Frequency of congenital heart diseases in neonatology section of a tertiary care hospital Peshawar

To determine the frequency of common congenital heart diseases [CHD] in children presenting to Pediatrics, Department of Lady Reading Hospital, Peshawar. Cross sectional descriptive study. This study was conducted in the Pediatrics and Neonatology Department of Lady, Reading hospital Peshawar, from 14[th] July 2010 to 14[th] July 2011. A total of 481 patients, using 3.1% propotion of ASD in cases with CHD, 95% Confidence interval, 1.55% margin of error, under WHO software formula for sample size determination. Children from 0-18 years of age clinically diagnosed cases with their echocardio-graphy which was also suggestive of CHD were included in this study. Postoperative cases of CHD as they require different kind of management plan and Confirmed cases of CHD were excluded. Patients with acyanotic CHD were 416 [86.48%] and with cyanotic CHD were 65 [13.52%]. Cases of ventricular septal defect [VSD] were 190 [39.5%] and amongst them 120 [63.16%] were males and 70 [36.8%] were females. Cases of atrial septal defect [ASD] were 146 [30.35%] and amongst them 63 [43.15%] were males and 83 [56.84%] were female. Thus, there was a female preponderance of ASD patients as compared to VSD. As for patent ductus arteriosus [PDA] there were 80 [16.63%] cases and of transposition of great arteries [TGA] were 30 [6.23%]. Whereas cases of tetrology of fallot [TOF] were 35 [7.27%]. Congenital heart defects [CHD] are among the most common birth defects and are the leading cause of birth defect-related deaths. VSD is the commonest acyanotic CHD whereas TOF is the commonest cyanotic heart disease

Surgical site infection; in-vitro anti-bacterial activity of different brands of ceftriaxone against bacteria commonly implicated in surgical site infection and their cost effectiveness

Ceftriaxone is used in wide range of day to day microbial infections in clinical practice3. Despite the incumbent drug regulating authority in Pakistan, there is scanty literature comparing the anti-microbial efficacy of different available br and s of ceftriaxone. Objectives: To know the in-vitro activity of various br and s of ceftriaxone against bacteria most commonly isolated from surgical site infection [SSI]. A comparison of five days cost of these br and s will also be done. Design: Experimental study. Period: Feb 2013 to Aug 2013 Setting: Surgical "C" unit Lady Reading Hospital [LRH] in collaboration with departments of pharmacology Khyber Girls Medical College [KGMC] and microbiology department of Lady Reading Hospital Peshawar. Material and Methods: Isolates of five bacteria i.e. Staphylococcus aureus, Proteus mirabilis, Escherischia coli, enterobacter Spp, and Klebsiella pneumoniae, found sensitive to ceftriaxone were grown on 50 slops each and the zone of inhibition was checked for each of the ten br and s of ceftriaxone. Results: The zones of inhibitions of different br and s of ceftriaxone against the above mentioned bacteria were not significantly different. The cost of therapy was significantly different for ten br and s. Conclusions: Various br and s of ceftriaxone of variable cost had no influence on their activity against bacteria involved in SSI.

Iron deficiency anemia; red cell distribution width [RDW] and red cell indices in the prediction of among healthy women in third trimester of pregnancy

