Shaikh Zayed Hospital Research Articles

Hypothyroidism and its relationship with lipid profile in patients with Type II diabetes mellitus.

Objectives: To determine the frequency of hypothyroidism in type II diabetic patients and to compare the lipid profile of diabetic patients with and without hypothyroidism. Study Design: Cross Sectional Study. Setting: Medicine Unit I Shaikh Zayed Hospital Lahore. Period: 5th August 2016 to 5th February 2017. Material & Methods: A total of 350 patients, aged 35-80 years, of both gender and having type II DM diagnosed at least 1 year ago were enrolled in our study. Fasting (12hr) blood samples were obtained and sent to the laboratory for measurement of serum TSH, total cholesterol, LDL and TGs. Patients with TSH value >10 μg/ml were labeled as hypothyroid. Two groups (hypothyroid diabetic and euthyroid diabetic) were made and lipid profile was compared in both groups. Results: Frequency of hypothyroidism in type II diabetic patients was recorded as 13.42% (n=47). When lipid profile of hypothyroid diabetic patients (group I) was compared with euthyroid diabetics (group II), it was noted that patients in group I had mean total cholesterol of 170.32 ± 12.90 mg/dl whereas in group II, it was 138.81 ± 28.89 mg/dl. Mean triglyceride level in group I was 176.21 ± 15.98 mg/dl, whereas in group II, it was 151.02 ± 27.78mg/dl. Mean LDL in group I was 87.17±15.97mg/dl, and 71.35±20.40 mg/dl in group II. Conclusions: Frequency of hypothyroidism in type II diabetic patients is higher as compared to general population. Moreover, dyslipidemia is significantly higher in hypothyroid diabetics when compared with euthyroid diabetics.

Facial and Hand Scars Appearance after Autologous Nanofat Grafting in Patients with Post Burn Scars

Introduction: Management of unsightly post -burn scars has changed tremendously in current era of cosmetic awareness. 5-12% of all worldwide injuries are burn injuries and approximately 11 million patients need hospital care. Multiple treatment methods for scar improvement including fat grafting are under investigation. Nano fat Grafting is newer modality of fat grafting for improving scar quality. Aims & Objectives: The aim of this study was to assess the outcome of facial and hand scars appearance after autologous Nanofat grafting in patients with post burn scars. Place and duration of study: The study was performed in Plastic Surgery Department of Shaikh Zayed hospital, Lahore Pakistan from October 2018 to September 2019. Material & Methods: 30 patients with post-burn scars of face and hands were included; age range was 18 to 43 years. Skin type 2 to 4 (Fitzpatrick skin type) . Patients with skin graft, hypertrophic scars, contractures, or keloids were excluded. Scars were assessed by the patients and observer on a scale “POSAS” (Patient and Observer Scar Assessment Scale), the observer was a plastic surgeon. Scar was assessed before surgery using the POSAS scar scale. Fat was taken from the abdomen using 3mm cannulas with side holes of 1- 2mm under tumescent conditions and transferred to 10 cc syringes with luer-lock. Nano fat obtained after emulsification by passing 30 times from one syringe to another through luer-lock. The follow up was on 7th day, at 3 months and at 6 months. Results: The mean POSAS score of observer decreased significantly from admission 35.8±4.0, at 3 months 31.3± 3.8 and 6 months to 27.5± 3.0, p value < 0.05. The mean POSAS score of patients also significantly decreased, p value < 0.05 over the same time period from admission at 42.4±5.2, to 3 month 37.3±4.0 and 6 month to 32.2±3.2. Conclusion: Nano fat grafting results in improvement in scar appearance and is an effective approach towards the management post burn scar of face and hands.

Efficacy of surfactant administration to preterm infants via thin catheter versus InSurE technique.

