Pattern of acid base abnormalities in critically ill patients

To find out the pattern of acid base abnormalities in critically ill patients in a tertiary care health Sacility. A descriptive study. The study was carried out in the department of pathology, Combined Military Hospital Kharian from January 2013 to June 2013. Two hundred and fifty patients suffering from various diseases and presenting with exacerbation of their clinical conditions were studied. These patients were hospitalized and managed in acute care units of the hospital. Arterial blood gases were analysed to detect acid base status and their correlation with their clinical condition. Concomitant analysis of electrolytes was carried out. Tests related to concurrent illnesses e.g. renal and liver function tests, cardiac enzymes and plasma glucose were assayed by routine end point and kinetic methods. Standard reference materials were used to ensure internal quantify control of analyses. Two hundred and fifteen patients out of 250 studied suffered from acid base disorders. Gender distribution showed a higher percentage of male patients and the mean age was 70.5 +/- 17.4 years. Double acid base disorders were the commonest disorders [34%] followed by metabolic acidosis [30%]. Anion gap was calculated to further stratify metabolic acidosis and cases of diabetic ketoacidosis were the commonest in this category [47%]. Other simpie acid base disorders were relatively less frequent. Delta bicarbonate was calculated to unmask the superimposition of respiratory alkalosis or acidosis with metabolic acidosis and metabolic alkalosis. Though triple acid base disorders were noted in a small percentage of cases [05%], but n7ere found to be the most complicated and challenging. Mixed acid base disorders were associated with high mortality. A large number of critically ill patients manifested acid base abnormalities over the full spectrum of these disorders. Mixed acid base disorders were commonest and were bad prognostic indicators, most often associated with high mortality. This warrants a high index of suspicion, a thorough clinical assessment of patient and a structured approach to analyze the relevant laboratory data in the given clinical setting. Only with prompt detection of an acid base disorder, clinician can formulate an appropriate management strategy for the patient

Comparison of efficacy of oral and intramuscular iron supplementation for treatment of iron deficiency anemia in children

To compare the efficacy of oral iron preparation with intramuscular iron sorbitol in treatment of iron deficiency anemia in children. Randomized controlled trial. Paediatric department of Combined Military Hospital Kharian, Pakistan, from October 2011 to March 2013. In total 200 anemic chldren from 6 months to 5 years of age were included. Cut off value for Hb was < 8 gm/dl. Patients were divided into two groups, each of 100, randomly. Group A received oral sodium feredetate [iron edetate] and group B received intramuscular iron sorbitol. Rise in Hb > 10 gm/dl was kept as the desired value. Maximum duration of treatment planned was 12 weeks for group A and 2 weeks for group B. Laboratory parameters such as Hb%, mean corpuscular volume [MCV], retic count and serum ferritin level were used to detect the responses in both groups at one week, two weeks, four weeks and twelve weeks of treatment. Among 200 patients, male and female distribution was 45% and 55% respectively. Desired rise in Hb in group B was achieved much earlier i.e. at two weeks as compared to group A. Progressive rise in laboratory parameters was observed but this rise was more evident in group B as compared to group A. After one week treatment in group A, rise in retic count, Hb, ferritin and MCV was 0.759 +/- 0.318, 0.814 +/- 0.387, 0.47 +/- 0.154 and 4.28 +/- 2.468 respectively. But rise in these values in group B was 2.235 +/- 0.632, 2.335 +/- 0.135, 6.31 +/- 1.123 and 12.11 +/- 0.414 respectively. Same persistent different trend was observed at 2 and 4 weeks. After 12 weeks treatment in group A, rise in retic count, Hb, ferritin and MCV was 1.044 +/- 0.222, 5.204 +/- 0.134, 17.39 +/- 2.551 and 16.61 +/- 1.214 respectively but rise in these laboratory indices in group B was 0.551 +/- 0.261, 6.097 +/- 0.21, 42.49 +/- 2.768 and 20.68 +/- 2.233 respectively. The comparison of hematological indices after 12 weeks in A and B groups show sigruficant differences. All these parameters improved in both groups but improvement in group B was drastically more prominent when compared with group A [p-value < 0.05]. Intramuscular iron sorbitol therapy is an alternative and comparatively better treatment option as compared to oral iron therapy, sodium feredetate, in regards of treatment duration and earlier rise in the laboratory indices

Group B streptococcus neonatal meningitis-less common cause of neonatal meningitis in pakistan and disparity between csf culture and other parameters

