BLOOD EOSINOPHILIA IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS

Background; The short-term benefits of inhaled corticosteroids for patients with chronic obstructive pulmonary disease (COPD) are greater in patients with evidence of eosinophilic airway inflammation. This study was conducted to determine the frequency of blood eosiniphilia in patients with acute exacerbations of COPD. Objective: To determine the frequency of blood eosinophilia in chronic obstructive pulmonary disease exacerbations. Material and methods; A total of 159 patients with acute exacerbations of COPD were registered and their eosinophil count was done. All data was entered on SPSS-20 and analyzed. Setting: Study was conducted in the pulmonology department of Nishtar Hospital Multan. Study design: Descriptive cross sectional study. Sampling technique: Non probability consecutive. Results; Of these 159 study cases, 87 (54.7%) were male patients while 72 (45.3%) were female patients. Mean age of our study cases was 57.87 ± 8.99 years (with minimum age of our study cases was 44 years while maximum age was 70 years). Mean body mass index (BMI) of our study cases was 23.89 ± 2.74 kg/m2, 32 (20.1%) were overweight and 16 (10.1%) were obese. Smoking was seen in 48 (30.2%) patients and 5% were light smokers, 10.1% were  moderate smokers and 15.1% were heavy smokers. Mean duration of COPD was 8.18 ± 2.34 years (with minimum duration of illness was 6 years while maximum duration was 14 years). Mean duration of acute exacerbation of COPD was noted to be 6.21 ± 1.71 days (ranging from 4 to 10 days). Blood eosinophilia was noted in 87 (54.7%) of our study cases. Conclusion; Blood eosinophil count is a promising biomarker of response to inhaled corticosteroids in patients with COPD and very high frequency of blood eosinophilia was noted in our study. Blood eosinophilia was significantly associated with increasing age, heavy smoking and duration of COPD. Keywords; Blood eosinophilia, COPD, acute exacerbations

WEIGHT GAIN ON WHO RECOMMENDED F100 DIET IN CHILDREN UNDER 5 YEARS OF AGE HOSPITALIZED WITH SEVERE ACUTE MALNUTRITION

Background; Severe acute malnutrition (SAM) affects approximately 19 million children below five years of age in low and middle income countries, which is defined as low weight for height or mid-upper arm circumference with respect to international standards, or the presence of bipedal edema. These children have a considerably increased risk of dying and it is estimated that malnutrition is the underlying cause of 45% of global deaths in children below 5 years of age. Material and Methods; Patients of severe acute malnutrition having weight for height/length less than -3 SD (Less than 70% of expected) were admitted in hospital nutritional. In stabilization phase, life-threatening problems were identified and treated, metabolic abnormalities were reversed and feeding was begun with F75 diet according to guidelines set by World Health Organization (WHO), the duration of stabilization phase was at least seven days. Patients in rehabilitation phase on F100 formula were included in study. Duration of rehabilitation phase is usually two to six weeks. Initial weight (W1) was measured as soon as the child was admitted and final weight (W2) was measured on 7th day of rehabilitation phase about one hour after a feed after standardizing the scale. Results; Mean age of our study cases was 16.68 ± 10.37 months, 16 (36.4%) were male and 28 (63.6%) were female patients. Mean weight at the time of admission was 4.82 ± 1.70 Kg. Similarly mean height of these study cases was 64.36 ± 11.24 cm. Mean weight at the start of F-100 was 4.85 ± 1.69 kg. Mean weight at the time of discharge was 5.72 ± 1.67 kg. Mean duration of hospital stay was 12.91 ± 6.85 days. Mean weight gain in our study cases was 14.10 ± 5.23 g/kg/day. Adequate weight gain was seen in 36 (81.8%) of our study cases while inadequate gain was seen 8 (18.2%) of our study cases. Conclusion; Use of F-100 milk significantly improved weight gains among our study cases, hence we recommend its use in children with SAM. No adverse side effects were seen in our study population which emphasize towards safety of this product. Keywords; Severe acute malnutrition, Weight gain, F100

