Parvovirus B19: a rare cause of post-renal transplant anemia

Parvovirus B19 infection should be contemplated as one of the differential diagnoses of persistent anemia in transplanted patients. There must be high index of suspicion of Parvovirus B19, when post-transplant patients present with refractory and severe anemia with reticulocytopenia and all the other common causes of anemia such as blood loss, adverse effects of immunosuppressant agents and graft dysfunction has been ruled out. In suspected patients, diagnosis is confirmed by serological tests [IgM and IgG], PCR from blood and/or bone marrow and by bone marrow biopsy finding of pure red cell aplasia. Intravenous immunoglobulin [IVIG] is the treatment of choice and highly rewarding. Here we are reporting two cases of post-transplant Parvovirus infection, one in an adult lady and second in an adult man who underwent live renal transplantation recently

Epidemiological features of dog bite and its awareness among victims: report from abbasi shaheed hospital karachi

Objective: To estimate the burden of recently reported cases of dog bite in a tertiary care center of Karachi and to analyze the awareness of these victims or their attendants about dog bite or rabies

Methods: This cross sectional study was conducted during January to June 2008 at Emergency department of Abbasi Shaheed Hospital. Our sample was comprised of 393 patients, reporting first time after stray dog bite incident. The relevant information was obtained regarding patients' age, gender, details of injury, management and patients' knowledge about dog bite and rabies. SPSS 13 was used to manage data and perform analysis

Results: It was found that 83% of the victims were males and 52.4% were of less than 15 years of age. In our data, 26.7% victims reported within twenty-four hours of the dog bite. Mapping of dog bite cases revealed that 24% belonged to Orangi town while 14% each from North Karachi and Nazimabad. Knowledge of people related to rabies was very poor and 91% did not know that rabies could result after dog bite. Only 7% knew that rabies is a fatal disease and 0.7% responded that it can be prevented by vaccines

Conclusion: Dog bite is a significant public health problem among young males with preponderance in certain areas of Karachi. Lack of education of people and lack of health communication reflected well through carefree practices and attitude of victims of dog bite

Comparison between Captopril and Imidapril in relation to their in vitro effects on tracheal tissue

Objective: To observe two drugs [captopril and imidapril] action on smooth muscle tone of trachea and to facilitate safe and rational use of ACE inhibitors, particularly in patients with chronic obstructive airway disease

Study Design: Comparative controlled in-vitro experimental Study

Place and Duration of Study: This study was conducted at the Pharmacology Department, Army Medical College, Rawalpindi from December 2012 to May 2013

Materials and Method: First the effect of bradykinin acetate on the smooth muscle of trachea has been observed. Cumulative concentration-effect relationship was studied with different concentrations of bradykinin on the smooth muscle starting with 22 micro g to 132 micro g/dl. The method was done again with captopril 10[-5] M concentration and imidapril 10[-5] M respectively. In second set of experiments cumulative concentration-response curves were prepared by increasing concentrations of captopril and imidapril separately with fixed concentration of bradykinin 66 micro g/dl

Results: Dose related vacillating contraction of smooth muscle of trachea is produced by bradykinin. The average value of effect received with 132 micro g/dl of bradykinin in the presence of captopril was 51.33 +/- 2.79 and in the presence of imidapril was 25 +/- 7.26. All these ACE inhibitors displaced the concentration effect curves of bradykinin to left and upward. On comparison among themselves it was observed that imidapril produced least enhancement of tracheal contraction. Similar results were produced by second set of experiments

Conclusion: Imidapril is found to cause least enhancement of contraction caused by bradykinin on tracheal muscle. Further clinical trials may be conducted to establish the differential effects of various clinically used ACE inhibitors on the respiratory passages in hypertensive patients concomitantly suffering from COAD

Diabetes knowledge in elderly type 2 diabetes mellitus patients and association with glycemic control

Background: With the increased life expectancy, there is rise in geriatric diabetic population. A knowledgeable diabetic in collaboration with physician can contribute to a successful diabetes management plan. Current study was conducted to determine the diabetes knowledge, its associations and risk factors in elderly type 2 diabetics

