IntroductionParaphenylene diamine (PPD) ingestion is manifesting as one of the more common ways of committing suicide in Southern Punjab, Pakistan, especially Bahawalpur. PPD is an ingredient of a compound commonly known “Kala Pathar” which means “Black Stone” in Urdu. It is readily available in the market at low cost and is used to dye hair and fur. Its intoxication inhibits cellular oxidation and affects the muscles causing rhabdomyolysis. This leads to myoglobinuria followed by renal failure and edema of face and throat resulting in respiratory difficulty. Very little is known about the impact of PPD intoxication on liver tissue.ObjectiveThe purpose of the study was to find out the frequency of acute hepatitis following PPD intoxication.MethodsWe reviewed the medical records of 109 patients with PPD intoxication admitted to Medical Unit-2, Bahawalpur Victoria Hospital from January 1, 2015, to June 30, 2015, in a descriptive, cross-sectional study. We noted the frequency of acute hepatitis and other complications, and we recorded the demographic features, clinical features, and outcomes of these patients.ResultsOur study included 32 men (29%) and 77 women (71%). The mean age was 22 ± 3.4 years, and most patients were young women aged 15 to 24 years. Suicidal ingestion was the leading cause of admission for 101 patients (93%). The most common clinical presentation was cervicofacial edema (95%), throat pain (88%), dysphonia (95%), cola-colored urine (100%), and oliguria (95%). Rhabdomyolysis (86%), acute hepatitis (51%), and acute renal failure (63%) were the most common clinical conditions following poisoning. Overall mortality was noted in 39 patients (36%) while all other patients achieved complete clinical recovery (64%). In patients with mortality, 20 of 39 (51%) developed acute hepatitis. Most patients (95%) in our study underwent tracheostomy.ConclusionThe frequency of acute hepatitis in PPD intoxication is high in this population, especially in young women. Measures need to be instituted regarding the management of acute hepatitis in PPD intoxication to improve patient outcomes. Workups in patients with PPD poisoning should include regular monitoring of aspartate aminotransferase and alanine aminotransferase to observe any damages to the liver so that acute hepatitis can be managed in a timely fashion.
Self-medication with antibiotics is a most rapidly emerging problem especially in developing countries like Pakistan. Antibiotics are easily accessible to the general public without consulting any practitioner even without prescriptions. So there are many risks linked to the inappropriate use of antibiotics. The main aim of this study was to assess the wrong practice of self-medication in public sector universities of southern Punjab. The current study also compares the self-medication practices in various departments of universities. A validated questionnaire was used to collect data. Descriptive statistics were used to analyze the data and inferential statistics (chi-square test). The study was included data from 900 students including both males and females from various departments. Among 900 students, 450 students of medical while 450 were non-medical students. Frequency of self-medication was found to 57 %. The antibiotics more frequently use for self-medication were Augmentin (37 %), Amoxicillin (23 %). Fever and cough were the most frequent indication for the use of self-medicated antibiotics. Because of their sufficient knowledge of pharmacology, most students were self-medicated (40%). Academic knowledge is the principal source of antibiotic information (60%). Just (39%) of the students thought that self-medication is part of the self-core, 31% of the students perceived that the availability of non-prescription drugs could prevent the growing trend of self-medication with antibiotics. 30% of students perceived that antibiotics were aware of the harms of self-medication or informed about them. Based on this study, it can be concluded that a high proportion of medical students and non-medical students use antibiotics without medical prescription and such practices are more common in the general public sector.
Background: Patients with liver disorders are often found to have deranged lipid profile. Clear decline is observed in the levels of cholesterol as well as TG among individuals having severe hepatitis and liver failure as synthesis of lipoprotein is reduced. This study was done to determine the frequency of dyslipidemia and the mean lipid profile values in patients of liver cirrhosis.Methods: A cross sectional, descriptive study, done at the Department of Medicine, Medical Unit-1, Bahawal Victoria Hospital, Bahawalpur, from July to December 2019. A total of 246 patients presented with cirrhosis of liver of age 20-60 years and both genders were included. Analysis for serum total cholesterol (TC) level, serum triglycerides level, low density lipoprotein (LDL) and high density lipoprotein (HDL) were done and findings were noted.Results: Mean age was 51.67±6.21 years. Out of the 246 patients, 153 (62.20%) were male and 93 (37.80%) were females with male to female ratio of 1.6:1. Mean values of lipid were, LDL cholesterol 95.76±29.65 mg/dl, HDL 43.37±11.46 mg/dl, TC 147.51±42.69 mg/dl and TG 101.29±21.59 mg/dl. Dyslipidemia was found in 59 (23.98%) patients, whereas there was no dyslipidemia in 187 (76.02%) patients.Conclusions: Frequency of dyslipidemia in cirrhotic patients is high. Evaluating patients of liver cirrhosis, dyslipidemia need to be considered for early recognition and analysis.