To determine the importance of the RDW and other red cell indices [MCV, HBG] in the prediction of iron deficiency anemia in third trimester of pregnancy in a tertiary care hospital of Peshawar. Cross sectional study. OPD Department of Gynecology and Obstetrics Postgraduate Medical Institute, Lady reading Hospital [PGMI-LRH] Peshawar. Period 1[st] August 2012- 10[th] Dec 2012. A Total of 152 women attending the centre were included. Necessary information's were recorded on the questionnaire prepared in accordance with the objectives of the study. A total of 152 women in their third trimester presenting to Gynecology and obstetrics department of Lady reading hospital Peshawar. The age range of the patient was from 20 years to 55 years with mean age of 33 +/- 3.4 years. Out of total 27[18%] were primagravida. Majority of the cases 118[77.6%] were from Peshawar, 9% from charsadda, 8% nowshera etc. We also received 2 patients 1.2% from Afghanistan. Regarding financial status 57%[87] females were in upper Class [i.e. income >20000/month] on recall. Of total 81[53%] of the females were having hemoglobin less than 11g/dl and 22% of the women had HCT<32% which as per criteria of the WHO were anemic at the time of presentation. While 29[19%] patients had low value of MCV [microcytic]. Fifty five patients [36.2%] had RDW CV[%] more than 15% which points more towards the microcytic nature of anemia and more anisocytosis. Fifty five patients [36.2%] had RDW CV[%] more than 15% which points more towards the microcytic nature of anemia. While 29[19%] patients had low value of MCV [microcytic]. Increased RDW is best indicator for the detection of iron deficiency anemia than MCV. Increased RDW even in the presence of normal MCV can be an early signal for iron deficiency anemia in pregnancy. Hence RDW is more reliable indicator for iron deficiency especially in pregnancy. Changes in RDW in last trimester is more significant that MCV

AFP surveillance; review of Mohmand Agency Fata

To determine the status of the AFP surveillance system at Mohmand agency FATA in a sense to improve the sensitivity of the system in 2012. Retrospective study. Mohmand agency FATA. Jan-Dec 2011. The relevant information were recorded from the Rec files of these cases in accordance to the objectives of the study. A total of 25 cases were reported in 2011 in Mohmand agency as AFP cases. Eleven were females [44%] and 14[56%] were males. The age range of these patients were from 6 months to 14 years of age. Mean age with SD was 37.12+33 months. Four cases were confirmed polio type 1 wild type cases. The frequency of cases reported from various tehsils were: safi [36%], Pindialy and ekka ghund, Halimzai 16%, Prang ghar and ambar4%, and Khweze/baizai 8%. Fourteen [56% cases] reported as urgent cases. Majority of the cases [28%] were injection neuritis, 20% cases diagnosed as traumatic neuritis, 4% as Guillain barre syndrome, and 8% as meningitis. 16 cases were cross reported from other agencies and the remaining from the agency itself. Ghallani AHQ Hospital, RHC Ekka ghund and Mechany BHU are main diagnostic and referral centers for AFP in the agency. The lab results reported 4 cases with P1 wild type virus. We have at time a bit weak surveillance system for AFP and the agency being a part of FATA and its security volatile situation, all makes it more suitable for the polio virus to circulate. There is low level of awareness and stigma associated with Polio vaccines which is alarming for public health workers. The cross reported cases ration is more which shows bit weak catch up at station level

audit of the mortality due to severe head injuries in a neuro-surgical intensive care unit

To analyze the data of patients died in neurosurgical intensive care unit due to severe head injuries. This retrospective study was conducted in neurosurgical intensive care unit in Lady Reading Hospital, Peshawar from January to December 2007. The Clinical record of all the patients presenting with severe head injuries, who then expired in neurosurgical intensive care unit was collected. The record was analyzed accordingly for discussion and recommendations. Out of 112 patients, majority were young adults [n=64, 57.14%] followed by children [n=34, 30.35%] and elderly [n=10, 8.92%]. Road traffic accidents were the major cause of presentation [n=75, 66.96%] followed by history of fall [n=23, 20.53%] and fire arm injuries [n=13, 11.60%]. The correctable surgical causes were present only in 18 patients [16.07%] and the majority 94 [83.92%] were given conservative management. Among the non-surgical cases, both ventilatory therapy in 7 [6.25%] and tracheostomy in 39 [34.82%] patients failed to change the outcome. Road traffic accident was the major contributor in the mortality in patients presenting to neurosurgical intensive care unit. Most involved were young adults

Anterior spinal decompression and bone grafting in densely paraplegics due to tuberculosis

