Typhoid fever with jaundice; a clinical study in Abbottabad

Typhoid fever is a systemic infection which is caused by Samonella enterica serotype typhi. It is a multi-system disorder involving many organs including liver. Liver involvement could be in the form of jaundice, rise in liver enzymes or hepatomegaly. It can present as acute hepatitis in rare cases, called typhoid hepatitis. This study was carried out to study the association of typhoid fever in patients with jaundice. To determine the frequency of typhoid fever among patients presenting with jaundice. Descriptive cross sectional study. At Gastroenterology Unit, Ayub Teaching Hospital, Abbottabad. March 2011 to December 2011. Total 115 patients were included in the study based on inclusion and exclusion criteria. Typhidot IgM test was performed to confirm the diagnosis of typhoid fever. The mean age of patients was 28.5 +/- 10.14 years, with 54.8% male gender predominating the overall sample. The male to female ratio was 1.2:1. Typhoid fever was found in 22 [19.1%] out of 115 patients with jaundice and there were 68.2% were males and 31.8% were females. Typhoid fever is not rare to present as jaundice in our part of the world where typhoid fever is endemic. Therefore, all those patients who have fever, jaundice, abnormal liver function tests or hepatomegaly must be screened for typhoid fever especially in areas where typhoid fever is endemic

Aetiological factors in mechanical intestinal obstruction

Background: Intestinal obstruction occurs when the normal flow of intestinal contents is interrupted. The most frequent causes of intestinal obstruction are postoperative adhesions and hernias, which cause extrinsic compression of the intestine. Less frequently, tumours or strictures of the bowel can cause intrinsic blockage. Objective of the study was to find out the various aetiological factors of mechanical intestinal obstruction and to evaluate the morbidity and mortality in adult patients presenting to Surgical 'A' unit of Ayub teaching hospital with mechanical intestinal obstruction. Methods: This cross-sectional study was conducted from March 2009 to September, 2009. All patients presenting with intestinal obstruction and were above the age of 12 years were included in the study. Patients with non-mechanical obstruction were excluded from the study and those who responded to conservative measures were also excluded. Results: A total of 36 patients with age ranging from 12 to 80 years [Mean age 37.72 +/- 19.74 years] and male to female ratio of 1.77:1, were treated for mechanical intestinal obstruction. The most common cause for mechanical intestinal obstruction was adhesions [36.1%]. Intestinal tuberculosis was the second most common cause [19.4%], while hernias and sigmoid volvulus affected 13.9% patients each. Malignancies were found in 5.6% cases. Conclusion: Adhesions and Tuberculosis are the leading causes of mechanical intestinal obstruction in Pakistan. Although some patients can be treated conservatively, a substantial portion requires immediate surgical intervention. Keywords: Intestine, Mechanical [Dynamic], Intestinal obstruction