Frequency Of Different Causes Research Articles

An observational study of the causes of an isolated elevated alkaline phosphatase level of unclear etiology

BackgroundSerum alkaline phosphatase (ALP) is a commonly obtained laboratory test, but its diagnostic specificity is limited because it is found in multiple tissues. We investigated patients with isolated, elevated, ALP levels without an obvious etiology at presentation to determine the frequency of different causes of an isolated elevated ALP. MethodsThis was a retrospective, cohort study of adults (age >18 years old) from January 1st, 2013, to June 30th, 2020 in both the in- and outpatient setting at the Medical University of South Carolina. 260 patients with an isolated, elevated ALP of unknown etiology (patients with known biliary obstruction, underlying parenchymal liver disease, or pregnancy were excluded) were included. A secondary outcome was mean survival time from the ALP result. ResultsThe most common cause of ALP elevation was due to underlying malignancy (147, 57%), with 61 patients having infiltrative intrahepatic malignancy, 52 patients having bony metastasis, and 34 patients having both hepatic and bone metastasis. Bone disease (75, 29%), unsuspected parenchymal liver disease (18, 7%), non-malignant infiltrative liver disease (7, 2%), and other disorders (13, 5%) accounted for the remainder of the cohort. Notably, 123 of 260 (47%) patients died within an average of 58 months after identification of isolated, elevated ALP. ConclusionsAn isolated, elevated ALP of unclear etiology is associated with several very specific and important disorders, in particular metastatic intrahepatic malignancy - and is uncommonly associated with primary parenchymal liver disease. Providers should be aware of the potential clinical significance of an elevated ALP.

Causes of Primary Versus Secondary Infertility in Women Undergoing Diagnostic Laparoscopy

Abstract Background: Infertility is defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse,. This study was planned to compare the frequency of different causes of infertility undergoing diagnostic laparoscopy and chromopertubation. Objective: To compare the frequency of different causes of infertility in women with primary and secondary infertility undergoing diagnostic laparoscopy Material and Methods: This study was a five-year retrospective observational study conducted in Lady Reading Hospital from January 2017 to December 2021. Data record of all patients who underwent diagnostic laparoscopy and chromopertubation for infertility was retrieved. Basic demographic features like age, type of infertility (primary or secondary) and duration of infertility were noted in all patients. During the procedure, any abnormal features of the uterus, ovaries, and fallopian tubes including patency, uterosacral ligaments, Pouch of Douglas, and any adhesions or endometriosis were also noted. Findings were recorded on proforma.IBM SPSS Version 22.0 was used for data analysis Results: In this study, we got a record of 1945 patients, n=1427 (71.9%) patients had primary infertility while n=518 (26.1 %) had secondary infertility, mean age was 29.73± 4.37. Regarding causes of infertility, abnormal findings in fallopian tubes were more common in patients with secondary infertility (31.46% versus 23.05% of cases of primary infertility),an ovarian abnormality was observed in 16.88% in primary versus 22.58 in secondary infertility, endometriosis was seen in 27.99% of cases of secondary infertility in comparison to 22.42% in primary infertility, fibroid uterus was noted in 11.5% of primary infertility and 8.5 % of cases of secondary infertility. Conclusion: Tubal pathology and endometriosis are the most frequent abnormalities found in patients with secondary infertility, and uterine abnormalities are more common in patients with primary infertility.

Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital.

