Live renal donors; comparison of CT angiographyand per operative findings

To compare the findings of helical computed tomographic angiography and intra-operative findings in live related donors. To evaluate the accuracy of helical computed tomography with advanced 3D techniques in depicting the renal vasculature, parenchymal and anatomy of collecting system. Sheikh Zayed Post Graduate Medical Institute and National Institute of kidney diseases Lahore. Between June 2006 to May 2009 eighty potential donors underwent CT angiogram as a part of their preoperative workup. We retrospectively studied the CT angiogram and compared the finding with the surgical findings. The results were reviewed with radiologists to determine the discrepancy in discordant cases. The accuracy of CT angiography was 93.40% to predict number of vessels. Five arteries and one vein was missed, this disconcordant comprised 7.59% during initial CT interpretation. The overall concordance between CT angiography and operative findings in delineating the arterial anatomy was found in 74 [93.67%] and venous in 78 [98.73%] donors. All CT scans demonstrated normal collecting system except one, which showed a dilated right pelvicalical system and ureter. Simple renal cysts about the size of 2-4 cm were found in the four left kidneys. CT scan supplied additional important anatomical information including kidney size and the presence of nephrolithiasis. Helical CT angiography is very specific for arterial and venous anatomy as well as other anatomical and functional details. It provides all the information required by a surgeon. It can become the single imaging modality for preoperative assessment of potential donors in place of conventional angiography and intravenous urography. CT angiography is minimally invasive and cost effective

Stable angina; the frequency of coronary artery stenosis among patients having left bundle branch block

To see the frequency of coronary artery stenosis in the patients of stable angina having left bundle branch block, and to see the effects of gender and age on this correlation. Experimental case series. Bahawal Victoria Hospital, Bahawalpur. June 2006 to May 2008. One hundred and forty one [141] patients of Stable Angina presenting with atypical chest pain, both male and female of 30-70 years age, positive for LBBB and with normal Cardio-Thoracic Ratio, normal echocardiography and negative for conventional risk factors and family history of Coronary Artery Disease were taken. All patients were angiographied. A total of 141 patients were investigated through coronary angiogram to see the frequency of coronary artery stenosis in these patients. Ninety five [67.4%] patients proved to have coronary artery stenosis. The male patients showed higher frequency [87.4%] of harboring coronary vessel blockade as compared to that [35.2%] in females [P value <0.0005]. There was no relation between age and the frequency of coronary stenosis [P value > 0.05]. There is significant difference [P value < 0.0005] in coronary artery stenosis among men and women having LBBB

Frequency of risk factors in patients presenting with acute coronary syndrome to coronary care unit, Bahawal Victoria hospital, Bahawalpur

ACS is a clinical diagnosis encompassing three entities; ST-Elevation Myocardial Infarction [STEMI], Non ST-Elevation Myocardial Infarction [NSTEMI], and Unstable Angina. It is one of the biggest causes of hospital admissions and mortality worldwide. As it is preventable problem, we should know the commonest risk factors and address them simultaneously. The aim of study was to determine the common most risk factors of ACS in local patients. It was a cross-sectional, descriptive study conducted at Coronary Care Unit, Bahawal Victoria Hospital, Bahawalpur. The patients from all ages and both sexes who presented with the diagnosis of ACS during December 2008 to May 2009 were included in the study by convenience sampling technique. The patients having additional medical problem [Advanced congestive cardiac failure, cerebrovascular disease, respiratory failure, autoimmune disorders, connective tissue diseases and end stage kidney disease], which could confound the results, were excluded from the study. During the study period of one year, 320 patients fulfilling the inclusion and exclusion criteria were taken in our analysis. The male to female ratio was 2:1. The mean age was 55.06 +/- 18.79 years. The diagnosis was STEMI in 60 [%], NSTEMI in 98 [%] and UA in 162 [%] at the admission. The top most implicated risk factors observed in our study were male gender [66.87%], hyperlipidemia [60.31%], smoking [55.94%]. At least one of the well knownjconventional risk factors was present in almost all [99.38%] patients of ACS while any four risk factors were present in half of the patients

Primary extraskeletal osteosarcomata of liver, kidney, breast and thigh

Extraskeletal or soft-tissue osteosarcoma is rare, occurring approximately as 1.2% of all soft-tissue sarcomas and 4% of all osteosarcomas. The peak occurs in patients, which are in the 6th decade of life. The males are slightly more frequently affected. Symptoms often include a slowly growing painful mass, with a history of trauma [1 2% of cases]. Common sites of involvement are the deep soft tissues of the thigh [47% of cases], upper extremity [20%], and retropcritoneum [17%]. The identification of neoplastic osteoid matrix formation and aggressive characteristics are necessary for histological diagnosis of osteosarcoma. We are going to discuss 06 cases of extraskeletal osteosarcomas including primary renal, primary hepatic osteosarcoma, one arising in a cystosarcoma phylloides and 03 cases involving the thigh regions

