FEV1/FEV6 as an alternative to FEV1/FVC in the spirometric detection of airway obstruction in chronic smokers

Introduction: Chronic obstructive pulmonary disease [COPD] is defined as a disease state characterized by airflow limitation that is not fully reversible. FEV1/FEV6 is a new more reliable spirometric index, which is derived from maneuvers that can be performed more easily and can detect early airway obstruction

Objective: To determine the diagnostic accuracy of FEV1/FEV6 by taking FEV1/FVC as gold standard in the detection of airway obstruction in chronic smokers. Study Design: Cross sectional [Validation] study. Setting: This study was conducted in the Department of Medical Unit-II, Allied Hospital Faisalabad. Duration with Dates: Six months from 01-12-2014 to 31-05-2015

Subjects: A total of 192 patients were enrolled from Medical OPD of Allied Hospital Faisalabad. Every patient was asked to take three practice attempts before actual readings were taken to avoid technical error. The patient was asked to breathe in as deeply as possible and then exhale. The both FEV1/FVC and FEV1/FEV6 were calculated for each patient

Results: The mean age of the patients were 42.1 +/- 8.9 years. There were 152 [79.2%] male and 40 [20.8%] female patients. The sensitivity of FEV1/FEV6 in the detection of airway obstruction was 88%, specificity 94%, positive predictive value 95%, negative predictive value 85% and diagnostic accuracy 91%

Conclusion: It is concluded from this study that FEV1/FEV6 is a sensitive and specific test for the diagnosis of airway obstruction. FEV1/FEV6 can be used as a valid alternative for FEV1/FVC in the diagnosis of airway obstruction

Interferon-induced central retinal vein thrombosis

A middle-aged lady presented with sudden onset of unilateral central retinal vein thrombosis after completing 6 months course of interferon and ribavirin for chronic hepatitis C infection. She had no risk factors and all her thrombophilia workup was normal, however, she was found to be dyslipidemic which may have contributed to atherosclerosis and predispose to thrombosis. Despite anticoagulation, her visual acuity deteriorated. This case illustrates the possibility of unpredictable visual complication of interferon. Frequent eye examination should be undertaken in patients having underlying risk factors like diabetes, hypertension or dyslipidemia undergoing interferon therapy

Facial nerve palsy with chronic inflammatory demyelinating polyneuropathy

Chronic inflammatory demyelinating polyneuropathy is an autoimmune disease characterized by progressive symmetrical motor and sensory dysfunction. There is a known association of chronic demyelinating polyneuropathy with diabetes mellitus. Cranial nerve palsies are also reported with CIDP. Here we are going to present a case of 40 years old diabetic who presented to us with progressive parapresis and left facial nerve palsy which subsequently turned out to be a case of CIDP on CSF examination and nerve conduction studies. We started oral steroids and Azathioprine to the patient and he showed dramatic response to steroids

Prevalence of H. pylori

Acid peptic disease is a world wide problem among all the age groups and both sexes. Duodenal ulcer is common as compared to gastric ulcer. Its prevalence being 4:1 in USA and UK and 5:1 in Pakistan. Etiology of peptic ulcer is almost certainly multi-factorial. Basic paradigm for ulcer disease is the imbalance between the digestive activity of acid and pepsin and the protective mechanism in place to resist mucosal digestion. Over the past few years a new line of thought has been evolved after isolating spiral campylobacter like organism from antral biopsy specimens. H pylori is now considered to be an important if not the only causative agent of gastritis and peptic ulcer disease. The dictum; No acid - No ulcer summarized the pathogenesis of peptic ulcer disease but new dictum seems to be; No H. pylori -No ulcer, as over 90% of Duodenal ulcer and 70% of Gastric ulcer patients are infected by H. Pylori. Aim of the study was to evaluate the prevalence of H. pylori among duodenal ulcer patients at Faisalabad District and its suburbs. Descriptive Study. From Mar 2008 to Oct 2008. 50 patients [40 males, 10 females] belonging to Faisalabad District and surrounding areas with upper gastrointestinal symptoms of acid peptic disease and endoscopy proved duodenal ulcer were subjected to gastric antral mucosal biopsies for evaluation of the H. Pylori status with the help of unease test and histological examination of biopsy specimen. Epigastric pain was the most frequent symptom 90%. [46 out of 50 patients]. 92% showed evidence of H. pylori infection. Maximum incidence of H. pylori was recorded in age group IV [46-55 years]. Maximum number of patients was skilled workers [35 out of 50] 70%. 80% of the patients belonged to lower and middle class. Percentage of H. pylori positivity was 89.1% and 84.34%. Acceptance of contributory role and high prevalence rate of H. pylori instigates us for addition of antimicrobial treatment to the conventional treatment with H2 Blockers and PPls which is cost effective and alter the course of the disease

Frequency of increased mean platelet volume in patients suffering from hypertensive retinopathy

The pathophysiological mechanism of hypertensive retinopathy is not fully established. It is thought that increased platelet activation may play a role in its pathogenesis. As mean platelet volume is a marker of platelet activation, so this study was designed to answer the question: does mean platelet volume increase in hypertensive retinopathy. To determine frequency of increased mean platelet volume in hypertensive retinopathy. Cross-sectional study. Six months. Outpatient department of Medical. unit III, Allied Hospital, Faisalabad. 138 patients of essential hypertension with hypertensive retinopathy of all ages and both sexes were included. For grading of hypertensive retinopathy according to the Keith Wagener classification, direct ophthalmoscopy was performed in all the subjects and mean platelet volume was measured after taking the blood sample. The mean platelet volume was found to be normal [10 fl] were found in 41 patients [29.7%], of these 19 were males while 22 were females. In patients of grade 1 hypertensive retinopathy, the mean platelet volume was 9.1 +/- 0.6 fl. In grade 2, 3 and 4 hypertensive retinopathy the values of mean platelet volume were 9.6 +/- 0.5 fl, 10.1 +/- 0.3 fl and 10.7 +/- 0.6 fl respectively. This study concluded that frequency of mean platelet volume is increased in patients of hypertensive retinopathy and frequency increases with increasing the severity of hypertensive retinopathy

