IN-HOSPITAL MORTALITY AMONG PATIENTS OF LIVER CIRRHOSIS WITH VARICAL BLEED

Background; A major cause of cirrhosis-related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Each episode of active variceal bleeding is associated with 30 percent mortality. This study was planned to determine frequency of variceal bleeding in patients with liver cirrhosis and frequency of in-hospital mortality of these patients in our population. Objective; To determine the frequency of variceal bleed in hospitalized patients with cirrhosis of liver and its outcome in terms of in-hospital mortality. Material and Methods; Consecutive 139 Patient diagnosed with cirrhosis of liver were included in this cross-sectional study from department of Medicine, Bahawal Victoria hospital Bahawalpur. Complete history and physical examination was assessed to document duration of duration of liver disease, ascites, Hepatic encephalopathy, Previous GI bleed and systemic coagulopathy. All the patients had undergone diagnostic upper GI endoscopic examination to document varices. Results; Of these 139 study cases, 77 (55.4 %) were male and 62 (44.6 %) were female. Mean age of our study cases was 45.50 ± 10.81 years. Mean duration of disease (liver cirrhosis) was 3.25 ± 2.32 years. Majority of our study cases i.e. 94 (67.6%) were having liver cirrhosis for the duration of less than 5 years. Child-Pugh class C was more prevalent i.e. 77 (55.4%) of our study cases. Variceal bleeding was observed in 100 (71.9 %) of our study cases. Frequency of mortality was 35 (25.2%) in our study cases with liver cirrhosis, while frequency of mortality in patients with variceal bleeding was seen in 31 (31%). Conclusion; Very high frequency of variceal bleeding was observed in patients with liver cirrhosis. In-hospital mortality was significantly more prevalent in patients with variceal bleeding than without bleed. Variceal bleeding was significantly more seen in patients with increasing age, duration of disease and with more severe level of disease (Child Pugh class C). There was no statistically significant difference of bleeding with regards to gender. Keywords; Liver Cirrhosis, Variceal bleeding, Mortality.

ASSOCIATION OF UNSAFE ABORTIONS WITH COMPLICATONS

Background; Unsafe abortion is a persistent, preventable pandemic. WHO defines unsafe abortion as a procedure for terminating an unintended pregnancy either by individuals without the necessary skills or in an environment that does not conform to minimum medical standards, or both. This study was conducted in our local population of southern Punjab to ascertain magnitude of the problem in terms different maternal complications after unsafe abortions. Objective: To determine the frequency of complications of unsafe abortions at a tertiary care hospital. Material and Methods; All the study cases (n=169) who met inclusion criteria of my study were taken from Department of Gynecology and Obstetrics, Bahawal Victoria Hospital, Bahawalpur, Pakistan from June 2015 to June 2016 in this descriptive cross – sectional study . Once registered, these study case had undergone required investigations like blood tests (TLC count to determine sepsis and serum urea and creatinine levels to ascertain ARF). These blood tests were performed by a trained pathologist. These patients were also arranged for X – Ray chest (PA view) to diagnose perforation and complications such sepsis, hemorrhage, ARF and perforations were noted in the proforma by the researcher. Data was analyzed by using SPSS Version 20. Results; Mean age of our study cases was 29.39 ± 4.12 years (with minimum age of our study cases was 24 years while maximum age was 37 years) and majority of our study cases i.e. 93 (55 %) belonged to age group 20 – 30 years of age. Of these 169 study cases, 104 (61.5%) were from rural areas, 113 (66.9%) were poor, 141 (83.4%) were illiterate, 111 (65.7%) spouses were illiterate and most of them i.e. 112 (66.3%) belonged to joint family system. Mean body mass index of our study cases was 24.78 ± 3.24 kg/m2 and obesity was present in 27 (16 %) patients. Hemorrhage was noted in 94 (55.6%), sepsis in 74 (43.8%), acute renal failure in 39 (23.1%) and perforations in 19 (11.2%) of our study cases. Conclusion; Our study results indicate that unsafe abortion is a major cause of maternal morbidity with hemorrhage was commonest complication followed by septicemia, mostly because the procedure was performed by untrained health care providers under unhygienic conditions.  Majority of the patients had multiple complications. There is urgent need to improve quality of services offered by family planning programs and provision of safe abortion services to decrease significant morbidity among targeted population. This will improve their quality of life and also provide relief to health authorities in terms of more investments due to prolonged hospitalizations. Keywords; Unsafe abortion, hemorrhage, sepsis

