Prevalence of primary headache in association with age, sex, obesity and hypertension among patients received at OPD of Liaquat University Hospital, Hyderabad / Jamshoro

Aim and Objective: To determine the association of primary headache with age, sex, obesity and hypertension among patients received at medical Out-patient-department of Liaquat University Hospital, Hyderabad / Jamshoro

Study Design: It is a cross-sectional study conducted at Liaquat University Hospital Out-Patient Department, Hyderabad / Jamshoro, to determine the prevalence of primary headache in association with sex, age, obesity and hypertension

Place and Duration of Study: Out-Patient-Department of medicine in Liaquat University Hospital, Hyderabad / Jamshoro from 1[st] January 2015 to 1[st] June 2015

Methodology: This cross-sectional study was conducted with 200 patients [both male and female] from different age groups received in Out-Patient-Department of Liaquat University Hospital, Hyderabad. SPSS 20 version was used for analysis and results. Proforma questionnaires were used for patients including bio-data, history, blood pressure and BMI. Inclusion criteria: All adult patients, both males and females, over the age of 18 years, with presenting complaint of headache were included in the study after taking proper consent. Proper history taking, vital signs, neurological examination, eye examination, BMI, and random blood sugar level were performed. Exclusion criteria: Patients having stroke, hypoglycemia [blood sugar <60mg/dl], diabetic ketoacidosis, intracranial hypertension, eye problem, and Chronic Liver Disease were excluded from this study

Results: Out of a total number of 200 patients, 60% were female and 39% were male, while 1% was dropout during follow-up. Most of the patients were between the ages of 30-60 years. Our study determines 86% of patients have primary headache with normal blood pressure [normal BP 88%] and 13% have secondary headache mostly caused by hypertension [BP 10%], 1% patients was dropout during follow-up from study. Out of 200 patients, 48% were found to have a normal BMI [body mass index], whereas 39% were over weight and 11% had obesity and 2% came under category of morbid obesity

Conclusion: This study result determined that among the patients received at medical Out-Patient Department of Liaquat University Hospital, Hyderabad / Jamshoro, primary headache is more common in young females who have an increased body mass index and normal blood pressure. So it is prudent to spread awareness through media campaigns, seminars, and workshops etc, regarding prevention and proper treatment of primary headache in such patients

MDCT at LUMHS: detection the small pulmonary nodules by use of maximum intensity projection images

Objective: To assess the benefit of computed tomography by using Maximum Intensity Projection [MIP] compare to Volume Rendering [VR] reconstructions to study pulmonary metastases

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at Radiology Department of Liaquat Medical University Hospital Hyderabad from July 2015 to April 2016

Materials and Methods: Computed tomography studies of 30 pulmonary metastatic cases were reviewed retrospectively. Images were evaluated as number of the nodules. Two viewers on VR and MIP reconstructions on axial-source images assessed these parameters. Independent evaluation of the MIP and VR images was done by well experienced chest radiologist. In the course of independent image assessment, each pulmonary nodule was indicated by an arrow as well as recorded in the Performa

Results: A total of 30 cases were integrated in our study. The mean age of the cases was 52.12 +/- 7.33 years. Out of 30 cases male were in majority 24[80%]. Total 334 nodules were detected by MIP images, while out of them 276 were detected by VR images and 58 were missed, therefore MIP images is the significantly more detectable technique for pulmonary nodules detection. P= value 0.001. Following by central 253 nodules were detected by MIP images, out of them 40 nodules missed by VR images and 113 were detected, with significant difference P value = 0.001. Similarly all the peripheral nodules were also significantly more detected by MIP images, as compare to VR images. P value = 0.001

Conclusion: Maximum intensity projection is more useful and best technique, to detect the small pulmonary nodules especially in central lung

Etiology and clinical pattern of patients presenting with pancytopenia at tertiary care hospital

Objective: The objective of the study was to evaluate the various cause and clinical presentation in patients having pancytopenia in tertiary care hospital

Study Design: Descriptive / cross-sectional

Place and Duration of Study: This study was conducted in the Medicine Department of LUMHS, Jamshoro from 2013-2015

Materials and Methods: Total 80 cases of pancytopenia were enrolled in the study. Patients were included above age of 15 years from both sexes. Pancytopenia was defined as: WBCs [

