Prophylactic antibiotic in cardiac surgery - does duration of prophylaxis effect the outcome?

To evaluate that duration of prophylactic antibiotics in patients undergoing open-heart surgery have an impact on deep sternal infection. [Mediastinitis]. Cross sectional comparative study on patient undergoing open-heart surgery. This study was conducted at cardiac surgery department, Mayo Hospital Lahore. It included patients operated from May 2005 to July 2006. Duration of study was 14 months. Total of 200 patients undergoing open-heart surgery were included in the study. We compared 100 patients, receiving less than 48 hours of prophylactic antibiotics [Group A] with another 100 patients, receiving more than 48 hours of prophylactic antibiotics [Group B]. The endpoint of study was development of mediastinitis requiring sternal rewiring. Ten patients were rewired for sternal dehiscence [5%]. Test of proportion was applied and it was concluded that there is no difference in proportion of infection in the two groups. [p value of 0.05]. Conclusions: The results provide evidence that there is no need to continue antibiotic prophylaxis for more than 48 hours in patients undergoing open-heart surgery

Role of wound classification in predicting the outcome of diabetic foot ulcer

To compare the effectiveness of Wagner and University of Texas [UT] classification systems of diabetic foot ulcers in directing appropriate therapy and possibly predicting outcomes. A total of 383 patients with foot ulcer were seen. Details of socio-demographic and clinical profiles of 200 patients were completely available. Patients were assessed and classified into different grades and stages according to Wagner's and UT classification systems. Their duration of healing was recorded. The outcome endpoints were defined as complete healing, major or minor amputations, or expired. Out of the 200 subjects, 65% were males and 35% were females. Mean age in males was 53.04 +/- 10.33 years and in females was 51.14 +/- 9.94 years. Average duration of treatment in males was 109.68 +/- 82.26 days and in females was 85.10 +/- 61.97 days. Forty five percent of the subjects had neuropathic ulcers. Median healing time increased with increase in Wagner grade and UT grade and stage. The higher the UT grade and stage at the time of presentation, the less the chances of ulcer to heal within the study period. Our study has shown that grading and staging of diabetic foot ulcer affects and predicts the outcome. Amputation rates increase with increase in grade. Addition of stage to grade in UT classification helps further on assessing the severity of wound at the time of presentation and shows better association with the outcome

clinical manifestations of systemic lupus erythematosus in Pakistan correlate with rest of Asia?

Systemic Lupus Erythematosus [SLE] is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data. Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University Hospital between 1986 and 2001 were studied by means of a retrospective review of their records. The results were compared with various studies in different regions of Asia. Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is generally consistent with Asian data. There was less cutaneous manifestations, arthritis, serositis, haematological and renal involvement compared to various regions in Asia. The neurological manifestations of SLE, however, place Pakistani patients in the middle of a spectrum between South Asians and other Asian races. This study has shown that the clinical characteristics of SLE patients in our country may be different to those of other Asian races. Although our population is similar to South Asians, but clinical manifestations of our SLE patients are considerably different, suggesting some unknown etiology. Further studies are required to confirm the above results and to find statistically sounder associations

Clinico-laboratory findings in male lupus patients from a tertiary care hospital, Pakistan

This study was conducted to delineate the clinical pattern of a cohort of Pakistani male patients with systemic lupus erythematosus [SLE]. Clinical and laboratory data were collected of 24 male patients who were diagnosed with SLE and admitted to a tertiary care hospital between 1986 and 2001. Imaging and invasive studies [including aspirations and biopsies] were also recorded. Fourteen patients [58%] had renal involvement, with WHO class 4 and 5 comprising 89% of the cases. Eight patients [33%] had neurological involvement. Out of these 8 patients, 3 presented with psychosis [12.5%] and 4 [17%] with seizures. Twenty three patients [96%] had hematological involvement, 6 [25%] had serosal and 10 [41%] had articular involvement. Cutaneous lesions were noted in 10 [41%] patients. A majority of the patients were noncompliant and were lost to follow-up; therefore, ultimate outcome could not be clearly delineated. A high index of suspicion for SLE in males may permit early diagnosis and dictate the need for more aggressive therapy

Renal Involvement in Systemic Lupus Erythematosus in Pakistan

To find the prevalence of lupus nephritis, delineate its clinical, immunological and therapeutic characteristics and compare them with the data worldwide. Between 1985 and 2001, 198 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association [ARA] admitted to the hospital were studied by means of a retrospective review of their records. Renal involvement was found in 89 [45%] patients. Biopsy showed lupus nephritis in 42 patients; there were 9 male and 33 females. Mean age at initial presentation was 27 years and mean duration of follow-up was 2.3 years. The histological types [WHO Classification] were mainly class. 4 [n=27], class 3 [n=7] and class 5 [n=6]. Immunoflourescence showed a predominantly granular pattern of IgG, IgA and C3. Renal manifestations included renal failure [50%], microscopic hematuria [67%], active urine sediment [22%], and proteinuria [74%]. Proteinuria was nephrotic range in 45% patients. Treatment was with combinations of prednisolone and cyclophosphamide [n=13], prednisolone and azathioprine [n=27]. 19 patients received high dose methyl prednisolone [1 gm/day for 3 days]. There was no difference in mortality rate between prednisolone and cyclophosphamide and prednisolone and azathioprine treatment groups. The overall mortality rate was 17% [n=7]. Mortality was higher in WHO class 4 and 5 as compared to class 2 and 3 [p<0.001]. The prevalence of lupus nephritis in our population is an intermediate between Caucasians and other Asians. Certain clinical characteristics in our patients with lupus nephritis are different as compared to various other studies. Because of limited resources for treatment in developing countries, we believe that patients with lupus nephritis should be treated with improved ancillary medical therapies and more effective immunosuppressive regimens

Ischemic monomelic neuropathy: a complication of vascular access procedure

Ischemic monomelic neuropathy [IMN] is an infrequently recognized type of ischemic neuropathy produced by shunting of blood or due to acute noncompressive occlusion of the major proximal limb artery. Most reports about this complication appear in the neurology literature. IMN predominantly occurs in diabetic patients with evidence of peripheral neuropathy and atherosclerotic peripheral vascular disease. We report a case of ischemic monomelic neuropathy occurring in a patient with end stage diabetic nephropathy following PTFE [polytetrafluoroethylene] graft placement in proximal upper limb for chronic maintenance hemodialysis