Objectives: To compare the efficacy of administering surfactant to preterm infants using thin catheter and Intubate-Surfactant-Extubate (InSurE) techniques in terms of need of mechanical ventilation within 1st 72 hours of life. Study Design: Randomized controlled trial. Setting: Neonatal intensive care unit (NICU), Federal Postgraduate Medical Institute and Shaikh Zayed Hospital (FPGMI and SZH), Lahore. Period: From November 2014 to April 2015. Material & Methods: A total of one hundred preterm infants who developed respiratory distress syndrome (RDS) and fulfilled the inclusion criteria were enrolled in the study. The enrolled infants were randomly divided into two groups each comprising fifty infants. The infants in Group A were administered surfactant via thin catheter technique, whereas those in Group B by InSurE technique. The infants were monitored by clinical and laboratory parameters for the need of mechanical ventilation within 1st 72 hours of life. Descriptive statistical analyses were performed. Results: Majority of the preterm infants in Group A (54%) and Group B (56%) were born through Caesarean section. Group A constituted 58% (n=29) males and 42% (n=21) female infants, while Group B constituted 52% (n=26) males and 48% (n=24) females. Mean gestational age in Group A and Group B was found to be 29.43±4.24 weeks and 28.54±3.87 weeks, respectively. Mean birth weight in Group A and Group B was found to be 1375.87+143.36 and 1392.87+129.27 grams, respectively. Efficacy of surfactant was recorded as 64% (n=32) in group A and 44% (n=22) in group B (p=0.04). Conclusion: Surfactant administration using thin catheter is significantly more efficacious than InSurE in respect of the need of mechanical ventilation during 1st 72 hours of life.

Acute-on-chronic liver failure: MELD score 30-day mortality predictability and etiology in a Pakistani population

Background: Cirrhosis is a pathological condition that ultimately leads to liver failure. Acute on chronic liver failure (ACLF) has a high short term mortality rate. Viral hepatitis is the most common cause of liver failure in our local population. We carried out this study to identity the 30-day mortality and etiology of patients presenting with ACLF using Model for End-Stage Liver Disease (MELD) score predictability.
 Methodology: This was a descriptive case series, conducted at Sheikh Zayed Hospital, Lahore, Pakistan from January 31, 2018 to July 30, 2018. One hundred and eighty five patients who met the inclusion criteria were enrolled using 95% confidence level and 4% margin of error. Data was entered and analyzed with SPSS version 23.0. Numerical variables including age was presented by Mean ± S.D. Categorical variables i.e. gender, etiology of acute-on-chronic liver failure and 30-day mortality were presented by frequency and percentage. Data was stratified for age, gender, duration of chronic liver disease and MELD grade to address the effect modifiers. Post-stratification chi-square test was calculated using 95% significance (p?0.05).
 Results: Majority of the enrolled patients were male (74.6%) while only 25.4% of the patients were female. One hundred and thirty patients (70.3%) had underlying viral hepatitis while twelve patients (6.5%) and forty three patients (23.2%) presented with alcoholic liver disease and drug-induced ACLF, respectively. Eighty patients (43.2%) died within 30 days of admission.The 30-day mortality with respect to MELD grade was statistically significant (p<0.001) with the highest mortality noted in grade-IV and thirty five patients (43.8%) dying within 30 days of admission (p<0.001). Grade-II and III MELD scores also contributed to the 30-day mortality with twenty three patients (28.8%) and nineteen patients (23.8%) dying within 30 days of admission (p<0.001).
 Conclusion: MELD scores are able to accurately predict the short-term mortality in patients with ACLF and viral hepatitis was the most common etiology in our population. Early detection and use of appropriate prognostic models may alleviate mortality and morbidity in paitents with ACLF.

Diagnostic accuracy of Platelet Count for prediction of Esophageal varices in patients presenting with Chronic Liver disease.

Thrombocytopenia increases the risk of bleeding in CLD patients. The determination of the presence of Esophageal Varices (EV) by endoscopy is an invasive procedure. As a noninvasive tool, low platelet count (PC) can be helpful in prediction of variceal bleed in CLD patients with esophageal varices. Objectives: To assess the diagnostic accuracy of thrombocytopenia in predicting the presence of esophageal varices in patients with chronic liver disease. Study Design: Descriptive Cross sectional study. Setting: Medicine Unit I, Sheikh Zayed Hospital, Lahore. Period: 6 months from 1-07-2015 to 31-12-2015. Material and Methods: About 150 cases were included in our study through Non-Probability, Consecutive sampling method after obtaining written Informed consent. Blood sample was obtained from each patient and were immediately sent to the laboratory for assessment of platelet count. Reports were assessed. Those with low platelet count were referred to endoscopy room for confirmation of esophageal varices. Reports of endoscopy were compared with platelet count. Data was entered and analyzed through SPSS version 23. Results: Mean age of patients was 49.64±11.54 years. There were 97(64.7%) male and 53(35.3%) female patients. Mean duration of chronic liver disease of patients was 3.51±1.39. Mean platelet count of patients was 172.3±81.20. Sensitivity and Specificity of Thrombocytopenia for prediction of esophageal varices in patients presenting with chronic liver disease was 92.63% and 89.09%. While PPV, NPV and Diagnostic accuracy of Thrombocytopenia for prediction of esophageal varices was 93.62%, 87.5% and 91.33% respectively. Conclusion: It has been concluded from the present study that PC has high accuracy for detection of EVs and can be helpful in prediction of EVs in CLD patients.

