Iqbal Haider

Psoriatic Arthritis Is an Indicator of Significant Renal Damage in Patients with Psoriasis: An Observational and Epidemiological Study

Background. Psoriasis affects joints in around 30% of the patients. Recent studies have demonstrated an increased risk of essential hypertension, ischemic heart disease, and stroke in psoriatic patients. However, the prevalence of renal disease in patients with psoriasis has not been evaluated properly. Objectives. Objectives were to evaluate renal functions in patients with psoriasis and to assess any possible relationship of renal failure with psoriasis and psoriatic arthritis. Methods. In this cross-sectional study, 30 participants were recruited into the following three groups: group-A, psoriatic arthritis; group-B, psoriasis without arthritis; and group-C, healthy subjects. Renal function tests were performed for every participant of each group. The data was analyzed by using SPSS version 16. Chi-squared and one-way ANOVA tests were applied, considering a P value of less than 0.05 as a standard criterion. Results. Serum creatinine, urea, and phosphate were the highest in group-A, higher in group-B, and normal in group-C, P < 0.05. Similarly, GFR was the lowest in group-A, lower in group-B, and normal in group-C. The difference in mean GFR values was statistically significant, F(2) = 355, P < 0.001. Moreover, proteinuria (gm/day) was seen in 96.7% of the patients with psoriatic arthritis, (M = 1.18 ± 0.55, P < 0.05) against 10% of the psoriatic patients without arthritis (M = 0.41 ± 0.10, P < 0.05). Conclusion. Derangement of renal function is more prevalent in psoriatic patients, especially in those with concomitant psoriatic arthritis. Therefore, each psoriatic patient must be routinely screened for an underlying renal failure.

High prevalence of the risk factors for QT interval prolongation and associated drug–drug interactions in coronary care units

ABSTRACT Objectives: Patients admitted in coronary care units are susceptible to QT interval prolongation due to numerous risk factors. The purpose of this study was to identify the prevalence of risk factors for QT interval prolongation; QT prolonging medications; drug–drug interactions; their predictors; and torsades de pointes risks of drugs. Methods: After obtaining approval, this cross-sectional study was carried out during one-year period in coronary care units of two major tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. The Arizona Center for Education and Research on Therapeutics QT drugs lists and Micromedex DrugReax® were used to identify the QT prolonging medications and QT prolonging drug–drug interactions. Results: Total 649 patients were included in this study. The most frequent QT prolonging risk factors included use of ≥ 1 QT prolonging drugs (74.9%) and myocardial infarction (61.3%). Total 181 patients were presented with 361 QT prolonging drug–drug interactions. There was significant association of the occurrence of QT prolonging drug–drug interactions with female gender (p = 0.01), 9–10 prescribed medications (p = 0.001), and > 10 prescribed medications (p < 0.001). Conclusions: The majority of patients presented with multiple risk factors for QT prolongation in coronary care units which may precipitate lethal outcomes.

Potential drug-drug interactions in outpatient department of a tertiary care hospital in Pakistan: a cross-sectional study

BackgroundPotential drug–drug interactions (pDDIs) are one of the preventable drug related problems having the risk of serious adverse events or therapeutic failure. In developing countries like Pakistan, this issue remains poorly addressed. The objective of this study was to explore prevalence of pDDIs in the Outpatient Department (OPD) of a tertiary care hospital in Pakistan. The secondary aim was to describe the levels of reported pDDIs and develop a list of widespread clinically relevant interactions.MethodsPrescriptions of 2400 OPD patients were analyzed for pDDIs through Micromedex Drug-Reax®. Prevalence, severity- and documentation-levels and widespread clinically relevant interactions were reported.ResultsOf total 2400 prescriptions, pDDIs were present in 22.3%. Whereas, moderate- and major-pDDIs were found in 377 (15.7%) and 225 (9.4%), respectively. PDDIs were more prevalent in Medicine (9.2%) and Cardiology (2.6%) as compared with other OPD specialties. Total 942 pDDIs were identified, of which, the majority were either moderate- (61.9%) or major-pDDIs (32.1%). Some of the most common interactions were ibuprofen + levofloxacin (n = 50), ciprofloxacin + diclofenac (32), aspirin + atenolol (24), and diclofenac + levofloxacin (19). The potential adverse outcomes of widespread interactions were seizures, bleeding, QT-interval prolongation, arrhythmias, tendon rupture, hypoglycemia/hyperglycemia, serotonin syndrome, drug toxicity, and decreased therapeutic response.ConclusionsOPD patients were at risk to pDDIs, particularly to major- and moderate-pDDIs. Screening of prescriptions for pDDIs and monitoring of pharmacotherapy in terms of response and associated adverse drug events will contribute to patient safety.

