Clinical presentations of nephrotic syndrome in patients of a tertiary care hospital at Peshawar.

BACKGROUND: Nephrotic syndrome (NS) is manifested by presence of pitting oedema, profound proteinuria in excess of 3.5 g/day, serum albumin levels of less than 3.0 g/dL and hypercholesterolemia. This study was conducted to determine the frequency and clinical presentation of nephrotic syndrome in patients coming to a tertiary care hospital. METHODS: This cross-sectional study was done from March to November, 2012 (for 9 months). Patients with complaints of peri-orbital or generalized swelling, and proteinuria on urine examination were included in the study through emergency or outpatient department. RESULTS: Out of 360 suspected cases, nephrotic syndrome was found with a frequency of 67.05%. Among these patients, 69.55% were male and 30.45% female. Majority (65.85%) were between 41-60 years with mean age of 40.36 +/- 15.93 years. All (100%) patients had oedema, 43.20% had oliguria, 17.28% presented with abdominal tenderness, 15.22% patients had fever, 13.16% showed hematuria, 10.28% patients had uraemia and 2.5% of the patients had thrombosis. The majority of patients (56.80%) were diabetic, and 43.20% patients had hypertension. In 23.86% patient's high blood urea alone was recorded and 17.28% showed high serum creatinine along with raised blood urea. Rest of patients had normal renal function at the time of presentation. CONCLUSION: Frequency of nephrotic syndrome was 67.05%. Among these majorities were males. Oedema was the commonest presenting complaint while oliguria, abdominal tenderness, fever, hematuria, uraemia and thrombosis were found in descending orders. Diabetes mellitus was leading cause in majority of patients, followed by hypertension, high blood urea, and high serum creatinine.

Radiation exposure in different cardiac catheterization procedures in cath lab.

BACKGROUND: Interventional procedures render cardiologolists and their team members to high doses of radiations. This study was conducted to assess the radiation exposure in various cardiac catheterization procedures. METHODS: This descriptive cross sectional study was conducted at the catheterization laboratory of Lady Reading Hospital Peshawar from November 2008 to December 2009. Patients were categorized into four groups for procedures a. coronary angiography, b. percutaneous coronary intervention (PCI), c. permanent pacemakers (PPM) and d. percutaneous transvenous mitral commisurotomy (PTMC), two groups for operators (consultants and trainees), and three groups for various accesses (femoral, radial and sub-clavian). RESULTS: A total of 99 patients undergoing cardiac catheterization were studied. Coronary angiography was performed in 52 (52.5%) patients, PCI in 32 (32.3%)), pacemakers in 6 (6.1%), and PTMC in 9 (9.1%) patients. Consultants did 72 (72.7%) procedures and trainees did 27 (27.3%) procedures. Through radial access, 22 (22.2%) procedures were performed, 71 (71.7%) through femoral, and 6 (6.1%) through sub-clavian. The mean radiation dose for coronary angiography was (4907.862 +/- 15231.6358 microGym2), PCI (10375.16 +/- 16083.4385 microGym2), pacemakers (1406.823 +/- 785.489 microGym2), and PTMC (1157.91 +/- 760.437 microGym2). The mean radiation dose for radial (6147.33 +/- 8480.37 microGym2), femoral (6512.58 +/- 16566.73 microGym2), and sub-clavian was (1406.82 +/- 785.48 microGym2). While for various operators consultants (7489.5 +/- 16925.55 microGym2), and trainees (2475.25 +/- 1178.86 microGym2). The mean time for radial (8.59 +/- 7.28 min), femoral (6.95 +/- 6.43 min) and sub-clavian was (8.24 +/- 4.81 min). The mean time for coronary angiography (4.56 +/- 5.32 min), PCI (11.44 +/- 6.92 min), PPM (8.24 +/- 4.81 min), and PTMC (8.28 +/- 5.01 min). CONCLUSIONS: Radiation dose varies substantially across different groups by different operators and different routes.