Effectiveness of Lacosamide on everyday cognitive deficits, psychiatric symptoms and resilience in patients with epilepsy.

Lacosamide is a novel antiepileptic with neuroprotective properties. The present study examined the effectiveness of Lacosamide on cognitive functioning, psychiatric symptoms, and resilience in patients of refractory partial epilepsy. This prospective study was conducted at Sheikh Zayed Hospital;Rahim Yar Khan, Nishter Hospital, Multan; and Bahawal Victoria Hospital, Bahawalpur, Pakistan, from November 2017 till May 2018.Thirty-six patients of refractory partial onset epilepsy and 36 healthy individuals particiated in the study.The participants completed brief psychiatric rating scale and brief resilience scale, while their informants completed everyday cognition questionnaire in baseline (pre-treatment) and post-Lacosamide treatment testing sessions. Patients with epilepsy had cognitive deficits, psychiatric symptoms, and lesser resilience in contrast with healthy individuals. Lacosamide treatment improved everyday cognition, reduced psychiatric symptoms and improved resilience in patients with epilepsy. Lacosamide is efficacious in the treatment of everyday cognitive impairment, psychiatric symptoms and resilience in patients with epilepsy.

Urinary Lithiases: Epidemiological, Clinical and Therapeutic Aspects of 164 Cases at Sheikh Zayed Hospital in Nouakchott—Mauritania

Urinary lithiases occupy an important position with respect to urological activities in our department. In our Sahel region, lithiasic pathology represents 40% in urology in Senegal [1]. In Mauritania, we did not find a study evaluating the prevalence of this pathology. The frequency and gravity are variable. The objective of the study was to report the clinical profile and the results of management of urinary lithiasis in our environment. Materials and Methods: We conducted a retrospective, descriptive study spanning over two years (April 2015 to March 2017) in the urology department of Sheikh Zayed Hospital in Nouakchott. All patients operated for urinary lithiasis during this period were included in the study. The operative techniques used were semi rigid ureteroscopy, extra corporeal lithotrity, open surgery. Our center did not have flexible ureteroscopy and percutaneous nephrolithotomy. The indications were lithotrity for calculations lower than 20 mm of low density. Biger than 20 mm were by open surgery. Semi rigid ureteroscopy for distal ureteral calculi. Medical treatment or monitoring for non-obstructive calculi is less than 7 mm. Urine drainage by jj probe or nephrostomy are performed. We excluded all patients with lithiasis for the medical treatment. The result was good when absence of lithiasis residues was less than 7 mm and removal of the obstruction. Results: A total of 164 patients were found. The average age was 41 years, and F/M ratio was 1/10. Considering geographical origin, 82% of patients came from rural areas. The presenting complaint was mainly Lower Urinary Tract Symptoms (56%) and Renal Colicky Pain (31%). The bladder and kidneys were the most common (respective 45% and 35%) sites of stone location. Bilateral stones were 18%. Staghorn stones constituted 6% of the cases. Non steroidal anti-inflammatory treatment was administered in 82% of cases, while antibiotic therapy was administered in 32% of cases. Complications occurred in open surgery about 11% like parietal infection and residual stones. 0.6% of ESWL got uretere obstruction that needed jj catheter. 4% of cystolithotomy had infection. Conclusion: Urinary lithiasis often consults at the complication stage. Minimally invasive techniques are limited in our service and offer less complication.

