Epidemiological survey of varicella-zoster infection in faisalabad city v/s various adjoining areas of faisalabad in 2017

Objective: To study the distribution and frequency of Varicella infection and the influence of socioeconomic status or facility of better health care on the outcome of infection in Faisalabad city and its periphery

Study Design: An Epidemiological Survey

Setting: It was carried out at Allied Hospital Faisalabad

Period: Cases presented from Faisalabad city and its peripheral areas, from January to October 2017 were included

Sample Size: Overall 323 patients, irrespective of the time of their presentation since the appearance of varicella rash, were included in this survey

Methodology: Data was analyzed and concluded in Statistical Package for the Social Sciences [SPSS] version 17

Result: Total of 323 cases was reported all over the district Faisalabad in 2017, out of which 206 [64%] cases were from Faisalabad city and remaining 117 [36%] were from adjoining areas [Tehsil] of Faisalabad. They were then distributed according to the day of their presentation in Teaching Hospital, which reveals that among 44 late presenters only 18 [41%] cases were reported from Faisalabad city while remaining 26 [59%] cases were from peripheral areas [Tehsils] of Faisalabad. Out of 279, those who presented to the hospital early, only 5 [1.8%] cases were expired, as compared to 4 [9.1%] cases among 44 late presenters

Conclusion: Varicella infection is more common in urban areas, which are more densely populated. While the proportion of deaths among infected people is higher among those who dwell in peripheries, away from the better healthcare facilities

Role of branched chain amino acids in hepatic encephalopathy

Introduction: Hepatic encephalopathy [HE] or portosystemic encephalopathy is a state characterized by disordered central nervous system functions because of failure of liver to detoxify nitrogenous agents originating from gut because of dysfunction of hepatocytes and portosystemic shunting. Patients with HE often present alteration of mental status varying from minor psychological abnormalities to deep coma. Multiple studies conducted worldwide suggest that the branched-chain amino acids [BCAAs] leucine, isoleucine, and valine may be useful in improving survival and reducing morbidity in patients with HE

Objectives: To compare the efficacy of branched chain amino acids in reversal of hepatic encephalopathy in patients with cirrhosis of liver with placebo

Study Design: Randomized control trial Setting: Medical Unit V, DHQ Hospital Faisalabad

Duration: Study was carried out over a period of 6 months from 1st July 2016 to 30 December 2016

Results: A total of 60 patients [30 in each group] were enrolled, majority of the patients were between 41-50 years in both groups, 36.67% [n=11] in Study and 43.33% [n=13] control group, mean and standard deviation of age was calculated as 43.56+/-5.21 in study and 45.78+/-4.98 years in control group, 70% [n=21]patients were male in study group and 63.33% [n=19] in the control group, 30% [n=9] patients in study group and 36.67% [n=11] in control group were females, comparison of efficacy of BCAAs in reversal of HE with placebo reveals 63.33% [n=19] patients in study group showed reversal of HE and 26.67% [n=8] patients in control group

Conclusion: The results of the study conclude that branched chain amino acids are significantly effective in reversal of hepatic encephalopathy when compared with placebo.

CPSP/HSE postgraduate overseas rotational programme: residents' perspective

Objective: to get direct upward feedback from the residents of first batch of CPSP/HSE Postgraduate Scholarship Programme

Study Design: mixed methods qualitative research study

Place and Duration of Study: CPSP, Regional Office, Lahore, in June 2015

Methodology: it is a mixed-method study that was conducted in June, 2015. Data was collected through an email survey with 33 medical residents doing their rotation in Ireland; and focus group discussions were carried out with 8 residents, who had successfully completed their rotation. Data were collected through pre-designed questionnaires comprising of open- and close-ended questions. The data were entered into SPSS version 21 and analyzed

