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1.
Pak J Med Sci ; 38(5): 1086-1092, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35799712

RESUMO

Objectives: To assess frailty in cirrhotic by calculating Liver Frailty Index (LFI) using bedside clinical tests and correlate it with Child-Turcotte-Pugh (CTP), MELD, MELD Na, Fib- 4 and Transient Elastography (TE) scores. Methods: This cross-sectional observational comparative study was carried out in Dr Ruth KM Pfau Civil Hospital, Karachi from August 2020 to September 2021. Patients were subjected to three performance-based testing including dominant hand grip strength (HGS), Chair to Stand (CTS) Time & Three Position Balance (TPB). LFI was calculated using the online LFI calculator, available at http://liverfrailtyindex.ucsf.edu and classified as 'Robust' if LFI <3.2, 'Prefrail' LFI between 3.2 and 4.4, and 'Frail' as LFI ≥4.5. Correlation of frailty with MELD, MELD-Na and CTP Scores was done. Means of MELD & MELD-Na Scores and CTP scores were calculated in all 3 classes of frailty using one way ANOVA. A p-value of ≤.05 was taken as significant. Results: Out of 118 patients, 62 (52.5%) were males. Mean MELD score was 11.4 ±3.3, MELD-Na was 15.97 ±8.54, CTP 8.25 ±2.21, Fib-4 was 2.79 ±1.034 and TE score was 18.20 ±9.17. Mean LFI was 3.87 ±1.07; mean HGS was 18.12 ±4.68; mean of CTS was 9.62 ±3.55. LFI Class distribution in our cohort showed Robust were 36 (30.5%), Prefrail 34 (28.8%) and Frail were 48 (40.8%). Correlation of all these variables with LFI showed significant correlation with LFI, but highest correlation coefficient was seen with MELD-Na. Conclusion: Significant correlation between frailty score in cirrhotic with cirrhosis severity scores highlights the need for frequently assessing LFI in all cirrhotic at regular follow up visits.

2.
Pak J Med Sci ; 38(4Part-II): 965-969, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35634610

RESUMO

Objectives: To compare the efficacy of Vonoprazan based dual treatment versus PPI based treatment for the eradication of Helicobacter pylori infection. Methods: A randomized controlled trial was conducted in Department of Medicine/Gastroenterology Ruth KM Pfau Civil Hospital, DMC during the period of 22 June to 21 September 2021. Sample size was calculated as 96 in each Group. All patients of age 18-75 years with Helicobacter Pylori Infection were inducted and randomly allocated to two groups. Group-A: were given Capsule Amoxicillin 1 gm; Tablet Clarithromycin 500 mg; Capsule Omeprazole 20 mg all medications were given twice daily for two weeks. Group-B were given Capsule Amoxicillin 1 gm; Tablet Vonoprazan 20 mg (Vonozon©, m/s Getz Pharma, Pakistan) twice daily for two weeks. Confirmation of Hp eradication was done by stool Hp antigen test four weeks after completion of treatment. Nine and four patients were lost to follow-up in Group-A & B respectively. Analysis was conducted on 87 patients in Group-A and 92 patients in Group-B. Results: Out of eighty-seven patients in Group-A and ninety-two patients in Group-B, 73 (83.9%) patients in Group-A and 86 (93.5%) patients in Group-B had negative H pylori result respectively after treatment (p = .042). Significantly higher frequencies of adverse events were observed in Group-A as compared to Group-B in nausea/vomiting (p = .035) and bloating (p = .045). Conclusion: VA-dual provides an acceptable eradication rate with fewer adverse events.