Comparison between two Fluid Management Techniques of Ringer lactate and Hydroxyethyl Starches in cases of Burn

Background: Fluid replacement is one of the important issues in the management of burn cases. Objective: To compare the outcome between Ringer lactate and Hydroxyethyl starches (HESs) in cases with burn injuries. Methodology: Study design: Randomized controlled trial. Place and duration of study: Department of Plastic Surgery, Sheikh Zayed Hospital, Rahim Yar Khan, from June to December 2018. Study subjects selected were those who had a burn of any type (thermal, chemical, electric) and at least more than 10% of the surface area of the body. The cases were then divided into two equal groups. The fluid requirement was calculated according to the Parkland formula. After this, the cases in group A were given Ringers lactate solution 500 ml while those in group B were given 500 ml of 6% hydroxyethyl starches (HESs) and further fluid was administered in group A as ringer only and in group B as ringer and HES in a ration of 2:1. The cases were then followed to look for various outcomes in the form of urine output, serum creatinine, and mean hospital stay. Results: In this study, there were a total of 60 cases (30 in each group). The mean age in group A and B was 17.33±5.39 vs 19.11±4.79 years (p= 0.33). Mean hospital stay was 14.65±3.31 vs 13.49±2.78 days with p= 0.41. Mean urine output per day was 1645.81±143.47 vs 1705.31±165.83 ml with p= 0.43 and mean creatinine in group A and B was 1.79±0.38 vs 1.83±0.44 with p= 0.86. Conclusion: There was no significant difference in both the groups regarding urine output, creatinine, and mean hospital stay.

TCF7-L2 rs7903146 polymorphism in metabolic syndrome with and without acute coronary syndrome.

To determine the frequency and association of single nucleotide polymorphism of transcription cell factor7-like2 rs7903146 (C>T) in metabolic syndrome patients with and without acute coronary syndrome. The cross-sectional comparative study was conducted at the University of Health Sciences, Lahore, Pakistan, from July to December 2017. Patients of metabolic syndrome with and without acute coronary syndrome were selected from Sheikh Zayed Hospital, Lahore, and the Punjab Institute of Cardiology, Lahore. Healthy subjects were enrolled to act as controls. A fasting blood sample of 8ml was taken for deoxyribonucleic acid extraction and estimation of biochemical parameters. Single nucleotide polymorphism of transcription cell factor7-like2 rs7903146 C>T was determined using restriction fragment length polymorphism. SPSS 22 was used for data analysis. Of the 500 subjects, 200(40%) were group A patients without acute coronary syndrome, 100(20%) were in group B with acute coronary syndrome and 200(40%) were group C controls. Overall, 385(77%) were males and 115(23%) were females. The frequency of CC variant in group A was 35(17.5%) and in group C 22(11%), while CT was 32(16%) and 65(32.5%), and TT was 133(66.5%) and 113(56.5%), respectively. There was significant association of TT genotype with increased risk of metabolic syndrome (p=0.031), and CC genotype had no association (p=0.121). There was no significant difference of genotype frequency between groups A and B (p=0.246), but TT variant was significantly higher in group A compared to group B (p=0.009). TT genotype of transcription cell factor7-like2 rs7903146 C>T was found to be associated with increased risk of metabolic syndrome in patients without acute coronary syndrome compared to those with acute coronary syndrome and healthy controls.

Frequency of impaired fasting glucose in first degree relatives of Type-II diabetic patients and its association with Body Mass Index.

Objectives:To determine the frequency of impaired fasting glucose in first degree relatives of people with Type-II diabetes and its association with BMI.Methods:This cross-sectional study was conducted in Diabetic clinic of Shaikh Zayed Hospital, Lahore from July to December 2017. Individuals aged ≥35 years, first degree relatives of people with Type-II diabetes, were selected and their fasting blood glucose levels were checked twice a week apart. Study participants were divided into 3 groups. Group-I were those with normal fasting blood glucose (FBS: <100mg/dl), Group-II were those with impaired fasting glucose (100-125mg/dl), considered as high risk and Group-III included those who turned out to be having frank diabetes (FBS: ≥126mg/dl). Exclusion criteria were known diabetes and pregnancy. Proportions of impaired fasting glucose levels versus BMI were compared using Chi-square test. Significance was considered at P <0.001.Results:A total of hundred subjects were included in the study with the mean age of 44.27 years. Sixty percent participants had normal FBS, 31% showed impaired FBS and 09% had frank diabetes (P <0.001). Significant association was found between impaired fasting glucose and BMI, as with increasing BMI the frequency of impaired fasting glucose increases.Conclusion:First-degree relatives of people with Type-II diabetes showed higher frequency of impaired fasting glucose and obesity was an important risk factor.

