Frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis.

Objectives: To assess the frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis. Study Design: Cross Sectional study. Setting: Department of Medicine, Independent University Hospital, Faisalabad. Period: 01-07-2017 to 30-06-2018. Material &amp; Methods: 100 patients having diagnosis of COPD according to the operational definition were selected from medical opd of hospital after consent of patients. All patients were given tablet azithromycin 250mg thrice weekly for 12 months, then these patients were followed up for episodes of exacerbations in one year. All patients were properly instructed to report in any change in their symptoms. Any episode of acute exacerbation was noted. There was no conflict of interest. Results: Frequency of acute exacerbation of chronic obstructive pulmonary disease was seen in 70 out of 100(70%) patients taking low dose azithromycin prophylaxis. In female patients frequency of acute exacerbation was high as compared to male patients. i.e. 62.9% vs. 37.1%. Frequency of acute exacerbation was higher in patients whose duration of disease was longer. i.e. 7-10 years followed by patients whose duration of disease was 4-6 years (28.6%) and 1-3 years (25.7%). Presence of acute exacerbation was significantly associated with decline in lung functions. Highest frequency of acute exacerbation was seen in patients who had 3-4 episodes. Conclusion: Results of this study showed a high frequency of acute exacerbation of COPD even with the prophylaxis of low dose azithromycin. However literature reported effectiveness of low dose azithromycin for acute exacerbation in patients of COPD. So further study in the form of randomized trail is needed to prove the efficacy of azithromycin.</jats:p

DANDY-WALKER SYNDROME;

Introduction: Dandy-Walker Malformation is an inborn condition that includesthe triumvirate of cystic enlargement of the fourth ventricle, posterior fossa distension with riseof the tentorium and agenesis of cerebellar vermis. The purpose of this study is to determinethe Clinical presentation and associated complications, mortality and morbidity of patientundergoing placement of shunt with Y- connector in Dandy Walker Malformation. StudyDesign: Case Series comprised of 85 cases. Setting: Neurosurgery Ward of Tertiary CareHospital in Karachi. Period: February 2011 to December 2015. Methodology: All patients whowere presented in OPD with complaints reminiscent of DWM with accompanied Hydrocephalusand then underwent CT scan Brain without contrast to confirm the diagnosis were admitted.The patients who have previous history of operation and other co-morbid anomalies wereomitted. These patients undergo drainage of Ventricular system and Posterior Fossa cyst wasdone mutually via Dual Shunt including Ventricular-peritoneal and Cysto-peritoneal shunt withY connector. There were few complications and mortality after this surgical intervention whichwas noted for a month. All records were recorded and evaluated by SPSS v.20. Result: Avast majority of patients included were Female. The average age of patients was 2.5 years+/- 1 Standard Deviation. The chief complaint was Hydrocephalus, existing in all patients,after that cerebellar signs in 55 (64.7%) and other signs in 10 (11.8%) patients. Others signsincludes; milestones were delayed, atypical gait and few patients were suffered from psychiatricproblems. Complications which were observed were shunt; Fracture/Dislocation in 10 (11.8%),shunt blockage in 8 (9.4%), malpositioning is also 8 (9.4%), Intracranial Hemorrhage in 7(8.24%) patients and Infection in 10 (11.8%). These complications were observed within amonth of surgery. Unfortunately, two (2.35%) patient were also expired after surgical approach.Conclusion: It is concluded that Dandy Walker Malformation is categorized by a triumvirate.Hydrocephalus is a most common symptom and principal cause of referral to hospitals. Thecommonest difficulty acknowledged after shunting is Malfunction and shunt infections. Thelowest mortality is related to Dual Shunt with Y connector when compared to other approachesfor management of shunt with Y-connector. Thus, it is found to be a worthy decision in givenDWM patients.</jats:p