Methods: This descriptive cross sectional study was conducted at outdoor Medicine Dept. Rawal Institute of Health Sciences Islamabad over 8 months period from January to August 2015. Geriatric type 2 diabetics [>65 years] were included. Critically ill patients, having physical or mental limitation to answer the questionnaire were excluded. The demographic details, socioeconomic class, literacy level, duration of diabetes, other modes of therapy and glycemic control documented. Michigan Diabetes Knowledge Questionnaire [DKQ-24] was applied with outcome of diabetes knowledge as good, acceptable and poor. Data analyzed by SPSS version 17 with significant p-value < 0.05

Results: Among 163 diabetics [21.5% males and 78.5% females], mean age was 64.7+5.6 years and mean duration of diabetes 8.4+6.6 years. Diabetes knowledge was poor in 86[52.8%], acceptable in 37[22.7%] and good in 40[24.5%] diabetics. Poor diabetes knowledge was found to be associated with illiteracy, poverty, unsatisfactory glycemic control, practicing other modes of therapy and poor dietary control

Conclusion: The unsatisfactory diabetes knowledge in geriatric diabetic population needs to be addressed. Illiteracy and low socioeconomic class are the contributory factors in addition to advanced age. Imparting knowledge to geriatric group about diabetes and its complications, dietary advice supplemented by easy to interpret diet charts and literature may lead to empowerment of geriatric diabetics for better diabetic control and reduced diabetes related morbidity

Predictors of severity of dengue fever in tertiary care hospitals

Background: Dengue fever, an emerging public health issue in Pakistan bears considerable morbidity and mortality. This descriptive cross sectional study was conducted to analyze clinical, hematological and serological characteristics of dengue fever variants and to identify biomarkers that predict its severity

Methods: 105 dengue cases [>12 years] were selected after ethical approval from Rawal Institute of Health Sciences and Benazir Bhutto Hospital Rawalpindi over 6 months [July to Dec 2015]. Patients having pre-existing hematological disorder, liver disease, malaria and typhoid co-infection were excluded. Demographic data, clinical findings, hematological and serological profile documented. Patients were classified as classic dengue fever [DF], dengue hemorrhagic [DHF] and dengue shock syndrome [DSS]. Data analyzed via SPSS version 17

Results: Among 105 cases, there were 79[75%] males and 26[25%] females. Mean age was 30 +/-12.8 years and mean duration of symptoms 5 +/-2 days. Dengue fever was found in 75[75%], dengue hemorrhagic fever 24[23%] and dengue shock syndrome 2[2%]. Gender, mean age and duration of symptoms were comparable between DF, DHF and DSS. Common clinical features were fever [100%], headache [56%], muscle pain [43%], vomiting [43%], retro-orbital pain [23%], bleeding [12%] and hypotension [10%]. Thrombocytopenia, leukopenia and pancytopenia were frequent in DHF vs. DF. Dengue NS-1 antigen positive in 71[90%] of DF cases vs 16[57%] DHF and 1[50%] DSS. Dengue-IgM positive in 32[47%] DF vs. 19[79%] DHF and 2[100%] DSS. Dengue -IgG detected in 33[42%] DF vs. 17[71%] DHF and 1[50%] DSS. 101[96%] dengue cases were treated successfully and one case expired

Conclusion: Dengue-IgG and IgM are better predictive variables for dengue hemorrhagic fever as compared to NS-1 antigen that predicts classic dengue fever. Utilizing these predictive variables, imminent severe dengue may be identified and with vigilant monitoring, fluid resuscitation and pre-hand arrangement of blood products we may reduce complications and mortality in high risk cases

Intraocular pressure; incidence of steroid induced rise in local population of normal, V.K.C and C.S.G patients

