ABSTRACT
Objectives: To assess frailty in cirrhotic by calculating Liver Frailty Index (LFI) using bedside clinical tests and correlate it with Child-Turcotte-Pugh (CTP), MELD, MELD Na, Fib- 4 and Transient Elastography (TE) scores. Methods: This cross-sectional observational comparative study was carried out in Dr Ruth KM Pfau Civil Hospital, Karachi from August 2020 to September 2021. Patients were subjected to three performance-based testing including dominant hand grip strength (HGS), Chair to Stand (CTS) Time & Three Position Balance (TPB). LFI was calculated using the online LFI calculator, available at http://liverfrailtyindex.ucsf.edu and classified as 'Robust' if LFI <3.2, 'Prefrail' LFI between 3.2 and 4.4, and 'Frail' as LFI ≥4.5. Correlation of frailty with MELD, MELD-Na and CTP Scores was done. Means of MELD & MELD-Na Scores and CTP scores were calculated in all 3 classes of frailty using one way ANOVA. A p-value of ≤.05 was taken as significant. Results: Out of 118 patients, 62 (52.5%) were males. Mean MELD score was 11.4 ±3.3, MELD-Na was 15.97 ±8.54, CTP 8.25 ±2.21, Fib-4 was 2.79 ±1.034 and TE score was 18.20 ±9.17. Mean LFI was 3.87 ±1.07; mean HGS was 18.12 ±4.68; mean of CTS was 9.62 ±3.55. LFI Class distribution in our cohort showed Robust were 36 (30.5%), Prefrail 34 (28.8%) and Frail were 48 (40.8%). Correlation of all these variables with LFI showed significant correlation with LFI, but highest correlation coefficient was seen with MELD-Na. Conclusion: Significant correlation between frailty score in cirrhotic with cirrhosis severity scores highlights the need for frequently assessing LFI in all cirrhotic at regular follow up visits.
ABSTRACT
OBJECTIVE: To determine the prevalence of latent tuberculosis infection (LTBI) in healthcare workers in tertiary care hospitals of Rawalpindi, using interferon gamma release assay. METHODS: It was a cross-sectional study. The samples were collected from pulmonology and microbiology departments of three hospitals; i) Military Hospital, Rawalpindi, ii) Fauji Foundation Hospital, Rawalpindi and iii) Pakistan Institute of Medical Sciences, Islamabad. The study was completed in one year from January 2017 to January 2018. Fifty-five asymptomatic healthcare workers of both genders between the ages of 18-50 years with a working tenure of at least one year in concerned departments were included and those with active tuberculosis were excluded from the study. Whole blood from subjects was collected and plasma was checked for interferon gamma value by IGRA (Interferon gamma release assay). RESULTS: In this study of total 55 healthcare workers a high prevalence 22 (40.0%) of latent tuberculosis was found. When LTBI distribution was analyzed within occupational categories, the most frequently affected were sanitary workers 3 (100.0%), nurses 5 (50.0%), doctors 6 (43%) and nursing assistants 2 (40%). CONCLUSION: The prevalence of LTBI in healthcare workers is alarmingly high in our local healthcare settings.
ABSTRACT
Diabetes insipidus is a rare endocrine disorder in paediatric patients. Polyuria is a cardinal manifestation that is extremely difficult to recognize in diapered infants. Careful urine quantification is the key to diagnosis in appropriate clinical setting. We report a case of a 4 months old infant presenting with an acute life threatening event following an episode of vomiting and decreased oral intake. She had profound hypernatremia which persisted after stabilization. Polyuria unrecognized by the mother was revealed by 24-hour urine output measurement. A diagnosis of diabetes insipidus was made after appropriate laboratory investigations including serum and urine osmolality. The central nature of the disease was confirmed by neuroimaging which showed holoprosencephaly.
Subject(s)
Diabetes Insipidus, Neurogenic/complications , Diabetes Insipidus, Neurogenic/diagnosis , Hypernatremia/diagnosis , Hypernatremia/etiology , Antidiuretic Agents/therapeutic use , Deamino Arginine Vasopressin/therapeutic use , Diabetes Insipidus, Neurogenic/drug therapy , Diabetes Insipidus, Neurogenic/physiopathology , Diagnosis, Differential , Female , Humans , Hypernatremia/drug therapy , Hypernatremia/physiopathology , Infant , Magnetic Resonance Imaging , Osmolar ConcentrationABSTRACT
A 4 years old boy presented with acute left hemiplegia. Preliminary neuroimaging suggested an arterial ischemic process. Clinical and laboratory evaluation excluded haematologic, metabolic and vasculitic causes. Cerebral angiography confirmed the diagnosis of Moyamoya disease. Treatment included physiotherapy and close follow-up for recurrence.