POST HEMORRHOIDECTOMY PAIN RELIEF

Background: The aim of my study is to evaluate post-operative pain reliefon patients who had hemorrhoidectomy. Materials and Methods: 300 patients who hadhemorrhoidectomy were divided equally in to three groups, according to anesthesia type,group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and generalanesthesia was considered to be group 3. Pain relief, post-operative complications, hospitalstaying time were measured and compared between the three groups. Period: Study wasperformed between Jan 2012 to Dec 2014. Results: The study showed that patients who hadlocal anesthesia infiltration and sedation a significant decrease of post-operative total painscores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group IIas compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperativeanalgesia doses in the 3 groups were 120:140:180 respectively, total hospital stayingtime were 130:210:260 days, headache in the ratio of 0:8:1, urine retention in 0:6:1 patients,nausea and vomiting in 0:1:5 patients were reduced by 30 %,. P-value &lt; 0.05. On the otherhand, spinal anesthesia which is group 2 showed slight decline of patients numbers who hadrespiratory symptoms, hypotension and urticarial.Conclusion: Post-operative pain, analgesia,total cost, hospital staying time, nausea and vomiting have been significantly reduced by localanesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higherrate in post-operative urine retention, headache and hypotension compared to local anesthesiawith sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced inlocal anesthesia with sedation compared to spinal and general anesthesia.</jats:p

Association of hypertension and diabetic retinopathy in type 2 DM patients.

Objectives: To evaluate the association of hypertension and diabetic retinopathy in type 2 DM patients. Study Design: Case Control study. Setting: Diabetic Clinic Department of Medicine, Independent University Hospital, Faisalabad. Period: From January 2019 to June 2019. Material &amp; Methods: One Hundred Type 2 diabetic patients of either sex were reviewed and these patients were screened for diabetic retinopathy using welchallyn ophthalmoscope. The patients with diabetic retinopathy fulfilling the inclusion criteria were placed in group A (cases) and patients without diabetic retinopathy were placed in group B (control). After resting the patient in supine position for 5 minutes, blood pressure (BP) measurements were taken in all these patients using mercury sphygmomanometer in two successive out-patient department visits, and mean value of B.P. was taken. All patients were asked for duration of diabetes, hypertension and visual problems specifically. These patients were advised following investigations: - FBS. - RBS. - HbAlc. Relevant statistics, mean &amp; standard deviation were computed for variables. T-test was applied on hypertension (independent) and DM retinopathy (dependent) variables. Results: Systolic and diastolic blood pressure were significantly higher in the patients with retinopathy (mean systolic B.P 153.4± 17.13 and mean diastolic B.P. 84.1±9.26) than in those without retinopathy (mean systolic B.P. 130.65±11.94 and mean diastolic B.P 77.3 ±6.64). There was significant correlation of diabetic retinopathy with systolic hypertension (P&lt;0.05) and diastolic hypertension (P&lt;0.001). Conclusion: There is strong association between diabetic retinopathy and hypertension. So early detection and treatment of hypertension can retard the development and progression of diabetic retinopathy.</jats:p

Abstract P1117: Dissimilarities Between and Carotid and Forearm Pressure-Decay and Windkessel Parameters: Implications for Circulatory Models

We studied whether: 1) the carotid and forearm diastolic pressure-decay time constants (tau) are similar and 2) the associated Windkessel (WK)-derived compliance and stiffness values are also similar and are related to arterial stiffness. Ambulatory normotensive and hypertensive subjects were studied after 30 minutes of supine rest with radial and carotid arterial tonometry (Sphygmocor), standard oscillometric cuff BP, and central (heart-femoral, hf) and peripheral (femoral-ankle, fa) pulse wave velocity (PWV, Colin VP1000). Brachial and carotid Doppler flow studies were performed in a subset. Tonograms were photo-digitized and the pressure in late diastole was modeled as an exponential decay to an asymptote A with time constant tau and start-decay time t0. [Resistance = mean pressure/flow; WK compliance = tau/resistance and WK stiffness = 1/WK compliance.] Tonometry and PWV data were available in 98 individuals; carotid and forearm blood flow in 22: (mean[SD]) age 50[20] years, weight 81[17] kg, BP 134/77[17/12] mmHg, resting HR 66[12], 38% female. Data are presented in the Table; hfPWV and faPWV were well correlated (p&lt;0.001) but neither was correlated with carotid or forearm tau or the corresponding regional WK stiffness. We conclude that diastolic pressure decay (tau) and WK stiffness (or compliance) are not systemic indicators but rather unique regional characteristics not related to central or peripheral large artery stiffness. These findings suggest that single-WK models do not adequately represent the arterial circulation. </jats:p

Frequency of distribution of joint involvement in rheumatoid arthritis patients.

