Role of high resolution computed tomographic scan in diagnosis of interstitial lung diseases in local population

The objective of this study was to find the role of High Resolution Computed Topographic [HRCT] scan of the chest in the diagnosis of Interstitial Lung Diseases [ILD] in our local population. A prospective study of fifty patients already diagnosed as ILD on transbronchial or open lung biopsy was performed in the Medical B Unit of the Department of Medicine Khyber Teaching Hospital, Peshawar from January, 2008 to December, 2008. Both male and female admitted patients above 15 years of age were included in this study. Of the fifty patients meeting the inclusive criteria 18 were male and 32 were female. The commonest affected age was 40-60 years. The commonest symptoms were shortness of breath and cough respectively. Inspiratory crepts and wheezes were the most common physical findings followed by clubbing, raised jugular venous pressure and edema feet. HRCT Scan revealed ILD in 88% with sensitivity of 95% and specificity of 75% having 95% positive predictive value and 75% negative predictive value. HRCT Scan of chest is the most sensitive non invasive test in the diagnosis of ILD compared to chest X ray, pulomary faction tests and can abate the need of lung biopsy in many cases

Frequency of hepatocellular carcinoma in cirrhosis

To find the frequency of hepatocellular carcinoma in cirrhotic patients of our population. Prospective observational study. Medical A Unit Hayat Abad Medical Complex Peshawar. Period: 1st January 2010 to 31st July 2011. Material and All patients were screened for presence of Hepatocellular carcinoma [HCC] by performing Alpha fetoprotein and ultra sound [U/S] abdomen. Contrast enhanced computed tomography scan [CT] of abdomen was done in selective cases. European Association for the Study of Liver Diseases [EASLD] Noninvasive criteria [limited to patients with underlying cirrhosis] was used for diagnosis of HCC i.e. Two coincident imaging techniques that identify a focal lesion more than 2 cm showing arterial hypervascularization or one imaging modality that identifies a focal lesion more than 2 cm in diameter showing arterial hypervascularization and serum AFP levels greater than 400 ng/Ml. A total of 370 patients cirrhotic patients were enrolled in this study. Thirty nine patients [10.5%] were diagnosed as having HCC. Male patients were 30 [77%] and 9[23%] were female. Mean age was 49.2% [range 18 to 72 years]. Abdominal discomfort was predominant symptom present in 94% patients, followed by anorexia present in 90% patients, abdominal distension in 76%, weight loss in 62%, jaundice was present in 46% patients, altered mental status was notice in 36% patients and history of upper gastrointestinal [GI] bleed and malena was extracted from 26% patients. Ultrasound abdomen and CT abdomen showed unifocal lesion in 48.7% patients, multifocal lesion in 30.7% patients and massive lesion in 20.5% patients. Alpha fetoprotein ranged from 45ng/dl to 630ng/dl. Hepatitis C [HCV] was the commonest cause present in 51% patients, Hepatitis B [HBV] in 15.3% patients and HBV and HCV co-infection in 10.25% patients, history of alcoholism was revealed in 5% patients and in 2.5% patients alcoholism was present along with HCV and HBV each, while in 10% cases the cause of cirrhosis remained unknown. Hepatocellular carcinoma is the most common primary hepatic tumor and one of the most common cancers worldwide. It is concluded that HCC is more common in males compared to female cirrhotic patients. Hepatitis C followed by HBV are the leading causes of HCC related cirrhosis in local Population of Khyber pakhtoonkhwa

Comparability and validity of siriraj stroke score and allen stroke score in differentiation of acute ischemic and haemorrhagic stroke