Neonatal bacterial meningitis is a devastating illness with significant mortality and morbidity. Incidence and etiology of neonatal bacterial sepsis and meningitis varies among developed and developing countries. We are reporting a case of 6 days old neonate who presented with fever, refusal to take feed and then followed by an episode of seizure activity. Laboratory parameters for complete sepsis screening including cerebrospinal fluid [CSF] and metabolic screening were absolutely normal for his age, but CSF culture revealed growth of group B Streptococcus [Streptococcus agalactiae] Patient was treated successfully without any morbid sequel

Malaria; assessment of haematological changes

To see the effects of malaria infection on platelet count and haemoglobin in children suffering from malaria. Descriptive study. CMH Okara and CMH Pano Aqil Cantt. July 2008 to June 2012. Children admitted with fever of less than seven days duration who had positive smear for malaria parasite were included in the study. After detailed history and thorough examination, patients were investigated to find out the cause of fever. All the patients with localizing cause for fever and history of drug intake were excluded. All patients were investigated with complete blood counts and serial peripheral smears for malaria parasite. Peripheral blood smear examination for malarial parasite was taken as gold standard for the diagnosis of malaria. Cut off 9 value for low hemoglobin [anemia] was taken as 10gm/dl and platelet count of less than 150x10[9]/L, was used to define thrombocytopenia. Patients with thrombocytopenia were divided in to three categories. Mild thrombocytopenia was defined as patients with platelet count of <50x10[9]/L to >150x10[9]/L, moderate thrombocytopenia included patients with platelet counts of <20x10[9]/L to >50x10[9]/L and severe thrombocytopenia consisted of patients with platelet counts of <20x10[9]/L. A total of one hundred and fourteen smear positive patients were analyzed, out of which 93% had low and 7% had normal platelet count. 95% had Vivax and only 5% had Falciparum malaria. Mean platelet count was 87x10[9]/L. Mean platelet count in Falciparum was 42x10[9]/L whereas it was 88 x10[9]/L in Vivax malaria. Sixty two [54%] patients had anaemia. Mean haemoglobin was 9.54gm/dl. Mean Hb in Falciparum malaria was 7.5gm/dl and in Vivax it was 9.6gm/dl. Higher frequency of mild to moderate thrombocytopenia and anaemia was observed in hospitalized children suffering from malaria. Plasmodium Vivax was found to be the most common species

Variations in thyroid stimulating hormone levels in various non-thyroidal illnesses

To find out the pattern of variations in thyroid stimulating hormone [TSH] levels in hospitalized patients with major Non-Thyroidal Illnesses [NTIs] leading to stressful state. A cross-sectional study was carried out in the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology [AFIP] and the Department of Pathology, Army Medical College Rawalpindi in collaboration with Department of Internal Medicine MH, Rawalpindi. Two hundred patients, were selected by convenience sampling, who were suffering from acute febrile illness, acute psychiatric illness, acute myocardial infarction and surgical trauma [50 each]. Fifty age and sex matched subjects without present or previous history of thyroid disorders were also included as controls to neutralise the confounding variables affecting TSH estimation. Serum TSH, triidothyronine [T[3] and free tetraidothyronine [fT[4] were measured during the course of these illnesses and after complete recovery. Serum TSH, T[3] and fT[4] were estimated in the laboratory by chemiluminescence method using auto-analysers lmmulite-2000 [DPC-USA] and LIA-Mat [Sangtech-Germany] at AFIP and Army Medical College, respectively. Tests related to the concurrent illnesses e.g. liver and renal function tests and cardiac enzymes were assayed by routine end-point and kinetic methods using commercial kits manufactured by M/S Linear Chemicals [Spain] on Selectra 2 Chemistry Auto-analyser. [Mecrk-Germany]. In patients of acute febrile illness there was no statistically significant difference in serum TSH levels in patients [mean: 2.03 mlU/L] and control group [mean 1.99 mlU/L] [P>0.05]. Serum TSH was significantly higher in patients of surgical trauma [mean 3.87 mlU/L [J/L] acute myocardial infarction [mean 5.55 mlU/L] and in patients with acute psychiatric illness [mean: 3.94 mlU/L] as compared to controls [P<0.05]. The transient abnormalities in serum TSH levels can mimic or at times mask the biochemical changes observed in patients with intrinsic thyroid disease, so realisation and recognition of these responses help in avoiding misdiagnosis