Potential drug-drug interactions in pediatric patients admitted to intensive care unit of Khyber Teaching Hospital, Peshawar, Pakistan: A cross-sectional study

Purpose To investigate frequencies, levels, clinical relevance and predictors of potential drug‐drug interactions (pDDIs) in pediatric intensive care unit (PICU). Methods Case notes of 411 patients were reviewed for pDDIs through Micromedex. Frequencies, levels and clinical relevance of pDDIs were reported. Logistic regression was applied to calculate the odds‐ratios for predictors of pDDIs. Results We recorded pDDIs in 59.4% patients. Major‐pDDIs were found in 34.5% patients. Total 990 pDDIs were identified, of which, 37.8% were of moderate‐severity and 30.6% of major‐severity. Patients case notes of top‐ten pDDIs showed presence of signs/symptoms such as fever, jaundice, vomiting, anorexia, tachycardia, drowsiness, & lethargy; and abnormalities in labs such as total leukocytes count, blood urea nitrogen, alanine aminotransferase, & potassium‐level. Odds of exposure to major‐pDDIs were significantly higher in patients aged 6–12 years (p = 0.008); hospital stay of ≥ 7 days (p = 0.05); and ≥ 11 prescribed medicines (p < 0.001). Conclusion Substantial numbers of patients in PICU are exposed to pDDIs. Major‐pDDIs are of particular concern. Timely identification of pDDIs, preferably with computerized source, is crucial point for their management. Monitoring of clinically relevant parameters and identification of various predictors are needed to minimize or prevent the associated negative consequences of pDDIs. HighlightsConsiderable number of pediatric patients in ICU presents with pDDIs. Major‐pDDIs are of particular concern.Use of computerized DDIs screening system in pediatric ICU are very useful to identify pDDIs.Rational prescribing can be promoted by giving proper consideration to the identified contraindicated and major‐pDDIs.Patients’ monitoring‐plan should include monitoring parameters for pDDIs as well.

AN ATYPICAL PRESENTATION OF HYPEROSMOLAR NON-KETOTIC COMA

Diabetes is a common ailment in our world. It has some atypical presentations as well; one of them is hemiballismus-hemichorea. Here we report a case of newly diagnosed diabetic patient presenting as hemiballismus-hemichorea secondary to hyperosmolar non-ketotic coma. Her MRI brain showed T1 high signals in right basal ganglia and corona radiata suggestive of metabolic derangement. These symptoms may take from months to years to resolve. It has a good prognosis if it is recognised early and treated effectively.

Coexisting giant splenic artery and portal vein aneurysms leading to non-cirrhotic portal hypertension: a case report

BackgroundSplenic artery aneurysms are the commonest visceral and third most common abdominal artery aneurysms, having a strong association with both pregnancy and multiparity. Here we report possibly the first case of a giant splenic artery aneurysm in association with a smaller portal vein aneurysm, in a woman who had never conceived, leading to non-cirrhotic portal hypertension.Case presentationA 40-year-old Pakistani Asian woman who had no evidence of liver cirrhosis presented in April 2016 for a diagnostic workup of ascites, massive splenomegaly, and pancytopenia. An abdominal ultrasound followed by computed tomography angiography showed a giant aneurysm in her splenic artery and another smaller one in her portal vein.She underwent splenectomy and excision of the splenic artery aneurysm. Surgical findings included a giant splenic artery aneurysm pressing on her portal vein and causing its aneurysmal dilatation. On her first review in July 2016, she was generally in good health, ascites had subsided, and her full blood count was normal. Her portal vein aneurysmal dilatation, which was presumed to be secondary to the pressure effect from the splenic artery aneurysm, had shrunken remarkably in size.ConclusionA giant splenic artery aneurysm can cause non-cirrhotic portal hypertension and should be treated with splenectomy and aneurysmectomy.

Lujan-Fryns Syndrome (LFS): A Unique Combination of Hypernasality, Marfanoid Body Habitus, and Neuropsychiatric Issues, Presenting as Acute-Onset Dysphagia.

Background Lujan–Fryns syndrome (LFS) is an extremely rare, X-linked disorder, for which the full clinical spectrum is still unknown. Usually, it presents with neuropsychiatric problems such as learning disabilities and behavioral issues in a typical combination with marfanoid features. Often, there is a positive family history for the disorder. However, sporadic cases have also been reported in males. More interestingly, there is no case of LFS presenting with acute-onset dysphagia in the English language medical literature. Case Presentation A 17-year-old Pakistani mentally normal school boy was admitted for the workup of acute-onset dysphagia, hypernasal speech, and nasal regurgitation of liquids. He had no neuropsychiatric issues, and his family history was unremarkable. An obvious nasal twang, facial dysmorphism, and marfanoid body habitus were found on examination. The genetic tests revealed a pathogenic missense mutation in the MED12 gene on his X-chromosome. Conclusion LFS can present as acute-onset dysphagia and in the absence of any neuropsychiatric issues or positive family history of the syndrome.