Hepatorenal Syndrome In Patients With Cirrhosis Of Liver According To 2007 International Ascites Club Criteria.

BACKGROUND: Heptorenal syndrome is a complication of cirrhosis of liver and is characterized by progressive renal failure. This study was done to determine the frequency of hepatorenal syndrome according to 2007 international ascites club criteria among patients of cirrhosis attending Medical Units of Civil hospital Karachi. METHODS: This is a cross-sectional study conducted on the hospitalized patients in the Department of Medicine-Civil Hospital Karachi from 01-04-2014 to 30-09-2014 where total 265 patients of either gender, age >18 years & <60 years & diagnosed case of CLD were included. Patients with shock, SIRS, sepsis, known cases of intrinsic renal diseases, or history of diabetes mellitus, Hypertension or connective tissue diseases were excluded. Mean±SD were expressed for continuous variable like, age, duration of CLD. Frequency & percentages of other categorical variables, i.e., gender, residence were expressed. Effect modification was tested through Chi-square with p-value <0.05 significant. RESULTS: The mean±SD age of patient was 48.23±7.87 years with range 18-60 years. Mean±SD duration of chronic liver disease was 5.60±1.92 years with a range of 3-12 years. More than 155 (58%) participants in this study were male and females were 110 (41.51%). More than 36 (13%) were of age less than and equal to 40 years; 121 (45.67%) were from 41-50 years, while 108 (40.75%) were from age 51-60 years. More than 176 (66.41%) belonged to rural areas while only 89 (33.58%) belonged to urban areas. The study observed that according to IAC 2007 criteria of diagnosis of hepatorenal syndrome 15.09% of patients with cirrhosis were found to have HRS. CONCLUSIONS: Hepatorenal syndrome represents the end stage of a sequence of reduction of renal perfusion induced by advanced liver failure. Almost every seventh patient of Cirrhosis can develop hepatorenal Syndrome. This should be looked up at an early stage so that it can be prevented.

Hide and seek: hematological aspects of malaria - a developing country perspective.

INTRODUCTION: Malaria, a major problem in tropical climates, presents with various hematological aberrations. We aimed to assess whether complete blood indices would increase the probability of malaria in patients with acute febrile illness. METHODOLOGY: Between February 2009 and December 2010, we conducted a study involving 824 consenting consecutive patients older than 12 years with a confirmed diagnosis of malaria based on thick and thin blood films. A detailed history and physical examination were completed on all patients before inclusion. Complete blood counts and detection of Plasmodium species were also performed as well as liver function tests, prothrombin time, reticulocyte counts, and parasite load. All data was analysed using SPSS 16.0 and percentages were calculated. RESULTS: Out of 824 patients, 616 (75%) were male and 208 (25%) were female with an age range of 18 to 55 years (33.2 ± 8.3). Out of 87% thrombocytopenic patients, 66% were affected with Plasmodium falciparum and 21% with Plasmodium vivax. In patients with P. falciparum, thrombocytopenia was mild (16%), moderate (43%) and severe (7%), while in P. vivax patients thrombocytopenia was mild (10%) and moderate (9%). Thrombocytopenia was moderate in the mixed cases (2%). Anemia was seen in 71% and normal leucocyte counts were observed in 79% of the cases. Normal differential leucocytes counts were seen as follows: eosinophils in 80%, neutrophils in 93%, lymphocytes in 85%, monocytes in 97%, and basophils in 100%. CONCLUSION: Blood indices should be included in patient evaluations as various hematological aberrances can lead to the diagnosis of malaria.

Comparison of incision and drainage against needle aspiration for the treatment of breast abscess.

We aim to compare the incision and drainage against ultrasound-guided aspiration for the treatment of breast abscesses. Sixty-four patients were randomly allocated to Group A (incision and drainage) and Group B (needle aspiration). Incision and drainage was done under general, whereas aspiration was done under local anesthesia with antibiotic coverage after the pus sample was taken for cultures. Time taken to resolve symptoms including point tenderness, erythema and hyperthermia, recurrence of breast abscess, and healing time was recorded. Patients were followed until 8 weeks. Culture and sensitivity of the pus were done. Data were analyzed in SPSS 16.0. The mean difference of healing time was significant (P = 0.001). A total of 93.3 per cent were healed in Group B and 76.6 per cent in Group A (P = 0.033). Twenty-two samples (34.37%) had no bacterial yield and the remaining 42 samples (65.6%) yielded 11 anaerobic cultures (17.18%) and 31 aerobic cultures (48.4%). Ultrasound-guided aspiration of breast abscesses with the judicious use of antibiotics is a better treatment modality than incision and drainage.