To assess the incidence of steroid induced rise in intra-ocular pressure in different group of patients. The study was conducted in the department of ophthalmology Akhtar Saeed Trust Teaching Hospital of Akhtar Saeed Medical and Dental College Lahore and Continental Medical College Lahore from Jan 2009 to Oct 2010. Three groups were formulated in which group A comprised of normal population with no ocular disease, group B included patients with vernal keratoconjunctivitis while group C comprised of chronic simple glaucoma patients with controlled intraocular pressure. Dexamethasone 0.1% eye drops were used four times daily for four weeks and patients were evaluated weekly in terms of IOP monitoring after which they were labeled as either low or non-responders, moderate responders or high responders. In group A 40% of the patients showed rise in IOP, group B showed 95% rise in IOP and the response in group C cases was 100%. Topical steroids result in significant rise in IOP therefore careful monitoring should be done in all patients on corticosteroids

Future of physical therapy in Pakistan - satisfaction amongst Pakistani physical therapists about their profession

Objectives: To determine the level of satisfaction in Pakistani physical therapists about their profession as well as future prospects in the field

Study design: A cross sectional Survey

Place and duration: A structured Questionnaire was introduced to one hundred Physiotherapists selected through purposive sampling technique for the study in Rawalpindi from different Physiotherapy institutions of Pakistan from June 2010 to August 2010. Data was entered and analyzed using SPSS 17

Methodology: A total of 100, [male 69 and 31 females] professional Physiotherapists were interviewed about their opinion regarding their future and satisfaction in the physiotherapy profession. There were only 32% [n=32] PTs who were satisfied with their professional growth and 68% [n=68] who were not satisfied with the professional growth in Pakistan

Results: A total of 100, [male 69 and 31 females] professional Physiotherapists were interviewed about their opinion regarding their future and satisfaction in the physiotherapy profession. There were only 32% [n=32] PTs who were satisfied with their professional growth and 68% [n=68] who were not satisfied with the professional growth in Pakistan

Conclusion: Considerably low level of satisfaction was found amongst the participants regarding their earnings and quality of education. Mostly the participants were hopeful in future to see their profession developed with the help of regulatory body and empirical commitments from the government

Frequency of catheter related blood stream infections due to indwelling temporary double lumen catheter with respect to duration of catheterization in hemodialysis patients

Background: Temporary hemodialysis catheters are an important means of gaining immediate vascular access. Catheter related blood stream infection [CRBSI] is the most important complication limiting its use. Frequency of CRBSI increases with duration of catheterization

Objective: To find the frequency of catheter related blood stream infections due to indwelling temporary double lumen catheter with duration of insertion in hemodialysis patients

Materials and methods: This is a hospital based cross-sectional study which includes 40 renal failure patients requiring dialysis with temporary hemodialysis catheter who were found to have CRBSI. The frequency of catheter related blood stream infections due to temporary double lumen catheter in relation to duration of insertion in hemodialysis patients was calculated

Results: Mean duration of catheterization till CRBSI developed was 16.97+/-8.56 days, although, it varied from 7 to 37 days. The frequency of CRBSI at 1[st] week, 2[nd] week, 3[rd] week, 4[th] week and more than 4 weeks was 4 [10%], 14 [35%], 11 [27.5%], 4 [10%] and 7 [17.5%] respectively. A sub-group analysis of frequency of blood stream infections with respect to duration of catheterization amongst diabetics against non-diabetics, internal jugular [IJ] against subclavian [SC] vein site, optimal against sub-optimal hygienic conditions, males against females and amongst various age groups was conducted and did not show any statistically significant difference. [p value> 0.05]

Conclusion: The frequency of CRBSI in temporary hemodialysis catheters increases with duration of catheterization and is maximum at 2nd week post catheterization. We recommend duration of catheterization should be limited to less than two weeks in hemodialysis population

