Aetiology of exudative pleural effusion in district D. I. Khan

Pleural effusion is commonly seen in the clinical practice. A larger number of diseases can cause it. Its causes are variable in different communities. Transudative effusions pose little diagnostic difficulty as compared to the exudative ones. In this study we investigated the aetiology of exudative pleural effusion in adult patients in our setup. It is a cross-sectional study. From January 1st to June 30 th, 2002 we studied adult patients presenting to Medical unit DHQ Teaching Hospital D. I. Khan, Pakistan, having a pleural effusion confirmed by chest radiographs. Patients having clinical and/or laboratory evidence of transudative pleural effusion were excluded from the study. A detailed history and through clinical examination was recorded. Routine investigations were performed. Thoracocentesis and pleural fluid analysis were performed in all patients. Pleural biopsy was taken in patients with exudative pleural effusion. Other investigations were performed according to the clinical indication. Fifty patients with pleural effusion were studied. Out of these, 22 had exudative pleural effusion. Further investigations revealed that 15/22 [68.18%] had tuberculosis, 3/22 [13.63%] had neoplasia, 2/22 [9.09%] had amoebic infection, 1/22 [4.54%] had para-pneumonia and 1/22 [4.54%] had ampyema thoracic. We conclude that of the exudative pleural effusion in this region is mainly due to tuberculosis. Neoplasia is the second common cause in adult population. Amoebiasis should be considered in right sided pleural effusions

study of prevalence of malaria in adult population of D.I.Khan, Pakistan

Malaria is a serious global health challenge. It continues to be a threat to the developing countries. Epidemiological data from different regions of Pakistan is insufficient to exactly evaluate the incidence of various types of malaria. D. I. Khan is a hot area on the right bank of the river Indus, providing favourable circumstances for mosquito breeding. We conducted this study to see the prevalence and presentation of various types of malaria in adult patients presenting with fever, and its response to anti-malarial agents in this region. This cross-sectional study was conducted in the department of Medicine, Gomal Medical college, D. I. Khan, from 28[th] August 2005 to 27[th] February 2006. All adult patients presenting to the outpatient clinic with fever were included in the study. A total of 490 patients presented with fever as a chief complaint. After detailed history and thorough clinical examination, Giemsa stained thick and thin blood films were examined. Species determination and parasite count were performed. Patients were grouped into two; Group A having Falciparum malaria and Group B any other type. Group A patients were randomly given either Quinine or Artemnether. Group B patients were given Chloroquine, Quinine or Artemether in standard doses. MP and parasite count were repeated on day 7 and 14 and the presence of more than 25% parasitaemia as compared to pretreatment was taken as treatment failure. Out of 490 patients, ninety-eight [20%] were found positive for malaria, seventy-five males and 23 females. Comparing the symptoms in falciparum and vivax malaria, it was found that nausea/vomiting was twice as common in falciparum malaria. Comparing the anti-malarial drugs, Chloroquine and Quinine were found to be effective in all patients. On the other hand Artemether was found to be 100% effective in vivax malaria and poor response to therapy was observed in two [4%] patients with falciparum malaria. As a conclusion malaria is responsible for fever in every fifth adult patient in our setup. Males are three times more commonly affected than females. Plasmodium falciparumn is 1.5 times more common than vivax. Nausea/vomiting and pallor are more common in falciparum, while splenomegaly is seen in vivax malaria. Commonly used anti-malarial drugs are effective in most of the cases

Hepatitis C: a leading cause of cirrhosis at DHQ hospital D.I.Khan

Heptatic cirrhosis is a common condition in our country and because of its morbidity and mortality the financial implications of this disease are enormous for our health care system. Diagnosis of cirrhosis, especially in the advanced stage, means ultimate progression to death due to the complications occurring in due course of the disease. It is therefore important to know about the main factors responsible for this condition so as to avoid or remove them before establishment of this deadly disease. Alcohol is an important cause of cirrhosis in the western world but in developing countries hepatotropic viruses namely Hepatitis B virus and Hepatitis C virus are mainly responsible for this condition. The aim of this study was to know about the recent situation regarding causation of this disease in our area and to make comparison with similar studies carried out elsewhere. This study was conducted in department of medicine at DHQ Teaching Hospital D.I. Khan from 1st January 2003 to April 2006. All cirrhotic patients attending this hospital were admitted to the Medical Unit. Serum was tested for Hepatitis B surface antigen and for Hepatitis C virus antibodies by ELISA. A total of 336 patients were studied. Their variables were recorded and analyzed. Out of 336 patients, 190 [56.54%] were HCV positive, 102 [30.35%] were positive for Hepatitis B Surface antigen. Sixteen [4.76%] were having markers of both Hepatitis B and Hepatitis C virus indicating dual infection. In 28 [8.33%] patients there was no evidence of infection with either Hepatitis B or Hepatitis C virus. Two hundred and twenty eight [67.85%] patients were males and 108 [32.15%] were females. As a conclusion cases of cirrhosis due to Hepatitis C virus outnumber all other causes and the condition is more common in males