Prevalence of HCV genotypes in patients reporting in tertiary health care hospital of Karachi

The present study was designed to see the variables which may affect the conventional treatment outcome by injection interferon in chronic hepatitis "C" patients. Among these variables hepatitis "C" genotype is most important, as it influences the duration and dosage of anti-viral therapy. To determine the frequency distribution of HCV genotypes, a study was conducted in a tertiary care centre of Karachi, the largest metropolitan city of Pakistan, where people of all ethnic origins are found. All the HCV positive patients, including impatient admitted in hospital and outpatients, more than 18 years of age, reported for genotyping of HCV in the clinical laboratory of Dr. Ziauddin Hospital from May 2009 to April 2010 were studied. HCV genotyping was performed on a total of 457 patients who tested positive for presence of Hepatitis "C" viral RNA. The most prevalent genotype was type 3 with 392 [85.8%] cases, followed by type 1 with 51 [11.2%] cases. There were only two cases with a co-infection of type 1 and 3, while genotype 2,4 and 5 were also seen in a few cases. Among the cases studied, there were higher proportion of females 276 [60.4%], dominating the HCV infected population. The present study revealed that genotype 3 was the most common genotype in patients with HCV infection in Karachi. Other genotypes were also present in the patients infected with HCV, but were of lesser frequency. To prevent the treatment failure it is advisable that before commencement of therapy, the genotype of the patient should be established so that appropriate treatment in correct dosage for optimal duration of time of time could be instituted

Allium sativum Linn a review of its pharmacological attributes

Garlic, a member of the lily family, is a perennial plant that is cultivated worldwide. The garlic bulb is composed of individual cloves enclosed in a white sheath or skin. It is the bulb, either fresh or dehydrated, that is used as a spice or medicinal herb. The garlic oil is obtained by steam distillation of the crushed fresh bulbs

Pattern of aetiological and predisposing factors regarding carcinoma breast

To study the pattern of aetiological and predisposing factors regarding Carcinoma Breast. Prospective, descriptive study from Jan. 2001 to Jan. 2006. Surgical Unit IV, Civil Hospital, Karachi. All the biopsy proven cases of Carcinoma Breast were included. The relevant data regarding history, risk factors, examination and treatment was recorded and analyzed. The total number Carcinoma Breast cases were 54. Out of these 37[68.5%] were under the age of 50 years and 45[83.3%] belonged to the lower socio-economic group. The mean age at menarche was 13.4 years and at menopause 45.13 years. Nine [16,6%] patients had a positive family history of breast carcinoma or other malignancies, and four [7.4%] patients were nulliparous. None of them had a history of long term use of hormonal therapy i-e oral contraceptives or hormone replacement therapy. The established risk factors like early menarche, late menopause, old age, nulliparity, family history, low socio-economic status differed from the international data. It, therefore, seems worthwhile that a larger scale, multicentric study should be conducted to verify and explain these patterns in our population

Bowel injuries secondary to induced abortion: a dilemma

To study the pattern of bowel injuries incurred by induced abortion, and the morbidity and mortality associated with them. Prospective descriptive study from December 2002 to December 2005. Surgical Unit three Gynaecology and Obstertrics Unit two, Civil Hospital, Karachi. All patients with bowel injuries due to induced abortion. Detailed data of all the patients was collected and analyzed. A total of 22 patients, mostly young with an average age of 26.86 years, presented with bowel injuries following induced abortion. Severe hemorrhage occurred in 8[36.4%] patients while 11[50%] had ileal perforation; 9[40.9%] underwent primary repair and 2[9.1%] ileostomy formation. Two [9.1%] patients with jejunal perforation had primary repair, whereas two with both jejuna and ileal perforations underwent resections with anastomosis in one and ileostomy in another. Seven [31.8%] with large gut involvement had colostomy formation. Septicemia and wound infection occurred in 7[31.8%] patients each, faecal fistula and abdominal wound dehiscence in 3[13.6%], and pelvic abscess in 1[4.6%] patients. The total mortality in this series was 6[27.3%] patients. Iatrogenic injuries during induced abortion, most commonly caused by quacks, can be minimized substantially if the procedure is performed by qualified medical personnel in proper health care facilities. There is a need for radical overhauling of the mind set in our society together with legislation

