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

Mini Clinical Evaluation Exercise (Mini-CEX): An overview

Over the last two decades, medical education has changed its role significantly to move from the traditional curriculum to the outcome based education. This is done after deciding the competencies to be achieved by the students more clearly1. The Institute for International Medical Education (IIME) has clearly focused the minimum essential core competencies that a medical graduate must possess including the clinical skills, communication skills, professional values, attitudes and behaviors1.&nbsp

Comparative study of marital adjustment and life satisfaction among spouses of patients with alcohol dependence and normal healthy control: a case control study

Background: Alcohol dependence is associated with domestic violence, which in turn aggravates the physical and emotional distress of the family. Alcohol dependence also leads to decrease in social support not just for the affected individual but for the family. Various studies revealed low level of life satisfaction and among the family members of patients with alcohol dependence. The aim of the study was to compare marital adjustment and life satisfaction among the spouses of patients with alcohol dependence with normal healthy control.Methods: It was cross sectional study conducted at Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi. Thirty patients with alcohol dependence syndrome with their spouses and 30 age and socio-economic status matched healthy control with their spouses were inducted in the study based on inclusion and exclusion criteria. Spouses of the two groups were compared for their life satisfaction and marital adjustment using life Satisfaction Scale and Marital Adjustment Questioner respectively.Results: There was significant difference in respect to life satisfaction among the spouses of individual with alcohol dependence syndrome and normal healthy control. Life satisfaction as well as marital adjustment was better in spouses of normal healthy control as compared to spouses of patients of alcohol dependence.Conclusions: There is significant difference in respect to life satisfaction among the spouses of individual with alcohol dependence syndrome and normal healthy control. Wives of normal healthy control had better marital adjustment as compared to spouses of alcohol dependence syndrome. There was positive co-relation between life satisfaction and marital adjustment.

Empyema thoracic presenting as low back ache

AbstractA 24 years old female was presented with a 2 weeks history of fever (high grade), cough, fatigue, shortness of breath, chest pain right side and low back ache. Patient prefers to lie towards right side. CECT thorax reveals empyema thoracic with paravertebral extension. Patient was put on IV antibiotic according to culture and sensitivity. Clinical and Radiological improvement was evident after 1 week

Transfusion transmitted malaria in three major blood banks of Peshawar, Pakistan

Malaria is one of the most important transfusion associated infections in many parts of the world, particularly the developing countries where it is endemic. This study estimates the risk of acquiring malaria from a single unit of blood in North of Pakistan. A prospective study was conducted to investigate transfusion transmitted malaria in three major blood banks of Peshawar, Pakistan. A total of 1558 (1534 males and 24 females) healthy volunteer blood donors were screened for the presence of malarial parasites in thick and thin smears using microscopy. Nine donors (0.577%) were found positive for malarial parasite, with trophozoites and gametocytic stages of Plasmodium falciparum (1) and Plasmodium vivax (8). Majority of the donors (82.09%) belonged to age group 15 - 30 years. Donors who suffered from malaria in recent years were 28 in number and 3 of them were found positive for malaria in the present study. The results of the present study indicated that transfusion transmitted malaria is a risk in malaria endemic regions like Pakistan. Further research on this aspect using more sophisticated and advanced diagnostic techniques like enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) are required for proper assessment of actual situation and control of transfusion transmitted malaria in Pakistan.Keywords: Transfusion, malaria, blood-borne infections, screening, microscopy, blood banksAfrican Journal of Biotechnology Vol. 9(33), pp. 5445-5449, 16 August, 201

Role of Platelet-Rich Plasma and Adipose-Derived Stem Cells in the Treatment of Spinal Cord Injury: A Case Report

Autologous platelet-rich plasma (PRP) and adipose tissues have proven beneficial in treating diabetic ulcer, eye infections, cataracts, and dermatologic conditions. We treated a patient with spinal cord injury with two consecutive platelet-rich plasma and stem cell therapies with an interval of 15 days. We assessed the patient’s gait, posture, and deep tendon reflexes before and after the therapy. Before the treatment patient exhibited hyperreflexia, was unable to stand without support, and could not maintain an upright posture. No improvement was observed after the initial treatment. However, after the second therapy, the patient reported marked control of his lower limbs and the ability to stand upright without support. Subsequently, his condition further improved and he began to walk without support. Our observation suggests that the use of platelet-rich plasma and adipose-derived stem cell (ADSC) in cervical spine injuries is beneficial and should be further tested in randomized trials. Keywords: Adipose-Derived Mesenchymal Stem Cells; Platelet-Rich Plasma; Spinal Cord Injury