Results: Total 80 cases were studied, who represented pancytopenia. Male were in majority 61[76.25%]. Majority of the young cases was found with mean age of 33.23 years. Most common clinical feature was found general weakness in 19[23.75%] patients followed by fever [18.75%], dyspnea 11[13.75%], bone pain 6[7.5%], anemia 6[7.5%] and pain in legs in 4[5%] patients. According to the etiological pattern aplastic anemia and malaria was found most common in 18 [22.5%] and 11 [13.75%] cases respectively

Conclusion: Aplastic anemia and malaria was the commonest factor of pancytopenia in this study mostly in young males. The commonest clinical presentation observed was generalized weakness after that fever and dyspnea

Relation of vitamin D level with demographic and lab feature for local population

Objective: To analyze relationship of vitamin D status with Age, Gender, Occupation, Serum Calcium, ESR and Hemoglobin level in local population at Liaquat University of Medical and Health Sciences

Study design: Cross-sectional observational study

Duration of study: Liaquat University Hospital in Medical ward and Out Patient Department [OPD] from 1[st] May 2015 - 1[st] December 2015

Methodology: This cross-sectional observational study was conducted at Department of Medicine, LUMHS Hyderabad. All cases were collected from OPD of medical ward and emergency, after taking informed consent. A specifically designed semi structured proforma was used to record demographic, history, examination and laboratory reports including serum calcium, ESR, Hemoglobin and vitamin D level. Patients having chronic liver disease, ischemic heart disease, cerebrovascular disease, road traffic accident and others critical illness were excluded. Data entered into SPSS 20 version for analysis and p value

Results: A total of 160 patients were included in this study. The mean age of enrolled participants was 40.2+/-13.7 years. Ninety seven [60.6%] were females with female to male ratio of 1.5:1. One hundred thirty [81.3%] patients were seen in out-patient department of institute. One hundred and twelve [70%] patients are working at home. The mean hemoglobin level was 11+/-1.3 gm/dl, mean ESR 26.2+/-15.8, mean serum calcium 9.6+/-2 mg/dl and mean vitamin D3 level was 32+/-6.6 IU. Comparison of demographic and lab features of vitamin D deficient patients and with normal vitamin D was summarized in Table I

Conclusion: In Pakistan vitamin D deficient sample are more prevalent in all age group. Study shows relationship of age, sex, occupation with serum hemoglobin level, erythrocyte sedimentation rate and serum calcium level. Study results show that vitamin D deficient is more in house workers, laborers, students and executive professional workers. Hemoglobin level was found low in vit D deficient patients as compared to vit D normal population but serum calcium, ESR were normal in both group of vitamin D deficient and controlled group of population

Stroke localization: clinical correlation versus findings of CT scan brain in patients admitted at Liaquat University Hospital Hyderabad/Jamshoro

Objective: to study clinical localization of stroke and correlate with findings on C-T Scan of Brain

Design: observational study

Place and Duration of study: the study was conducted at the Medical Department of Liaquat University Hospital Hyderabad/Jamshoro from January 2006 to December 2006

Material and Methods: total 110 patients with features of stroke were included in this study. These patients were further evaluated for clinical correlation with findings on CT scan brain, done within 24 hours after the development of focal neurological deficit. Brain tumor, meningitis, viral or bacterial encephalitis, multiple sclerosis and metabolic derangements that could explain focal neurological deficit e.g hypoglycemia were` the exclusion parameters

Results: total of 110 patients, 60 [54.5%] were males and 50 [45.5%] were females. Age of patients ranged 22-84 years with mean +/- SD age of 53 +/- 5 years. On clinical ground cerebral infarction was suspected in 89 [80.9%] and cerebral hemorrhage in 21 [19.1%] patients. In 74 [83%] patients infarction was confirmed by CT scan brain, whereas cerebral hemorrhage was proved in 10 [47.6%] out of a total of 21 patients. These patients were further evaluated for clinical localization of area of stroke. Clinically left parietal / temporo parietal lobe infarction was suspected in 43 patients and right parietal / temporo parietal lobe in 25 patients. Left frontal lobe infarction in 7 patients right frontal lobe infarction in 8 patients, left internal capsule infarction in 2 patients and right internal capsule infarction in 4 patients. Comparing with the CT scan brain findings: left parietal / temporo parietal lobe infarction was confirmed in 41 [95.34%] patients, right parietal / temporo parietal lobe in 19 [76%], left frontal lobe in 5 [71.4%], right frontal lobe in 4 [50%], left internal capsule in 2 [100%] and right internal capsule in 3 [75%] patients. Left middle cerebral artery territory involvement was observed in 43 [58%] patients and right middle cerebral artery territory in 22[30%] patients. No Significant difference was observed in other cerebral artery territories

