Experiences of stigma among hepatitis B and C patients in Rawalpindi and Islamabad, Pakistan

Hepatitis B and C are chronic diseases with mental and social impacts which can result in poor quality of life. The aim of this study was to determine the experiences of stigma in a sample of hepatitis B- and C-positive patients in Pakistan. In a cross-sectional study, 140 inpatients and outpatients from 3 tertiary-care hospitals in Islamabad and Rawalpindi answered a semi-structured questionnaire about stigma experienced from relatives, friends, spouse and health-care providers, and about work/financial problems. The majority of patients [75%] said they had had to change their lifestyle, and significantly more were males than females. Stigma was marked in terms of disease transmission, with 66% of patients fearing that they could transmit the infection to others; 19% said that family members avoided sharing towels, soap and eating and drinking utensils. Marital relationships were affected for 51% of married patients who had told their spouse. Patients' comments showed a sense of family and societal discrimination resulting in feelings of disappointment and isolation

Torsion of fimbrial cyst

A case of fimbrial cyst torsion is presented in an 18-year-old virgin female. She presented with severe left lower abdominal pain. Ultrasound scan was suggestive of an ovarian cyst. On laparotomy, a large 22 x 22cm twisted leftfimbrial cyst was found and a left salpingectomy was performed. Although torsion of fimbrial cyst is rare, it should be considered in the diagnosis of acute abdomen in females

Role of mean corpuscular volume as screening test for thalassaemia in pregnant women at Isra University Hospital Hyderabad

To see the sensitivity, specificity, positive and negative predictive value of mean corpuscular volume [MCV] in screening for beta thalassemia minor in pregnant women attending antenatal clinic at Isra University Hospital [IUH] Hyderabad. This validation study was conducted at the department of obstetrics and gynecology Isra University Hospital Hyderabad from 1st November 2004 to 30th October 2005. Women were interviewed using a pre designed questionnaire regarding their demographic profiles and Gestational age at the time of presentation. On their first antenatal visit MCV were checked as less than or equal to 70 fl on complete blood picture. HbA2 level were assessed by Hemoglobin electrophoresis to find out the carrier of beta thalassaemia minor. The data was analyzed on SPSS vr 15. This study showed that MCV is a good screening test for beta thalassemia minor. Out of 100 screened subjects 53% had MCV less than 70 fl or equal to 70 fl. Positive MCV test [<70 fl] showed a sensitivity of 79% and specificity of 30% in screening for beta thalassaemia trait. The positive and negative predictive values were 56% respectively. Our study showed that MCV is 79.9% sensitive and 30% specific and positive and negative predictive value is 56% in detection of beta thalassaemia minor. It was found to be a good screening tool in pregnant women for beta thalassaemia. This test can be adopted in future as part of evaluation for sub fertility in all young women

Hepatitis C: frequency, risk factors and pregnancy outcome

To determine the frequency of HCV in pregnant women, to find out the risk factors for HCV in pregnant women and to compare the pregnancy outcome of HCV positive with HCV negative mother. Case - control study. Obstetrics and Gynecology Department of Isra University Hospital Hyderabad, from Nov 2007 to August 2008. Study was conducted on pregnant women who were screened for HCV antibody during antenatal consultation and were admitted for delivery. Five ml blood was drawn from each patient and serum was tested for anil HCV by ELIZA. Detailed history was taken for evaluation of risk factors. All results were analyzed on statistical software SPSS version 16. Fishers exact test or Chi square were applied among the categorical variables. Frequencies and percentages and 95% confidence intervals were calculated. Student t test was also used to compare the mean [2 tailed] of numerical parameters. P value of less than or equal to 0.05 was considered as significant. Frequency of hepatitis C in our study was 8% [n-23]. After computing the measures of association for cases and controls with regard to the risk factors, history of previous surgery [p=0.01], blood transfusion [p=0.02], dental surgery [p=0.004] and history of injections [p=0.01] were found to have significant association with HCV positive status of the patients. Logistic regression was used to control the effects of various risk factors under study and to find out the direct effect of risk factors on HCV positive status. Using logistic regression, history of previous surgery [p=0.01], blood transfusion [p=0.02], dental surgery [p=0.04] and history of injections [p= <0.001] were found to have significant association with HCV positively in our study. Statistically no significant difference was found in birth weight, gestational age and Apgar score of new bom in cases and control groups. Frequency of hepatitis C in our study was 8%. No adverse effect on pregnancy outcome was observed when compared to controls