Disease pattern at the paediatric opd of shifa ul-mulk memorial hospital, hamdard university, madinat Al-Hikmah, Karachi

To study disease prevalence and determine disease pattern in the 28 villages around Madinat al-Hikmah, a retrospective study has been carried out at the Department of Clinical and Pre-Clinical Sciences, Shifa ul-Mulk, Memorial Hospital, Hamdard University, Madinat al-Hikmah, Karachi, Pakistan. Three groups have been made on yearly basis from January 2001-June 2003. Review has also been conducted according to age, sex and disease pattern. It was found that respiratory and diarrhoeal diseases top the list. Male to female ratio was nearly 2:1 and highest numbers of patients are under the age of 5-yrs. It was concluded that morbidity and mortality is highest in under 5-years age group, hence special attention is required to deal with patients of this age group

Ventricular septal defect in infants and children with increased pulmonary vascular resistance and pulmonary hypertension - surgical management leaving an atrial level communication

To evaluate the surgical and medical efficacy of the patients operated for Ventricular Septal Defect [VSD] with Pulmonary Hypertension and Pulmonary Vascular Resistance [PVR]. Infants and children with elevated PVR and Pulmonary Hypertension are associated with significant mortality and morbidity after surgical closure. Circulatory assist devices and sophisticated medicines may not be available to help in the management of infants and children with elevated Pulmonary artery pressure and resistance. We left Patent Foramen Ovale [PFO] or made atrial communication to decrease the morbidity and mortality associated with the closure of large VSD in this risky group. Sixteen infants and children were operated with median age of 12 months, operated by the same surgeon [IU], from January' 2004 to December' 2005. They were with large VSD of elevated PVR [3.9+0.3] and underwent VSD closure leaving PFO or artificial ASD [5mm]. Surgical approach was through right atrium. Post operatively, all the patients were electively ventilated for 36 hours. They were given intravenous dilators [Glyceral Trinitrate + Phentolamine] and oral Sildenafil up to 1mg /Kg, six hourly. Five cases went into acute pulmonary hypertensive crisis postoperatively, and were rescued by Prostacycline Nebulization. Sixteen patients had VSD as the primary lesion that underwent operation. The overall early mortality was 6.25% [1/16]. There have been no late deaths. Closure of large VSD with elevated PVR can be performed, leaving PFO or artificial ASD, with acceptable mortality and morbidity

Community based epidemiological/statistical studies of male patients/diseases in out-patient-department at Shifa-ul-Mulk memorial hospital for Eastern Medicine

Shifa-Ul-Mulk Memorial Hospital for Eastern Medicine is the first and only Hospital in Pakistan, providing health care facilities through Unani/herbal System of Medicine. It is a 50-beded Hospital providing free health care. It has well equipped Wards, Laboratory, Operation Theater, Labour room, etc. The Hospital was founded in 2000 and since, it is the only Health Care Center of <28 villages near the city of education, Bait-Ul-Hikmah. Statistical data based on number of patients, diseases, age groups, etc has long been needed in order to promote and elevate the health care facilities to the patients of the rural areas around the Bait-Ul-Hikmah. The objective of our study is to determine the prevalence of male diseases specially those, not responded to therapies of modern medicine. Also, we have an eye on the diseases which are occurring more frequently, so that we are able to target the etiology and better management of these diseases. 35,216 male patients were seen at the OPD. 6,919 in the Year 2000, 9,144 in 2001, 9,693 in 2022 and 9460 in 2003. Number of patient's increases from 2000 to 2002 and decreases in 2003. Disease of GIT [34.47%] has the highest prevalence while Respiratory disease [22.89%] being the second. Age group of 18-45 years has got the largest numbers and most of the patients were married. Respiratory, skin and infectious diseases are more common in children