Background Dengue is the most common vector-borne disease worldwide. It poses a significant health burden in tropical and subtropical countries. Common clinical presentations include retro-orbital pain, fever, headache, nausea, vomiting and aches and pains in the body. A severe form of dengue fever is known as dengue hemorrhagic fever (DHF) that includes signs of hemorrhage. Besides the typical signs and symptoms, atypical presentations of dengue include myositis, hepatitis and encephalitis. Hepatic involvement in dengue has varied presentations. This study aims to highlight the importance of acute hepatitis, an atypical presentation in dengue patients. Methods We conducted a descriptive, cross-sectional study in the Medical Unit-1 of Bahawal Victoria Hospital, Bahawalpur, a tertiary-care hospital serving the area of Southern Punjab, Pakistan. The relevant medical records of 63 patients admitted with dengue-associated hepatitis to the Medical Unit-1 of Bahawal Victoria Hospital, Bahawalpur, between January 1, 2015 and December 1, 2016, were reviewed. Informed consent was given. Information regarding demographic variables and disease course was collected and analyzed. Results This study included 55 men (87.3%) and eight (12.7%) women. Fifty (79.3%) patients were diagnosed with dengue fever (DF). Thirteen patients were managed on the lines of DHF. Out of the total 63 patients, only six were locals. The common clinical presentations in these patients included high fever, retro-orbital pain, severe headache, rash, dark-colored urine, bleeding problems and hepatomegaly. Higher levels of aspartate aminotransferase (AST) were noted in comparison to alanine transferase (ALT). Despite the complicated clinical course in some patients, all patients were managed successfully and discharged, except one. Conclusion The frequency of acute hepatitis in dengue patients is high, especially in young men. Early diagnosis and prompt treatment are necessary for better prognosis. Although no specific treatment guidelines are available, supportive treatment in a timely fashion can prevent complications. Transfusion with packed cell volume (PCV) and N-acetyl cysteine (NAC) has produced promising results.
Objective: Objective was to determine whether the outcome of ischemic stroke is different or not in diabetics than nondiabetics. Study Design: Prospective observational. analytical study Study place and Duration; It was conducted in medical unit-2 Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College Bahawalpur from October I, 2004 to September 30. 2005. Patients and methods: 132 patients of ischemic stroke, confirmed by CT scan, were enrolled during one year study period. The patients of hemorrhagic stroke, TlA, focal deficits of non-vascular origin and infratentorial lesions were excluded. Patients were devided into two groups; diabetics and nondiabetics and were studied regarding their in hospital outcome according to the modified Rankin Scale. The variables applied were age, sex, hypertension and type of infarct (lacunar/cerebral). Results: Out of 132 ischemic stroke patients 36 (27%) were diabetics and 96 were nondiabetics. Hjipertension was present in 83 (62%). Overall mortality wa s 11.3%. Mortality was significantly more frequent in diabetics than nondiabetics (16.6% Vs 9.3% p<0.05). Disability was also more frequent in diabetics (25% Vs 13.5% p<0.05). In diabetic group good recovery (8.8% Vs 12.5%) as well as partial recovery (50% Vs 64.5%) was less frequent. Patients <40 years were few in number with good recovery in both diabetics as well as nondiabetics. Diabetics of 40-60 years were found to have significantly high number of deaths (15.3% Vs 7% p<0.05) and disability (15.3% Vs 10.7% p<0.05) than non-diabetics. Similar pattern was seen in patients >60 years. Increasing age was found to be associated with poor outcome in both the groups but poorer in diabetics. Sex did not discriminate the poor outcome in diabetics. The presence of hypertension worsened the out come in both the groups but more in the diabetic group both in term of mortality (20.8% Vs 11.8% p<0.05) as well as disability (33.3% Vs 15.2% p<0.05). Lacunar infarct was found in few patient with good prognosis while cere bral infarct was associated with poor prognosis and put the diabetics at higher risk in term of mortality (17.6% Vs 9.8% p<0.05) as well as disability (26.4% Vs 14.2% p<0.05). Conclusion: Diabetes Mellitus is associated with poor outcome of ischemic stroke patients both in terms of mortality and morbidity during acute hospitalization. Hypertension. increasing age and large infarct size further worsens the outcome.
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