Conclusion: it was concluded from the study that cerebral infarction was more common than hemorrhage and middle cerebral artery territory infarction of both sides was more common than other cerebral artery territories. Localization of stroke on clinical basis is not always easy. Confident diagnosis requires careful case history taking, extensive neurological assessment and with the help of focal neurological deficit of a particular area

Category: internal Medicine

Heat stroke victims in Sukkur city of Sindh - Pakistan

This is a descriptive, cross-sectional study, conducted on 14 cases of heat stroke and hyperpy-rexia admitted in Civil Hospital, Sukhur between 1st Jan. and 31st Dec, 2006. The objective was to evaluate the clinical presentation, socio-demographic pattern and to suggest preventive strategies for the control of this problem. Data analysis showed mean age was 32.86 with S.D. +/- 17.06. 85.7 were males and 14.37 females, making a male to female ratio of 6:1 occupation wise, date showed 7.17, house wives, 28.47, labourers, 43.9% farmers and 21.4% were children. With proper and efficient management the cure rate was 100%. Study concluded that the lives of the victims of heat stroke and hyperpyrexia could be saved with proper preventive measures, first aid programmes and efficient treatment practices

Cirrhosis of liver: etiological factors, complications and prognosis

Objective: To determine the etiological factors, complication[s] and prognosis of patients suffering from liver cirrhosis in our setup. Design: Cross-sectional study. Setting: Medical and surgical departments of Liaquat University Hospital Hyderabad/ Jamshoro, Sindh - Pakistan, from April 2005 to April 2007

Methods: Patients having an evidence of cirrhosis of liver on ultrasound examination of abdomen were enrolled. All those patients who were not confirmed to be cirrhotic, excluded from this study. All cases were studied to determine the etiological factors, complications and prognosis of disease. All data were recorded on a proforma. Patients with acute variceal hemorrhage were referred to surgical department for endoscopic sclerotherapy or variceal band ligation

Results: Total 100 patients were studied, 67[67%] males and 33[33%] females. Their mean age was 53.09 with SD= 8.85814 years. Majority of patients, 52[52%] had HCV infection, 16[16%] had HBV infection, 16[16%] had HBV and HCV co-infection, 08[08%] had alcohol abuse, 01[01%] had primary biliary cirrhosis, 02[02%] had Wilson's disease and no etiological factors were recorded in 05[05%] patients. Ascites was present in 59[59%] cases, portal hypertension in 42[42%], esophageal varices in 29[29%], spontaneous bacterial peritonitis in 29[29%], acute variceal hemorrhage in 27[27%], hepatic encephalopathy in different grades in 24[[24%], hepatorenal syndrome in 09[09%] and hepatocellular carcinoma in 07[07%] patients. All patients with acute variceal episode[s] were adequately and timely treated in surgical department. When cirrhotic patients were grouped into child-Pugh's classification, 37[37%] were in class 'A' category, 37[37%] in class 'B' category, and 26[26%] in class 'C' category

Conclusion: HCV infection is the major risk factor for cirrhosis in our setup. Ascites was the commonest complication. Patients with child-Pugh's class 'A' cirrhosis had significantly longer survival than patients with child-Pugh's class 'B' and 'C'. A multidisciplinary approach for prevention and control of ever increasing HCV infection must be adopted and to make the public awareness through the mass media about its drastic complications, and possible modes of its transmission

Frequency of night blindness in cirrhosis and effective restoration of vision with vitamin A therapy

Objective: To determine the frequency of night blindness among cirrhotic patients and evaluate the restoration of vision with vitamin A therapy. Design: - Case-control observational study. Setting: Medical ward of Liaquat University Hospital Hyderabad / Jamshoro, Sindh - Pakistan; from January 2006 to December 2007

Methods: Two hundred cirrhotic patients admitted at medical unit IV were enrolled in the study. The non-cirrhotic patients were excluded. Fifty healthy volunteers took part as the control subjects

Results: Out of 200 patient, 116[58%] were males and 84[42%] females. The mean age of the cirrhotic patients was 48.46 + 11.97 years. The cause of cirrhosis was hepatitis C virus in 146 [73%] cases, hepatitis B virus in 19[9.5%] cases, hepatitis C and B virus in 7[3.5%] cases, non B and C virus in 24[12%] cases and alcohol in 4[2%] cases. When cirrhotic patients were grouped into Child-Pugh's score, 44[22%] were in class A, 106 [53%] in class B and 50[25%] in class C. Among 200 patients, 122 [61%] had history of night blindness and 25[12.5%] had the colour blindness. Restoration of vision was observed in 105[86%] patients with vitamin A therapy [tablet Vitamin A 50,000 IU, Wilson Pharma], twice daily, for 6 weeks time