Frequency, awareness, treatment and control of hypertension in bank employees of Bahawalpur City

The study was designed to determine the frequency, awareness, treatment and control of high blood pressure among the bank employees of Bahawalpur City. It was an observational, cross-sectional study, carried out by the Department of Cardiology, BVH, Bahawalpur. The study was done from 1[st] December 2006 to 22[nd] September 2007. A sample of 188 bank employees working in different banks was taken by convenience sampling technique. Bankers of all ages and both sexes were included and those absent at the time of visits and temporary trainees were excluded. The subjects were interviewed and examined according to Equipment, Condition of patient and Techniques [ECT] recommendations as laid down by US JNC 7[th] report. The data was collected on a questionnaire and was analyzed manually. Frequency of hypertension in bank employees was 40.96%. Almost half [51.94] of the hypertensives were aware of their disease and the other half were screened during this study. Out of 40 diagnosed patients of HTN, only 23 [57.5%] were taking anti-hypertensive therapy and among those, only 14 [60.87%] were having adequate control of their blood pressure. Hypertension was found to be more frequent among males as compared to females. Other associated risk factors were advancing age, BMI >27, family history of hypertension, tobacco smoking and lack of physical exercise. The study shows a high frequency, low awareness, bad treatment compliance and improvable control of hypertension among the bank employees of Bahawalpur City

Efficacy of combination of ezetimibe and simvastatin versus atorvastatin in reducing low density lipoprotein-cholesterol in male patients of hypercholesterolemia, at Bahawalpur

To see the efficacy of reducing Low-Density Lipoprotein cholesterol [LDL-C] with the combination of Ezetimibe/Simvastatin compared with Atorvastatin monotherapy in the local patients of hypercholesterolemia. This was a single-blind, randomized, uncontrolled, study [6 weeks of active treatment with Step 1 dietary advice and a 3 week wash out period]. Patients with hypercholesterolemia were randomized by an equal allocation to 2 treatment groups: Ezetimibe/Simvastatin [10/10 mg] and Atorvastatin [20mg]. Two hundred and nineteen [219] men came for follow up after 6 week treatment when their lipid levels were compared to those at the start of treatment to calculate the efficacy measures; the percent change from baseline to the end of the 6-week treatment period in LDL-C levels and the percentage of patients who achieved the treatment goals for LDL-C levels after 6 weeks of treatment. LDL-C concentrations [in milligram per deciliter] were calculated by using Friedewald equation. The subjects having Coronary Heart Disease [CHD], Diabetes Mellitus [DM], metabolic syndrome, thyroid disease, chronic renal disease and hepatic disease were excluded from the sample. Mean percentage change from baseline in LDL-cholesterol levels after 6 week treatment with the combination therapy was found significantly superior to that with the monotherapy. There is significant [P<0.01] advantage of the combination therapy over the monotherapy for the achievement of LDL-C levels reductions below the clinical cut off value of 100mg/dl. Combining Ezetimibe with statins looks to be advantageous to the statins alone for LDL-C lowering in patients of hypercholesterolemia

Frequency of dyslipidemia in normotensive diabetics

As diabetes mellitus has been declared CHD equivalent we conducted the study with the idea of the presence of clustering of risk factors. These risk factors may appear mild when considered individually, but when added together, they can raise the risk for heart disease significantly. We specially looked the level of various fractions of lipid -in -type 1-and type 2 diabetes mellitus. This cross sectional comparative study was conducted on 100 diabetic patients [50 patients of type-1 and 50 patients of type-2 diabetes mellitus] selected by convenience, who presented in OPD, Department of Medicine, Bahawal Victoria Hospital, Bahawalpur and Qazi Diabetic Clinic located in the premises of Medical Colony Bahawalpur. Study included diabetic patients of all groups and from both sexes. Patients with at least one year history of diabetes mellitus. Among the 100 patients suffering from diabetes mellitus, 68 [68%] were males and 32 [32%] were females. Having 18 to 60 years, in type 1 average age 39.18 +/- 9.86, in type 2 average age was 53.64 +/- 9.95 years. Level of serum total cholesterol was 211.91 +/- 40.19 mg% in type 1, 229.54 +/- 55.60 mg% in type 2. Level of serum triglycerides was 217 +/- 62.34 mg% in type 1 and it was 352.54 +/- 181.47 mg% in type 2. Level of serum LDL-C was 131.82 +/- 32.17 mg% in type 1 and 134.08 +/- 38.48 mg% in type 2. Level of serum HDL-C was 38.88 +/- 3.88 mg% in type 1 and 38,82 +/- 3.62 mg% in type-2. Dyslipidemias were more common in female diabetic patients. Duration of diabetes showed linear correlation with dyslipidemias. We found elevated levels of serum triglycerides and total cholesterol, decreased HDL-C and disturbed values of LDL-C in both types of diabetes mellitus. So all the diabetics should be educated about dyslipidemias and their serum lipid levels should be checked regularly. Primary prevention can minimize the complications resulting due to diabetic dyslipidemias

comparative study of complications in patients of myocardial infarction managed with and without streptokinase