Thoracoscopic evacuation of retained post-traumatic hemothorax

Post-traumatic retained hemothorax is a major risk factor for empyema thoracis leading to prolonged hospitalization, entrapped lung and a need for decortication. VATS [Video Assisted Thoracoscopy] for retained hemothorax shortens the duration of chest tube drainage and length of stay. From December 2004 to July 2009, 110 consecutive patients underwent VATS for retained or clotted hemothoraces at the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi. Majority of the patients were males [n = 91; 82.7%]. Sixty-five patients [59.1%] underwent VATS within 6 days and 45 patients [40.9%] between 7 - 14 days of injury. In 8 patients [7.3%] VATS was abandoned for thoracotomy. Post VATS full lung expansion was achieved in 87 patients [79.0] with complete evacuation of hemothorax. Chest tubes were removed within the first week in 100 patients [90.9%]. In hemodynamically stable patients, VATS is a safe, reliable and effective technique for the evacuation of retained hemothorax. Early intervention within 6 days of injury avoids the need for a thoracotomy and is associated with a better short and long-term outcome

Congenital heart disease screening: which referral factors are most important?

To identify the referral factors for fetal echocardiography which are associated with congenital cardiac defects in the fetus. Cross-sectional descriptive study. Radiology Department, CMH, Rawalpindi, from January 2007 to November 2010. All patients referred for fetal echocardiography with one or more risk factors for the development of congenital heart disease, and those patients with incidental discovery of congenital heart disease on antenatal ultrasound were evaluated. Patients with no risk factors who were found to have normal fetal echocardiography were excluded from the study. Univariate logistic regression analysis was carried out for each variable. The variables with statistical significance of less than 0.05 were subjected to multivariate logistic regression. Fetal echocardiographic diagnosis was taken as the dependent variable and all other variables were the independent variables. Two hundred and sixty four patients were evaluated by fetal echocardiography for congenital heart disease. The statistically significant factor was detection of congenital heart disease on routine ultrasound examination. A routine obstetric scan should include evaluation of the heart with four-chamber and base-of-heart views to exclude cardiac anomalies. A cardiac anomaly picked up on routine ultrasound scan is the most important indication for referral for fetal echocardiography. Fetal arrhythmias and echogenic focus in the left ventricle do not have a significant association with structural cardiac malformation

Detection of congenital heart disease by fetal echocardiography

The objective of the study was to determine the sensitivity, specificity, accuracy and predictive value of fetal echocardiography in our set up using postnatal echocardiography as gold standard. Validation study. This is an ongoing study in the Radiology department of CMH Rawalpindi and Armed Forces Institute of Cardiology [AFIC] Rawalpindi and the data collected from January 2007 to Jan 2012 is presented. Two hundred eighty seven patients reported for fetal echocardiography. Two hundred twenty nine patients were subsequently included in the study. These included patients of all ages who reported to the Radiology department of CMH Rawalpindi for fetal echocardiography. Fetal echo was done on Toshiba Aplio with 3.5 MHz probe having Doppler facility. Post natal evaluation was done by a pediatric cardiologist. There were 207 [90.4%] true negative cases, 15 [6.6%] true positive, 2 [0.9%] false positive and 6 [2.2%] false negative cases. The sensitivity, specificity, positive and negative predictive values were 75%, 99%, 88%, 97% respectively. Fetal echocardiography has high specificity, negative predictive values and accuracy and cases diagnosed as normal can reassure the parents about the normal cardiac status of the fetus