Relation between maternal C–reactive protein in early pregnancy and neonatal complications

Background C-reactive protein (CRP) is an acute-phase reactant and a commonly employed indicator of low-grade systemic inflammation. Elevated CRP levels are accompanied by higher risk of popular diseases. This study aimed to study the correlations of maternal CRP level with fetal growing and the risk of neonatal complications. Participants and methods This prospective observational randomized study was conducted in Al Zahraa University and El Sheikh Zayed hospital throughout the interval from April 2018 to March 2020. It included 150 pregnant women attending for antenatal care in the outpatient clinic. CRP was done twice. The first measure was done at second trimester (13–20 weeks), and the second measure was done after 26 weeks. Positive results were obtained at a CRP concentration above 10 mg/l. The pregnant women were subdivided into two groups: group A, with positive (high) CRP, and group B, with negative (ordinary CRP). Follow-up was done by ultrasound during pregnancy [to detect Intrauterine Growth Restriction (IUGR), low birth weight, and congenital anomalies]. Follow-up during labor was done to detect mode of delivery, IUGR, respiratory distress, and NICU admission. Results Median CRP level at 13–20 weeks was higher than median CRP level at 26–30 weeks. Regarding CRP finding, it was found that ∼60 (40%) women had positive CRP and 90 (60%) women had negative CRP. IUGR was statistically significantly higher among positive CRP group than negative CRP group (5 and 0%, respectively; P=0.031). Respiratory distress was statistically significantly higher among positive CRP group than negative CRP group (6.7 and 0%, respectively) (P=0.01). Admission at neonatal ICU was statistically significantly higher among positive CRP group than negative CRP group (6.7 and 0%, respectively; P=0.031). Conclusion Maternal-grade inflammation in pregnancy, as estimated by CRP counts, was accompanied with fetal growing restriction and higher risks of neonatal complications.

Assessment of Acoustical Level in Healthcare Design: In Comparison with the Standards of World Health Organization

&#x0D; &#x0D; This research was undertaken to assess acoustical conditions in the hospital environment, researcher aimed at investigating sound levels of local hospitals and to evaluate how much their current status complied with recommendations levels given by World Health Organization. To assess the actual noise impact, sound levels of six local hospitals were measured using non – probability sampling technique at five different locations of every hospital i.e. Waiting Area, Emergency Department, Corridor, Intensive Care Unit and General Ward. All readings obtained during morning, afternoon and night intervals were then compared with World Health Organization acoustic guidelines for hospitals (30-40dB) Findings revealed that sound levels of all hospitals studied were significantly high as compared to standards given by WHO, the hypothesis was significant with p&lt;.005, twice as high sound levels were observed in comparison to the recommended limits. Equivalent continuous sound levels (Leq) in most hospitals of Lahore ranged between (70-80dB), irrespective of time of the day, indicating a serious issue of noise pollution. Results also indicated that the highest sound levels were observed in waiting area at Hameed Latif hospital (110dBA). While the lowest sound levels were observed in Intensive Care Unit of Sheikh Zayed hospital (59dBA), which despite being the lowest were high in comparison to standards given by World Health Organization. Furnishings and interiors of a hospital usually have easy-to-clean surfaces that are hard and reflective in order to prevent infections, but such surfaces tend to propagate noise into the patient rooms and down the corridors causing sound to reverberate. Optimal sound levels in hospitals can only be achieved through regular sound assessment, proper zoning of high and low activity areas and use of sound absorbing materials in building design that do not compromise hygiene requirements of the place. Only then patients can truly receive the quality of care they deserve.&#x0D; &#x0D;

A comparison of bupivacaine with or without tramadol in caudal epidural block for postoperative caudal analgesia in children undergoing lower abdominal surgery under general anesthesia

