Refeeding syndrome in a young girl with anorexia nervosa.

We report the case of a 20-year-old anorexic girl (BMI=12.9), who was misdiagnosed the first time and developed severe electrolyte imbalances due to lack of awareness about refeeding syndrome. Few cases of RS have been reported in literature and protocols have been suggested for prevention and management of this syndrome, including the awareness of circumstances in which it is most likely to develop, refeeding slowly and building-up micronutrient content over several days. Improved awareness and understanding of refeeding syndrome along with a well-coordinated plan are vital in delivering safe and effective nutritional rehabilitation. We suggest a slow and gradual increase in nutrition along with nutritional counselling and psychotherapy

De novo descending aorta thrombus in a patient with metastatic colorectal cancer: A case report

Thromboembolic events in patients with cancer are frequently reported in literature and usually involve the venous circulation. De novo thrombus formation in the arterial system without any underlying atherosclerosis, dissection or aneurysm is extremely rare. We report the case of a patient with metastatic colorectal carcinoma who developed a thrombus in the descending aorta without any intervention or risk factors. The patient presented with non-specific gastrointestinal symptoms. A CT scan revealed an aortic thrombus obstructing 70% of the lumen. She opted for no treatment of her thrombus and was later complicated by extensive lower limb emboli. Patients with aortic thrombosis usually present with subtle symptoms which may be underestimated by both the patient and the physician. A high index of suspicion is required for early recognition and prevention of complications

Presentation And Diagnosis: Pregnancy Induce Diabetes And Hypertension In Medical Doctors At Hospital And Clinics

OBJECTIVES The aim of this study was to assess pregnancy induce diabetes and hypertension in medical doctors. METHODOLOGY This case-control study was conducted after approval by the ethics committee. A total of 72 physicians who were pregnant and diagnosed with pregnancies causing hypertension or diabetes participated in the study. Daily details of hourly blood glucose levels were recorded at the beginning and end of the day. Use SPSS version 24.0 to analyze the results. RESULTS Out of the 33 patients, 23 remained hypertensive at the end of the day, while 10 had normal hypertension at the beginning of the day. Hypotension appeared from the 39th day of which 24 of her ended high, 15 were normal and 10 were diet controlled. The maximum number of pregnancies was 40 in high-care controls and 32 in low-care controls. Out of 30(16) had high FBS at the beginning of the day and 17 of the 42 who had the highest at the end of the day had low FBS. The highest score of 17(42) was presented at the beginning of the day with low FBS and 17 at end of the day with a high ratio and high count of 42.   CONCLUSION   Health care is important for all patients, whether they are health workers or not. Daily Record helps patients and providers understand patient disease management and take appropriate action.

Wilson\u27s disease: experience at a tertiary care hospital.

Wilson\u27s disease (WD) is a rare autosomal recessive disorder of copper metabolism. Data regarding WD is not available from Pakistan. A cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, and all patients admitted with primary and secondary diagnosis of Wilson\u27s disease were added. A total of 47 patients were seen; 68% (n = 32) were male. The mean age was 26.6 ± 9.97 years. Most of the patients presented with hepatic, (n = 22, 46.8%), neurological, (n = 17, 36.2%) and psychiatric (n = 8, 17%) symptoms. Mean ceruloplasmin level was 0.17 ± 0.13 g/dl; it was \u3c 0.25 g/dl in 39 (86.6%) patients. Serum copper (Cu) was reduced in 32 (68.1%) patients and 24-hr-urinary Cu was raised in 22 (47.6%) patients. Slit lamp examination for Kayser-Fleischer (KF) rings was done on 15 (31.9%) patients and 9 (60%) of them had KF rings. Mean serum aspartate transaminase (AST) / alanine transaminases (ALT) ratio was 1.92 and median alkaline phosphatase / total bilirubin ratio was 79.30 (IQR 35.05; 166.50)

Electrophysiological changes in patients with liver cirrhosis in a tertiary care hospital in Karachi, Pakistan

