Chandka Medical College

About: Chandka Medical College is a education organization based out in Larkana, Pakistan. It is known for research contribution in the topics: Population & Outpatient clinic. The organization has 106 authors who have published 108 publications receiving 1170 citations.

Natural infection of the sand fly Phlebotomus kazeruni by Trypanosoma species in Pakistan.

Abstract: The natural infection of phlebotomine sand flies by Leishmania parasites was surveyed in a desert area of Pakistan where cutaneous leishmaniasis is endemic. Out of 220 female sand flies dissected, one sand fly, Phlebotomus kazeruni, was positive for flagellates in the hindgut. Analyses of cytochrome b (cyt b), glycosomal glyceraldehyde phosphate dehydrogenase (gGAPDH) and small subunit ribosomal RNA (SSU rRNA) gene sequences identified the parasite as a Trypanosoma species of probably a reptile or amphibian. This is the first report of phlebotomine sand flies naturally infected with a Trypanosoma species in Pakistan. The possible infection of sand flies with Trypanosoma species should be taken into consideration in epidemiological studies of vector species in areas where leishmaniasis is endemic.

Frequency and transmission mode of hepatitis C virus in northern Sindh.

Abstract: OBJECTIVE To study the frequency of hepatitis C and mode of transmission in patients of chronic liver disease (CLD). DESIGN A descriptive, non-interventional study. PLACE AND DURATION OF STUDY The study was conducted in the department of Medicine, Chandka Medical College Hospital, Larkana over a period of 6-year (January 1997-December 2002). PATIENTS AND METHODS The study included 1074 patients of chronic liver disease admitted to the department of medicine due to HCV. Their variables were recorded and analyzed. RESULTS A total of 1074 patients, comprising of 564 of chronic hepatitis (group I) and 510 of cirrhosis liver (group II) respectively were studied. The male to female ratio was 2:1 in both groups. Anti-HCV antibody was present in 51% in group I and 57% in group II. Use of syringes (62%) was an important risk factor. CONCLUSION HCV is a leading cause of CLD. The leading risk factor identified is the use of contaminated syringes.

Pyrazinamide induced hyperuricemia in patients taking anti-tuberculous therapy.

Abstract: Objective To record the effect of pyrazinamide on uric acid in patients of tuberculosis. Design Descriptive and observational study. Place and duration of study Chandka Medical College Hospital, Larkana from February 2000 to January 2003. Patients and methods All patients receiving anti-tuberculosis drugs with pyrazinamide were included. Serum uric acid levels were monitored at weeks 0, 2, 8 and 12 of therapy. Serum creatinine was done at weeks 0, 8 and 12. Results Results were reported on 216 patients. Mean uric acid and creatinine levels at the start of therapy, i.e., week '0' were 5.07 -/+ 0.57 mg/dl and 0.87 -/+ 0.11 mg/dl respectively. The results show significant increase in uric acid levels from week '0' to week '2', at the end of week '8', the levels remained elevated and there was no statistical significant difference from that at week '2'. The uric acid levels reduced at week '12' after pyrazinamide was stopped and the difference was significant. Despite that renal function steadily improved with the treatment of tuberculosis to the extent that comparable pre-treatment values were obtained at the end of treatment. Conclusion Anti-tuberculous therapy with pyrazinamide affects the uric acid levels early. This change is reversible after the withdrawal of the agent.

Precipitating Risk Factors, Clinical Presentation, and Outcome of Diabetic Ketoacidosis in Patients with Type 1 Diabetes.

Abstract: Introduction Over the past few years, there have been drastic advancements in the management of type 1 and 2 diabetes mellitus (DM). Prevention of complications is a prime concern of all physicians dealing with DM. However, whether or not these interventions have helped in reducing the incidence of diabetic ketoacidosis (DKA) in patients with type 1 DM, is still an unanswered question. The aim of this study is to assess the clinical pattern of DKA, evaluate its outcomes, and study the predictors of outcome. Methods The study was conducted as a prospective, observational one in the department of medicine of a tertiary care hospital from July-December 2018. Patients of type 1 DM presenting in the emergency department with DKA were evaluated for their predisposing factors, clinical presentation, biochemical parameters, rate of mortality, and predictors of mortality. Data was processed through and analyzed using IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., Armonk, NY). Results The common clinical presentations include severe vomiting (32.2%), abdominal pain (27.9%), and depressed mental state (DMS) (26.8%). Infections (36.5%) and inadequate insulin dose (22.5%) were frequently seen as the predisposing factors. In one-fourth of the patients, this episode of DKA was the first presentation of DM (26.8%). The rate of mortality was 23.6%. The predictors of mortality included DMS, markedly low pH and serum bicarbonate, and high serum potassium at the time of presentation, random blood sugar >300 mg/dL and urine positive for ketones even after 12 hours of medical intervention, >50 international units (IU) insulin requirement within the first 12 hours, >6L fluid replenished within the first 24 hours, and new onset of fever within the first 24 hours. Conclusion The clinical presentation of DKA is not stark and vague signs such as generalized fatigue, nausea vomiting, abdominal pain, and DMS should raise suspicion. Underlying infections and inadequate insulin regimen predispose to acute DKA attack. Rate of mortality is high in these patients. Morality may be predicted by various clinical and biochemical parameters.

Role of percutaneous nephrostomy (PCN) in malignant ureteral obstruction.

Abstract: Objective To assess whether PCN placement in patients having malignant ureteric obstruction can provide patient benefit or increase morbidity. Methods A prospective study was conducted in the department of Urology CMCH Larkana from 1st January 2004 to December 2006. Patients having malignant ureteric obstruction admitted in our department either directly or referred from other departments with deranged renal functions and in whom retrograde ureteria catheterization had failed, were included. PCN was placed by the standard technique. Results A total forty (40) patients fulfilled the criteria for initial PCN placement for their malignant ureteral obstruction. There were 20 males and 20 females with an age range from 21 to 70 years. Of the 40 patients 17 (42.5%) presented directly in this department, with 10 (25%) having anuria and 7 (17.2%) with symptoms of uraemia. Among them ten patients were already diagnosed cases, and seven were diagnosed in our ward. The remaining 23 patients (57.5%) were referred by other departments and were diagnosed cases of malignancy. It was from this study that patients having early or urogenital malignancies benefited from the PCN placement while patients with advanced malignancies and nonurogenital malignancies showed poor response. The median survival in urogenital malignancies was about 350 days (range was 150-700 days), and in non urogenital malignancies except lymphoma it was about 25 days. (Range was 7-80 days). Loss of nephrostomy catheter was the most frequent complication observed in this series. Conclusions PCN is an excellent initial procedure for relieving the malignant urinary obstruction with minimal complications. It was concluded from this study that patients having early or urogenital malignancies benefit from PCN placement while patients who have advanced malignancy or non-urogenital malignancies showed poor response. Also patients treated for primary neoplasia that can still be treated with other therapeutic modalities especially radiotherapy, chemotherapy and hormone therapy can also benefit from the procedure.