3.
Pak J Med Sci ; 38(1): 1-8, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35035392

RESUMO

OBJECTIVES: This study aimed to validate Baveno-VI recommendations for variceal screening in cACLD in our region and proposed our own cutoff values. METHODS: Prospective cross-sectional study was conducted on cACLD patients from August 2020 till April 2021. Patients segregated into Group-A, having Liver stiffness measurement (LSM) of ≥ 20 kPa and platelet of ≤ 150 × 109 cells/L; and Group-B having LSM of < 20 kPa and PLT of > 150 × 109 cells/L. Gastroscopic findings were segregated into three categories, VNT, Varices Not Needing Treatment (VNNT) and No Varix (NV). ROC plots were generated for LSM and Platelet for VNT for sensitivity, specificity, Negative and Positive Predictive Values were calculated. RESULTS: A total of 134 patients of cACLD were included. Group-A had 72 (53.7%) patients and Group-B had 62 (46.3%) patients. Group-A had 6 (8.3%) NV; 18 (25.0%) VNNT and 48 (66.7%) VNT. Group-B had 26 (41.9%) NV, 24 (38.7%) VNNT and 12 (19.4%) VNT. The sensitivity of 66.7%, specificity of 80.6% and NPV of 67.56% was obtained. Thus 19.4% VNT were missed on following Baveno VI recommendations. ROC in our study suggested cutoff value of 11.5 kPa with sensitivity of 100% and 1-sepcifity pf 78% (AUROC = 0.865; p < .001) of LSM below which screening gastroscopy could be avoided. The positive and negative predicted values for 84.85% and 100% respectively. Cut off value of platelet count for VNNT came out to be ≥ 97.5 × 109 cells/L with AUROC 0.891 (p < .001), having sensitivity of 100 % and 1-specificity of 83.3%. CONCLUSIONS: Substantial number of VNT in cACLD patients are missed by following Baveno-VI recommendations and these needs to be revised on regional basis.

4.
Pak J Med Sci ; 37(2): 515-519, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33679942

RESUMO

OBJECTIVE: To compare 7-Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with Those with Score of <5. METHODS: All patients of age more than 18 years, of either gender admitted in HDU of Medical Unit-II, CHK between September 2019 to February 2020 were included. MEWS was calculated for each patient at time of admission. Patients with MEWS score of ≥5 were allocated to Group-A and those with score of <5 were allocated to Group-B. Patients were followed for seven days and outcome status of alive, expired or discharged was noted. RESULTS: Total of 336 patients were selected out of which 168 patients was inducted in Group-A and 168 patients in Group-B. MEWS Score in patients who expired was significantly higher (Mdn=11) than in those who survived (Mdn=4), p <.001. 7-day mortality in Group-A was 62 (39.9%) while in Group-B was 40 (23.8%). ROC was plotted of MEWS Score for mortality, it showed significant area under curve of 68.4% (p <.001, 95% CI = .62 to .75). MEWS Score of 3.5 showed sensitivity of 89.2% and specificity of 65%. CONCLUSION: Our results show that MEWS has a positive trend to predict mortality. MEWS score of 3.5 is suggested cut off based on ROC in our study.

5.
Clin Respir J ; 15(5): 513-521, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33497542

RESUMO

OBJECTIVES: This study was conducted to determine the impact of insulin resistance using Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score and BMI in non-hypoxemic out-patients with COPD on FEV1 using linear and polynomial regressions and to determine their correlation. METHODS: COPD patients of both genders were included after informed consent. Fasting blood sugar and serum insulin were done to calculate HOMA-IR, which were segregated into two groups of ≥ 3 and < 3 labeled insulin resistance present and absent, these were compared with BMI. Patients were segregated into GOLD Grade 1-4 per GOLD Guidelines and compared with HOMA-IR and BMI. Curve and linear regressions, multivariate and univariate analysis of HOMA-IR with BMI, FVC, and FEV1 were done. RESULTS: A total of 273 subjects were inducted after informed consent. There was a linear correlation between HOMA-IR and BMI (r2 0.498, P < 0.001) and nonlinear correlation between HOMA-IR and FEV1 (r2 0. 617, P < 0.001) which showed little evidence of association above FEV1 > 60 predicted, but a clear negative association below that. Significant increase in HOMA-IR was seen from GOLD-2 to 3 and from GOLD-3 to 4 classes. The impact of HOMA-IR on FEV1 was 49.9% (P < 0.001) on FVC was 43.7%. CONCLUSIONS: The results indicate that there is a high prevalence of IR in non-hypoxemic COPD. A nonlinear association is present between FEV1 and HOMA-IR which is most evident with FEV1 <60% predicted.