Role of carotid doppler in coronary artery disease

To find out the Intima media thickness [IMT] of carotid artery disease in coronary artery disease and to identify hemodynamically significant stenosis [i.e.>70%] in patients undergoing coronary artery bypass surgery. A descriptive study. The study was conduct at AFIC and MH Rawalpindi from 2003 to 2004. One hundred patients of triple, double and single vessel coronary artery disease were studied. There were 85 male and 15 female patients, ranging from 35 to 77 years. The patients were studied by Toshiba Ultrasound Machine equipped with high frequency linear transducers. In 10 patients having more that 70% ICA stenosis, conventional angiography was done. Intima-media thickness of common carotid artery was increased in 92 patients with mean value of 1.1 mm. Plaques were seen in 92 patients with commonest location at carotid bifurcation with extension into the origin of ICA. 15 patients has >70%, 10 patients > 50% stenosis and 67 patients in the range of 1-50% stenosis. 6 patients showed normal intima-media thickness with no evidence of plaque. In two patients ultrasound could not locate bifurcation of CCA. Doppler ultrasound showed 98% sensitivity in diagnosis of > 70% stenosis. Doppler ultrasound is a non-invasive imaging modality of choice in evaluation of extra-cranial carotid artery disease

Radial artery as a grafting surgery: Early experience at AFic / NIHD

The long-term patency of vein grafts in the coronary circulation has been poor. By contrast, the left internal thoracic artery [LITA] graft to left anterior descending coronary artery [LAD] has been associated with excellent patency and good clinical results. The revival of radial artery [RA] as a graft has offered another source of arterial conduit in addition to the use of right internal thoracic artery [RITA]. We evaluated our early experience with the use of RA as a conduit for coronary artery bypass grafting [CABG] surgery to establish its safety and efficacy. we studied 606 consecutive patients from January 2003 to December 2003 who underwent CABG surgery at our institute. Radial artery was used as a conduit 'in 214 patients. Data was collected prospectively. In the radial artery group, the age range was 27 - 72 years, mean age 49.5 years. 136 [64%] of the patients had diabetes, only 7 [3.27%] patients were females. 8 [3.73%] patients had left ventricular ejection fraction of less than 30%, 146 [68.22%] patients had EF of 30-45% and rest were with good left ventricular function. 23 [10.74%] patients were classified as unstable/urgent. The conduits included were 206 left internal thoracic arteries, 26 right internal thoracic arteries and 214 radial arteries and 170 were vein grafts. Average number of grafts per patient was 2.87. Top ends of the free arterial grafts as well as all the vein grafts were anastamosed directly to the ascending aorta. Patients were followed up to 6 weeks, 24 weeks and then 6 monthly thereafter. Complications included intra operative or post operative myocardial infarction in 6 [2.8%] patients, sternal wound infection in 4 [1.86%] patients, reoperation for excessive bleeding 17 [7.94%] patients. 14 [6%] patients required intra aortic balloon pump support, 46 [21%] required inotropic support. The incidence of hand complication was 7% [15 patients]. The overall mortality rate in radial artery group was not much different from the non-radial artery group of patients undergoing CABG surgery in our settings. Conclusions: Radial artery may be used as a conduit for coronary artery bypass grafting operation with confidence as regards its safety

Outcome of surgery of congenital heart disease at AFIC/NIHD, Rawalpindi, Pakistan in year 2000

Surgery of congenital heart disease is palliative as well as curative and outcome of this surgery depends upon nature and gravity of lesion, facilities of operation theatre, expertise of surgeons, anesthetists and paramedical staff, postoperative intensive care, prediction and timely management of post operative complications. A non randomized, non experimental study was carried out to analyze the postoperative complications of congenital cardiac surgeries at AFIC/NIHD Rawalpindi. All children up to 12 years of age undergoing operative procedures of their congenital cardiac lesions in year 2000 were followed up for complications. There were total 202 surgeries up to 12 years of age in year 2000. Overall mortality rate was 10.3%, being maximum of total correction [25%] and minimum for ASD closure and pulmonary volvotomy [0%]. Mortalities of other surgeries were; B-T shunt 16%, mitral valve replacement 16%, PA banding 14%,VSD closure 11.3% and PDA ligation 2.2%. Regarding etiology of these mortalities RV failure complicated by fluid retention and deranged hemodynamics for total correction, shunt block for B-T shunt, respiratory infection superimposed by compromised heart for PA banding and aspiration pneumonia for PDA ligation. Out of these mortalities about 75% were due to surgeries of registrar surgeons. This rate may be reduced by more experience and formulating structured training. Thorough evaluation revealed that scrupulous preoperative assesment by echocardiography, screening tests for sepsis, surgery in expert hands, meticulous cardiac anesthetic care, prediction and urgent treatment of post operative complications, intensive postoperative, management and regular follow-up with clinical and echocardiographic evaluation can reduce the incidence of mortality and morbidity from these operations