Relationship between fibrosis score and response to interferon alfa and ribavirin combination therapy in chronic HCV infection

To compare the response to Interferon Alfa [IFN] and Ribavirin [RBV] combination therapy in patients of chronic HCV infection with fibrosis stage 1 [F1] and stage 2 [F2] with fibrosis stage 3 [F3] and stage 4 [F4]. Quasi-experimental study. Military Hospital, Rawalpindi, from Jan 2004 to Jun 2004. Forty patients of chronic hepatitis C were selected on the basis of raised ALT, presence of anti-HCV antibodies, detection of viral RNA on PCR and liver biopsy. They were divided into 2 groups on the basis of stage of fibrosis. Group A constituted 20 patients with fibrosis stage 1 and 2 and group B constituted 20 patients with fibrosis stage 3 and 4. Interferon Alfa 03 Million units subcutaneously three times a week and Ribavirin 1200 mg orally per day in divided doses for patients who weigh 75 kg and 1000 mg for those weighing less than 75 kg for six months was administered. Polymerase chain reaction [PCR] for HCV RNA was performed at 0 and 6th months at Armed Forces Institute of Pathology Rawalpindi. At completion of treatment, HCV-RNA levels in serum were not detectable in 14 of 20 [70%] patients in group A as compared to 07 of 20 [35%] patients in group B who received interferon alpha and ribavirin combination therapy. Patients with early fibrosis on liver biopsy have better response to IFN- Ribavirin therapy compared to patients with advanced fibrosis

Assessment of proteinuria by using protein: creatinine index in random urine sample

To assess the quantitative measurement of proteinuria by using random urine protein: creatinine index/ratio in comparison with 24 hours urinary protein excretion in patients of renal diseases having normal glomerular filtration rate. One hundred and thirty patients, 94 males and 36 females, with an age range of 5 to 60 years; having proteinuria of more than 150 mg/day were included in this study. Qualitative urinary protein estimation was done on random urine specimen by dipstick. Quantitative measurement of protein in the random and 24 hours urine specimens were carried out by a method based on the formation of a red complex of protein with pyrogallal red in acid medium on Micro lab 200 [Merck]. Estimation of creatinine was done on Selectra -2 [Merck] by Jaffe's reaction. The urine protein: creatinine index and ratio were calculated by dividing the urine protein concentration [mg/L] by urine creatinine concentration [mmol/L] multilplied by 10 and mg/mg respectively. The protein: creatinine index and ratio of more than 140 and 0.18 respectively in a random urine sample indicated pathological proteinuria. An excellent correlation [r=0.96] was found between random urine protein: creatinine index/ratio and standard 24 hours urinary protein excretion in these patients [p<.001]. Dipsticks showed moderate correlation [r=0.52] and error in interpretation of proteinuria. The protein: creatinine index in random urine is a convenient, quick and reliable method of estimation of proteinuria as compared to 24 hours of urinary protein excretion for diagnosis and monitoring of renal diseases in our medical setup

Assessment of proteinuria by using protein: creatinine index in random urine sample

To assess the quantitative measurement of proteinuria by using random urine protein: creatinine index/ratio in comparison with 24 hours urinary protein excretion in patients of renal diseases having normal glomerular filtration rate. One hundred and thirty patients, 94 males and 36 females, with an age range of 5 to 60 years; having proteinuria of more than 150 mg/day were included in this study. Qualitative urinary protein estimation was done on random urine specimen by dipstick. Quantitative measurement of protein in the random and 24 hours urine specimens were carried out by a method based on the formation of a red complex of protein with pyrogallal red in acid medium on Micro lab 200 [Merck]. Estimation of creatinine was done on Selectra -2 [Merck] by Jaffe's reaction. The urine protein: creatinine index and ratio were calculated by dividing the urine protein concentration [mg/L] by urine creatinine concentration [mmol/L] multilplied by 10 and mg/mg respectively. The protein: creatinine index and ratio of more than 140 and 0.18 respectively in a random urine sample indicated pathological proteinuria. An excellent correlation [r=0.96] was found between random urine protein: creatinine index/ratio and standard 24 hours urinary protein excretion in these patients [p<.001]. Dipsticks showed moderate correlation [r=0.52] and error in interpretation of proteinuria. The protein: creatinine index in random urine is a convenient, quick and reliable method of estimation of proteinuria as compared to 24 hours of urinary protein excretion for diagnosis and monitoring of renal diseases in our medical setup