Assuntos
Resistência à Insulina , Doença Pulmonar Obstrutiva Crônica , Glicemia , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Testes de Função Respiratória
6.
Pak J Med Sci ; 36(7): 1651-1654, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33235591

RESUMO

OBJECTIVE: To determine the frequency of hyponatremia in patients taking Sodium Picosulfate Solution (SPS) solution for bowel preparation prior to colonoscopy and to compare serum sodium levels before and after SPS. METHODS: This interventional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between June 2019 to November 2019. Patients undergoing colonoscopy were included in the study. All patients were given SPS. Two samples of blood for electrolytes were taken, one 30 minutes before taking SPS solution and another 30 minutes before colonoscopy. Paired sample t-test was used to determine the difference between serum sodium level before taking the colonoscopy solution and serum sodium level before colonoscopy. RESULTS: Fifty- four patients fulfilling inclusion criteria were included. Out of the 54 patients 28 (51.9%) were males and 26 (48.1%) were females. Mean sodium levels before taking colonoscopy solution was 139.7 ±3.5 mEq/L and mean sodium level before colonoscopy was 138.9 ±3.8 mEq/L. The difference between serum sodium level before taking SPS colonoscopy solution and before colonoscopy was found to be statistically insignificant (t (53) = 1.308; p = 0.196). CONCLUSION: No serious adverse effects were reported in any of our patients. There was no significant difference in the serum sodium level of patients undergoing colonoscopy before taking SPS bowel preparation solution and serum sodium level before colonoscopy.

7.
Pak J Med Sci ; 36(2): 37-41, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32063928

RESUMO

OBJECTIVE: To determine number of sessions of Endoscopic variceal band ligation required to obliterate the esophageal varices. METHODS: This study was conducted at Civil Hospital Karachi between June 2018 to April 2019. All patients undergoing endoscopic Variceal Band Ligation (EVBL) were inducted. Number of sessions of band ligation required to obliterate the varices were recorded. Number of EVBL sessions were correlated with Child-Pugh's Score and etiology of CLD by χ2 test, while it was compared with duration of Chronic Liver Disease (CLD) by One-way ANOVA test. RESULTS: One hundred ninety-two patients fulfilling selection criteria were admitted after informed consent. These included 101 (52.6%) males and 91 (47.4%) females. Most common cause of cirrhosis was HCV (66.7%) in our patients. Most of the patients were in Child Class-B (71.9%). Majority of patients (52.6%) underwent 3 sessions of EVBL while 68 (35.4%) underwent 4 sessions of EVBL. Duration of CLD was analyzed with number of sessions of EVBL by One-Way ANOVA test and it showed significant more sessions of EVBL were done with longer duration of CLD (p <0.001). CONCLUSION: Most patients underwent 3-4 sessions of EVBL for obliteration of varices. Number of EVBL sessions increased significantly with duration of disease.

8.
Pak J Med Sci ; 36(2): 172-176, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32063954

RESUMO

OBJECTIVE: To determine effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility. METHODOLOGY: A randomized, single blinded placebo control trial was done in patients undergoing oesophago-gastro-duodenoscopy for any indication at DOTs Endoscopy Suite, CHK during the period of April to June 2019. Informed consent was taken. Patients were randomly allocated in two groups. Group-A received placebo while Group-B received Simethicone. Evaluation of mucosal visibility was assessed at 4 sites (oesophagus, fundus, antrum & duodenum) by previously validated scoring. Mean of visibility scores were compared in two groups. RESULTS: Two hundred and forty-eight patients were inducted and randomly allocate to two groups of 124 each. Mean of total sum of scores in Group-A was 8.14 ±2.44 and that of Group-B was 5.80 ±1.75 (p<0.001). Adequate visibility in Group-A was seen in 41.1% and that in Group-B was 78.2% (p<0.001). CONCLUSION: Use of Simethicone significantly improves mucosal visibility during OGD.

9.
Pak J Med Sci ; 35(6): 1516-1519, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777485

RESUMO

Objective: To determine the caecal intubation time depending on bowel preparation as per Boston Bowel Preparation Scale. Methods: This cross-sectional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between August 2018 to February 2019. A total of 201 patients were included in the study. Time was recorded from insertion of colonoscope to the time required to reach the cecum. Bowel preparation was graded during withdrawal of colonoscope by using Boston Bowel Preparation Scale. Pearson Correlation test was used to study correlation of BBPS scores with CIT, gender, BMI, adenoma and polyp detection. Results: In this study 201 patients undergoing colonoscopy were included. Mean ±SD of age of patients was 36.9 ±15.8 years. Out of the 201 patients 112 (56%) were males and 89 (44%) were females. The results of our study showed that increased Boston Bowel Preparation Scale Scores were associated with decreased caecal intubation time. The mean CIT was 10.7 ±5.4 minutes and Pearson correlation was significant at 0.002. Significant correlations of BBPS were also found with BMI and adenoma detection. Conclusion: The diagnostic effectiveness of colonoscopy depends upon the quality of the preparation. Good bowel preparation improves the speed of colonoscopy and its completeness.