Objectives: To determine the frequency of joint distribution in rheumatoid arthritis presenting at Independent University Hospital Faisalabad. Assessment of joint involvement in RA patients is not only important to determine the disease activity but also to assess the future joint damage. Study Design: Cross Sectional Study. Setting: Independent University Hospital Faisalabad. Period: July 2019 to Jan 2020. Material &amp; Methods: 384 consecutive RA patients fulfilling inclusion and exclusion criteria, of either sex between age of 17- 60 years were enrolled from Rheumatology division of Independent University Hospital Faisalabad from July 2019 to Jan 2020. Frequency of joint distribution was assessed. Chi square test was used to compare the frequency of joint distribution among different treatment groups, age groups and gender, disease duration. A p-valve of &lt; 0.05 was considered statistically significant. Results: In this study 384 patients with RA were studied. Joint distribution was determined according to pattern of joint involved at presentation. More patients (178) were noted in oligoarticular group, with predominant small joint involvement 111 (28.9%). 173 patients were noted in poly-articular group with 102 (26.6%) were in predominant small joint involvement. Conclusion: Pattern of joint distribution in RA patients is very important especially if there is monoarthritis or oligoarthritis, along with its association with gender, age of onset, disease duration, investigations.</jats:p

Abstract P177: The Dissociation of Heart Rate and Blood Pressure Masks the Regulatory Role of Heart Rate in Systemic Hemodynamics

Blood pressure (BP) and heart rate (HR) are independent cardiovascular risk factors but there is little information about interactions among HR, BP, and systemic hemodynamics throughout the day. We performed 24-hour ambulatory pulse wave analysis (Mobil-O-Graph, IEM, Stolberg, DE) with measurements at 20 minute intervals. Variables measured were: systolic and diastolic BP (SBP and DBP), HR, oscillometric pulse wave velocity (oPWV), stroke volume index (SVI), and total vascular resistance index (TVRI). We also performed regression analyses within-subjects to determine the slopes of the SVI-HR and TVRI-HR relationships within individuals and for the group. We studied 89 individuals (mean age 61 years, weight 84 kg, BP 138/82 mm Hg (38 normal or controlled BP, 51 uncontrolled BP), resting HR 69 beats/min (bpm), 36% non-white, 64% female); 24-hour mean HR was not correlated with corresponding SBP or DBP values (r= -0.013 and r= 0.154, pNS, respectively) and this dissociation persisted in corresponding day-time vs. night-time comparisons and subgroup stratification by BP control status, age, and gender. In contrast, 24-hour mean HR was strongly correlated with 24-hour mean cardiac index (r=0.629, p&lt;0.000) but strongly inversely related to mean 24-hour SVI and TVRI (r= -0.508 and r= -0.505, p&lt;0.000 each); each 10 beat/min change in mean HR was associated with a 2.3 mL/m 2 (6%) change in SVI and a corresponding 6% change in TVRI. Analysis of individual 24-hour studies also revealed no correlations between HR and BP but the within-individual slopes and correlation coefficients between HR and SVI or TVRI were more variable; higher oPWV (which correlated with the SD of SBP, p=.01) was associated with a lesser sensitivity of SVI to HR change and a greater sensitivity of TVRI to HR change (p&lt;0.001 each) independent of age, gender, or BP. We conclude that BP is normally independent of HR, which plays a hidden but important regulatory role in the underlying systemic hemodynamics between and within individuals. The clinical impact of differential sensitivity of systemic hemodynamics to HR change is not established but people with stiffer arteries display diminished SVI sensitivity and greater TVRI sensitivity to HR change, which may contribute to their greater SBP variability. </jats:p