Background: Electrophysiological changes in cirrhosis are well known but least investigated especially in our country hence we wanted to see electrophysiological changes especially QT interval in cirrhotic patients. Methods: A cross-sectional study was conducted at Aga Khan University Hospital Karachi (AKUH) in which medical records (duration 2008-2010) of cirrhotic patients were reviewed. Results: Three hundred and eighty cirrhotic patients\u27 charts were studied, 227 (59.7 %) were male and mean age of this cohort was 52.8±12.6 years. The most common cause for CLD was Hepatitis C (CHC) in 260 (68.4%), NBNC in 56(14.7%) and HBV in 51 (13.4%). Only 225 had complete ECG workup, the mean corrected QT interval was 0.44±0.067sec. Among the electrophysiological abnormalities, 79 (35%) had a prolonged corrected QT interval, 7 (3.1%) had a prolonged PR interval (\u3e0.22s) and prolonged QRS duration was seen in 23 (10.4%) patients. QT prolongation was seen in 1 of the 5 patients with Child Class A (20%), 22 of the 73 patients with Child Class B (30.1%), and 25 of the 61 patients with Child Class C (41%). However, this difference however was not statistically significant. (p-value=.331). CONCLUSIONS: We conclude that QT prolongation is more frequent in patients with liver cirrhosis especially when the disease is more advanced like in Child C hence these patients are more prone to sudden cardiac death. Moreover, this study shows that the risk associated with QT prolongation is present through all classes of liver cirrhosis. We recommend that routine cardiac screening with ECG of all cirrhotic patients be performed

Assessing the Mental Health Status and Sleep Quality among House Officers in Peshawar

OBJECTIVES The aim of this study was to assess the mental health status and quality of sleep among house officers in Peshawar and to determine the correlation between their mental health status and quality of sleep.METHODOLOGY This was a cross-sectional study, conducted on house officers of four tertiary care hospitals in Peshawar. Data was collected through a self-administered questionnaire using convenience sampling technique. Pittsburgh sleep quality index (PSQI) scale was used for assessing the sleep quality and Warwick Edinburgh mental wellbeing scale (WEMWBS) was used for assessing the mental health status of the respondents.RESULTSAmong the 276 house officers, the mean mental health score was 48.13±9.17, and mean sleep quality score was 6.39±3.27. In comparison, female House officers had poor mental health status (female: 45.72±9.32, male: 49.83±8.70, p<0.05) and sleep quality (female: 6.91±3.77, male: 6.03±2.82, p<0.05.  The hospital status showed no significant association between sleep quality (p value: 0.778) and mental health score (p value: 0.573). Furthermore, quality of sleep had a positive correlation with mental health status of house officers (p<0.01).CONCLUSIONMental health status and quality of sleep among house officers was poor. Female house officers had a poor mental well-being and a poor sleep quality compared to male house officers. There was no significant difference between the mental health status and quality of sleep, of house officers working in public hospitals and those working in private hospitals. House officers having a poor sleep quality also had a poor mental health status showing a positive correlation between the tw

Primary Hepatic Carcinoid Tumor with Poor Outcome

Primary Hepatic Carcinoid Tumor (PHCT) represents an extremely rare clinical entity with only a few cases reported to date. These tumors are rarely associated with metastasis and surgical resection is usually curative. Herein, we report two cases of PHCT associated with poor outcomes due to late diagnosis. Both cases presented late with non-specific symptoms. One patient presented after a 2-week history of symptoms and the second case had a longstanding two years symptomatic interval during which he remained undiagnosed and not properly worked up. Both these cases were diagnosed with hepatic carcinoid tumor, which originates from neuroendocrine cells. Case 1 opted for palliative care and expired in one month’s time. Surgical resection was advised to the second case, but he left against medical advice

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Pattern of chromosomal abnormalities in adult acute lymphoblastic leukemia

OBJECTIVES: To study the pattern of chromosomal abnormalities in adult patients with acute lymphoblastic leukemia. STUDY DESIGN: A retrospective study. PLACE AND DURATION OF STUDY: January 1998 to June 2005 at the Cytogenetics department, Aga Khan University Hospital, Karachi. PATIENTS AND METHODS: A retrospective analysis of cytogenetic studies was carried out in patients who were diagnosed as ALL and were more than 15 years of age. Cytogenetic analysis was performed using a trypsin-Giemsa banding technique. Karyotypes were interpreted using International System for Cytogenetics Nomenclature (1995) criteria. RESULTS: The requests were received for cytogenetic analysis of bone marrow specimens in 69 patients who were diagnosed as ALL. Cytogenetic results were available in 62 patients; out of which 51 were males and 11 were females. 44 patients (70%) were found to have a normal karyotype. In 18 patients (29%), abnormal karyotype was found. CONCLUSION: Cytogenetic studies should be part of the initial work up of every patient with ALL. Larger scale studies will help refine our understanding of the less common chromosomal patterns and conduct multivariate analysis to define the relative prognostic value of karyotypic results