10.
Pak J Med Sci ; 35(2): 360-364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31086515

RESUMO

Objectives: To document frequency of non-specific impairment of lung functions (NILF) in patients of HCV and to compare according to gender, genotype, liver fibrosis score and smoking status. Methods: Patients of chronic hepatitis C were included after informed consent. Demographic data was recorded, and they underwent baseline investigations, fibroscan, abdominal ultrasound and PFT. Patients were segregated on basis of gender, fibroscan stages and smoking status. NILF was labelled if any two of three criteria are fulfilled (a) FVC < 80% of Predicted, (b) FEV1 < 80% Predicted, (c) FEV1/FVC ≥ 70. Results: Two hundred thirty four patients were of chronic HCV who fulfilled the selection criteria were inducted in study. These included 49.6% males and 50.4% females. There were 15.0% smokers, 16.2% were ex-smokers while 68.8% were never smokers. NILF was present in 130 (55.6%) out of which 61.5% were female and 38.5% were male (p <0.001), its presence in smokers was 56.2% and in never smokers was 55.3% (p=0.507). Presence of NILF increased with Fibroscan stages from F1 to F4 (p <0.001). Conclusions: NILF pattern on spirometry with normal chest radiograph is common among HCV patients. It was found more common in females and frequency increased progressively with fibro scan stages.

11.
Pak J Med Sci ; 35(1): 205-210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881424

RESUMO

Objective: To determine level and factors of job satisfaction among doctors working in tertiary care hospitals in Pakistan. Methods: This is a multi-center cross-sectional survey conducted among Post graduate trainees, medical officers, consultants and faculty doctors. Job satisfaction was measured using 35 specific questions about sources of work-related stress and sources of work-related satisfaction. Satisfaction was defined if mean score of a factor was≥3.0, where factors were rated using a 5-point Linkert scale ranging from 1 (completely dissatisfied) to 5 (completely satisfied). Results: In this study 373 doctors participated, out of which 215(57.6%) were males. Over all mean satisfaction score was of 2.69 ±0.37. Departmental mean satisfaction scores were Internal medicine 2.71 ±0.35, Medical subspecialties 2.63 ±0.38, Surgical and allied 2.73 ±0.45. Designation means were Consultant 2.87 ±0.38, Faculty 2.78 ±0.44, Medical officer/ Registrar 2.50 ±0.32, Post graduate trainee 2.71 ±0.45. Public and private sector means satisfaction scores were 2.53 ±0.80 and 2.92 ±0.84 respectively. Conclusion: Job dissatisfaction was seen among doctors from all the tiers and departments. Public sector doctors were more dissatisfied than private sector doctors. Increasing age, duration of current posting and working experience, positively correlated with satisfaction level.

12.
Pak J Med Sci ; 32(3): 595-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27375696

RESUMO

OBJECTIVE: To determine frequency of Minimal Hepatic Encephalopathy in illiterate patients with compensated cirrhosis. METHODS: Illiterate patients with compensated cirrhosis with F4 Score on Shear-wave Elastography were selected for study after informed consent. Sample size was estimated at 106. Selected patients were subjected to two tests for detection of MHE, Number Connection Test A and Block Design Test. Patients taking ≥ 30 seconds were labelled as Positive for MHE. RESULT: Out of 110 selected patients 10.9% were alcoholics and in 8.2% of patients no hepatic virus infection was detected. HCV was positive in 48.2% patients while HBV was positive in 13.6% of patients. MHE was detected in 72 (65.5%) of patients. Major differences were found in MHE Stage II & III by two tests. Over all BDT detected more cases and gave higher Staging in Stage II & III as compared to NCT-A test. CONCLUSION: Minimal Hepatic Encephalopathy (MHE) could be detected in illiterate patients using NCT-A and BDT Tests.

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