Results: the mean age of residents was 29.9 +/- 1.1 years, 7 [21.2%] were females and 24 [72.7%] respondents were males. Residents agreed that HSE programme has improved their evidence-based decision making [mean score of 3.3 +/- 1.2] and enhanced professionalism [mean score of 3.6 +/- 1.1]. They disagreed that training has polished their procedural skills [mean score 2.4 +/- 1.2]. The identified strengths of the programme are: adopting a systematic approach towards patients, evidence-based decision making, better exposure and opportunities, financial stability and development of communication skills. The weaknesses are: less exposure to procedural skills, difficulty in synopsis and dissertation writing and difficulty in adjustment with rotational schedules

Conclusion: residents of CPSP/HSE Programme believed that CPSP/HSE has improved their professionalism, communication skills and increased their future opportunities for career growth. Better communication between CPSP focal person and residents will help sort out many minor but important issues

Complications of insertion of double lumen catheter in subclavian vein in patients of renal failure

Introduction: The demand of long term central venous access devices has risen over the last few decades. These devices are increasingly being used for administration of antibiotics and chemotherapeutic drugs, for total parentral nutrition and providing high flow access for hemodialysis and plasmapherisis. Inadvertent arterial puncture, ateriovenous fistula, thoracic duct injury, brachial plexus injury, laceration of the subclavian vein, and air embolism are the well described complications of the central line insertion

Objective: This study was designed to find out the frequency of complications during Central venous line insertion via sub clavian route

Methodology: This cross-sectional descriptive study was conducted at DHQ Hospital Sargodha from April 2014 to April 2015. Two hundred patients both male and female requiring hemodialysis were included in the study. All patient underwent double lumen catheterization of subclavian vein after informed consent

Results: Mean Age of the patients was 54.55 +/- 10.45. 71% of the patients were female and 29% of the patients were male. Out of 200 patients subjected to double lumen catheterizations; 28 [14.0%] developed various complications related to insertion. Out of 28 patients who developed complications, in 08 [28.57%] cases complication was failure to cannulate, in 08 [28.57%] cases there was arterial puncture, in 04 [14.28%] cases catheters were mal-positioned/kincking. Hemothorax and subclavian arterio-venous fistula developed in 02 [7.14%] each. 02 [7.14%] cases had arrhythmias and death occurred in 02 [7.14%] cases

Conclusions and Recommendations: Subclavian double lumen catheters proved to be reasonably safe, easy and a reliable way of obtaining vascular access for hemodialysis. The procedure is a short term alternative to AV fistula formation for patients requiring long term hemodialysis. It is recommended that double lumen subclavian vein catheterization should be part of post graduate training in large units where hemodialysis is available

Bed side diagnosis of pleural fluid using reagent strips

Introduction: on average, the total volume of pleural fluid in a 70-kg non-smoking human is 18mL

Objectives: to determine the frequency of correctly diagnosed type of pleural effusion by reagent strips in comparison to Light's criteria

Study Design: cross sectional Analytical study

Setting: Department of Pulmonolgy DHQ Hospital Faisalabad

Duration of Study: study was carried out over a period of six months from 01-06-2015 to 31-11-2015

Materials and Methods: total one hundred patients with pleural effusion were included in this study. The pleural fluid was tested by use of a reagent strip. Different cut off values for reagent strip were:[specific gravity; dark green 1.005, light green 1.015, brown 1.02, orange 1.03] and [protein; 1+ 30, 2+ 100, 3+ 500 mg/dl]. The type of pleural effusion [exudative or transdative] obtained from reagent strips as per according to operational definition were compared with results according to Light's criteria which was taken as Gold Standard

Results: regarding age distribution, majority of the patients i.e. 38 [38.0%] were between 40-59 years of age while minimum 9 [9.0%] were < 20 years. Mean age of the patients was observed 41.3+/-6.9. Distribution of cases by gender shows 63 [63.0%] patients were male while remaining 37 [37.0%] were females. Out of 100 patients, 84 [84.0%] were correctly diagnosed type on reagent strips

Conclusion: pleural effusion is a commonly encountered problem in medical practice in our country. The initial step in evaluating case of pleural effusion is to establish the type of pleural effusion

