Background and Objective:Vitamin D deficiency has strong association with various respiratory disorders in which bronchial asthma is one of them. The objective was to determine the efficacy of vitamin D supplementation in cases with bronchial asthma.Methods:This case control study was conducted at private clinical set up of district, Rahim Yar Khan from August to October 2016 in which 100 cases of bronchial asthma were randomly divided into Group-A and Group-B each contained 50 patients. Group-A was given placebo and Group-B with vitamin D in a dose of 50,000 units per day orally. Both the groups were followed in terms of improvement in FEV1 at 1, 2 and 3 months.Results:There was no significant difference in both groups in terms of BMI and duration of asthma at start of study. The mean pre treatment vitamin D level of Group-A was 14.23±1.66 and of Group-B, 15.30±2.05 ng/dl (p= 0.23). FEV1 in pre treatment Group-A was 64.35±3.16 and of Group-B was 62.35±2.16 with p= 0.95. There was no significant difference in terms of FEV1 in both the groups at one month (p= 0.32). While at two months it was significantly higher in Group-B with p= 0.04. At 3 months the final outcome was seen where the post treatment FEV1 in Group-A was 66.13±2.75 and in Group-B, 75.15±2.04 with p value of 0.001.Conclusion:Vitamin D supplementation improves FEV1 significantly at two months and these can be even highly significant if it is extended up to 3 months.
Background High value of neutrophil lymphocyte ratio (NLR) is a strong independent predictor and biomarker of ongoing vascular inflammation in various cardiovascular disorders. Objective The main focus of the study is to investigate the effect of nebivolol on NLR in mild to moderate hypertensive patients in comparison with metoprolol. In addition, BMI, blood pressure, TLC count, blood sugar, and lipid profile were also assayed before and after treatment. Materials and Methods In this 12-week prospective double-blinded randomized study, 120 patients with mild to moderate hypertension were randomly divided into two groups to prescribed daily dose of tab nebivolol 5–10 mg and metoprolol 50–100 mg, respectively, for 12 weeks. The data were analyzed using SPSS 16 software. Results A total of 100 patients completed the study. Both drugs lowered blood pressure significantly, nebivolol 20.5/10.5 and metoprolol 22.5/11.2 (p < 0.001) from baseline. Regarding inflammation, nebivolol reduced total leukocyte count (p = 0.005) and neutrophil count (p = 0.003) and increased lymphocyte count (p = 0.004) as compared to metoprolol. Similarly, nebivolol but not metoprolol significantly reduced NLR ratio (p = 0.07). Nebivolol improved lipid profile and blood sugar compared to metoprolol, but values were nonsignificant. Conclusion Nebivolol has a strong impact on reducing NLR, a marker of subclinical inflammation in hypertensive patients. Moreover NLR can be used as a disease and drug monitoring tool in these patients.
Objective:To see the role of Vitamin D supplementation on physical status of patients suffering from Congestive Heart Failure (dilated cardiomyopathy).Methods:In this nonrandomized clinical trial, Forty three Patients with dilated cardiomyopathy who were not showing any significant improvements in physical performance on optimal treatment of heart failure were included. Vitamin D (200,000 IU) supplementation on weekly basis for a period of 12 weeks was added to heart failure treatment. And its effect was seen on 6 minutes’ walk distance and Pro-BNP levels. SPSS version 19 was used for data analysis. Dependent sample t-test was used to see the significant effect of vitamin D supplementation on pre- intervention vitamin D levels, 6MWD and Pro-BNP. Taking p-value <0.05 as significant.Results:On clinical assessment most of the patients were in NYHA class II (65%), the percentages of NYHA Class I, III and IV was 19%, 9% and 7% respectively. The baseline mean vitamin D level of the study group was 16.59±3.54ng/ml and it raised to 31.97±3.64ng/ml after 12 weeks of supplementation with vitamin D, p value<0.0005. The mean distance travelled by the study group before the intervention was 806±380ft while it increased to 945±393ft after the intervention, p value of 0.008. The mean of pro-BNP level of the study group before the intervention was 1024±635 while it improved to 159±80 after the intervention with a significant p value<0.0005.Conclusion:Vitamin D supplementation decreases the severity of HF as reflected by reduction in serum pro-BNP levels and significant increase in six minutes’ walk distance.