Metabolic Profile of Offspring of Mothers with Gestational Diabetes Mellitus

Introduction: Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes before gestation. Unrecognized and untreated GDM confers significantly greater maternal and fetal risk, which is largely related to the degree of hyperglycemia. The specific risks of diabetes in pregnancy include but are not limited to, spontaneous abortion, pre-eclampsia, fetal anomalies, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and respiratory distress syndrome. Additionally, GDM is also implicated in long-term metabolic derangements in the offspring in the form of obesity/overweight, hypertension, dysglycemia, insulin resistance, and dyslipidemias later in life. To determine the prevalence of anthropometric and metabolic derangements in children between 1 and 5 years of age, born to women with GDM. Methods: This hospital-based cross-sectional study was conducted between November 2019 and November 2021 at our Pediatric Endocrine Clinic. Women were diagnosed as having GDM based on the American Diabetes Association Criteria (2019). History regarding the treatment of the GDM (diet only/diet and medical treatment) and detailed physical examination, including anthropometry and blood pressure, were recorded. Blood samples were collected from children for the estimation of their metabolic profile. Results: Overweight, obesity, and severe obesity were present in 18 (11.3%), 2 (1.3%), and 2 (1.3%) children, respectively. Hypertension was found in 21 (19.4%) children. Elevated LDL, triglyceride, and total cholesterol were seen in 3 (1.9%), 84 (52.5%), and 1 (0.6%) children, respectively. Impaired fasting glucose (IFG) was found in 6 (3.8%) children, while 27 (16.9%) subjects were found to be having impaired glucose tolerance after OGTT. Insulin resistance was found in 30 (18.8%) children. GDM mothers with a higher BMI tended to have children with a higher BMI (correlation coefficient, r = .414, P < .001). Higher serum triglyceride levels (r = −0.034, P = 0.672) were recorded in children, irrespective of the BMI of their mothers. There was no significant correlation of maternal BMI with blood pressure (r = −0.134, P = 0.091) or with HOMA-IR (r = 0.00, P = 0.996) in children. However, mothers with a higher BMI had children with statistically higher fasting blood glucose (r = +0.339, P = <0.001) as well as blood glucose 2 hours after OGTT (r = +0.297, P = <0.001). This positive correlation of maternal BMI with the glucose metabolism of their offspring was observed for both male and female genders. Conclusion: Children of women with GDM had a higher BMI, and the mode of treatment for GDM did not lead to differences in childhood BMI. The higher BMI of a GDM mother is associated with altered glucose metabolism in their offspring. Deranged levels of triglyceride across the gender were not found to be statistically significant. This has implications for future metabolic and cardiovascular risks in targeting this group for intervention studies to prevent obesity and disorders of glucose metabolism as one potential strategy to prevent adverse metabolic health outcomes

Thyroid Dysfunction in Non-Interferon Treated Hepatitis C Patients Residing in Hepatitis Endemic Area

Background. Association of thyroid dysfunction (TD) with interferon treatment of HCV is well known to clinicians. However, a few studies have highlighted the role of hepatitis C virus per se in the development of TD. The aim of this study was to know the prevalence of TD in non-interferon treated HCV infected patients referred for thyroid function testing. Patients and Methods. Among 557 ELISA-positive HCV patients 446 (341 females, 105 males) were selected for this study. Serums FT4, FT3, and TSH were determined by radioimmunoassay method. Results. TD was detected in 15.2% of patients: 9.0% hypothyroidism and 6.3% hyperthyroidism. In increasing order subclinical hypothyroidism, overt hypothyroidism, overt hyperthyroidism, and subclinical hyperthyroidism were found in 4.7%, 4.3%, 3.6%, and 2.7% patients, respectively. Overall TD was more common in female than in male HCV patients but the difference was not significant (16.1% versus 12.4%; p=0.648). Hyperthyroidism and subclinical hypothyroidism were slightly more common in female and overall hypothyroidism and overt hypothyroidism in male patients but the difference was not statistically significant (p>0.05). The incidence of TD was relatively high in patients above 36 years (median age) but the difference was not statistically significant either collectively or in gender base groups (p>0.05). Conclusion. Prior to interferon treatment, HCV infection itself causes biochemical thyroid dysfunction in 15.2% of local HCV patients