E-Log system in monitoring of residency program: trainees' perspective

To record residents' perspective about the utility of newly introduced E-Log system at the College of Physicians and Surgeons Pakistan [CPSP]. Sequential mixed method design using survey questionnaire and in-depth interviews. CPSP, Regional Center, Lahore, from March to June 2014. Data was collected from registered trainees through a web-based survey questionnaire on a scale of 1 to 7 about the utility of E-log system. In-depth interviews were conducted with 7 students using non-probability purposive sampling. The interviews were tape recorded and subsequently transcribed. Quantitative data was analyzed using SPSS version 20 and qualitative data was analyzed using content analysis by identifying themes and patterns. A total of 4399 responses were received. Motivation was 4.61 +/- 1.98; 4.33 +/- 2.00 remained acknowledgment of control of one's training by the new system. Ease of use got a mean score of 4.56 +/- 2.15. The overall acceptance of the students regarding E-Log system was high. Scheduling IT workshop at the start of training will add to the student satisfaction regarding utility of E-Log system

Restless legs syndrome in end stage renal disease patients undergoing maintenance hemodialysis

To study the frequency of restless legs syndrome in patients of end stage renal disease undergoing maintenance hemodialysis.Cross sectional descriptive study. Department of medicine, CMH multan from November 2010 to April 2011. One hundred and ninety four [n=194] patients of end stage renal disease who had been on maintenance hemodialysis for at least 3 months, were included in the study after full informed consent and using consecutive sampling. Patients having dementia, psychiatric illness, pregnancy, hypothyroidism, parkinson's disease and alcoholics were excluded from the study. Patients who fulfilled all four diagnostic criteria for restless legs sydrom as proposed by international restless syndrome study group [IRLSSG], by direct questioning were diagnosed as having restless legs syndrome. The frequency of restless legs syndrome was found to be 12.4% in patients undergoing hemodialysis [10.5% in males verus 16% in females].The mean duration of hemodialysis was higher among RLS positive patients [12.88 +/- 5.543 months] as compared toRLS negative patients[6.94 +/- 4.610 months]. RLS is a frequent, under-diagnosed co-morbidity in patients undergoing maintenance hemodialysis

Frequency of carotid artery stenosis in ischemic stroke

Stroke continues to be a significant cause of morbidity and mortality throughout the world. According to the world health organization, 15 million people suffer stroke worldwide annually. Despite maximal medical management, carotid artery atherosclerosis leading to stenosis continues to portend a poor prognosis. Conservative management frequently fails in this disease, leaving patients at high risk for cerebral infarction and death

Objective: To determine the frequency of carotid artery stenosis in patients with stroke using Doppler Ultrasonography

Study design: cross-sectional analytical study

Setting: outpatient and emergency department of Medical Unit-I, Allied Hospital, Faisalabad

Duration of study: Study was carried out over a period of seven months from 01-03 2014 to 30-09-2014

Subjects and methods: A total of 100 cases were included in this study. Every patient was undergone a list of investigation including lipid profile, electrocardiography [ECG], X-ray chest [PA], computed tomography [CT] scan brain and echocardiography to rule out any cardiac source of embolism

Results: Out of 100 cases, 12 patients [12%] were between 18-40 years old, 34 patients [34%] were 41-60 years of age while 54 patients [54%] were 61-80 years old. Mean age of the patients was 51.9 +/- 5.1. Regarding gender distribution, 62 patients [62%] were male and 38 patients [38%] were female. Of 100 patients, 56 patients [56%] had carotid stenosis on color Doppler Ultrasonography of carotid arteries. 29 patients [51.8%] had mild stenosis, 17 patients [30.3%] had moderate stenosis and 10 patients [17.9%] severe stenosis

Conclusion: It is concluded that carotid artery stenosis is strongly associated with ischemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke

Pattern of different types of cerebral stroke in Faisalabad

Objective: To determine the frequency of different types of stroke in patients with cerebral stroke presenting in DHQ hospital Faisalabad

