-Tuberculous Meningitis

Objective: To find out the association of Cerebrospinal Fluid [CSF] adenosine deaminase [ADA] Levels with tuberculosis meningitis

Study Design: Case control study

Place and Duration of Study: This study was conducted in the department of Medicine, Pak Emirates Military Hospital, Rawalpindi over a period of six months from May to Oct 2015

Material and Methods: One hundred and ten participants i.e. 55 cases and 55 controls were included in the study. Lumbar puncture were done and 2cc CSF was obtained. CSF for routine examination and ADA levels were sent to a single lab and pathologist verified report. Based on CSF report, patients were classified as tuberculous meningitis [TBM] and Non- tuberculous meningitis and comparative analysis of ADA level were done in both groups

Results: Mean age of the patients was 51.33 +/- 21.60 and 41.76 +/- 18.66 in tuberculosis meningitis and non-tuberculosis meningitis participants. In Tuberculous Meningitis patients, 33 [60.0 percent] were males while in non Tuberculous Meningitis participants, 35 [63.6 percent] were males. Mean ADA level in CSF [13.71 +/- 4.25 vs. 4.76 +/- 3.49, p<0.001], cerebrospinal fluid [CSF] protein level [144.71 +/- 99.15 vs 58.27 +/- 15.62, p<0.001] and mean cell count [185.00 +/- 97.29 vs. 73.71 +/- 111.38, p<0.001] were significantly higher in Tuberculous meningitis patients as compared to non Tuberculous Meningitis participants. However, mean glucose was significantly [p<0.001] lower 29.42 +/- 8.63 in Tuberculous Meningitis patients in comparison to 57.38 +/- 9.13 non-tuberculous meningitis participants

Conclusion: In conclusion, the estimation of CSF-ADA level is a speedy and simple method, which can be confidently used for diagnosis of tuberculous etiology in TBM patients and differentiating it from non- tuberculous etiology

Association of depression with socio-demographic factors in patients undergoing hemodialysis

Objective: To determine the association of depression with socio-demographic factors in patients undergoing hemodialysis

Study Design: Cross sectional comparative study

Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi, from Jul 2014 to Jun 2015

Material and Methods: Eighty eight patients undergoing hemodialysis were included. Data were collected using the Hamilton Depression Rating Scale. Demographic data, including age, gender, status within the family, education, duration of dialysis and social support was documented. Patients were graded on the basis of Hamilton scoring as: 0-9: normal, 10-13: mild depression, 14-17: moderate depression, above 17: severe depression

Results: There were 61[69.3%] male and 27 [30.7%] female patients with mean age of 48.43 +/- 12.69 years. The mean duration of dialysis was 35 +/- 29.73 days. Sixty seven patients [76.1%] were identified as having depression. Out of these 28 [31.8%] had mild depression while 12 [13.6%] had moderate and 27 [30.7%] had severe depression. Mean depression score was higher in females [17.56 +/- 6.67] than in males [13.13 +/- 5.67] and the difference was significant [p=0.002]. No association of depression with age [p=0.75], duration of dialysis [p=0.07], marital status [p=0.500], status within the family [p=0.47] or education [p=0.59] was revealed, however it was strongly and positively correlated with social support [p<0.005]

Conclusions: A reasonably high percentage of patients undergoing hemodialysis is likely to suffer from depression and by providing social support their depression can be reduced. Female patients are more likely to have depression and need more social support for alleviation of their depression

Frequency of ECG abnormalities in patients of chronic obstructive pulmonary disease according to disease severity

Objective: The objective of this study was to find out the frequency of ECG abnormalities in patients of COPD in relation to disease severity

Study Design: Cross Sectional study

Place and Duration of Study: This study was carried out at the Department of Medicine, Military Hospital Rawalpindi, from Oct 2011 to Jun 2012

Material and Methods: All patients presenting to the Department of Medicine both inpatient and outpatient, with diagnosis of COPD were included in the study. Patients with cardiac comorbidities were excluded. Also, patients on diuretics and long term oxygen therapy were excluded. A total of three hundred and forty three patients [343] were included in the study. Spirometry of all these patients was done to determine the FEV1 and FVC in order to classify the grade of severity of COPD. Standard 12 lead ECG of all these patients was done to find out the various ECG abnormalities