Objective: To assess the prevalence and underlying causes of thrombocytosis among patients seeking medical attention at a prominent tertiary care facility located in Lahore. Thrombocytosis, characterized by an elevated platelet count, can signify an array of underlying health conditions, and this research seeks to unravel the frequency of these causes within the study population. Study Design: Cross-sectional. Setting: Department of Pathology, Allama Iqbal Medical College and Jinnah Hospital. Period: November 2019 to May 2020. Methods: A total of 150 patients were carefully selected from diverse medical specialties, including but not limited to medical, surgical, gynecological, obstetric, gastroenterological, nephrological, and intensive care units. The diagnostic criteria for thrombocytosis were aligned with the operational definition provided by the World Health Organization (platelet count exceeding >450 x 10^9/L) during the stipulated study period. Statistical analysis of gathered data was performed using SPSS version 17.0. Results: The findings of the study showcased that infections and iron deficiency emerged as the predominant contributors to thrombocytosis among the adult patient cohort. These factors were trailed by conditions like chronic infections, trauma accompanied by blood loss, and instances of splenectomy. Interestingly, instances of primary thrombocytosis, notably essential thrombocythemia, constituted a mere 2% of the overall sample size, signifying its rarity within this adult population. Conclusion: In the realm of thrombocytosis, the research highlights a notable prevalence of secondary thrombocytosis, while primary thrombocytosis remains a considerably infrequent occurrence among adults. The study emphasizes the significance of infections and iron deficiency anemia as the leading triggers for secondary thrombocytosis. Such insights contribute to an improved understanding of the spectrum of conditions associated with elevated platelet counts and may aid clinicians in effectively diagnosing and managing these underlying causes.

Ocular injuries sustained at home in five metropolitan cities: a review of 5008 cases.

In Iran, ocular injuries sustained at home are a growing public health issue, and few studies have explored their prevalence and the frequencies of different causes of these injuries. We investigated the features of ocular injuries at home among children and adolescents (aged < 18 years), adults (18 - 64 years), and the elderly ( ≥ 65 years) in five metropolitan cities. In this cross-sectional study, we recruited individuals with ocular injuries sustained at home who presented to 12 public/teaching hospitals in five metropolitan cities during a 5-month period. Using clinical records within the emergency department archives, we collected the following data: age, sex, frequency of injuries requiring hospital admission or surgical intervention, and causes of eye injuries, documented as 1) cleaning products, 2) chemical products, 3) kitchen items, 4) cooking activities, 5) toys, 6) falls from height, 7) sports equipment, 8) penetrating or cutting, 9) abrasions, 10) foreign bodies, and 11) direct blows by other individuals. Of 5008 participants from the five cities, 74% (n = 3711) were male and 26% (n = 1297) were female. The most frequent causes of injury among children and adolescents, adults, and the elderly were toys, kitchen items, and cooking activities, respectively. In children and adolescents, injuries were caused by kitchen items, toys, foreign bodies, and direct blows by other individuals more frequently than in adults or the elderly, and by cleaning products and abrasions more frequently than in the elderly (all P < 0.05). In adults, injuries were caused by cleaning products, cooking activities, falls from height, sports equipment, penetrating or cutting, and abrasions more frequently than in children and adolescents or the elderly (all P < 0.05), and by kitchen items, toys, and blows by other individuals more frequently than in the elderly (all P < 0.05). In the elderly, injuries were caused by chemical products more frequently than in children and adolescents or adults, and by cooking activities, falls from height, and sports equipment more frequently than in children and adolescents (all P < 0.05). In adults, the frequency of ocular injuries was significantly higher in Tehran and lower in Mashhad when comparing each with that of the other four cities (all P < 0.05). We found a significantly higher frequency of ocular injuries by cleaning and chemical products in Tehran, by toys in Shiraz, by falls from height in Isfahan, and by direct blows by other individuals in Ahvaz when comparing each to that of the other four cities (all P < 0.05). Regarding the prevalence of severe ocular injuries among the children/adolescent and adult age groups, conditions were relatively better in Shiraz and relatively unfavorable in Mashhad. Ocular trauma was more common in male individuals and the younger age groups. Approximately half of the causes were kitchen items, toys, and foreign bodies, which are avoidable by enhancing public eye health awareness. The prevalence of severe ocular injuries in individuals aged < 18 years was high, highlighting the necessity of nationwide preventive strategies for pediatric ocular injuries.

