Pulmonary renal syndrome in a patient with vasculitis: case report and review of literature

Granulomatosis with polyangiitis [GPA] previously known as Wegner's granulomatosis, is a small vessel vasculitis that preferentially involves capillaries, arterioles and venules, presenting as multisystemic disease classically with alveolar haemorrhage and renal insufficiency. We report a case of GPA diagnosed on history, clinical findings and supported by imaging and very high levels of C-ANCA. Renal biopsy confirmed the typical histopathological findings. We discuss herein the management of the case and review of literature

Etiology and epidemiology of patients presenting with liver disease during pregnancy

We conducted this study to elaborate the etiology and epidemiology of liver diseases presenting during pregnancy. It was a prospective, observational study. This study was conducted in the Department of Gastroenterology, Fatima Memorial Hospital in collaboration with the Department of Obstetrics and Gynaecology from June 2011 -May 2013. 73 patients were evaluated. Data was evaluated for quantitative and qualitative variables. Outcome of mother, pregnancy and neonates was also recorded were available. During the study period 73 pregnant patients were evaluated for the presence of liver disease giving an incidence of 3.6%. The mean age of the patients was 26.3 +/- 3.8 [median: 26, range: 16 - 45] years. The patients presented at a mean gestational age of 5.8 +/- 2.4 [median: 6, range: 1- 9] months. The mean STB and ALT levelswere 11.5 +/- 8.5 [median: 9.3, range: 1.4 - 48] mg/dL and 943.5 +/- 887.4 [median: 765, range: 13 - 4810] IU/Lrespectively. The mean duration of jaundice and mean hospital stay were 6.82 +/- 5.32 [median: 5, range: 2 - 30] days and 5.6 +/- 2.7 [median: 5, range: 1-18] days. Fulminant hepatic failure was seen in 6.8% of the patients. Acute Hepatitis E was the most frequent diagnosis in our population. Maternal deaths were seen in 8.2%, foetal deaths were seen in 12.3% and neonatal deaths in 6.5%. Liver diseases during pregnancy can have multiple causes and may predict poor outcomes for the patients and neonates

Temporary hemodialysis; taurolidine lock to prevent catheter-related blood stream infections

Catheter related blood stream infections [CRBSI] in patients undergoing hemodialysis frequently results in significant morbidity and mortality. Attempts at prevention of CRBSI by catheter lock antibiotics, antibiotic combinations or solutions including Taurolidine have emerged over years. Objectives: To determine the role of taurolidine lock in presentation of Catheter related infection in hemodialysis. Design: Multicentre un-builded, r and omized controlled, non-inferiority trail. Period: Jul 2012 to Dec 2013. Setting: Department of Nephrology, Fatima Memorial Hospital UHS Lahore. Methods: It was a multicentre, un-blinded, r and omized controlled, non-inferiority trial. Results: Out of 95 patients, total of 38 patients were r and omized into two groups. In group A catheters were locked with Taurolidine 2% and Heparin [5000IU/ml] equal to the catheter volume according to the protocol. In group B [control] catheters were locked with Heparin alone. 36 patients completed the study protocol. For primary end point analysis [30 days] the mean duration of catheter days was 27.25 + 5.5 days [median 30 days]. During this period of follow up only one patient from Group B had CRBSI resulting in a point incidence of CRBSI of 2.7%. Conclusions: Catheter lock with Taurolidine 2% in combination with heparin compared to heparin alone had no additional benefit in prevention of CRBSI. This however needs to be evaluated in a larger study using non cuffed temporary vascular access [TVA]

Acute hepatitis E during pregnancy; maternal and foetal outcomes

Liver disorders during pregnancy may have a strong bearing on both mother and the foetus. Acute Hepatitis E is rightly considered to be an emerging infection. Loco-regional studies have shown it to be the most common cause of Acute Hepatitis in pregnant females. We carried out our study to elaborate the demographic profile of pregnant females presenting with Acute Hepatitis E along with the fetomaternal outcomes

Study Design: It was a prospective, observational study

Intervention: None

Settings and Participants: Over a period of two years, 73 pregnant patients were evaluated by our team in the Department of Gastroenterology for suspicion of liver disease

Outcomes and Measurement: Data was evaluated for quantitative and qualitative variables. Outcome of mother, pregnancy and neonates was also recorded where available

Results: During the study period 73 pregnant patients presented with liver disease giving an incidence of 3.6%. Serological evidence of Acute Hepatitis E was found in 50 [68.5%] of the patients. Fulminant hepatic Failure developed in 5 [10%] patients. All five patients with FHF could not survive. There were 4 [8%] intra-uterine deaths, 1 [2%] abortion and 5 [10%] neonatal deaths

Shortcomings: Relatively small sample size

Conclusions: Acute hepatitis E during pregnancy predicts poor outcomes for the mothers, foetus and neonates