Psychological complications of polycystic ovarian syndrome and women’s health

Background: Polycystic Ovarian Syndrome (PCOS) affects approximately 5-10% females of reproductive age worldwide. Recent research shows that this syndrome is associated with psychological upset and devastating effects on women′s mental health and wellbeing.  Lack of clinicians′ awareness of adverse psychological effects is a major concern in developing countries to provide standard care and to improve overall health outcomes.Purpose of study was to determine the frequency of anxiety and depression among women with PCOS in order to promote awareness among clinicians about psychological complications of disease.Methods: Present study was conducted in the department of Obstetrics and Gynaecology/ University Medical and Dental College, from October 2018 to March 2019. Sixty patients with diagnosis of PCOD and sixty participants without this disease were included in the study. Participants having other endocrine or metabolic disorders were excluded from study. Hospital anxiety and depression scale was used to detect anxiety and depression among both groups. SPSS version 16 was used for data analysis. Chi- square test was applied to compare prevalence of anxiety and depression in both groups, p-value ˂0.05 was taken as statistically significant.Results: Women having PCOD exhibited statistically significant prevalence of anxiety (78.3% vs 35%) and depression (60% vs 30%) with p value of 0.0001 and 0.001 respectively.Conclusions: It is highly recommended that initial evaluation of these patients should include assessment of psychological domain of disease to provide more comprehensive treatment to improve overall health related quality of life

Antibiotic Susceptibility Pattern in a Tertiary Care Institution

Background: Isolation of different types of organisms from urine, high vaginal swab (HVS), pus and blood and determining their sensitivity and resistance pattern. Methods: The study was conducted in the Department of Pathology (Microbiology Section) Rawalpindi General Hospital. Four thousand and seventy five (4075) indoor and outdoor patients were analyzed by taking their different samples i.e. Blood, Urine, HVS and Pus, which were then cultured on different media i.e. MacConkey’s and Blood agar. CLED media was preferred for urine. Results: Out of 4075 samples, 515 cultures yielded growth. These included 170 samples of HVS, 163 of pus, 158 of urine and 24 of blood. Escherichia coli (29.8%), Staphylococcus species (26.52%) and Pseudomonas (18.66%) were the most common organisms isolated. Conclusion: Due to high resistance, antibiotic use policy should, strictly adhere to WHO guidelines and their unnecessary use should be discouraged

Antimicrobial Sensitivity Pattern for Urine Isolates in Urinary Tract Infection

Background: The increased frequency and management of antibiotic resistance pattern in urinary tract infection (UTI) is a challenging task for the clinicians. Therefore, the current study was planned to identify the microbial etiology of UTI and the most suitable antibiotics used. The objective of the study was to assess the frequency of antimicrobial sensitivity pattern in patients with urinary tract infection.Material and Methods: This cross-sectional study was carried out at Al Sayed Hospital, Kidney Centre, Rawalpindi over a period of seven months i.e. June 30, 2018 to January 30, 2019. A total of 152 patients were enrolled according to the inclusion and exclusion criteria of the study. Urine culture proceedings were done as per latest recommended guidelines of Clinical and Laboratory Standard Institute (CLSI) for UTI.Results: Regarding overall sensitivity of antibiotics for the pathogens of urine culture, highest sensitivity was observed for carbapenems (83.5%), followed by polymyxin B (72.3%), phosphonic acid derivatives (65.8%), aminoglycoside group (65.7%), extended spectrum penicillin (63.1%), imidazolidinedione (59.9%) and tetracycline (59.9%) groups. The least sensitivity was observed for Oxazolidinone (linezolid) (14.5%), teicoplanin (13.8%), tigecycline (10.5%) and first-generation cephalosporins (1.3%).Conclusions: Carbapenems showed maximum sensitivity for all urine isolates. The second and third options were polymyxin B and phosphonic acid derivatives, respectively