Causes, Types and Management of Zygomatic Bone Fracture in Patients Presenting at Tertiary Care Hospital

Aim: To assess the frequency of different causes, types and management options of zygomatic bone fractures. Method: A cross sectional study was conducted from March 2022 to March 2023 at Oral &amp; Maxillo-Facial Surgery Department, Nishtar Institute of Dentistry, Multan. Seventy two zygomatic bone fracture patients were included meeting inclusion &amp; exclusion criteria after complete clinical &amp; radiological examination.Patient's demographic data, cause, type of fracture and treatment modality executed were collected on a specially designed proforma. Data was analyzed using SPSS version 22. Frequencies, percentages, mean ± standard deviation were taken. Results: Male to female ratio was 3.8:1 with male predominance. Road traffic accident was the leading cause of zygomatic bone fractures (n= 43,60.6%)while Rowe &amp; Kelly’s type IV (inward &amp; posterior) Fracture was most common type of fracture(n=21, 29.2%). ORIF with Two-point fixation was the most common treatment modality executed(n=27,37.5 %). Conclusion: Etiology varies due to geographic area, socio-economic status °ree of RTA. Type fracture depends upon side of impact and Open reduction is modality of choice for the treatment of zygomatic bone fractures. Keywords: Road traffic accidents (RTA);Open reduction &amp; internal fixation (ORIF); zygomatic bone fracture.

A PROSPECTIVE STUDY OF ETIOLOGY OF PANCYTOPENIAS IN TERTIARY CARE HOSPITAL

Background: Peripheral pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes. The aim of this study was carried out to investigate for and to identify the causes of pancytopenia, to nd out the frequency of different causes, to determine the incidence of pancytopenia in relation to sex and age and to compare our ndings with those of other similar studies from this part of the world. Methods: This Prospective Observational study was done from June 2021 to April 2022 in tertiary care hospital. A total of 100 cases male and female were studied based on inclusion and exclusion criteria. All patients were done routine investigations, like cbp, peripheral smear. furthur evaluated for the cause of pancytopenia by doing a biopsy. all patients above 5 years were enrolled in the study. The study was carried out in all patients fullling the inclusion and exclusion criteria. Results: In our study there was male preponderence with males 53 and females 47 in the ratio 1.12:1.there were more number of patients in the age group 41-60yrs[36];21-40yrs[28];5-20yrs[24];61-80yrs[12];the most common aetiology for pancytopenia was megaloblastic anaemia[53],infectious causes 12.out of infectious causes 4 were SLE,5 were HIV and 3 were dengue.the next in the order were aplastic anaemia 10,carcinomas 10,fanconi's anaemia 5,mds 5 and cld 5.organomegaly was observed in 25 patients with infectious causes and there was no organomegaly in 75 patients. Conclusions: we conclude from our study that pancytopenias should be evaluated furthur for etiology. the diagnosis of etiology of pancytopenia can be acheived by careful physical examination and doing blood investigations. in our study megaloblastic anaemia was the major factor causing pancytopenia.

Frequency of Various Causes of Hospitalization and Its Other Related Factors in Patients with Heart Failure

Background: Heart failure has the highest rate of Rehospitalization with 20-33% readmissions within 1 to 3 months of discharge from the hospital. we decided to find out the frequency of different causes of hospitalization in patients with heart failure during 2017 to 2019.&#x0D; Methods: This study was a cross-sectional descriptive study. A total of 120 patients with heart failure who were referred to Afshar Hospital of Yazd during 2017 to 2019 were enrolled. The random sampling method was used.The required information was collected from heart failure patients’ registry project. datum were collected and were analyzed by statistical tests and SPSS version 18.&#x0D; Results: The mean age of patients was 53.53±12.36 years. Of the 120 patients under study,41.7% were women and 58.3% were male. The results showed that, 14.2% did not follow the recommended diet,14.2% had not regular use of drugs,14.2% had renal dysfunction,9.2% had miscellaneous causes,8.3% had pulmonary disease and 40% had idiopathic cause(where the cause of the condition is not known). There was no significant difference among the distribution of various causes of hospitalization in terms of the variables in the study.&#x0D; Conclusions: It can be concluded that the most common reason for hospitalization of patients with heart failure is idiopathic cause.