Baseline leukocyte count and acute coronary syndrome: predictor of adverse cardiac events, long and short term mortality and association with traditional risk factors, cardiac biomarkers and C-reactive protein

The elevated WBC count has been accepted as part of healing response following myocardial infarction as well as a predictor of adverse cardiovascular events. The study was designed to find out correlation between WBC count and coronary risk factors, cardiac biomarkers, C-reactive protein [CRP], incidence of adverse cardiac events and mortality in patients of ACS in Pakistan. One hundred and thirty- three patients of ACS were stratified according to WBC categories, WBC1 [<700/mm[3]], WBC2 [7100-10, 000/mm[3]] and WBC [>10, 000/mm[3]]. The WBCs were counted on admission by Sysmex cell counter, CRP by immunoturbidimetric method, and CK-MB and Trop-I by enzyme immunoassay. Adverse cardiac events and mortality were recorded for 12 months of follow up period. Long term mortality in patients with ACS was 6.4% in WBC1, 18.2% in WBC2 and 40.9% in WBC3 categories, while short term mortality was 2.6%, 3.0% and 18.2% in WBC2 and 40.9% in WBC3 categories respectively. Relative to patients in lower 2 WBC categories, patients in the highest category were 7 times more likely to die during 30 days [HR 7.83, p=0.017] and more than 9 times during the total follow up period [HR 9.42, p<0.001]. Cox regression analysis showed WBC3 a strong independent predictor of mortality [HR 6.36, p=0.016]. WBC count showed a positive correlation with coronary risk factors, cardiac biomarkers and CRP. WBC count is a strong independent predictor of mortality in patients with ACS and has positive correlation with coronary risk factors, cardiac biomarkers and CRP

Attitude and knowledge of medical students of Isra university about dysmenorrhoea and its treatment

Dysmenorrhoea is the term for painful menstruation. It is a common gynaecological complaint among female adolescent. The objective of this study was to assess attitude and knowledge about treatment of dysmenorrhoea among medical students of Isra university. This study was conducted at Isra University Hyderabad. Non-probability, convenient random selection from MBBS student was done. Participants included were 18-25 years of ages, irrespective of marital status. Girls with irregular menstrual cycles, primary or secondary amenorrhea were excluded from the study. Pre-designed questionnaire was filled by the students. A total of 197 female medical students were recruited, dysmenorrhoea was reported in76%, of these 62.43% had primary and 13.19% has secondary dysmenorrhoea. Majority 89 [59.70%] of the girls had mild G1 to moderate 48 [32.21%] G2 dysmenorrhoea and twelve 8.05% were with severe dysmenorrhoea. The most common symptoms observed were abdominal cramps 94 [63%], irritability 91 [61.07%], headache 41 [24.5%] and vomiting 34 [22.8%]. Different attitudes of students were assessed, that 40.6% of subjects can not do their routine work and 19.3% remain absent from education place. Only 69.5% students were using commercial pads, 67% girls were not taking bath and 92.4% were not doing exercise during menstruation, only 15 [7.6%] were doing exercise from the study population. Simple analgesic was the most known drug to 49.7% of participants for relief of dysmenorrhoea pain. Dysmenorrhoea is a common problem among young girls, and it significantly affects their class attendance, academic performance and routine work. Even being medical students, strong cultural believes were observed regarding menstrual cycle. Attitudinal changes are necessary to develop, educational strategies, appropriate use of medications and consultation with physician, to empower these young girls regarding healthy life-style