Background and Aim: Migraine is a spiking prime headache disorder that has a significant impact on both patients and society. Migraine and other headache disorders are major causes of misery and frailty on a global scale. The aim of the present study was to determine the prevalence of migraine in young male patients presented with severe headache. Methodology: This cross-sectional study was carried out on 276 young male patients who presented with severe headache Medicine outpatient department (OPD) at Ayub Teaching Hospital, Abbottabad from August 2019 to July 2020. Criteria of International Classification of Headache Disorders were followed for headache diagnosis. All the patients of age range 15-40 years with severe headaches were enrolled whereas patients of previous chronic medical conditions were excluded. Ethical approval was taken from the institutional ethical committee. All the demographic details were gathered in a pre-designed proforma. SPSS version 24 was used for data analysis. Results: A total of 276 young adult patients who presented with severe headaches were investigated during the study period. The mean age was 29.38±8.65 years with an age varies from 15 years to 40 years. Most of the patients were in the age range of 31-40 years 132 (47.8%) followed by 21 to 30 years 97 (35.1%). Patients of age 15-20 years were less frequent with a prevalence of 47 (17.1%). The overall prevalence of migraine headache was in 137 (49.6%) patients out of which migraine with and without aura was 5.7% and 43.9% respectively. Tension-type headache being the second common headache was found in 23.7% followed by Cluster headache at 2.8%. Conclusion: Migraine without aura was the most prominent headache among young male outpatients with severe headache. The findings highlight the socioeconomic factors impact on headache epidemiology and show that excessive use of NSAIDs may have an effect the primary headaches distribution. More multicenter studies are needed to assess headache epidemiology across the country. Keywords: Severe Headache, Migraine, Prevalence, Tension Type Headache (TTH)
ORIGINAL PROF-3518 ABSTRACT… Objectives: The incidence of high degree atrioventricular block (HAVB) varies from 2.7 to 14% after acute STEMI. The aim of this study was to evaluate the incidence of high degree atrioventricular block (HAVB) in patients of acute myocardial infarction. Study Design: Observational study. Setting: Sheikh Zayed Medical College/Hospital Rahim Yaar Khan. Period: March 2016 to May 2016. Material and Methods: Two hundred patients of acute myocardial Infarction were included in this study. Patients suffering from 2 nd degree Mobitz type II or 3 rd degree heart block were labelled as High Degree Atrioventricular Block (HAVB). Data Analysis was made using Statistical Package for Social Sciences Software V17. Chi-square test was used to compare in-hospital mortality between the groups taking p-value <0.05 as significant difference. Results: The mean age of patients who presented with myocardial Infarction in our hospital was 50.13+6.97 years. Out of 200 patients, 35 (17.5%) were smokers, 83 (41.5%) hypertensives, 69 (34.5%) diabetics and 48 (24.0%) were with positive family history of Ischemic Heart Disease. Most common type of MI was anterior wall present in 50.5% patients and 2 nd most common was inferior wall MI presented in 26.5% patients. High degree atrio-ventricular block was present in 9 (4.5%) patients. In-hospital mortality was significantly high in patients with HAVB, in these patients in-hospital mortality was 2 (22.2%) as compared to only 8 (4.2%) in patients of without HAVB (p-value 0.01). Conclusion: Myocardial infarction complicated with high degree atrio-ventricular block (HAVB) is associated with higher rate of in-hospital mortality
Introduction: Chest pain is one of the most common presentations to theemergency and cardiology clinics and most serious of these is acute coronary syndrome (ACS)is a life threatening acute emergency.1 There are a number of complications, which can causedeath immediately in patients of ACS which include arrhythmias, cardiogenic shock, progressiveheart failure, mechanical cardiac complications and repeat MI.2-3 Objectives: To determine thefrequency of different arrhythmias in patients with acute coronary artery syndrome in the first24 hours of hospitalization. Study Design: Cross sectional study. Period: 1st July 2016 to 31stJanuary 2017. Setting: Department of Cardiology, Sheikh Zayed Medical College/Hospital,Rahim Yar Khan. Methodology: 379 consecutive cases of ACS of either gender, with age rangeof 30 to 60 years were included. Socio-demographic data and other clinical data was taken.These patients were then attached with ECG monitors in department of cardiology, and ECGwas recorded for 24 hours and then the type of arrhythmias if detected (PVCs / AF / VF / nonsustained VT / sustained VT / first degree heart block/ second degree heart block/ third degree)and duration of develop arrhythmias was noted according to operational definitions. Results: Inthis study there were total 379 cases out of which 193 (50.92%) were males and 186 (49.08%)females with mean age of 48.80±4.51 years. Arrhythmias were detected in 175 (46.17%) cases.The most common arrhythmia was PVCs seen in 44 (11.61%) out of 379 cases. Arrhythmiasaffected more to age groups 30-45 years affecting 66 (58.9%) cases with p= 0.002 and thosewith BMI more than 30 (p= 0.01). The cases with DM and NSTEMI had it more with p= 0.02and 0.01 respectively. On stratification of different types of arrhythmia, the male gender wassignificantly associated with sustained VT and female with second degree HEART BLOCK. Theage group of 46-60 years was significantly associated with AF and sustained VT. Regardingdifferent type of ACS, NSTEMI as compared to STEMI was found significantly associatedwith VF, non-sustained VT, sustained VT and third degree heart block with p= 0.0001, 0.02,0.01 and 0.001. Conclusion: Acute coronary syndrome with arrhythmia is a well-encounteredcomplication presenting to the chest pain and coronary care units. Age group 30-45, higherBMI, and DM have significant association with different types of arrhythmias seen in patientsadmitted with ACS and PVC is the most common arrhythmia seen in ACS.
Chest pain is one of the most common presentations to the emergency and cardiology clinics and most serious of these is acute coronary syndrome (ACS) is a life threatening acute emergency. 1 There are a number of complications, which can cause death immediately in patients of ACS which include arrhythmias, cardiogenic shock, progressive heart failure, mechanical cardiac complications and repeat MI. 2-3 Objectives: To determine the frequency of different arrhythmias in patients with acute coronary artery syndrome in the first 24 hours of hospitalization.
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