Save the hearing, an ear surgery training project program to combat deafness in developing countries

BackgroundHearing loss is one of the most common health problems affecting people in the developing countries so our aim of the “Save The Hearing Project” was to combat deafness by training local doctors for ear surgery in order to treat their local patients with low cost as possible. The project was done as ear surgery campaigns in peripheral areas in Egypt, Yemen, and other countries, to train young ENT specialists and to treat patients there. Our plan was put according to the frequency of different causes of deafness as shown by previous surveys. We used the previous local and evidence-based researches to make our protocols of management of different diseases. These protocols were further evaluated during our work.The project has five stages. The first stage included management of sudden sensory neural hearing loss (SSNHL), otitis media with effusion (OME), and local anesthesia for the ear surgery—cartilage tympanoplasty and ossiculoplasty. The second stage included mastoidectomy cholesteatoma surgery and otoendoscopy. The third stage included more advanced surgery as stapedectomy and tympanosclerosis. The fourth stage included combating SNHL mainly through audiology and rehabilitation program, beside referral for cochlear implants to specialized centers. The fifth stage was only a plan for doing stem cell research in management of hearing loss.ResultsOur teams did about 42 campaigns only and the data of 31 were recorded. There were 259 attendants, 70 had hands on training, and 35 were well trained and became trainers. We did 270 tympanoplasties, 52 mastoidectomies, and cholesteatoma surgery beside 16 operations of stage III.ConclusionTraining an ear surgeon is a tedious and long process, but it is at the end very fruitful and useful for the community. Most causes of HL are preventable. We think that our project plan to combat HL is very suitable to be applied in developing countries in Africa and the Middle East.

SUN-461 EVALUATION OF POSTNATAL ULTRASOUND FOLLOW-UP RATE AND ITS RELATED FACTORS IN NEONATES WITH FETAL HYDRONEPHROSIS BORN IN MOUSAVI HOSPITAL OF ZANJAN DURING YEARS 1395-96

The most common fetal abnormalities during pregnancy are renal anomalies. Initial screening is performed by observation of hydronephrosis in fetal ultrasound, which is a nonspecific finding. About half of fetal hydronephrosis resolves uncomplicated and spontaneous, but a significant percentage remain pathologic, many of which may also have different kidney disorders and therefore require immediate medical treatment. It is not possible to distinguish possible diagnosis except by timely post-natal ultrasound. Therefore, it seems necessary to conduct studies such as this study to evaluate the rate of postnatal hydronephrosis, lack of follow-up reasons and frequency of different causes of hydronephrosis in neonates with fetal hydronephrosis. In this longitudinal descriptive-analytic study, all neonates born in Ayatollah Mousavi Hospital in Zanjan during one year, who had reported hydronephrosis in their fetal ultrasound, were enrolled. Initial infant data were extracted through identical questionnaires and hospital medical records. All mothers were given face-to-face information about fetal hydronephrosis and its postnatal outcomes, and follow-up with at least one post-natal ultrasound was recommended from the fourth day of birth until the end of the fourth week. The infants were observed for one month to determine the rate of postnatal follow-up, causes of non-follow-up, various diagnostic tests, and the causes of hydronephrosis and residual hydronephrosis in the first month of life. Data were analyzed by SPSS software version 16 using t-test, chi-square and ANOVA at the significant level of 0.05. In this study, out of 5952 newborns born in this center, 71 cases (1.19%) had fetal hydronephrosis in prenatal ultrasound. In 83.1% of cases ultrasound was performed in the third trimester of pregnancy. The highest degree of hydronephrosis was mild (78.2%) and in most of them, involvement was unilateral. Postnatal sonography showed kidney involvement in 18 infants (25%). The most common involvement was in the left kidney (61.1%). Seven infants had no follow-up after one month of birth (9.86%). Failure to follow up was due to the recommendation of physicians in 5 cases and the relatives of patients in 2 cases. There was no significant relationship between non-follow up with location of residence, maternal literacy, number of siblings, and gender of neonate. Postnatal follow-up rate in neonates with a history of fetal hydronephrosis after one month of birth is incomplete despite education at birthtime. Postnatal ultrasound should be performed at the time the baby is discharged from the hospital.