Open cholecystectomy: our experience

Different indications of cholecystectomy and outcome of open cholecystectomy were analyzed in a retrospective study at Department of Surgery, Baqai Medical University Hospital, Nazimabad, Karachi. A consecutive series of 250 patients with gallstone had open cholecystectomy, from May 2007 to June 2012, were analyzed. The criterion for diagnosis was based on history, clinical findings, ultrasound and CT scan. A total of 250 surgically treated patients of symptomatic gallstone disease were included who underwent open cholecystectomy. Age ranges were from 20 years to 80 years. Sex distribution showed female preponderance. Sixty five patients [26%] had acute cholycystitis, 18 [7.2%] had empayma gall bladder, 8 [3.2%] patients had mucocele and 15 [6%] patients had gall stone pancreatitis. Eight [3.2%] patients each had contracted gallbladder and deranged liver functions without common bile duct stones, respectively. Seventy [28%] patients were diabetics and 48 [19.2%] had hypertension. Twenty eight [11.2%] were known cases of ischemic heart disease, whereas 40 [16%] had both diabetes mellitus and hypertension. In 145 [58%] patients elective cholecystectomy and in 80 [32%] patients interval cholecystectomy was performed. In this series 18 [7.2%] patients underwent urgent cholecystectomy while tube cholecystostmy was performed in two [0.8%] patients. In 23 [9.2%] patients partial cholecystectomy was done. Eight [3.2%] patients under went common bile duct exploration during cholecystectomy. Out of total 250 patients, 12 [4.8%] developed wound infection, two [8%] patients had incisional hernia and one [0.4%] patient had common bile duct injury which was managed by endoscopic retrograde cholangiopancreatography. It is concluded that open cholecystectomy is still a standard procedure and have definite indications for surgical education and training of surgical resident

Amoebic liver abscess and gender differences

The study was undertaken to elucidate the clinical profile and to find out the of results of Ultrasound guided aspiration of liver abscess in the Department of General Surgery, Baqai Medical University Hospital Nazimabad Karachi, from April 2007 to April 2012. 60 cases were included in the study, which were diagnosed to have amoebic liver abscess with 96.5% male and 3.5% female patients. The diagnosis was based on persistent fever, pain in right upper abdomen with pointing tenderness over liver, serodiagnosis, ultrasound evidence of liver abscess and CT scan in selected cases. Those having abscess larger than 5 cm subjected to percutaneous transhepatic ultrasound guided aspiration of liver abscess and the abscess size and resolution was monitored. Parental antibiotic cover for 4 to 6 weeks was provided to all patients. Fever was the most frequent symptom as diagnosed in 57 [94%] patients, followed by pain in right upper abdomen in 54 [90%] patients and diarrhea in 6 [10%] patients, anorexia and weight loss in 18 [30%] patients. 11 [18.3%] patients had hepatomegaly, 8 [13.5%] showed deranged LFTs and 9 [15%] patients had right sided pleural effusion. Out of total cases, 54 [90%] patients had right lobe abscess, 2 [3.3%] patients had left lobe abscess and three [5%] patients had multiloculated right lobe abscess. One [1.6%] patient had multiple abscess in both lobes of liver. Serology test for Entamoeba histolytica was positive in all patients Ultrasound guided needle aspiration employed in 38 [63.5%] patients and 22 [36.5%] patients were managed conservatively. In 8 [13.3%] patient's second attempt of aspiration employed. In one [1.5%] patient right chest drain was passed. Patient with amoebic liver abscess with fever and pain in right upper abdomen were noted. Our study showed amoebic liver abscess had seven times higher incidence in male than in female

Dual source multislice computed tomography for pulmonary embolism: initial experience at AFIC/NIHD Rawalpindi

Observation of different computed tomography findings in patients suffering from pulmonary embolism. All patients who underwent computed tomography for pulmonary embolism and had positive findings of pulmonary embolism, were included in the study. Armed Forces Institute of Cardiology/ National Institute of Heart Disease, between April 2009 and October 2010. Patients on mechanical ventilation were excluded from the study. CT pulmonary angiograms were obtained with 64 slice dual source computed tomography [DSCT] machine [Somatom definition] from Siemens. Before scanning breath holding was taught. A craniocaudal acquisition was obtained with a collimation of 64 x 0.6 mm and a pitch of 1.2-1.4. Total number of patients included in the study were 34 with mean age 50 years. The mean of Score by Miller was 10 +/- 5.532 and the mean percentage obstruction by method of Miller was 62.5%. The mean of Score by Qanadli was 19.62 +/- 12.32 and the mean percentage obstruction by method of Qanadli was 49.04%. The mean of Score by Mastora was 54.53 +/- 33.27 and the mean percentage obstruction by method of Mastora was 35.18%. Calculated mean and SD of right ventricular [RV] diameters was 44 +/- 7.75mm, left ventricular [LV] diameter was 32 +/- 8.06mm, RV/LV ratio was 1.508 +/- 0.58 mm, main pulmonary artery [PA] luminal diameter was 29 +/- 4.16mm, ascending aorta size was 32.46 +/- 5.14mm, PA/Aorta ratio was 0.913 +/- 0.188mm, Azygos Vein diameter was 11.14 +/- 1.88mm and superior vena cava [SVC] diameter [at azygos arch] was 18.93 +/- 3.37 mm. Correlation between methods was generally significant. Reflux of contrast injection was noted in 24 out of 34 patients, leftward bowing of inter-ventricular septum was observed in 21 patients, pleural effusion was noted in 10 patients and pericardial effusion was seen in only 3 patients. CT pulmonary angiography has emerged as a reliable non invasive tool for not only confirmation of diagnosis of pulmonary embolism in short time but also gives valuable information about prognosis of these critically ill patients. Further it can provide accurate follow up of thrombolytic therapy and can help plan an interventional strategy