Study Design: Cross Sectional Descriptive Study

Setting: Study was conducted in Medical Unit IV DHQ Hospital Faisalabad between 01-06-2014 to 30-11-2014

Materials and Methods: 100 patients both male and female of ages more than 16 years admitted with acute stroke with in and after 24 hours of stroke and patients having infarction, hemorrhage and subarachnoid hemorrhage as a cause of stroke diagnosed on Computerized Tomography [CT] scan of the brain were included in the study. After Informed Consent, data collection was carried out after taking history, performing clinical examination and doing investigations. Data was analyzed by using Chi-Square test at 5% level of significance. Statistical analysis was carried out with the use of SPSS Version 21 for Windows. In this study, frequencies of major categories of stroke were found out in relation to different age groups and sex. Hypertension and association between frequencies of various categories of stroke and Diabetes Mellitus, Hypertension and association between frequencies of Diabetes various categories of stroke and irregularly treated Hypertension and Diabetes Mellitus were found out

Results: Our research found the frequency of Infarctive stroke, Intracerebral bleed and Sub-arachnoid hemorrhage as 62%, 28% and 10% respectively. Correlation of gender with major categories of stroke was found to be statistically significant. Peak age range for cerebral infarction was found to be 51-60 years accounting for 22 cases [i.e. 35.48% of all cerebral infarction cases], peak age range for intracerebral bleed was also 61-70 accounting for 12 cases [i.e. 42.86% of all intracerebral bleed patients] and peak age range for Sub-arachnoid hemorrhage was 41-50 accounting for 4[40%] cases. Infarctive stroke was also found in the lowest age range i.e. 21-30 accounting for 3 cases. Patients with uncontrolled Hypertension and Diabetes Mellitus were found to be at more risk of developing cerebral stroke

Conclusion: Infarctive Stroke is more common in our study as compared to hemorrhagic Stroke. Proper awareness and treatment about the major risk factors of stroke such as hypertension and diabetes mellitus can help to reduce the episodes of stroke in population. Patients need proper education about modifiable risk factors for cerebral stroke

Visual outcome and complications in Ab-externo scleral fixation IOL in aphakia in pediatric age group

To assess the visual outcome and complications in patients after Ab-externo scleral fixation of intraocular lens in pediatric age group [15 years or less]. This quasi experimental study was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2012 to December 2012. All cases included were worked up according to the protocol. All patients underwent Ab-externo scleral fixation of IOL under general anesthesia. Patients were followed up at 1stday, 1[st] week, 1[st] month, 2[nd] month and 3[rd] month. Complete eye examination including best-corrected visual acuity and complications were noted on each visit. Thirty patients were included in the study, with mean age of 8.6 years [ +/- 3.93569]. Most of the patients, 20 [66.7%], had visual acuities of 6/18 or better. No complication was seen in 18 [60%] of the patients intra operatively while soft eye was observed in 7 [23.3%] of the patients. Another complication noted was vitreous hemorrhage, which was seen in 5 [16.7%] patients. Most common post-operative complication was Uveitis followed by astigmatism. Lens dislocation and iris abnormalities were seen in only one patient. Most of the patients showed significant visual improvement after surgery. Ab-externo scleral fixation of an IOL was found to be safe and showed favorable postoperative results with fewer complications

Prolongation of QTc duration and increased heart rate in patients with cirrhosis of liver

Objective: To compare QTc duration and increasedheart rate in patients with cirrhosis with noncirrhoticcontrols

Design: Cross-sectionalanalytical study

Place and Duration of Study:Medical Unit 1 Allied Hospital Faisalabad between1st March 2011 to 30th August 2011

Patients andMethods: 50 patients of cirrhosis were selected inGroup-I. An equal number of non-cirrhotic patientswere taken as control and were included in Group-II. ECG was recorded and Heart rate[HR] and QTcinterval was calculated in both the groups.Comparison of increased prolongation of QTc andHeart Rate were done using independent samples ttest with significance level at 0.05