Conclusion: The history of night blindness and its restoration of vision with vitamin A therapy is a rough indicator of vitamin A deficiency in cirrhotic patients. The larger studies are required especially RBP [plasma retinol binding protein] and serum vitamin A concentration before recommendation of vitamin A replacement. The Ophthalmic changes in cirrhotic patients are preventable and treatable

Stroke: frequency of risk factors in patients admitted at Liaquat university hospital Hyderabad/Jamshoro

Objective: To determine the frequency of various risk factors for stroke and its sub-types among males and females. Design: Cross sectional /Observational study. Place and Duration of Study: The study was conducted at the Medical Department of Liaquat University Hospital Hyderabad/Jamshoro from January 2006 to March 2007

Material and Methods: Patients with features of stroke confirmed by CT scan brain were enrolled. Brain imaging showing abnormality e.g. brain tumour, meningitis, multiple sclerosis and metabolic derangements that could explain focal neurologic deficit were the exclusion parameters. The frequency of various risk factors for stroke and its types among males and females were evaluated

Results: Out of total 100 patients, 78[78%] presented with infarction stroke and 22[22%] with hemorrhagic stroke. Their mean age at presentation was 56.89 with SD=8.92 years. Hypertension 35[59.3%] and smoking 18[94.7%] were the most important risk factors among males, while the presence of diabetes mellitus 16[55.2%] and IHD 10[62.5%] were found to be more common among females. Forty-two [42%] and 11[11%] males, while 36[36.3%] and 11[11%] females suffering from cerebral infarction and cerebral hemorrhage respectively. In-hospital mortality was 09[09%]

Conclusion: Frequency of various risk factors was high in this study which is similar to that observed in developed countries. Hypertension and smoking were the major risk factors for males, while diabetes mellitus and IHD were more common in females. We did not find any significant gender difference between the two stroke types. Category: Internal Medicine

Alpha-fetoprotien as a diagnostic tool in differntiating hepatocellular carcinoma from benign hepatic disorders

Objective: Differential diagnosis of hepatocellular carcinoma [HCC] from benign lesions of the liver is often difficult yet of great clinical importance. In the present study, we analysed diagnostic value of alpha-fetoproteins in hepato- cellular carcinoma. Design: A descriptive study Setting: Department of Internal Medicine, Liaquat University Hospital, Jamshoro, Sindh from February 2000 to December 2002

Subjects and Methods: Total 200 persons were studied. 100 presented with liver mass and other symptoms directing toward liver pathology, later confirmed histopathologically, as suffering from HCC while the other 100 subjects came to the department with jaundice and were HbsAg and anti-HCV positive on blood screening. All these subjects underwent blood test for alpha-fetoprotien. This tumor marker was analyzed by using enzyme immunoassay-based kit

Results: The alpha-fetoprotien positivity was statistically evaluated. In HCC, this test was statistically significant with p value of <0.001. In this study sensitivity of alpha-fetoprotien was 72%, specificity 89%, positive predictive value 86.7% and negative predictive value of 76.1%

Conclusion: These findings suggest that alpha-fetoprotien has the potential to differentiate between benign and malignant liver diseases and it is a useful tool in the diagnosis of HCC

Management of decompensated cirrhosis due to HbeAg-negative chronic HBV infection with lamivudine monotherapy

Objective: To evaluate the efficacy of long-term lamivudine monotherapy in patients with decompensated cirrhosis due to HbeAg-negative1HBV-DNA positive. Design: Case - control study. Setting: Departments of Medicine and Surgery, Liaquat University Hospital, Jamshoro, and Isra University Hospital Hyderabad, from March 2000 to June 2003

Patients and Methods: We analyzed the clinical course and outcome of lamivudine treatment in 30 consecutive cirrhotics and compared with 30 HBV untreated HbeAg-negative controls

Results: Significant clinical improvement, defined as a reduction of at least two points in Child-Pugh score was observed in 23 of the 30 treated patients [76.6%] versus none of the 30 patients in the control group [p< 0.0001] after a mean follow-up of 10.6 + 2.1 [+SD] months. There were 10 deaths in the treated group versus 24 in the control group [p= 0.07]. Patients with clinical improvement had better survival than patients with no improvement [p=0.04]

Conclusion: Lamivudine monotherapy significantly improves liver function in HbeAg-negative decompensated cirrhosis