Background and Objective: Millions of children receive sedative, anesthetic and analgesic drugs for surgery worldwide. Caudal epidural block with bupivacaine is widely used for perioperative analgesia in children undergoing surgeries under general anesthesia. Current study aims to determine postoperative pain relief and side effects due to caudally administered 0.25% bupivacaine (0.5-1 ml/kg) alone and a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg).Methodology: A randomized clinical trial was conducted at department of Anesthesiology, Shaikh Zayed Hospital, Lahore. Study duration was 1 year and 6 months (February 2015-August 2016). A sample size of 108 patients was calculated using WHO calculator. Non probability consecutive sampling was used. Patients were randomly divided into two groups; Group B was given inj. bupivacaine 0.25% while Group BT received a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg). Patients were observed for sedation score, FLACC pain score and adverse effects in both interventional groups. Data were analyzed using SPSS version 22. Student’s T-test was applied on data. P-value ≤ 0.05 was considered significant.Results: Total 108 patients were included in the study (1:1 randomization). Mean age of patients was 6.41 ± 1.77 y. There were 92 (85.2%) male and 16 (14.8%) female children. Mean sedative scores (p = 0.00) and mean FLACC pain scores (p = 0.000) were significantly lower in bupivacaine tramadol group as compared to bupivacaine group. However, bupivacaine group had more adverse effects as compared to combination of bupivacaine and tramadol group. Conclusion: Caudal epidural with a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg) has high postoperative analgesic efficacy and limited adverse effects as compared to 0.25% bupivacaine alone in children undergone general anesthesia for lower abdominal surgery.

Diastolic dysfunction in cases with Type II diabetes mellitus.

Objectives: To determine the frequency of diastolic dysfunction in patients presenting with type II Diabetes Mellitus. Study Design: Cross sectional study. Setting: Sheikh Zayed Hospital, Rahim Yar Khan. Period: From 01-01-2017 to 30-06-2017. Material &amp; Methods: In this study the cases were selected via non probability consecutive sampling of both male and female gender with age more than 40 years having type II DM of at least more than 2 years were included. The cases suffering from type I DM, gestational DM and those with HTN, end stage kidney and liver failure were excluded. Trans thoracic echocardiography was done to label diastolic dysfunction and was labelled as yes when the E/A ratio was &lt;0.8. The data was analysed using chi square test and p value less than 0.05 was taken as significant. Results: In this study, 100 cases of type II DM were included with mean age of 51.31±7.89 years at presentation. There were 61% males and 39% females. Diastolic dysfunction was observed in 53% of the cases. There was no significant difference in terms of gender where it affected 56.41% of females with p= 0.92. Diastolic dysfunction was more in cases that had duration of DM more than 3 years affecting 48 (70.58%) cases with p= 0.001 and it was also significantly high in cases that had BMI more than 30 where it was seen in 40 (70.17%) of cases with p= 0.001. Conclusion: Diastolic dysfunction seen in half of the cases suffering from type II DM and it is significantly high in cases that had duration of DM more than 3 years and BMI more than 30.

Frequency of fungal infections in nasal polypi.

Objectives: Determine the frequency of fungal infections in nasal polypi. Study Design: Cross sectional study. Setting: Histopathology Department at Shaikh Zayed Hospital Lahore. Period: Six months from 12/2/2015 to 12/8/2015. Material &amp; Methods: Two hundred surgical resections/biopsies using 95% confidence level, with 7% margin of error were collected. Formalin fixed specimens of patients of both genders and 10- 60 years of age with nasal polyps received after surgical procedure in department of ENT. Grossing and processing was done. Hematoxyin &amp; Eosin stained sections were examined by two consultant Histopathologists independently. The presence of fungal hyphae was confirmed by PAS and Silver stains. The study was approved by College of Physicians &amp; Surgeons Pakistan. All the data was entered and analyzed by using SPSS version 20. Results: Out of 200 patients all the patients showed the prescence of inflammatory cells in polyps (100%) with predominantly eosinophils in their submucosa (82%). Fungus was present in 48 cases (24%) most of them were in the age group of 42-57 years (13%) and 31(15.5%) patients having BMI &lt;30 and 17(8.5%) having BMI &gt;30 were positive for fungus.30 cases were of Aspergillus (62.5%) and rest 8 were of Mucor (37.5%). The fungus positive cases were more in males (13.5%). 160 of the cases were of unilateral polyps (80%) and 40 were of bilateral polypi (20%). Only 8% of the patients having diabetes had fungal infection. Conclusion: Hence, the frequency of fungal infection in nasal polypi is low with Aspergillus being the commonest pathogen affecting males predominantly.