To compare and validate Alien stroke score [ASS] and Siriraj stroke scores [SSS] in differentiating acute cerebral hemorrhage [CH] and cerebral infarction [CI]. This comparative, analytical study was conducted at Khyber Teaching Hospital Peshawar, Pakistan from July 2000 to February 2002. Study included 100 patients of acute ishemic or hemorrhagic stroke confirmed on CT scan brain after clinically evaluation. ASS and SSS were calculated for each patient and compared with the results of CT scan for comparability [Kappa Statistics] and validity by using SPSS 10. Out of 100 patients, 69 had CI and 31 had CH. The overall comparability of ASS and SSS was fair [Kappa=0.51]. ASS and SSS were uncertain in 27 and 18 cases respectively; with Kappa showing worst comparability in term of certain results [K= 0.23]. In 64 cases with both scores in the diagnostic range, the Kappa showing excellent comparability [K=0.91].The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of ASS was 38.70%, 91.30%, 66.67%, 76.82% respectively for CH and 71.1%, 80.64%, 89.09% and 55.56% respectively for CI, with overall predictive accuracy of 61%. The sensitivity, specificity, PPV and NPV of SSS was 67.74%, 94.2%, 84% and 86.67% respectively for CH and 78.26%, 90.32%, 94.73% and 65.11% respectively for CI, with overall predictive accuracy of 75%. Although, SSS being simple with more accuracy is better than ASS, both these scores lack sufficient validity to be used for exclusion of cerebral haemorrhage before offering antithrombotic or thrombolytic therapy

Diabetic foot risk classification in a tertiary care teaching hospital of Peshawar

To find out diabetic foot risk classification in patients admitted with diabetes mellitus at a tertiary care teaching hospital. The hospital record of one hundred and twenty seven patients of diabetes mellitus, admitted to the medicine department, Khyber teaching hospital Peshawar from 1st October 2005 to 31st March 2006 were evaluated against the Royal College of Physicians, London; Clinical Guidelines for Type 2 diabetes: prevention and management of foot problems. Both male and female indoor patients above 15 years of age were included in the study. An audit of 127 diabetes mellitus patient revealed that 25 [19.68%] patients were having low current risk, 21 [16.53%] were classified as having risk foot, 6 [4.72%] were categorized as high risk patients, 16 [12.59%] were admitted with ulcerated foot and 5 [3.39%] were having diabetic foot emergency according to Royal College of Physicians, London; Clinical Guidelines for Type 2 diabetes: prevention and management of foot problems. The main reason for poor diabetic foot outcomes in the tertiary care teaching hospital is the absence of classification of majority of diabetic patients into different risk groups for the appropriate treatment. This lack of risk classification results in ensuing gaps in the management and an overall increase in morbidity

Hypertension in acute ischemic and haemorrhagic stroke

To know the pattern of systolic and diastolic blood pressure in hypertensive patients with acute ischemic and hemorrhagic stroke. Material and This study was conducted on 100 patients with acute stroke, admitted in Khyber Teaching Hospital from July 2000 onward. Hypertensive patients were finally selected for analysis. BP was recorded at arrival and 24 hours after admission. Out of 100 patients with stroke, hypertension was present in 72 cases. Out of these 72 patients, 44 cases [61.1%] had cerebral infarction [CI] and 28 cases [38.9%] had cerebral haemorrhage [CH]. Overall mean systolic BP at arrival [SBP-A] was 163 [ +/- 35.606] mm Hg. Mean SBP-A in patients with CI was 152.3 [ +/- 34.397] mm Hg and in patients with CH was 181.25 [ +/- 30.357] mm Hg. Overall 68% of hypertensive stroke patients had uncontrolled systolic BP at arrival. Overall mean diastolic BP at arrival [DBP-A] was 95. 97 [ +/- 20.733] mm Hg. Mean DBP-A in CI was 88.75[ +/- 17.854] mm Hg and in CH was 107.32[ +/- 20.115] mm Hg. The mean difference of DBP-A in CH and CI was 18.57mm Hg. Mean systolic BP and Mean diastolic BP, 24 hours after admission were 157.85 mm Hg and 92.08 mm Hg respectively. Majority of hypertensive stroke patients have uncontrolled blood pressure. Hypertension is a risk factor for both ischemic and hemorrhagic stroke. More elevation of blood pressure is more frequently associated with cerebral hemorrhage than cerebral infarction