Background - Numerous meta-analysis have been published and on the basis of the results of the some or all of the more than 33 trials evaluating intravenous streptokinase for acute myocardial infarction. All of these reviews demonstrated a consistent, statistically significant reduction in mortality for patients with acute myocardial infarction who were treated with intravenous streptokinase. Objectives - Intravenous streptokinase clearly confers a protective effect against early mortality in patients with acute myocardial infarction, with this initial hope that the administration of thrombolytics to patients with evolving acute myocardial infarction will prevent infarct complications. We conducted prospective study to observe the rate of complications as a whole in patients who could not get the thrombolytic therapy. Setting - This study was conducted in the coronary care unit and out patient Department of Cardiology Bahawal Victoria hospital Bahawalpur affiliated with Quaid-e-Azam Medical College Bahawalpur. Methods - This observational study was carried out in 960 patients fulfilling the diagnostic criteria for acute myocardial infarction. These patients were prospectively followed for clinical end points during the hospitalization and 90 days follow up period. Streptokinase 1.5 million units was used as a thrombolytic agent in the patients fulfilling the eligibility criteria. Results - A total of 960[21.22%] patients with acute myocardial infarction were assessed for the complications of myocardial infarction with or without thrombolytic therapy. Male and female patients were 664 [69.16%] and 296[30.83%] respectively. Mean age of patients with myocardial infarction was 57.30 years. Anterior myocardial infarction was diagnosed in 680[70.83%] patients and inferior wall myocardial infarction was diagnosed in 280[29.16%] patients. Streptokinase was given in 500[52.08%] patients while 460[47.9%] did not get it. There was statistical significant difference of complications as a whole with p value of < 0.001. Conclusion - Thrombolysis is the first line between life and death and now it has become the established fact beyond doubt in the treatment of acute myocardial infarction. The advent of streptokinase has led to substantial changes in clinical practice of managing acute myocardial infarction especially evolving one. The magnitude of the treatment effect lowers the risk of mortality and hospital stay

Comparative study of frequency of cough with angiotensin converting enzyme inhibitors and angiotensin receptor blockers in hypertension

Background-Hypertension is an important factor in premature death and contributes to several of the leading causes of the death including heart diseases, stroke and renal diseases. The effect of ACEIs' and ARBs' was studied for the development of cough beyond blood pressure control. Setting - Outpatient Department of Cardiology and Medicine Bahawal Victoria Hospital, Bahawalpur attached with Quaid-eAzam Medical College Bahawalpur. Method - Two hundred male patients with uncomplicated mild to moderate essential hypertension were randomized to the treatment with ACEIs' and ARBs' for a mean period of twelve weeks. During each treatment period, the incidence of cough which necessitated the withdrawl of drug, was studied after fulfilling the inclusion and exclusion criteria. Results - Two hundred male patients who were randomized to receive the drugs having mean age of 51.9 years, mean systolic blood pressure 164.55 mmHg and mean diastolic blood pressure 99.55 mmHg. The mean dose of enalapril was 13 mg and the mean dose of losartan potassium was 65 mg. After treatment of 12 weeks, mean systolic blood pressure was 124.55 mmHg and mean diastolic blood pressure was 92.55 mmHg. 25 patients [25%] with ACEIs' developed cough while 4 patients [4%] developed cough with ARBs' with significant difference of incidence of cough with <0.001. Conclusion - Now that numerous agents are available to manage hypertension, more research should be directed towards improving the compliance of patients with anti hypertensive therapy with less side effect profile. ARBs' may be preferred over ACEIs' in certain cases

Unstable angina and role of cardiac myoglobin in management and prognosis

To assess the role of Cardiac M [Myoglobin] in prognosis and management of unstable angina. Study Design: Study of 528 cases admitted in Coronary Care Unit of Bahawal Victoria Hospital affiliated with Quaid-e-Azam Medical College Bahawalpur, during a period of 3 years [April 1999 to March, 2002]. Cardiac M detects minor cell necrosis in about 40% to 60% cases of unstable angina, Cardiac M performed in 528 patients. It was positive in 336 cases and was negative in 192 cases. 136 [52.3%] patients developed complication in those with positive test and only 19% developed complications in nagative patients. The procedure of Cardiac M is mush easier, economical more effective and almost confirmatory in the diagnosis of unstable angina. It can be used at bed side, and costs half the price of cardiac enzymes