Evaluation of Renal Function Parameters in Normotensive and Pre-Eclamptic Pregnant Women at Different Stages of Pregnancy

Introduction: Pre-eclampsia is one of the most common causes of maternal and fetal complications in developing countries. Owing to its multisystem involvement, hypertension and proteinuria in pre-eclamptic women may lead to acute or chronic renal failure. Early diagnosis is vital to avoid this organ failure. Aims &amp; Objectives: To assess renal function by measuring and comparing four renal function parameters including Blood urea Nitrogen (BUN),serum creatinine, creatinine clearance and 24-hr urinary protein in pre-eclamptic and normotensive pregnant women at different stages of pregnancy. Place and duration of study: This prospective and observational study was conducted in 2009 at Shaikh Zayed Hospital. The patients were taken from Gynae and Obstetrics OPD, with 24 weeks of gestation. Material &amp; Methods: In this study, 25 normotensive Controls and 25 pre-eclamptic pregnant women (cases) were included. Serum and urinary samples were taken at 24 weeks, 28 weeks, 32 weeks of gestation as well as at term (38 weeks). Blood urea nitrogen (BUN), serum creatinine, spot urinary protein and urinary creatinine were measured by clinical Chemistry Auto analyzer Dimension AR. Whereas, 24 hours urinary protein and creatinine clearance were calculated later. Results: BUN level of cases were significantly high as compared to controls at 32 weeks and at term (p&lt;0.01) however creatinine clearance was found to be significantly low (p&gt;0.05) in pre-elamptic women only at 38 weeks. Apart from other results, 24-hours urinary protein was found to be significantly high (p&lt;0.05) in pre-eclamptic women as compared to normotensive women at all stages of pregnancy. Conclusion: Our study showed that BUN, Creatinine clearance and most importantly 24-hr urinary protein may be used to assess the renal function in relation with the severity of pre-eclampsia. Key words: Pre-eclampsia, Blood Urea Nitrogen (BUN), Proteinuria.

Frequency of QT Interval Prolongation in Chronic Liver Disease Patients

Introduction: The frequency of QT interval prolongation as published in the international and local literature has been variable. Aims &amp; Objectives: To determine the frequency of QT interval prolongation in patients with chronic liver disease and resolve the variability in the literature. Place and duration of study: The present study was conducted in Gastroenterology and Hepatology Unit Shaikh Zayed Hospital Lahore from 1st March 2017 to 31st August 2017. Material &amp; Methods: About 240 patients with diagnosed chronic liver disease were selected. Electrocardiography (12 lead) was performed in all patients to look for QT interval prolongation and their mean was calculated for purpose of analysis. Results: Mean age of our patients was 53.7±11.9 and male gender was dominant (55.8%). It was noted that QT interval was prolonged in 62 patients (25.8%) while rest of the 178 patients had normal QT interval. Conclusion: QT interval prolongation is frequently observed (25.8%) in chronic liver disease patients. Therefore, every patient with chronic liver disease should be investigated for QT interval prolongation. Key words: Chronic liver disease, QT interval, Electrocardiography

Evaluation of the positive predictive value of atypical thyroid cytology cases according to the Bethesda system taking histopathology as gold standard.