Spinal tuberculosis is a common problem in neurosurgery practice and is endemic in the third world countries like Pakistan. Present study was therefore designed to assess the results of anterior spinal decompression and bone grafting in densely paraplegic patients due to tuberculosis. This prospective observational study was conducted in Department of Neurosurgery, Government Lady Reading Hospital, Peshawar from April 2003 - May 2007. Thirty-six paraplegic patients with spinal tuberculosis were admitted and operated. Clinical and demographic characteristics of patients like name, age, sex and duration were documented. All necessary investigations like x-ray, CT scan, MRI and histopathology along with biochemical and haematological studies for diagnostic purpose were documented. Clinical criteria, operative findings, procedures and postoperative outcome of these patients were also assessed. Thirty-six cases with paraplegia due to spinal tuberculosis were operated. Excellent results [where patients were well without neurologic deficit] were achieved within 2 months in 27[75%] patients, while good [where neurologic deficits were still impaired] results were seen in 9[25%] cases within a 6 months duration. Anterior spinal decompression and fusion with bone graft has excellent results in paraplegic patients due to tuberculosis

Principal causes of coma in medical units of a tertiary care hospitals of Peshawar

To determine the principal causes of coma in patients admitted to the medical units of a tertiary care hospital of Peshawar. This cross sectional study was conducted at department of medicine, Khyber teaching hospital Peshawar, from July 2006 to August 2007. All patients were randomly selected. Relevant information's were recorded on a questionnaire prepared in accordance with the objectives of the study. A total of 124 patients with coma, 96[77.41%] males and 28[22.58%] females were included in the study. The age range of patients was from 12 years to 72 year with mean age of 50.5 years. The principal causes of coma were: cerebrovascular accident [CVA] 73.38% [n=91], epilepsy in 10.48% [n=13], injury head 5.64% [n=11], hepatic coma 2.41% [n=3], central nervous system [CNS] infections 2.41% [n=3], metabolic acidosis, drug abuse [1.61%] [n=2] each and cerebral malaria, hypoglycemia and uremia 0.8% [n=1] each. Risk factors for stroke recorded were hypertension in 46.2% [n=42/91], diabetes in 15.4% [n=14/91], ischemic heart disease 12.1% [n=11/91], smoking 5.5% [n=5/91], hyperlipedemia 3.3% [n=3/91] and atrial fibrillation 1.1% [n=1/91]. Scoring on Glasgow coma scale showed that 74.2% [n=92] patients scored 3-8, 25.8% [n=32] scored 9-12 and none of the patients scored 13-15. In our setup CVA is the most common cause of coma followed by epilepsy, and trauma head. Other minor causes recorded were metabolic acidosis, drug abuse, central nervous system infections, cerebral malaria, hypoglycemia and uremia

Rheumatic heart diseases

To determine the frequency of rheumatic heart diseases in a hospital based study in Peshawar. A cross sectional observational. Cardiology department, Lady-Reading Hospital Peshawar. From July 2005 to July 2006. Relevant in formations were recorded from patients and treatment chart of the patients, on a questionnaire designed in accordance with the objectives of the study. A total of 88 patients with established diagnosis of rheumatic hear diseases [RHD] were randomly selected. Out of total 70.45% were females and 29.54% males, with males to females ratio of 1:2.38. The age range of the patients was from 8 years to 64 years with mean age of 47 years. The mode of age was 35 years. The frequency of rheumatic heart diseases was: Mitral Stenosis 13.63%, Mitral Regurgitation 60.22%, Mitral Stenosis /Mitral Regurgitation 21.59%, Aortic Stenosis/Aortic Regurgitation 2.27%, Aortic Stenosis 1.13% and Tricuspid Valve Stenosis 1.13%. We observed that RHD were more common in lower social class people [42.04%] with income less than 5000/month. In our setup RHD are more common in female gender and especially in the younger age. Mitral Stenosis was recorded as major type of RHD in our patients

Peculiar risk factors and complications of pregnancy induced hypertension in a tertiary care hospital of Peshawar