Perinatal outcome in diabetic mothers at Isra university hospital

To evaluate perinatal outcome in diabetic mothers in our tertiary care set up. A descriptive study. Out patients department and labour ward of Obstetrics and Gynaecology Unit, Isra University Hospital Hyderabad, Sindh- Pakistan, from 3[rd] January 2007 to 2[nd] January 2008. Total 110 pregnant women between the age of 20 and 40 years with diabetes, irrespective of their parity and previous obstetric history were selected by convenience [non-probability] sampling. Women with eclampsia, antepartum haemorrhage, pregnancy induced hypertension and medical disorders were excluded from the study. All information was recorded on preformed proforma and analysed through SPSS version 11.0. Among perinatal complications, macrosomia was seen in 41.8% of fetuses, biochemical abnormalities in 85.3% infants, moderate to severe birth asphyxia in 33.6% and congenital malformations in 6 infants of diabetic mothers. Perinatal complications of diabetic pregnancy are more common in high parity women. Macrosomia, biochemical abnormalities and asphyxia are the common perinatal complications in our set up

Frequency of vaginal candidiasis in pregnant women attending routine antenatal clinic

To determine the frequency of vaginal candidiasis in clinically symptomatic and asymptomatic cases of pregnant women attending routine antenatal clinic. A descriptive cross-sectional study. The antenatal clinic of Gynaecology and Obstetric Department at Isra University Hospital, Hyderabad, from April to October 2005. A total of 110 pregnant women were nonrandomly recruited by convenient sampling. The studied variables included the demographic data information on parity, trimester of pregnancy, presence of vaginal discharge and the presence or absence of diabetes. Vulva and vagina were inspected for signs of inflammation and discharge with sterile speculum and vaginal specimens were collected with sterile cotton tipped swabs. Swabs were subjected to Gram staining and examined microscopically for the diagnosis of candidiasis. The frequency of vaginal candidiasis during pregnancy was found to be 38%, in which 27% were symptomatic and 11% were asymptomatic group. Increased ratio of infection was observed in multigravida and diabetic women. There was no marked differences in results with respect to age and trimester of pregnancy. Although there is generally a high frequency of vaginal candidiasis, an increased ratio of vaginal candidiasis in multigravida and diabetic pregnant women requires these women to be routinely screened for vaginal candidiasis regardless of symptomatic status

Coagulation profile in patients with breast cancer

Fifty subjects with breast cancer patients and 25 healthy control were included in this study. Routine hematological investigations i.e. Hb, TLC, platelets count were done by hematology analyzer and specific investigations like prothrombin time [PT], activated partial thromboplastin time [APTT] and fibrinogen level were performed by using commercially available kits. Results obtained were analyzed by using Student's 't' test and level of significance was done. Platelets count and fibrinogen levels were increased in breast cancer patients but PT and APTT were comparable with control group

audit of indoor morbidity and mortality in a medical ward at a tertiay care, hospital

There is a great geographical variation in disease burden around the world, which is due primarily to environmental, genetic, social and economic factors. Similar variations exist in worldwide mortality figures from a particular disease that can be attributed almost entirely to the access and efficacy of healthcare facilities. We did this audit to identify the major causes of morbidity and mortality in patients admitted in a medical unit of a tertiary care hospital and to highlight the importance of primary prevention. The audit was carried out in West Medical Ward Mayo Hospital Lahore, Pakistan from 1st January 2004 to 31st December 2004. All patients admitted with medical problems from the Outpatient and Emergency Departments were included. During the year 2004, a total of 2045 patients were admitted, out of which maximum number of patients admitted in the ward were suffering from chronic liver disease [17%] followed by ischemic heart disease [14.4%] cerebrovascular accidents [10.4%] and renal diseases. Total number of deaths were 321 with male mortality was 167 [14.40%] and female mortality 154 [17.40%]. Chronic liver disease also had the highest mortality [16.8%] followed by cerebrovascular accidents [14%], renal disease [11.5%] and ischemic heart disease [7.8%]. Even the mortality due to chronic liver disease was significantly higher [p <0.01] than ischernic heart disease. The number of patients having the four common diseases having age 45 years or more [770] was significantly greater [p <0.0001] then the number of patients [279] in the age range of 15 to 44 years. It was observed that significantly greater number of male patients [595] had morbidity than females [462], [p <0.0001], while mortality has no difference. Chronic liver disease, ischemic heart disease and cerebrovascular accidents are the diseases putting maximum burden on our health resources and disabling our productive population. This audit highlights the fact that all these three groups of diseases can be prevented and thus obviates the need of primary prevention of these major killers