Frequency of Intestinal Parasites in Stool Samples

Background: To study the frequency of intestinal parasites in the stool specimens Method: In this cross sectional study, 643 samples of stool were collected. Each stool sample was analyzed grossly and microscopically. Results: The highest prevalent infections were of the protozoan (84.9%). Entamoeba histolytica(63.5%), followed by Giardia lamblia(1.4% were the most prevalent. The cases of helminthiasis (Ascaris lumbricoides, Hymenolepis nana, Ankylostoma duodenale, Enterobius vermicularis and Taenia Saginata) came out to be 14.9%. Conclusion: Protozoal infections due to Entamoeba histolytica and Giardia lamblia are much more prevalent than the helminthiasis . The prevalence of intestinal parasitic infections was higher in males (62%) than females (38%)

Clinical outcome of post placental IUD CuT380 insertion in terms of expulsion

Background: Insertion of an intrauterine contraceptive device (IUD) immediately after delivery has been recommended by the World Health Organization (WHO), as one of the safe and effective methods of temporary contraception. In the immediate post delivery period the women are highly motivated and need an effective method for contraception so that the child can be brought up with a relaxed mind without the worry of unintended pregnancy. This approach is more applicable to our country where delivery may be the only time when a healthy woman comes in contact with health care personnel. However, immediate post-partum IUD insertion may have disadvantages as well. The risk of spontaneous expulsion may be unacceptably high.Methods: After taking approval from hospital ethical committee, all women planning vaginal delivery desiring IUD, admitted through OPD and emergency were evaluated in detailed on design Performa Performa include patient’s identity, age, parity, gestational age, no of alive children, outcome and timings of insertion. Informed consent was obtained. With aseptic precautions IUD was inserted with kellys forceps in the uterine cavity up to the fundus, then cervix was examined for thread (that should not be visible at cervix if proper insertion done). The procedure was performed by myself. Patients were followed at 6week by examining the threat of IUD. All the information was recorded by myself. Follow up was done by taking patients contact number.Results: In our study, out of 300 cases, 63.67% (n=191) were between 18-30 years of age while 36.33% (n=109) were between 31-40 years of age, mean+sd was calculated as 29.49+4.62 years, mean gestational age was calculated as 38.53+0.94 weeks, mean parity was calculated as 3.49+1.06 paras. Frequency of expulsion in post placental intra uterine device cuT 380 insertions reveals in 8.67% (n=26).Conclusions: We concluded that the frequency of expulsion in post placental intra uterine device cuT 380 insertions is not significantly higher and appears to be safe and effective method of contraception.

Oral versus intravenous maternal hydration in isolated third trimester oligohydramnios

Background: To study the effect of oral and intravenous maternal hydration in patients with isolated oligohydramnios in terms of mean change in amniotic fluid.Methods: A total number of 38 patients included in the study which fulfill the selection criteria.  Patients were randomly divided in two groups. Amniotic fluid index (AFI) of all patients was measured before the hydration therapy according to the method of Phelan et al.  In maternal oral hydration (Group A), every patient was instructed to drink two liters of water over two hours daily for 1 week. In intravenous hydration (Group B), every woman infused two liters of 0.9% normal saline in two hour daily for 1 week. After 48 hours and 1 week of oral and intravenous hydration, the AFI was reassessed by the same observer. Patients were monitored closely for sign and symptoms of fluid overload. Data was stratified for mean difference in improvement in amniotic fluid index.Results: After oral hydration therapy AFI was 5.926±0.4593 after 48 hours and 8.286±0.6000 after 7 days in Group A. In Group B AFI was 5.784±0.4622 after 48 hours and 7.868±0.2810 after 7 days of intravenous hydration. P value after 48 hours is 0.348 and p=0.014 after 7 days means oral hydration therapy significantly increase amniotic fluid index.Conclusions: Oral maternal hydration significantly increase the amniotic fluid index in patients with isolated oligohydramnios. It is simple, safe and non-invasive method

Tuberculosis of Gall Bladder

Gallbladder with Chronic cholecystitis and cholelithiasis is an everyday routine diagnosis in surgical pathology practice. However, one may encounter some rare diseases of gallbladder. Tuberculosis (TB) of Gall bladder is a rare infection; should also be considered amongst the differential list of gall bladder disorders and management of gall bladder pathologies.&nbsp