Inflammatory bowel disease is a systemic disorder with intestinal and extra-intestinal features. Arthritis is a well recognized extra intestinal manifestation. Spondylitis, sacroiliiatis are the common involvement with IBD. NSAIDs are generally recommended in the treatment with caution due to its potential of flaring up the gastrointestinal symptoms. Sulphasalazine, methotraxate, aziothioprine and anti TNF alpha agents are licensed for treatment of arthritis in IBD. This is a Review Article
Background: Chickenpox is a benign disease occurring in both children and adults. Common symptoms of disease include fever, generalized body rash, itching, fatigue, headache and body aches. The complications of the disease include respiratory, gastrointestinal, neurological, hematological and cardiac complications. These complications are more common in adult population. Estimated mortality from chickenpox is 31/100,000 in adults. Chickenpox pneumonia is the most serious complication followed by encephalitis. Objective: To highlight the various complications of chickenpox present in adult population of Faisalabad and its adjoining cities. Study Design: retrospective cross-sectional observational study. Settings: Department of Medicine, Allied Hospital, Faisalabad Pakistan. Duration: One year, January 2017 to December 2017. Methodology: Record of the admitted 350 patients was obtained, and Patients’ charts were reviewed with special emphasis on various complications of chickenpox. The patients included were above the age of 14 years and the diagnosis of chickenpox was made on clinical grounds. The diagnosis of complications was made with the help of laboratory and radiological investigations. Results: In our study 350 patients facing complications from chickenpox, from various regions of Faisalabad. Majority of them suffered from secondary bacterial skin infection i.e. 75 patients. Sepsis and ARDS turned out to be some of the major concerns for patients as well, as 31patients developed Sepsis and 29 patients suffered from ARDS respectively. Hepatitis, Myocarditis and Encephalitis were among the major issues affecting 11, 12 and 9 patients respectively. Conclusion: Chicken Pox can present with life threatening complications in adult population. Awareness of general population about the disease, its prevention, early detection and start of appropriate treatment can prevent development of complications and help reduce mortality and morbidity from the disease.
Background: Procalcitonin has been used globally as indicator marker of sepsis to define bacteremia or blood stream infection for early patient management or antibiotic therapy. Blood culture refers to a microbiological culture of a peripheral blood sample. The blood cultures help to determine the presence of systemic infections, such as septicaemia. If the culture is positive, the causative micro-organism can usually be identified, and antibiotic sensitivity testing performed. On the other hand, the sensitivity of procalcitonin in comparison to its specificity to certain bacterial infections is still in question. Methodology: In this study, we selected 309 patients without restriction of age gender with pre-diagnosed sepsis or septic shock syndrome. Blood culture samples were collected in bactAlert media plus culture bottles and were incubated in BactAlert 3D semi-automated blood culture system; blood sample was collected for serum procalcitonin on immunoassay principle. Results: Out of 309, a total 87 blood cultures were positive and PCT was positive in 134 whereas 179 were PCT negative. In positive PCT, 63 were having bacterial growth in their blood culture while 71 were with negative blood culture. Although in total, 179 PCT were negative, only 16 were having bacterial growth in blood culture samples whereas all others revealed no growth that showed maximum number of positive blood cultures were having PCT positive but not all PCT positive demonstrated bacterial growth in blood culture suggesting that the bacteremia or sepsis can only be suspected with positive PCT. In addition, blood culture positive or negative results cannot be predicted by PCT value to make diagnostic confirmation of sepsis. Keywords: Procalcitonin (PCT), Blood culture, Sepsis, 95%CI; confidence interval, IQR; Interquartile range
Introduction: Hepatic encephalopathy (HE) or portosystemic encephalopathy is a state characterized by disordered central nervous system functions because of failure of liver to detoxify nitrogenous agents originating from gut because of dysfunction of hepatocytes and portosystemic shunting. Patients with HE often present alteration of mental status varying from minor psychological abnormalities to deep coma. Multiple studies conducted worldwide suggest that the branchedchain amino acids (BCAAs) leucine, isoleucine, and valine may be useful in improving survival and reducing morbidity in patients with HE. Objectives: To compare the efficacy of branched chain amino acids in reversal of hepatic encephalopathy in patients with cirrhosis of liver with placebo. Study Design: Randomized control trial Setting: Medical Unit V, DHQ Hospital Faisalabad Duration: Study was carried out over a period of 6 months from 1 st July 2016 to 30 December 2016 Results: A total of 60 patients (30 in each group) were enrolled, majority of the patients were between 41-50 years in both groups, 36.67% (n=11) in Study and 43.33% (n=13) control group, mean and standard deviation of age was calculated as 43.56+5.21 in study and 45.78+4.98 years in control group, 70% (n=21)patients were male in study group and 63.33% (n=19) in the control group, 30% (n=9) patients in study group and 36.67% (n=11) in control group were females, comparison of efficacy of BCAAs in reversal of HE with placebo reveals 63.33% (n=19) patients in study group showed reversal of HE and 26.67% (n=8) patients in control group. Conclusion: The results of the study conclude that branched chain amino acids are significantly effective in reversal of hepatic encephalopathy when compared with placebo.
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