Cerebral salt wasting: a report of three cases

Hyponatremia secondary to the Syndrome of Inappropriate Anti-Diuretic Hormone [SIADH] secretion is commonly observed in patients with various neurological disorders. Cerebral Salt Wasting [CSW] resulting in hyponatremia is also an infrequent occurrence in some patients with neurological disorders. Confusion in differentiating CSW from SIADH may arise since both results in similar electrolyte disturbances. Herein, we report three cases of CSW with intracranial afflictions. CSW was diagnosed on the basis of fractional excretion of urinary sodium and uric acid along with extremely low serum uric acid. Improvements in serum sodium levels after saline hydration and fludrocortisone administration further supported the diagnosis

Two stage brachio-basilic transposition fistula provides superior patency for chronic haemodialysis: our experience in SIMS/ SHL

Background: Adequate vascular access is of utmost importance for hemodialysis treatment. Upper arm fistulae, obesity and deep or tortuous veins may impair cannulation and can cause significant complications and inconvenience for the technicians and patients

Objective: We intended to present the technique of superficialization [transposition] of the brachiobasilic fistula [BBF] and its clinical outcome regarding patency and complications

Materials and Methods: Twenty two brachiobasilic fistulas were fashioned in 20 patients between October 2010 to November 2011.The second stage superficialization [transposition] was carried out at a median of 59.1 days [range: 40-90 days] after fistula formation and involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the antero-medial aspect of the arm and transposing it beneath skin

Results: During the study period 20 brachiobasilic fistulas [BBF] were fashioned in 20 patients. There were 8 [40%] males and 12 [60%] females. The mean age was 53.45years + 12.34 years [range: 21-70years]. The patency rates were 90% at 6 months. Surgical complications of transposition were infection in 2 [10%] patients and lymphocoele in 4 [20%] patients

Conclusion: Transposition of brachiobasilic fistulas is technically feasible and relatively safe procedure. Patency rates at 6 months are excellent

Thrombocytopenia and platelets transfusion in Dengue fever

This study was done to see how much prevalent is thrombocytopenia and need and indications of platelets transfusion in patients with dengue fever in our community hospitals, This study was done from I[th], September 2010 to 15[th], November 2010 in three different hospitals, two were urban and one was rural and all three were tertiary care hospitals, Our study was based on 200 patients who were serologically confirmed cases for Dengue fever [IgM +ive] and had symptoms and signs of dengue fever for more than four to seven days at the time of admission. Clinical data reports of hematological investigations, platelets requirements, and data obtained from daily follow up, were analyzed. There were 200 serologically confirmed Dengue fever patients, among them 176 were males, 24 females, 183 patients were urban and 17 were rural patients. Thrombocytopenia was found in 174 [87%] on the day of admission. Among them 48 [24%] patients had platelets count in between 20, 000 to 40, 000/cumm, 46 [23%] had platelets count <20, 000/cumm, and 4 [2%] had platelets count <10, 000/cumm. Patients having platelets count <20, 000/cumm all have hemorrhage manifestations. Out of 48 [24%] patients having platelets count in between 20, 000 to 40, 000/cumm, 21[43%] had hemorrhagic manifestations. 98[49%] patients were given platelets transfusion. None of these patients got platelets transfusion with platelets count above 40, 000/cumm. 27 patients received platelets therapy inappropriately [platelets count < 40, 000/cumm with no hemorrhagic manifestations. There was only 2 mortality in these patients. Our study suggests that bleeding occurs more often in patients with severe thrombocytopenia [platelets count <20, 000/cumm] and these patients need urgent platelets transfusion. Patients having platelets count in between 20, 000-40, 000/cumm are at moderate risk and these patients require platelets transfUsion if they have hemorrhagic manifestation. Platelets count above 40, 000/cumm are at low risk and no need of platelets transfusion in these patients, only these patients need careful monitoring

Renal outcome in patients with pre-eclampsia and eclampsia at presentation, three and six months postpartum

To assess the natural history of Renal Disease in patients with Pre-eclampsia or Eclampsia. It was an observational study. This study was conducted simultaneously at two tertiary care hospitals: Fatima Memorial Hospital, l.ahore and Bhatti International leaching Hospital, Kasur from March 2009 to January 2011 women presented with pre-eclampsia or/ and eclampsia were consectively selected for the study fulfilling the inclusion criteria. A total number of 220 patients were eniolled in this study. All parameters required f'or the study were done carefully as blood pressure, proteinurla, renal function tests, urinary creatinine, weight, primary or multiparous, any previous history of pre-eclampsia. These parameters are checked at three and then six months post delivery. Among 220 patients, 140 [63.6%] were primigravida and 80 [36.4%] were multigravida. Blood pressure was from 140/90 to 210/110mmHg average blood pressure was 175100. 195 [8863%] patients had deranged renal function tests and 215 [97%] patients had protelnuria >2+. At Three months post-delivery 151[68.6%] patients achieved normal blood pressure and 190[86.3%] had normal serum creatinine i-e < 1.4. At six months 161 [73.8%] got adequate control of blood pressure, 59 [26.81%] had blood pressure > 140/90. Serum creatinine became in normal range in 195 [88.63%]. Acute renal failure was observed in 6 patents who weie put on renal replacement therapy