Open Access Original Article

Objective: The objective of this study was to determine the frequency of elevated homocysteine levels in acute ischemic stroke patients presenting to the medical department, civil hospital, Nawabshah. Methodology: A cross-sectional study was conducted at the Department of Medicine Civil Hospital, Nawabshah from 13/02/2021 to 12/08/2021. It included ischemic stroke patients and evaluated their homocysteine levels (≥15µmol/L were elevated). Homocysteine levels was compared then in relation with the other sub-groups of patients based on the age group, gender and obesity, smoking, hypertensive and diabetic status, and hyperlipidemia. Results: There were 171 (64.5%) males and 94 (35.5%) females with mean age 49.9 ± 5.8 years Elevated levels of homocysteine were recorded in 140 (52.8%) patients with acute ischemic stroke. The frequency of elevated levels of homocysteine across various subgroups of patients in relation to age, gender, obesity, smoking, hypertension, diabetes, and hyperlipidemia was found to be insignificant. Conclusion: The findings of this study show patients with acute ischemic stroke had elevated levels of homocysteine which suggests potential implications of homocysteine level assessment in the diagnostic workup as well as risk stratification and management planning of patients with acute ischemic stroke presenting in future medical practice.

Introduction: Bacterial Infections in cirrhosis of liver is one of the main complications with increase mortality rate. Infection of ascitic fluid in cirrhosis of liver was introduced by Conn and fessel [2], termed as spontaneous bacterial peritonitis. Objective: To determine the frequency of Spontaneous Bacterial Peritonitis (SBP) in patients presenting with cirrhosis of liver. Methodology: It is a descriptive cross-sectional study which was performed in the Medicine Ward at People’s Medical College Hospital Nawabshah Pakistan from 1st June 2018 to 31 July 2020. Total 100 admitted patients were selected for this study, male patient were 58 and female patient were 42. Consent was taken from the patients and their relatives. Primary and secondary outcomes measured. All the patients with diagnosis of cirrhosis of liver were included for this study, ascites due to other causes and patients on antibiotic therapy were excluded from this study. Ascitic fluid aspirated for culture and DR. Blood CP, Urea, Creatinine, LFT and PT was performed. Results: Among these 100 patients 13 were culture positive raised ascites PMN, 17 were culture negative raised ascites PMN. E. coli was detected in majority of the culture positive patients. 70 patients presented with sterile ascites. SBP patients presented with fever, abdominal pain, jaundice, Encephalopathy and raised prothrombin time. Conclusion: SBP common complication of cirrhosis associated with high mortality. All cirrhotic Patients admitted in medical wards with history of abdominal pain, fever and Encephalopathy, diagnostic paracentesis is compulsory. Early management with intravascular expansion with albumin and antibiotics with good prognosis mortality can be reduced.

Objectives: To determine the frequency of altered cardiac repolarization by measuring the heart rate corrected QT interval in COPD patients. Setting: Department of Medicine at LUMHS hospital Hyderabad/Jamshoro. Study Design: Descriptive Cross sectional study.          Duration of Study: 6 months from 01-03-2019 to 31-08-2019. Methods: A total of 232 patients with severe acute exacerbation of COPD were included in this study. A 12 lead ECG was performed. QT intervals were measured on a resting ECG tracing in lead II. The QT interval was measured manually from the starting point of the QRS complex to the terminal point of the down slope of the T wave. Results: A total of 232 patients with COPD were included in this study. Most of the cases were above 50 years of age. The average age of the patients was 53.74±4.35 years. There were 92.67% (215/232) male and 7.33% (17/232) female. Out of 232 patients, 21.14% were current smoker and 75.86% were ex-smoker. A QTc interval >0.44 seconds was considered abnormally prolonged. Frequency of altered cardiac repolarization by measuring the heart rate corrected QT interval in COPD patients was 31.47% (73/232). Rate of altered cardiac repolarization was not significant among different age groups (p=0.641). Rate of altered cardiac repolarization was significantly high in male as compare to female (33.5% vs. 5.9%; p=0.018). This was not significant between obese and non-obese groups (p=0.100). Rate of altered cardiac repolarization was significantly high in former smoker (p=0.0005) and those patients whose duration of COPD was above 15 years (p=0.0005). Conclusion: Patients with hypoxic chronic obstructive pulmonary disease (COPD) have evidence of a subclinical parasympathetic autonomic neuropathy, with apparent preservation of sympathetic function. Measuring heart rate corrected QT interval (QTc) test is repeatable, easy to perform and a sensitive indicator for autonomic dysfunction in breathlessness individuals with COPD.

Objectives: To evaluate the frequency of autoimmune cutaneous disorders in patients with celiac disease. Study Design: This descriptive cross sectional study. Setting: conducted at Dermatological Department of Liaquat University Hospital Hyderabad/ Jamshoro. Period: From 1st March 2015 to 31st August 2015. Material & Methods: Total 352 patients of age 15 to 45 years & either gender having celiac disease were enrolled consecutively. Patients with history of abnormal serological test results and already on gluten free diet, known cases of diabetes mellitus, tuberculosis, systemic lupus erythematosus (SLE), secondary syphilis, hyper or hypothyroidism, iron deficiency anemia, pernicious anemia, Addison disease and pituitary insufficiency were excluded. The data was analyzed using SPSS version 16. The frequency/ percentage were calculated for autoimmune cutaneous disorders i-e; Dermatitis herpetiformis, Alopecia areata, vitiligo & psoriasis & for gender. The mean and standard deviation (SD) were calculated for age, duration of celiac disease and duration of cutaneous disorders. Stratified analysis was done followed by applying chi-square with a p value <0.05 taken as significant. Results: The mean age was 29.83 ± 8.91 years (Range 15-45). The mean duration of celiac disease was 5.99 ± 2.30 years (Range: 1-10 years). The Mean duration of cutaneous manifestation was 7.55 ± 3.30 months (Range: 3 to 15). Slight less than half of all patients were females 46.3%. More than two third patients i-e; 69% (n= 243) in this study were from rural areas. About 10.2% patients had dermatitis herpatiformis, 6.3% patients had alopecia areata, 2.6% patients had Vitiligo while 16.5% had psoriasis. The gender, age of patients, duration of CD & duration of development of skin symptoms were non-significant effect modifiers for the frequency of cutaneous manifestations among CD patients. Conclusions: Therefore, it concludes that psoriasis, dermatitis herpatiformis & alopecia areata are quite prevalent in CD patients. Vitiligo is rare condition. Screening for such autoimmune cutaneous manifestations and proper treatment of all such patients should be carried out routinely.