Colonoscopic Findings of Patients with Lower Gastrointestinal Bleeding in Erbil City

Background and objectives: Rectal bleeding is a frequent symptom in young people and often over- investigated.Rectal bleeding is defined as bleeding from lower gastrointestinal tract, which means bleeding from a place distal to ligament of Treitz. This study was conducted to determine the frequency of different causes of rectal bleeding in young patients. Methods: Four hundred and seventy patients with rectal bleeding were selected in out-patient department were referred to gastroenterology units of Hawler and Rizgary Hospital in Erbil. Patients with suspected upper GI source of bleeding excluded from the study. All patients were subjected to colonoscopy after preparation of the gut and the findings were recorded. When it was necessary, biopsy samples were also taken. Diagnosis was based on colonoscop- ic findings. Results: The total number of patients was 470. Their mean age + SD were 31.96 + 7.65 years, the median was 32 years, ranging from 12 to 46 years, more than one third of patients had hemorrhoids, either alone (35.7%), or with other finding, (45%) of patients had hemorrhoid with or without other diseases, (8.3%) had inflammatory bowel disease and colorectal tumor (4.7%), also 21.3% of patients found to be normal. Conclusions:Haemorrhoids were the main cause of bleeding per rectum, followed by evidence of inflammatory bowel disease. The incidence of colorectal tumor was low (4.7%). Though most findings were benign, colonoscopy should be strongly considered for this patient group with non urgent rectal bleeding.

Outcome after pre-hospital cardiac arrest in accordance with underlying cause

AimIn terms of treatment options, the underlying cause of out-of-hospital cardiac arrest (OHCA) has an impact on survival. This study aimed to examine the frequencies of different causes of OHCA and their outcomes using data from a national resuscitation registry. MethodsAll pre-hospital cardiopulmonary resuscitations (CPR) documented in the German Resuscitation Registry between 2007 and 2017 were retrospectively investigated with regard to cause of cardiac arrest, return of spontaneous circulation (ROSC), and hospital discharge rate with good neurological outcome. To avoid selection bias, only rescue services with a return rate in the form ‘further clinical treatment’ of >30% were included, this resulted in a total return rate of 84% of the included data. ResultsIn total, 33,772 patients were included. The most common causes of OHCA were cardiac events (62.2%), hypoxia (11.1%) and trauma (3.2%), in 17.2% no or unknown cause were documented. Overall, 44.8% of patients achieved ROSC, 13.1% of patients were discharged alive from hospital and 68.3% of these were in good neurological condition (9.0% of all patients). ROSC rates differed between 8.9% (sudden infant death syndrome) and 64.4% (intracranial bleeding), while discharge rates with good neurological outcome ranged between 0.9% (sepsis) and 14.0% (intoxication). ConclusionThe most common causes of OHCA are cardiac events and hypoxia. Depending on the underlying cause, outcome after pre-hospital CPR varies widely with a survival rate with good neurological outcome ranging from 0.9 to 14%.