Objectives: For the past 20 years Fine Needle Aspiration Cytology (FNAC) has evolved as the most sensitive diagnostic tool for the initial screening of patients with thyroid nodules. Unfortunately FNAC is complicated by a recognized false negative rate of approximately 5%. The clinicians could face the difficulty in the management of patient when a cytological diagnosis is atypical only. The objective of study is to evaluate the positive predictive value (PPV) of atypical thyroid cytology cases according to the Bethesda system taking histopathology as gold standard. Study Design: Cross sectional study. Setting: Department of Pathology at Shaikh Zayed Hospital, Lahore. Period: Six months i.e. from 25.11.2014 to 25.5.2015. Materials and Methods: Patients presenting with solitary thyroid nodules in the outpatient department and fulfilling the inclusion criteria were included after evaluation by thyroid function tests and thyroid scan, FNAC was performed and reported according to Bethesda system of thyroid reporting. Later on, cases underwent lobectomy, total or hemi-thyroidectomy, the tissue was received in 10% formalin solution in our pathology department and then processed, stained and examined. FNAC results of atypical cases were then compared with the definitive histological diagnosis which were considered the gold standard. The slides were examined and any differences were sought by consensus of two pathologists. Eighty cases were observed with 95% confidence level, 11% margin of error, using non-probability purposive sampling technique for sample collection. Data was analyzed by SPSS version 15 (P value &lt;0.05). Results: The mean age of patients was 38 years with SD ± 2.16. There were 22 (28%) males and 58 (72%) females in our study. In this study, positive predictive value for Atypia of undetermined significance/ Follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm (FN), suspicious for malignancy and positive for malignancy were 33.3%, 25%, 66.6% and 100% respectively. Overall PPV of atypical cytology was 35.71%. Overall accuracy of FNAC was 86.30%, 87.50% sensitivity and 86.15% specificity, PPV value 43.75% and negative predictive value was 98.25%. Conclusion: Results showed that Bethesda system of reporting is helpful for the management of patients who falls in to undetermined categories as it categorically divide atypical cytology cases in to three definite categories AUS, FN and suspicious for malignancy and these categories have different risks of malignancy. Thus can help to determine a better patient outcome due to proper clinical management of thyroid swellings.

Frequency of QT Interval Prolongation in Chronic Liver Disease Patients

Introduction: The frequency of QT interval prolongation as published in the international and local literature has been variable. Aims &amp; Objectives: To determine the frequency of QT interval prolongation in patients with chronic liver disease and resolve the variability in the literature. Place and duration of study: The present study was conducted in Gastroenterology and Hepatology Unit Shaikh Zayed Hospital Lahore from 1st March 2017 to 31st August 2017. Material &amp; Methods: About 240 patients with diagnosed chronic liver disease were selected. Electrocardiography (12 lead) was performed in all patients to look for QT interval prolongation and their mean was calculated for purpose of analysis. Results: Mean age of our patients was 53.7±11.9 and male gender was dominant (55.8%). It was noted that QT interval was prolonged in 62 patients (25.8%) while rest of the 178 patients had normal QT interval. Conclusion: QT interval prolongation is frequently observed (25.8%) in chronic liver disease patients. Therefore, every patient with chronic liver disease should be investigated for QT interval prolongation.

Comparison of Efficacy of Laryngeal Mask Airway and Intersurgical-Gel Supraglottic Airway Device During General Anesthesia in a Tertiary Care Hospital

Background: Upper airways collapse during anesthesia is a common issue faced by anesthetists. Air way maintenance is an essential component of general anesthesia. Laryngeal mask airway and Intersurgical-gel (i-gel) air way devices are new advances in general anesthesia. Present study aims to compare the ease of insertion and hemodynamic response of i-gel supraglottic and laryngeal mask airway (LMA).&#x0D; Material and Methods: A Randomized Clinical trial was conducted at the Department of Anesthesia, Shaikh Zayed Hospital, Lahore. Study duration was 6 months (June 2014- December 2014). A total of 60 patients were selected through non-probability consecutive sampling. Ethical approval was taken from ethical review board of Sheikh Zayed Hospital and informed written consents were taken from all the participants. Patients were randomly divided into two groups using lottery method. Group A was given laryngeal mask airway device while group B patients were provided with i-gel supraglottic device during anesthesia. Patients were compared for ease of insertion and hemodynamic parameters. Data was analyzed using SPSS version 24. Chi-square and t-test were applied and p-value ≤0.05 was considered statistically significant.&#x0D; Results: A total of 60 patients were included in study. Mean age of patients was 35.2±11.7 years in LMA group and 36.7±13 years in i-gel group. Group B had lower number of insertion attempts (p=0.01) and high insertion satisfaction (p=0.4) as compared to group A. However, process failure and bleeding rate was found to be slightly higher in group B (16% and 13% respectively) as compared to group A (p&gt;0.05).&#x0D; Conclusion: i-gel supraglottic device is a successful alternative option in terms of ease of insertion and less hemodynamic response as compared to laryngeal mask airway during general anesthesia.&#x0D; Key words: , ,