ABSTRACT
Objective: To determine the diagnostic accuracy of breathing not properly (BNP) for evaluation of dyspnea NYHA III and IV due to systolic heart failure in emergency department patients keeping echocardiography as the gold standard. Study design: Cross-sectional validation study. Setting: Department of Accident and Emergency Duration of Study: 25 July 2022-25 January 2023. Subjects and methods: A total of 115 of both sexes presenting with acute onset of dyspnea and having NYHA Class III and IV were included. Emergency nursing staff had immediately taken a single venous blood sample for BNP and creatinine levels and a 2D echo was performed. Ejection fraction was recorded, and the diagnosis of systolic heart failure on the basis of an ejection fraction, that is less than or equal to 45% was documented. Results: The age range in this study was from 18 to 65 years, with a mean age of 49.147±8.73 years. Mean BNP levels were 139.452±84.04 pg/ml. Patients with NYHA class III was 67.8 and 32.2% belongs to NYHA class IV. BNP levels greater than or equal to 100 pg/ml diagnosed 76 (66.1%) and echocardiography has diagnosed 68 (59.1%) patients with heart failure. BNP levels greater than or equal to 100 pg/ml had shown sensitivity 94.1%, specificity 74.5%, and diagnostic accuracy 86%, positive predictive value 84.21%, negative prediction value 89.74%, likelihood positive ratio 3.68 and likelihood negative ratio was 0.08 in diagnosis of heart failure. Conclusion: BNP estimation is a sensible and particular procedure for diagnosing CHF in patients who present to the emergency department with acute dyspnea and may add extra advantages to the administration of patients with congestive heart failure (CHF) in our population.
ABSTRACT
Aim: This study aimed to identify the key parameters to assist the early diagnosis of Dengue Infection to prevent severe outcomes. Methodology: A cross-sectional study was conducted from June 2022 to December 2022 at a tertiary care hospital. 149 patients who presented with dengue symptoms for less than 5 days were enrolled in the study. Hepatic functioning was assessed by monitoring Serum Alanine Transaminase (ALT) (normal = 7-56 IU/L), and serum Aspartate Transaminase (AST) (normal = 10-40 IU/L) levels. Abdominal ultrasound and chest X-Ray were performed, and findings were recorded. Statistical analysis was done using SPSS Version 24. Results: 81 patients (54.36%) were found to have Classical DF, while 46 patients (45.64%) were diagnosed with DHF or DSS. Dengue fever is more common in males than in females, and it disproportionately affects those under the age of 30. Only 81 (54.63%) of the total 149 individuals developed DF, but of those, 79 (74.4%) had normal ALT levels and 2 (4.26%) had elevated ALT levels. Among the 68 patients with DHF (45.64%), 41 (87.23%) had elevated ALT, while only 23 (22.55%) had normal ALT and all 4 (8.51%) with DSS did as well. The p-value for the correlation between platelet count and elevated ALT levels is 0.007, which is statistically significant. Conclusion: Management of dengue disease requires close monitoring of hepatic enzyme levels, particularly ALT and AST, along with the platelet count. It will aid in reducing the severity of the dengue virus. In addition, there should be particular outdoor exposure guidelines, particularly during dengue season evenings, i.e., monsoon.
ABSTRACT
Paget's disease of bone (PDB) is a focal disorder of skeletal remodeling leading to alteration of bony structures and properties, uncommonly reported in people under the age of 40 years, particularly in the Southeast Asia region. In the literature, PDB has been well reported in regions of Europe, in contrast to Asia where there has been limited records of prevalence of PDM especially in the younger age population. Here, we report a 21-year-old male patient presenting with an advanced disease with complaints of auditory impairment, bone pain, and neurological signs due to compression of the interverbal disc developed progressively over two months, having an elevated serum alkaline phosphatase level of 601 IU/L. The patient was administered zoledronic acid that brought significant improvement in his health. We aim to signify the advanced presentation of PDB in our region to create awareness about the condition among physicians and aid in the prompt diagnosis and prevention of the most dreaded complications of the disease, such as osteosarcoma, secondary osteoarthritis, and fractures.
ABSTRACT
Background: Proton Pump inhibitors are widely used among the majority of the world's population as acid-suppressing medications. Proton Pump Inhibitors have been reported to cause intestinal damage and adverse gut microbiota changes affecting several mechanisms, including malabsorption, etc. Aim: In order to gain a deeper understanding, we conducted a cohort analysis to assess the prevalence & association of Vitamin B12 deficiency in patients on long-term use of PPIs. Methods: This single-center cohort study was conducted at the Department of Internal Medicine, KRL hospital in Islamabad, Pakistan from May 2021 to May 2022. Rao soft calculator with a 95% confidence interval and 5% error margin was used to find the estimated sample size. Vitamin B12 levels were analyzed using the Cobas e411 analyzer. Chi-square test, odds ratio, and t-tests were used for analysis. Results: Among the 1225 participants, more than half of the men (55.10%) had low levels of vitamin B12. Vit B12 levels were observed to be significantly lower in Omeprazole patients than in Pantoprazole patients. A vitamin B12 deficiency is 0.5 times more likely in patients taking PPIs. There is a substantial difference between the early and final levels of B12 indicated by the t-test. Conclusion: According to our findings, long-term usage of PPIs is linked to an increased risk of vitamin B12 insufficiency specifically in men falling under the ages of 18 and 40.