Frequency of Different Causes of Infant Cholestasis in a Tertiary Referral Center in South-East Iran

Objectives: This study reports frequency of different causes of infant cholestasis diagnosed by clinical and biochemical parameters as well as liver biopsy. Methods: Cholestasis persisting beyond two-weeks of age in 46 infants less than 6 months old was evaluated. A checklist including signs and symptoms, as well as laboratory, imaging and liver biopsy results was prepared. According to diagnosis, patients were classified into two groups: biliary atresia (BA) and non-biliary atresia (Non-BA) and results were compared between two groups. P value 91 days. The most common symptoms and signs were jaundice in 100% followed by hepatomegaly (78%), splenomegaly (52%), acholic stool (35%) and dark urine (37%). There were no significant differences between the two groups for age, gender, onset of jaundice and organomegaly. Patients in BA group experienced more acholic stool, abnormal AST, ALT and bilirubin (P < 0.05). The most common underlying causes of liver disease in study group were BA (30.4%) and idiopathic neonatal hepatitis (INH) in 30.4% followed by metabolic disorders. Conclusions: Sixty one percent of infants with cholestasis in present study had BA and INH. A systemic approach is the key for rapid diagnosis to rule out BA and other treatable disorders for a better outcome.

Etiological spectrum of recurrent jaundice in adults: A retrospective observational study from a tertiary care center

Introduction: Studies regarding etiological spectrum of recurrent jaundice are rare. We conducted this study to identify the causes of recurrent jaundice in a tertiary care center. Materials and Methods: Frequency of different causes of recurrent jaundice was assessed from 130 patients attended General Medicine Department over a period of 3 years. Recurrent jaundice was considered when patients had more than one episodes of jaundice with serum bilirubin ≥3 mg/dl since childhood. Recurrent jaundice was diagnosed from past medical records, records of follow-up visits, and current clinical presentation. Causes were identified from past and present medical records of history, clinical and laboratory examinations. Results: Causes of recurrent jaundice included prehepatic (30%), hepatic (59.23%), and posthepatic (10.77 %) disorders. Prehepatic disorders were Gilbert's syndrome (GS), megaloblastic anemia, autoimmune haemolytic anemia, Wilson's disease, G6PD deficiency, etc. Hepatic disorders were exacerbations of alcoholic hepatitis, hepatitis B and C, autoimmune hepatitis, congestive cardiac failure, sarcoidosis, benign recurrent intrahepatic cholestasis, eclampsia, pregnancy induced cholestasis, falciparum malaria, drug induced liver injury (DILI), etc. Posthepatic causes were choledocholithiasis, recurrent pancreatitis, periampullary carcinoma, choledochal cyst, ascariasis, hemobilia, HIV cholangiopathy, autoimmune pancreatitis, etc. Prehepatic jaundice cases were younger. The highest level of total bilirubin was seen in alcoholic hepatitis, DILI, and hepatitis B. Alcoholic hepatitis was the most common cause of recurrent jaundice (19.23%). GS was the most common prehepatic cause. Mean age was lowest in GS and highest in DILI. Conclusion: Etiological spectrum of recurrent jaundice includes many prehepatic, hepatic or posthepatic disorders. A larger study may enlarge the spectrum.

Pediatric Heart Failure in the Developing World.

The exact prevalence of heart failure among children of developing countries is not known, as the data is limited. The relative frequency of different causes of pediatric heart failure varies widely across different countries and even among different parts of large countries like India. Children of developing countries face a double burden of etiologies. Conditions such us congenital heart disease, myocarditis and cardiomyopathies are common causes of pediatric of heart failure. In addition, diseases like rheumatic heart disease, nutritional deficiencies, and other tropical diseases also result in heart failure among children of the developing countries. However, most of the developing countries have low resources and hence management of pediatric heart failure becomes challenging. Advanced therapies for heart failure are rarely used in children of developing countries and cardiac transplant remains a distant dream.

An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital.