Results: Fiftypatients of cirrhosis of liver were inducted in Group-I with same number of non-cirrhotic patients ascontrol in Group-II. The mean +/- SD of QTc ofGroup-I was 0.472 +/- 0.012 sec and that in Group-IIwas 0.434 +/- 0.014 sec and that for HR in Group-Iand II were 79.26 +/- 10.08 and 74.24 +/- 7.58beats/min respectively. The mean QTc and HRvalues were significantly more in Group-I ascompared to Group-II with p value = 0.0001

Conclusion: Means of both HR and QTc weresignificantly higher in cirrhotic patients as comparedwith non-cirrhotic controls

Efficacy of arthemether-lamefuntrine in Malaria

Objective: To determine the efficacy ofArthemether-Lamefuntrine [AL] in patients withmalaria

Study Design: Quasi-experimental study

Place and Duration of study: Study was conductedin Medical Unit DHQ Hospital Sargodha andMedical Unit V, DHQ Hospital Faisalabad from 1stJanuary 2011 to 30 June 2011

Subjects andMethods: 129 adult patients both male and femalediagnosed to have malaria both on clinical andlaboratory examination were included in the study.Patients were given AL [20/120] 2 tablets 12 hourlyfor three days. An adequate clinical andparasitological response [ACPR] was defined asabsence of fever and parasitaemia [negative slide forMalarial parasite] by day 45 after end of treatment

Results: Out of 129 patients adequate response[ACPR] was seen in 122 patients with efficacy of94.6%

Conclusion: AL is an important andeffective treatment option for treatment of patientswith malaria

Nutritional profile and inflammatory status of stable chronic haemodialysis patients at Nephrology Department, Military Hospital Rawalpindi

Protein-energy malnutrition [PEM] is common in the haemodialysis population. Identification and management of these patients can result in significant reduction in morbidity and mortality. Aim of the study was to find the prevalence of PEM in otherwise stable haemodialysis patients at Military Hospital Rawalpindi at a single point in time with the help of established biochemical and physical markers. Height, dry weight and body mass index [BMI] were recorded for 64, stable, 14-75 year-old patients who were on haemodialysis for >/= 3 months. Blood samples were drawn [pre-dialysis] for complete blood count, serum C-reactive protein, serum total protein, serum albumin and serum Creatinine. Ideal body weights and BMI were obtained from Pakistan Army Selection and Recruitment standards. Out of 64 patients 43 [67%] were males. Mean age was 44.5 +/- 14.3 yr. Mean haemoglobin was 8.84 +/- 2 g/dl. Fifty-seven patients [89%] had haemoglobin

Accuracy of surgeon - performed abdominal utrasound for gallstones

Gallstone disease is common in Pakistan. It is primarily diagnosed by ultrasonography, which is traditionally done by radiologists. If surgeons could perform ultrasonography, it would enable early diagnosis in one-stop clinic. This study was done to evaluate the accuracy of surgeon-performed abdominal ultrasonography to detect gallstones. This study was carried out at Surgical A and Surgical C units of Ayub Teaching Hospital, Abbottabad from July. 2000 to December, 2002. One hundred fourty two patients with signs and symptoms of gallstone disease who had ultrasonography performed by a surgeon, trained in ultrasonography were exclusively studied. These patients were referred for further scanning by the radiologists who were unaware of the surgeons interpretation. The results of surgeon and radiologist performed ultrasonography were compared. The interpretation of surgeon-performed ultrasonography was correct in 100 patients and incorrect in 42 patients. There were 100 True Positive. 41 True Negative, One False Negative and Zero False Positive scans yielding 99%, Sensitivity, 100% Specificity and 99.3% Accuracy. Sensitivity of surgeonperformed ultrasonography in detecting gallstones compared to operative findings was 100%,. Conclusions: Abdominal ultrasonography performed by an ultrasonography trained surgeon can detect gallstones as accurately as by a radiologist