Predictors Of Re-Bleeding After Oesophageal Variceal Banding In Cirrhotic Patients At 4 Weeks.

BACKGROUND: Acute upper gastrointestinal bleeding is a serious complication in cirrhotic patients. Without recommended management, recurrent bleeding happensin 30-40% within the next 2-3 days, and up to 60% within 1 week. Aim was to determine predictors of re-bleeding after oesophageal variceal banding in cirrhotic patients for 4 weeks. It was a descriptive study, conducted at the Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Six months from June 21 to December 21, 2021. METHODS: A total of 93patients with active oesophageal variceal bleeding were included in this study. Upper gastrointestinal (UGI) endoscopy was performed to look for bendable varices (grades 1-4) and band ligation was applied. Patients were followed for 4 weeks for the history of hematemesis or Malena, fall in haemoglobin of 2 grams per decilitre or more and endoscopic rebleeding findings. RESULTS: Out of 93 patients, 67(72.0%) were males, while 26(28.0%) were females. The Mean age of the patients was 45.66±16.61 years. According to Child Pugh Classification, the majority of the patients 45(48.4%) had Child-Pugh Class-A, while 33 (35.5%) were Child B and 15 (16.1%) patients belonged to Child-Pugh Class C. Red wale sign was noted in 22 patients (23.7%). Among 93 cirrhotic patients who presented with variceal bleeding, 9 (9.7%) had re-bleeding within 4 weeks. Amongst 9 patients, 8 patients (88.9%) had red wale sign, grade II or above oesophageal varices and belonged to severe liver disease with child class B or C. CONCLUSIONS: Endoscopic variceal band Ligation is an effective treatment modality for the control of oesophageal variceal bleeding. Re-bleeding after band ligation was 9.7%. The major contributing factors to re-bleeding were the severity of cirrhosis, grades and columns of oesophageal varices, number of bands ligation and findings of red wale sign. Increasing age and duration of cirrhosis were contributing predictors of increased re-bleeding risk.

Study of Culture and Sensitivity Patterns of Urinary Tract Infections in Patients Presenting with Urinary Symptoms in a Tertiary Care Hospital.

Objective To study the culture and sensitivity patterns of urinary tract infections in patients presenting with urinary symptoms in a tertiary care hospital. Study design  A cross-sectional study. Place and duration of the study The departments of General Medicine, Nephrology, and Urology at Nishtar Hospital, Multan, from May 5, 2019, to November 5, 2019. Methodology A total of 120 patients suffering from complicated urinary tract infection (UTI) between 20 and 60 years of age were selected for the study. Mid-stream samples of urine were collected in sterile containers and immediately processed for further procedures. MacConkey agar (Oxoid, England) was used to subculture the colonies to get pure growth of the microorganisms. The Kirby-Bauer disk diffusion method was used to determine the antibiotic susceptibility of the isolated colonies. Müller-Hinton agar plates were used to identify the sensitivity pattern. After this, the measurement of the zone of inhibition of bacterial growth was performed and comparison was done with the guidelines of the Clinical and Laboratory Standards Institute (CLSI, 2013). Results Among 53 positive urine cultures, Escherichia coli was detected in 21 (39.6%), Enterococcus species were detected in 18 (33.9%), and Pseudomonas was detected in seven (13.2%). Methicillin-resistant Staphylococcus aureus (MRSA), Coliform, Streptococci, and Klebsiella were detected in 03 (5.7%), 02 (3.8%), 01 (1.9%), and 01 (1.9%) of the positive cultures, respectively. Conclusion The current study shows E. coli to be the most common pathogen in UTI, with very high antibiotic resistance. This warrants the careful selection and conservative use of antibiotics.