BackgroundPeripheral pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes. Only a few systematic studies have been published on the topic of pancytopenia, although extensive studies have been done for its different etiological factors like aplastic anemia, megaloblastic anemia, leukemia, etc. Thus, this study was carried out to investigate for and to identify the causes of pancytopenia, to find out the frequency of different causes, to determine the incidence of pancytopenia in relation to sex and age and to compare our findings with those of other similar studies from this part of the world.MethodsThis was a prospective study conducted in the Department of Pathology of a teaching institute and a tertiary care hospital in southern Maharashtra, India, over a period of two years. All the patients referred to the central clinical laboratory for routine complete blood count (CBC) and peripheral smear (PS) examination, from both - the outpatient and the inpatient departments, were screened for pancytopenia. Of these, a total number of 250 cases that fulfilled the diagnostic criteria were selected.Detailed hematological investigations followed by bone marrow aspiration wherever indicated and possible were performed according to standard methods to ascertain the causes of pancytopenia.ResultsA definite male preponderance was observed, the male to female ratio being 2.6 : 1. The majority of cases were encountered in 3rd and 4th decades. Hypersplenism (29.2%), Infections (25.6%), Myelosuppressants (16.8%) and Megaloblastosis (13.2%) were the four most common causes in this large series on pancytopenia from a single centre in India.ConclusionDetailed clinical history and meticulous physical examination along with baseline hematological investigations, provides invaluable information in the complete workup of pancytopenic patients, helping in systematic planning of further investigations to diagnose and ascertain the cause, avoiding a battery of unnecessary tests.

Hemoptysis: A Prospective Analysis of 110 Cases

Background: Hemoptysis is one of the commonest manifestations of the various underlying disease. A major problem in managing hemoptysis is the wider spectrum of causative factors. The effective management of hemoptysis depends upon identification of the etiology and localization of the site of bleeding. Objective: The objective of present study was to validate the relative frequency of different causes of hemoptysis and to identify its various risk factors. Methods: This 2-year prospective study was carried out on 110 patients presenting with hemoptysis. Routine blood investigations and chest radiographs were done for all patients. Bronchoscopy and HRCT chest was done for selected patients. Results obtained were evaluated. Results: Male to Female ratio was found to be 2.23:1. A total of 73.63% (n=81) of patients were admitted for the first episode of hemoptysis and 26.36% (n=29) for recurrent hemoptysis. Bronchiectasis was found to be the most common cause of hemoptysis in 34.55% patients, followed by old tubercular lesions in 26.36% of patients. History of blood stained sputum was given by 59 (53.64%) patients, frank hemoptysis was reported by 33 (30%) patients, and 18 (16.36%) patients gave the history of hemoptysis. Conclusion: Even one episode of hemoptysis should not be ignored and investigated properly. Bronchiectasis was the most common cause of hemoptysis in followed by old tubercular lesions.

Profil étiologique des pancytopénies chez l’adulte à Marrakech (Maroc)

This retrospective study evaluated the frequency of different causes of pancytopenia in all adult patients with pancytopenia presenting to the Department of Haematology of Mohamed VI Hospital, Marrakesh from 1 January 2008 to 31 December 2010. A total of 118 cases of pancytopenia were found (average of 39 cases per year). The mean age of patients was 52 years (range 18-82 years) and 52.5% were male. The main clinical signs were pallor (100%), asthenia (100%) and fever (30.5%). Mean haemoglobin was 6.5 g/dL (range 2.9-9.2 g/dL), mean white blood cell count was 2360/mm3 (range 840-3360/mm3) and platelet count 66 000/mm3 (range 3000-123 000/mm3). Bone marrow aspiration was performed in 112 patients; megaloblastosis was found in 32.2% and marrow blasts in 23.7%. Anaemia due to vitamin B12 deficiency (32.2%), acute leukaemia (23.7%) and aplastic anaemia (15.2%) were the main causes of pancytopenia. Given the incidence of acute leukemia among our cases, patients presenting with pancytopenia require urgent diagnosis and treatment.