Fiberoptic bronchoscopy; diagnostic role, a local experience

To demonstrate the usefulness of Bronchoscopy as a diagnostic tool in various pulmonary disorders. Prospective study. Nawaz Medicare Hospital Faisalabad. June 2004 to December 2007. This study was conducted on 52 patients, 37 were male and 15 were female. Their ages ranged from 26 to 85 years. These patients who under went Bronchoscopy were either suspected cases of bronchogenic carcinoma or had difficult to treat un-resolving pneumonias. Endobronchial biopsies and bronchial aspirates were obtained. In the patients suspected of bronchogenic tumor 66.67% patients turned out to be positive on endobronchial biopsies. Bronchial aspirates were diagnostic in 73.32% cases of un-resolving pneumonias. The commonest symptoms in patients under going Bronchoscopy were haemoptysis and cough. Bronchoscopy is very useful in the diagnosis of suspected cases of bronchogenic carcinoma. Bronchial aspirates are helpful in the diagnosis of un-resolving pneumonias

Superior sagital sinus thrombosis: a case report

A forty years old lady on 15[th] day of her puerperium presented in the emergency ward of Allied hospital Faisalabad with severe headache left sided hemiparesis and focal fits. On examination she had upper motor neuron signs on left side and bilateral papilloedema. CT scan brain showed multiple small areas of haemorrhages in a large infarct. CT venography showed superior sagital sinus thrombosis. She was anticoagulated. Cerebral venous thrombosis is a rare cause of CVA. It can be caused by number of congenital and acquired prothrombotic states and drugs. It usually presents with headache focal neurological deficit, fits, altered conscious level and papilloedema. Diagnosis is confirmed on CT venography and magnetic resonance venoghraphy. Patients suffering from this disease are treated with anticoagulants

Frequency of different HCV genotypes in Faisalabad

Hepatitis C Virus [HCV] is thought to be one of the major causative agent of viral hepatitis. A large number of HCV infected patients develop chronic hepatitis which often results in liver cirrhosis and even progress to hepatoma The HCV genotype is the strongest predictive parameter for sustained virological response [SVR]. Patients with different HCV genotypes respond differently to antiviral therapy. Firm evidence has been established that patients with genotypes 2 and 3 are more likely to achieve SVR to combination therapy than Genotype 1 patients. A total of 93 patients from Faisalabad, who were HCV RNA positive were tested for genotyping. Out of the 93 tested serum samples 84 were typable and 9 were found to be untypable. In the typable samples most prevalent genotype was found to be type 3a and common cause of untypable genotypes was a low viral load. The most common type of HCV infection in Faisalabad is due to genotype 3a and the common cause of untypable genotype is probably low viral load

Bacteriology of spontaneous bacterial peritonitis

Cirrhosis is a major cause of mortality worldwide and is the most common non neoplastic cause of death among hepatobiliary and digestive diseases. Ascites is often among the first signs of de-compensation in patients with chronic liver disease. Spontaneous Bacterial Peritonitis [SBP] [with out any source of infection] occurs in 30% of patients with ascites. Common causative organisms include escherichia coli, pneumococcus, Klebsiella and anaerobes. It has a 25% mortality and recurs in 70% of patients within a year. To determine the pathological agents causing SBP in patients with liver cirrhosis. Descriptive study. Medical Ward Allied and K.M. Hospitals Faisalabad. From 17 Nov 2004 to 15 May 2005. Fifty patients of either sex having cirrhosis of liver and ascites were included according to the criteria i.e ascitic fluid leukocyte count of >500 cells/L or >250 PMN, while results of bacterial cultures of ascitic fluid were pending. Out of 5 0 patients, 27 [54%] were males and 23 [46%] females. Mean age of whole the population was found to be 51 +/- 12.49] yrs. Classical spontaneous bacterial peritonitis was present in 27 patients and Culture Negative Neutrocytic Ascites [CN NA] in 23[46%] patients. Out of 50 patients, 27[54%] samples of ascitic fluid showed positive culture reports. E Coli was isolated in 9[18%] cases. Klebsiella pneumoniae in 6 [12%], streptococcus pneumoniae 4 [8%], staphylococcus aureus 2 [4%], pseudomonas aeruginosa 2 [4%]. Acinobacter 2 [4%] and proteus mirabilis 2 [4%]. E. Coli is the commonest organism followed by klebsiella pneumoniae

Diagnostic role of endoscopy; an experience at Faisalabad

To see the usefulness of Endoscopy in patients with various gastrointestinal manifestations. Prospective study. Department of medicine and gastroenterology Allied Hospital Faisalabad January 2005 to July 2005, This study was conducted on 500 patients presented to us with various gastrointestinal manifestations of either sex and between 13-70 years. 260 patients were Males and 237 were Females. Most common indication was epigastric pain. 60.4% of the patients had organic lesion. Endoscopy was maximally positive in inpatients [91.86%]. Most common lesion was in stomach i.e. gastritis. Collectively ulcerative lesions came out to be 27.30%. Diagnostic yield of Endoscopy is undoubtedly very high if the patient selection is done in a meticulous way