To determine the frequency of risk factors and complications associated with pregnancy-induced hypertension [PIH] in a hospital based study. Desriptive Study. Study was conducted in obstetric and gynecology department of Khyber teaching hospital Peshawar from March 2006 to March 2007. Sixty eight patients were included in the study. Relevant informations was recorded from patients and treatment chart of the patients on a questionnaire designed in accordance with the objectives of the study. The age range of the patients was from 14 to 48 years with mean age of 27.5 years, and mode of 26 years. The distribution of symptoms was: Increased blood pressure [100%] edema feet [86.76%], nausea, vomiting [32.34%] sudden weight gain [27.94%] visual changes such as blurred or double vision [22.05%] etc. Frequency of risk factors of PIH was: Primigravida [8.72%] previous pre-eclampsia [7.35%] diabetes mellitus [16.17%] obesity [10.29%], chronic hypertension [7.35%], large placenta [4.4%]. While no risk factors recorded in 10.29% patients. Complications of PIH occurred only in 52.94% cases. Frequency of various complications was: haemolysis, elevated liver enzymes and low platelets [HELLP] 80.55%, convulsions 16.66%, pulmonary edema 8.33%, cortical block and intra uterine growth retardation in 2.77% each. Increased blood pressure, edema feet, sudden weight gain, visual changes were main symptoms of PIH in our patients. Primigravida, previous pre-eclampsia, diabetes mellitus, chronic hypertension, obesity and large placenta were found to be as major risk factors of PIH. HELLP, convulsions and pulmonary edema were recorded major complication of PIH

Diagnostic upper gastrointestinal endoscopy

To evaluate Oesophagogastroduedenscopy [OGD] in term of its indications and endoscopic findings. Retrospective audit. Medical "C" unit Department of Medicine Government Lady Reading Hospital Post Graduate Medical Institute Khyber Medical University Peshawar from July 2002 to June 2007. Adult patients who underwent upper gastrointestinal [GI] endoscopies during the last 5 years period were included in the study. The procedure was performed as per the standard protocol with diagnosis based on established criteria. A total of 2282 were scoped 53.3% [n=1216] were female and 467% [n=1066] male. The mean age of the study population was 43.75 Standard Deviation [SD] +/- 1800 Dyspepsia [54.5%], upper GI bleed [12.3%], recurrent vomiting [11.1%] and dysphagia [7.8%] accounted for the common indications of the procedure. Endoscopy was normal in 164% [n=374] of patients Amongst the others [n=1908] single endoscopic diagnosis was made in 91% of the patients and in the remaining 9% of patients combination of lesions were seen. The endoscopic findings included gastritis and duodenitis alone or in combination [29.4%] oesophagitis [13.9%] duodenal ulcer [6.6%] gastric ulcer [7.4%] oesophageal varices [3.7%] and growth oesophagus [2.9%]. Gastric ulcer was more common than duodenal ulcer. Upper GI endoscopy is safe and an excellent diagnostic modality with high diagnostic yield. Dyspepsia upper GI bleed recurrent vomiting and dysphagia are the commonest indication for OGD. Gastro-duodenitis oesophagitis peptic ulcer disease oesophageal varices and growth oesophagus are the common endoscopic diagnosis

hospital-based study on causes peculiar to heart failure

We sought to determine the frequency of the risk factors for congestive cardiac failure [CCF] in a tertiary care hospital in Peshawar, Pakistan. This retrospective, observational study was conducted in the department of cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from March 2005 to September 2007. Relevant information regarding the risk factors of CCF was recorded on questionnaires, devised in accordance with the objectives of the study. This study recruited 1019 patients with an established diagnosis of CCF on the basis of clinical findings and pertinent investigations. The study population comprised 583 [57.12%] men and 436 [42.78%] women. The patients' age ranged from 6 years to 82 years with a mean age of 48.5 years and a mode of age of 45 years. The distribution of the causative factors of CCF was as follows: ischemic heart disease in 38.56%; hypertension in 26.30%; dilated cardiomyopathies in 10.10%; obstructive and restrictive cardiomyopathies in 5.39%; valvular heart diseases in 9.32%; congenital heart diseases like ventricular septal defects and atrial septal defects in 4.41% and 0.58%, respectively; constrictive pericarditis in 1.07%; pericardial effusion in 0.68%; chronic obstructive pulmonary disease and pulmonary hypertension in 1.47%; thyrotoxicosis in 0.68%; complete heart block in 0.29%; and Paget's disease in 0.09% of the cases. Ischemic heart disease, hypertension, cardiomyopathy, valvular heart disease, and congenital heart disease were the major contributors to CCF in our patients