Unreported urinary and anal incontinence in women

To know the occurrence of unreported urinary and anal incontinence in women and its relation with age, parity, pregnancy, childbirth and other factors. A descriptive study. Study was conducted at department of Obstetrics and Gynaecology, Isra University Hospital, Hyderabad from January 2002 to December 2003. Convenience sample of 858 women was taken to fill in a pre-formed questionnaire. All those who presented with urinary or anal incontinence were excluded from the study. The main outcome measures included occurrence and duration of incontinence as well as its relation to age, parity and other factors. Out of 858 women included in the study, 207 [24.12%] women admitted to have incontinence; 205 [23.89%] had urinary incontinence, 21 [2.44%] women had anal incontinence and among these there were 19 [9.26%] women having combined urinary and anal incontinence. One hundred and thirty eight [67.31%] females were between 21-40 years of age and 109 [53.17%] were between para 1-5. Eighty-one [39.51%] subjects had urinary incontinence for 5-10 years and 09 [42.85%] females had anal incontinence for 10-15 years. Sixty-nine [33.65%] women related the onset of urinary incontinence and 13 [61.90%] related the beginning of anal incontinence to first vaginal delivery. Other events related to the onset of incontinence included first pregnancy, second vaginal delivery, chronic cough, obesity, vaginal prolapse and menopause. Many women attending the Obstetrical and Gynaecological Outpatients department have symptoms of urinary and anal incontinence, but do not complain about these unless asked specifically. It is therefore, important for the gynecologist to ask direct questions regarding bowel and bladder dysfunction to identify such patients

Polycystic ovarian syndrome and hyperinsulinaemia

To determine the occurrence of hyperinsulinaemia in women with polycystic ovarian syndrome [PCOS]. A descriptive study. Isra University Hospital, Hyderabad from January 2002 to December 2003. Total 64 subjects were recruited from gynaecological outpatients department, between the ages of 15 and 40 years with clinical diagnosis of polycystic ovarian syndrome, presenting with weight gain, oligomenorrhoea, secondary amenorrhoea, hirsuitism or infertility and either ultrasound evidence of PCOS or raised Leutinizing Hormone [LH]/ Follicular Stimulating Hormone [FSH] ratio. Patient's venous blood was checked for fasting serum insulin. Out of total 64 women selected, 37[57.81%] were between 21 - 30 years of age. Weight gain was the commonest presenting complain [84.37%] followed by oligomenorrhoea [79.68%]. Infertility was found in 46 women [71.87%] and hyperandrogenism was observed in 43 women [62.49%]. Thirty-nine women [60.93%] had ultrasound evidence of PCOS and 43 [67.18%] had LH / FSH ratio greater than 2:1. Hyperinsulinaemia was seen in 27 [42.19%] women. In this study, 27 women [42.19%] had hyperinsulinaemia which indicates significant insulin resistance. Thus, all the patients presenting with clinical or biochemical evidence of PCOS must undergo checking of fasting serum insulin levels

Seis años de estudio: 537 hernioplastias inguinales libres de tensión / Six years of study: 537 tension-free inguinal hernioplasties