out break of more than 1300 cases of acute viral hepatitis in a tertiary care hospital in Rawalpindi in summer of 2009

To find out the short-term clinical course including common clinical features, laboratory parameters, treatment provided and outcome of cases of acute viral hepatitis hospitalized in a tertiary care hospital. Descriptive observational study. Military Hospital in Rawalpindi from May to July 2009. Patients hospitalized with acute viral hepatitis, both male and female, older than 12 years of age were included in the study. A detailed proforma including patients' particulars, clinical features; laboratory parameters, treatment provided, disposal/ outcome was designed and filled for each patient. During the study period a total 1334 patients were hospitalized, 1279 [95.87%] were male while only 55 [4.13%] were female. Majority of patients were young adults. Mean age was 26 years with a range of 12 to 85 years. Maximum serum bilirubin levels of 559 micromoles /I and serum alanine aminotransferase [ALT] levels of 7750 IU/L were observed. Maximum prothrombin time [PT] ranged from 105 seconds to failed to clot, against a control of 13 seconds. Thrombocytopenia was observed in some patients especially those with coagulopathy and encephalopathy but recovered with improvement in LFTs. Anti HEV serology was sent in a third of all admitted patients and was positive for IgM in patients tested. Five patients were pregnant ladies. Two patients also had laboratory proven malaria along with acute viral hepatitis. Majority of patients had uneventful recovery. A total of 13 patients went in to hepatic encephalopathy while three unfortunate patients died. HEV has been an important cause of acute viral hepatitis in Pakistan, particularly in adults from lower socioeconomic groups. The problem is more serious for those living in military camps, residential institutions and in segregated areas who consume untreated water from a common source. Outbreaks like the one described have significant morbidity and not ignorable mortality for the affected persons

comparison of pioglitazone with metformin in management of type 2 diabetes mellitus

To compare hypoglycemic effect of Pioglitazone and Metformin in type 2 Diabetes Mellitus. Quasi experimental study. Department of Medicine, Military Hospital Rawalpindi Cantt from 11-01-2007 to 12-08-2007. Sixty patients of type 2 diabetes mellitus from outdoor department were selected. On arrival at OPD each patient was examined thoroughly. Therapeutic option was allocated to the patients simply by using a table of random numbers and dividing them in two equal groups. Informed written consent was obtained. Each patient was followed on monthly subsequent visits [six in total] and his HbA1c, fasting and random blood glucose were recorded carefully. All the data thus obtained was processed and analyzed using SPSS version 10.0. Mean and SD were calculated for age, BMI, fasting blood glucose, random blood glucose and HbA1c levels. Mean drop of all three parameters were compared among two groups. At the end of six months, it was revealed that fasting and random [2 hours postprandial] blood glucose dropped more in Pioglitazone group; P=0.000 and 0.02 respectively. While almost comparable effect was observed in HbA1c [P=0.2]. Pioglitazone has significantly better hypoglycemic effect than Metformin in type 2 diabetes mellitus at the end of six months therapy

