To compare anti-albumin urea effects of valsartan alone with combination of valsartan and amlodipine in patients of chronic kidney disease.

OBJECTIVE: To compare anti-albumin urea effects of Valsartan alone with combination of Valsartan and Amlodipine in patients of chronic kidney disease. METHODS: This randomized clinical trial was conducted at the Department of Medicine, Combined Military Hospital Bahawalpur, from April 2014 to 30 September 2014. 140 patients of chronic kidney disease with baseline blood pressure more than 140/90mm Hg having raised urinary albumin: creatinine ratio (UACR). UACR more than 3.5 mg/mmol was considered abnormal. Group-A was treated with Valsartan 80mg daily and Group-B was treated with valsartan 80 and amlodipine 10mg once a day. We did not change the dose of drugs and check spot UACR at base line and after six months with therapy and compare improvement in UACR between Group-A and B. Data was analyzed by statistical software packages (SPSS 16.0). RESULTS: In both the groups, BP was significantly lower than the respective value. Mean decrease in spot UACR in Group-A was 3.18±2.64 mg/mmol and UACR in Group-B mean decrease in UACR was 13.01±20.11 mg/mmol. P value was< 0.05. CONCLUSION: The combination therapy of valsartan with amlodipine significantly lowers the albuminuria in chronic Kidney disease and reduce the progression of disease as compared to Valsartan alone therapy.

The association of factor V leiden mutation with recurrent pregnancy loss.

OBJECTIVE: To determine the association of factor V Leiden mutation with recurrent pregnancy loss. METHODS: The case-control study was conducted at the Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to June 2012, and comprised women of 18 to 45 years of age who had a history of recurrent pregnancy loss, and controls with no history of pregnancy loss. All the subjects belonged to Punjabi ethnic group. Three ml blood was taken from cases and controls and deoxyribonucleic acid was extracted. In order to identify Factor V Leiden mutation, polymerase chain reaction method was utilised combined with the amplification refractory mutation system. Data was analysed using SPSS 17. RESULTS: Of the 112 subjects, 56(50%) were in each of the two groups. The presence of factor V Leiden mutation among the cases was 3(5.4%) while it was absent among the controls. The mutation was significantly associated with recurrent pregnancy loss (p=0.017).Recurrent pregnancy loss was higher in cases than controls (p=0.001). CONCLUSIONS: Factor V Leiden mutation, Recurrent pregnancy loss, PCR (Polymerase chain reaction).

To determine the frequency of Factor V Leiden in cases of Deep Vein Thrombosis and Healthy controls.

OBJECTIVE: To determine the frequency of Factor V Leiden in cases of Deep Vein Thrombosis and Healthy controls. METHODS: This case control study was performed in Armed Forces Institute of Pathology Rawalpindi, From 21(st) March to 25(th) September 2013. One hundred patients with diagnostic evidence of Deep vein thrombosis on Doppler ultrasound/Magnetic resonance imaging (MRI) scan were included in the study through non probability convenient sampling and compared with 100 matched healthy controls. DNA was extracted from the blood sample by kit method. In order to identify Factor V Leiden mutation, the polymerase chain reaction (PCR) method was utilized combined with the Amplification refractory mutation system. Data was analyzed using statistical package for social sciences (SPSS) version 17. RESULTS: In 100 patients of Deep Vein Thrombosis (DVT), frequency of Factor V Leiden (FVL) was 13% and it is was 2% in healthy control group. A significant association was found between FVL and DVT with odds ratio of 7.32 and with P value (P = 0.003). CONCLUSION: FVL was found to be highly prevalent among patients of DVT, Signifying strong association between the two.

Colonoscopic evaluation of middle aged patients with altered bowel habits.

OBJECTIVE: To determine the frequency of colorectal carcinoma in patients above 40 years of age presenting with altered bowel habits by colonoscopy. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Services Hospital, Lahore between August 2000 to August 2002. PATIENTS AND METHODS: A group of 50 consecutive cases presenting with altered bowel habits meeting the inclusion and exclusion criteria were included in the study. History and physical examination were recorded on a specifically designed proforma. Colonoscopy was done in these patients and any abnormality found was reported and biopsy specimen taken and sent for histopathology. RESULTS: A total number of 17 patients presenting with altered bowel habits were found to be suffering from colorectal carcinoma by colonoscopy. Among these in 30% the lesion was in the rectum, in 9% the lesion was in the sigmoid colon, 6% in the descending colon, 4% at the splenic flexure, 5% in the transverse colon, in 16% the lesion was found at the hepatic flexure and in 30% the lesion was in the ascending colon and caecum. CONCLUSION: Frequency of colorectal carcinoma is high in patients above 40 years of age who presenting with altered bowel habits. They should be investigated preferably by means of colonoscopy which is the most complete method of investigation and diagnostic procedure of choice in patients with a clinical suspicion of colorectal carcinoma.