Results: About 77 [22.5%] patients had mild COPD, while moderate COPD was seen in 121 [35.3%]. Severe COPD was seen in 100 [29.2%] patients and very severe COPD was seen in 45 [13.1%] patients. The most common ECG abnormalities noted was right atrial enlargement [RAE] in 6 [7.8%] patients of mild COPD, 27 [22.3%] patients of moderate, 48 [48%] patients of severe and 24 [53.3%] patients of very severe COPD. Right ventricular hypertrophy [RVH] in 1 [1.3%] patient of mild, 7 [5.8%] patients of moderate, 19 [19%] patients of severe and 12 [26.7%] patients of very severe COPD. Sinus tachycardia was present in 6 [7.8%] patients of mild, 17 [14%] patients of moderate, 19 [19%] patients of severe and 10 [22.2%] patients of very severe COPD. Right bundle branch block [RBBB] was seen in 5 [6.5%] patients of mild, 9 [7.4%] patients of moderate, 13 [13%] patients of severe and 9 [20%] patients of very severe COPD. SVT was present in 1 [1.3%] patient of mild, 6 [5%] patients of moderate, 10 [10%] patients of severe and 8 [17%] patients of very severe COPD. Low voltage ECG was seen in 3 [3.9%] patients of mild, 7 [5.8%] patients of moderate, 12 [12%] patients of severe and 6 [13.3%] patients of very severe COPD. Atrial premature contractions [APCs] were present in 3 [3.9%] patients of mild, 11 [9.1%] patients of moderate, 14 [14%] patients of severe and 6 [13.3%] patients of very severe COPD. Normal ECG was seen in 54 [70.1%] patients of mild, 52 [43%] patients of moderate, 14 [14%] patients of severe and 3 [6.7%] patients of very severe COPD

Conclusion: A number of ECG abnormalities were seen in patients with COPD. They were more frequent with increased grade of severity of COPD. Therefore, it is recommended that ECG should be done routinely in patients with COPD

Non-urgent visits to emergency department and comparison of urgency evaluation between patients and doctors

Objective: To assess the proportion of non urgent patients presenting to the emergency department and to compare urgency evaluation between patients and doctors. Study Design: Descriptive cross sectional study. Place and Duration of Study: Emergency department Combined Military Hospital [CMH] Jhelum, from November 2015 to December 2015

Material and Methods: All the patients presenting to the emergency department after working hours between 4-6 pm were documented for 16 consecutive working days. They were assessed as to the urgency of their condition by the doctor. The patients or guardians in case of children were also required to rate the level of urgency of their medical condition. The level of urgency was graded on visual analog scale from 0-10. A 5 and above score was labeled as urgent while a score of less than 5 was considered non urgent

Results: A total of 205 patients reported in 32 hours over 16 days, to the emergency department. Of these 31 [15.12%] were assessed as emergencies by doctors while 49 [24%] were thought to be emergencies by patients. The p-value for this difference was 0.021. The largest group of patients visiting the emergency department was pediatric and they comprised the largest group of non urgent visits to the hospital as well

Conclusion: Actual emergencies comprise a small proportion of visits to emergency departments while the main bulk consists of non urgent visits

Microalbuminuria: association with ischaemic heart heart disease in non-diabetics

In view of the high morbidity and mortality associated with ischemic heart disease [IHD], the estimation of individual cardiovascular risk over and above the assessment of classic risk factors, such as age, hypercholesterolemia and hypertension, is an important prerequisite for focusing preventive measures and therapeutic measures. Microalbuminuria [MA] as a marker of IHD in nondiabetics is currently under international debate. The present descriptive study undertaken at Combined Military Hospital, Lahore was aimed to determine the frequency of MA in nondiabetic IHD patients. One hundred consecutive non diabetic patients with IHD [73 males, 27 females]. Patients showing clinical albumiuria and with other causes of proteinuria were excluded. Urinary albumin in first morning sample was estimated by immunoturbidimetry method. Albumin to creatinine ratio [ACR] was calculated as mg/g. The frequency of MA [ACR > 30 mg/g] was 37% in patients. Frequency was highest in older age bracket for both genders. The mean ACR was 131.8 +/- 66.2 mg/g. Significant difference was observed in mean MA level among different age groups. MA is common in nondiabetics patients with IHD. The mean level of MA was higher in older patients