Se presentan los resultados con la técnica Lichtenstein para reparación de hernias inguinales, realizadas en 502 pacientes del hospital Dipreca. La serie está constituida por 454 hombres y 48 mujeres, con una edad promedio de 54,3 años (14 a 89 años). La ubicación fue derecha en 263 pacientes (52,4 por ciento), izquierda en 240 (47,8 por ciento). Del total de hernias, 475 hernias fueron primarias (88,5 por ciento) y 62 (11,5 por ciento) fueron recidivadas. El tamaño del defecto herniario se protocolizó, en tres grupos: ôAõ, hasta 2 cm, (35,6 por ciento); ôBõ, de 2 a 4 cm, (42,3 por ciento) y ôCõ, mayor de 4 cm, (22,1 por ciento). Los resultados fueron: complicaciones postoperatorias (8,6 por ciento). Hubo 6 recidivas, con una tasa global de 1,1 por ciento 0,4 por ciento para las primarias y 6,5 por ciento para las recidivadas. En un 9,6 por ciento se asocio una segunda cirugía. No hubo mortalidad.

experimental study of albino rats fed on nigella sativa and aspirin for four weeks duration: determination of coagulation profile

Ninety albino rats were selected and were divided into six groups on the basis of different diets given. Control group [I] was fed on synthetic diet and experimental groups [IIA, IIB, IIC, IID and IIE] were fed on 1 mg aspirin, 15mg, 30 mg, 45 mg Nigella Sativa per kg body weight respectively while HE was given 30 mg NS and 1 mg aspirin/kg body wt. Blood samples were collected by heart puncture and Coagulation parameters were done. BT was prolonged in groups taking aspirin only. APTT was reduced significantly in groups taking different concentration of NS when compared with control. Percentage of clot retraction was weak significantly in groups taking aspirin only when comparing with other groups

Insecticide-impregnated bed nets: a new tool for malaria prevention and control- an old strategy with new perspectives

Malaria is one of the major vector-borne diseases in many parts of the World. With the development of resistance of Plasmodium falciparum to drugs mosquito vector species to insecticides, the problem has become more critical. At present the emphasis is on the implementation of sustainable control by community participation through primary health care systems. One of the simple technologies which can be implemented with community assistance is the use of pyrethroid impregnated bed nets for protection against mosquito bites. Trials carried out in many countries have shown, that if properly used, such treated-nets are cheap, socially acceptable and effective for prevention against malaria. This paper presents a brief introduction to impregnated bed nets with particular reference to malaria control

Colecistectomía laparoscópca: experiencia del hospital DIPRECA en 700 casos / Laparoscopic cholecystectomy: experience of DIPRECA hospital in 700 cases

Desde marzo de 1991 a julio de 1992 se han realizado 700 colecistectomía laparoscópicas consecutivas en nuestro hospital. Nuestra población está constituída en un 66 por ciento por mujeres con un promedio de edad de 47 años. El 95,2 por ciento de los enfermos presentaba una colecistitis crónica, que motivó cirugía electiva. En 27 casos (3,8 por ciento ) el diagóstico preoperatorio fue colecistitis aguda. La técnica francesa se utilizó en el 61 por ciento de los casos y la americana en grupo restante. Se observó un 93 por ciento de éxito en efectuar la colecistectomía laparoscópica (646/700) siendo necesario convertir a colecistectomía abierta en el 7 por ciento por diversas complicaciones o hallazgos intraoperatorios. Se estudió radiológicamente la vía bibliar en el intraoperatorio en el 13 por ciento de los casos, observándose cálculo en el colédoco en el 15 por ciento de este grupo. Las complicaciones intraoperatorias incluyen, ruptura de la vesícula biliar en el 6,5 por ciento , lesiones vasculares (2,5 por ciento ) y de vía bibliar principal en el 0,7 por ciento . Las complicaciones postoperatorias alcanzan un 0,7 por ciento (5 reoperaciones). La estadía postoperatoria promedio fue de 2,3 días para la cirugía laparoscópica y de 6,2 días para los casos que requirieron método clásico