In-stent restenosis of innominate artery with critical stenosis of right internal carotid artery

A lady with aortitis syndrome developed in-stent restenosis [ISR] of the innominate artery stent and critical stenosis of right internal carotid artery. The therapeutic challenge was gaining access to the carotid vessel, after treating the innominate artery ISR and all the while using distal protection to circumvent potential cerebral embolism. Percutaneous transluminal angioplasty [PTA] with or without stenting is a safe therapeutic option for re-vascularization of the supra aortic vessels. In the event of re-stenosis, re-treatment with PTA and stenting is safe. Ample evidence-base exists now for carotid artery stenting [CAS] in preference to carotid endarterectomy in patients with stenotic lesions of the carotid vessels

Current pattern of acute peritonitis in adult

The studies were undertaken to evaluate the current pattern of Acute Peritonitis in adult. This study included consecutive pattern of peritonitis studied in term of clinical assessment, causes, site of perforation and surgical treatment. All patients were resuscitated and underwent emergency laparotomy. On laparotomy cause of peritonitis was found and treated

A total of 80 surgically treated cases of acute peritonitis were included. Out of total, all patients presented with acute peritonitis, the age was from 15 to 75 years, with male to female patient's ratio of 7:1. In our study, gastric perforation was found in one [1.25%] patient and duodenal perforation in 26 [32.5%] patients. The typhoid perforation was found in 38[47.5%] patients and TB perforation in terminal ileum was found in 4 [5%] patients. In one patient [1.25%] small intestinal perforation due to foreign body [stones] was managed. There were 8[10%] cases of peforated appendix in our study and 2 [2.5%] patient had caecal perforation. Highest numbers of perforation have seen in ileum, duodenum, appendix, caecum and stomach. The most common cause of peritonitis was found to be ileal perforation and followed by perforation. The pattern of peritonitis is variable, depending upon eating habits and socioeconomical conditions

Determination of various precipitating factors of hepatic encephalopathy in patients of chronic liver disease at military hospital Rawalpindi

To analyse the various precipitating factors of hepatic encephalopathy. A single centre, retrospective study. Military Hospital Rawalpindi from July 2009 to April 2010 One hundred and fifty admitted patients with hepatic encephalopathy were probed into for different precipitating factors, based on history, clinical examination and laboratory methods. Sixty two percent were female and 38% were male patients. The mean age of the patients was 57 years, with a range of 30-85 years. Evidence of Hepatitis C virus was detected in 141[94%] patients while in 9[6%] patients HBV was detected. Constipation was present in 42.7%, gastrointestinal bleeding in 37.3%, infections in 12%, use of sedatives 2.7%, surgery 2.7%, while hypokalemia and excess protein diet were seen in 1.3% of the total patients. Constipation is the most common precipitating factor followed by upper gastrointestinal bleeding and infections

Frequency of dyslipidemia in type-2 diabetes mellitus patients

To determine the frequency of dyslipdemias in patients of type -2 diabetes mellitus. Descriptive study. Combined Military Hospital Rawalpindi from January to July 2010. A total of 150 patients of DM fulfilling the required criteria were selected and subjected to fasting blood glucose, fasting lipid profile including total cholesterol, HDL- cholesterol, LDL- cholesterol and Triglyceride [TG] levels. The data obtained was analyzed using Statistical Package for Social Sciences [SPSS] version 10. Out of 150 patients 38% were female and 62% were male. The mean age of the patients was 57.63 years [SD +/- 8.09]. Minimum age was 36 years and maximum age was 77 years. Out of 150 patients dyslipidemia was present in 120[80%] patients. Hypertriglyceridemia was present in 120[80%] patients, raised LDL-cholesterol in 94 [62.7%] patients, decreased HDL-cholesterol in 88 [58.7%] patients, and raised levels of total cholesterol in 60 [40%] patients. Diabetic patients have a high frequency of dyslipidemias especially raised Triglycerides, therefore lipid profile is to be checked routinely and its management be given equal importance in addition to glycemic control