IRON DEFICIENCY ANEMIA

To determine the frequency of different causes of iron deficiency anemia in female patients of reproductive age group. 2) To determine the association between lack of balanced diet and iron deficiency anemia. Design: cross-sectional analytical study. Setting: Federal government services hospital, Islamabad. Period: From July 2008 to November 2008. Material and Methods: The study included female patients of reproductive age group i.e. 15-49 years of age having hemoglobin less than 11.5g/dl. The sampling technique was purposive. The data was analyzed using Microsoft excel 2000 and SPSS 10.0. Pearson correlation coefficient was used to determine the direction of relationship between total nutritional score and level of hemoglobin; student’s t-test was used to determine the significance of association. A pvalue of less than 0.05 was considered significant. Results: A positive correlation was observed between total nutritional score and level of hemoglobin (r = 0.402, p-value = 0.008). Correlation between animal protein and level of hemoglobin was 0.438 (p-value = 0.004) while between plant protein and level of hemoglobin was 0.211 (p-value = 0.179). Conclusions: It is concluded that there is a definite role of nutritional deprivation in the development of iron deficiency anemia. Lack of balanced diet especially protein group has much stronger association with thistype of anemia. Animal protein as compared to plant protein has strong association with the development of iron deficiency anemia.

Triage and management of pericardial effusion

Pericardial effusion may be detected as an incidental finding during echocardiography or following a diagnostic imaging study for a symptomatic patient. When a pericardial effusion is detected the first step is to assess its size, hemodynamic importance, and possible associated diseases. The more common causes of pericardial effusions include infections (viral, bacterial, especially tuberculosis), cancer, connective tissue diseases, pericardial injury syndromes, metabolic causes (i.e. hypothyroidism), myopericardial and aortic diseases. The relative frequency of different causes depends on the local epidemiology, the hospital setting and the diagnostic protocol that has been adopted. Many cases still remain idiopathic in developed countries, whereas tuberculosis is the dominant cause in developing countries. Specific testing should be performed according to clinical suspicion. The presence of elevated inflammatory markers and other criteria (chest pain, pericardial rubs, ECG changes) suggest pericarditis and management should be directed accordingly. Treatment should be targeted at the etiology as much as possible. Nevertheless, when diagnosis is still unclear, or idiopathic and inflammatory markers are elevated, empiric anti-inflammatory therapy may be worthwhile. A true isolated effusion may not require a specific treatment if the patient is asymptomatic, but large ones have a theoretical risk of progression to cardiac tamponade (up to one-third) if subacute with signs of right-sided collapse, and especially chronic (>3 months). Pericardiocentesis alone may be curative for large effusions but recurrences are also common and pericardiectomy or less invasive options (i.e. pericardial window) should be considered whenever fluid re-accumulates (especially with tamponade), becomes loculated, or biopsy material is required.

ELSEVIER AND COMPLEMENTARY THERAPIES IN CLINICAL PRACTICE BEST DISSERTATION AWARD

In terms of treatment options, the underlying cause of out-of-hospital cardiac arrest (OHCA) has an impact on survival. This study aimed to examine the frequencies of different causes of OHCA and their outcomes using data from a national resuscitation registry.All pre-hospital cardiopulmonary resuscitations (CPR) documented in the German Resuscitation Registry between 2007 and 2017 were retrospectively investigated with regard to cause of cardiac arrest, return of spontaneous circulation (ROSC), and hospital discharge rate with good neurological outcome. To avoid selection bias, only rescue services with a return rate in the form ‘further clinical treatment’ of >30% were included, this resulted in a total return rate of 84% of the included data.In total, 33,772 patients were included. The most common causes of OHCA were cardiac events (62.2%), hypoxia (11.1%) and trauma (3.2%), in 17.2% no or unknown cause were documented. Overall, 44.8% of patients achieved ROSC, 13.1% of patients were discharged alive from hospital and 68.3% of these were in good neurological condition (9.0% of all patients). ROSC rates differed between 8.9% (sudden infant death syndrome) and 64.4% (intracranial bleeding), while discharge rates with good neurological outcome ranged between 0.9% (sepsis) and 14.0% (intoxication).The most common causes of OHCA are cardiac events and hypoxia. Depending on the underlying cause, outcome after pre-hospital CPR varies widely with a survival rate with good neurological outcome ranging from 0.9 to 14%.