Principal causes of coma in medical units of a tertiary care hospital of Peshawar

To determine the principal causes of coma in patients admitted to the medical units of a tertiary care hospital of Peshawar. This cross sectional study was conducted at department of Medicine, Khyber Teaching Hospital Peshawar, from July 2006 to August 2007. All patients were randomly selected. Relevant information was recorded on a questionnaire prepared in accordance with the objectives of the study. A total of 124 patients with coma, 96[77.41%] males and 28[22.58%] females were included in the study. The age range of patients was from 12 years to 72 year with mean age of 50.5 years. The principal causes of coma were: cerebrovascular accident [CVA] 73.38% [n=91], epilepsy in 10.48% [n=13], head injury 5.64% [n=11], hepatic coma 2.41% [n=3], central nervous system [CNS] infections 2.41% [n=3], metabolic acidosis, drug abuse [1.61%] [n=2] each and cerebral malaria, hypoglycemia and uremia 0.8% [n=1] each. Risk factors for stroke recorded were hypertension in 46.2% [n=42/91], diabetes in 15.4% [n=14/91], ischemic heart disease 12.1% [n=11/91], smoking 5.5% [n=5/91], hyperlipedemia 3.3% [n=3/91] and atrial fibrillation 1.1% [n=1/91]. Scoring on Glasgow coma scale showed that 74.2% [n=92] patients scored 3-8, 25.8% [n=32] scored9-12 and none of the patients scored 13-15. In our setup CVA is the most common cause of coma followed by epilepsy, and head injury Other minor causes recorded were metabolic acidosis, drug abuse, central nervous system infections, cerebral malaria, hypoglycemia and uremia

Gastrointestinal diseases; frequency of symptoms

To determine the frequency of gastrointestinal [GI] diseases/symptoms in a tertiary care hospital of Peshawar. A Cross sectional observational study was conducted in Medical department Khyber teaching hospital Peshawar from August 2005 to March 2006. A total of 189 patients with established diagnosis of any gastrointestinal disease were randomly selected. Out of total 101 [53.43%] were males and 88[46.56%] were females. Relevant information's were recorded on a pre-designed questionnaire was designed in accordance with the objectives of the study. The age range of the patients was from 8 years to 82 years with mean age of 47.5 years. The mode age observed was 45 years. Of total sampling [43.91%] were Illiterate, primary passed [24.33%], matric education [15.87%], secondary education [11.11%] and [4.76%] patients had degree level education. The gastrointestinal disease pattern was: acute peptic disease/ dyspepsia [15.87%], reflux esophagitis [7.91%], duodenal ulcer [1.5%], gastric ulcer [0.5%], worm infestation [1.5%], esophageal carcinoma [0.5%] and miscellaneous in 136[71.95%] patients. The distribution of the gastrointestinal disease symptoms was: chronic diarrhea [19.04%], vomiting [12:16%], dysentery [6.34%], bleeding per rectum [5.20%], constipation [2.1%], anorexia [1.5%], dysphagia [1.10%] and multiple symptoms were recorded in [24.33%] patients. acute peptic disease/dyspepsia, chronic diarrhea dysentery, reflux esophagitis are major gastro intestinal [GI] diseases in our setup. Duodenal and gastric ulcers, carcinoma of gastrointestinal tract, worms infestation, dysphagia and anorexia were not as common

Acute appendicitis: experience in a tertiary care hospital of Peshawar

To study the patients' characteristics and predominant clinical features in patients with acute appendicitis in a teaching hospital. A cohort study. Surgical department, Khyber Teaching Hospital Peshawar [Pakistan], from August 2005 to August 2006. Convenient sampling. A total of 72 patients with established diagnosis of acute appendicitis were included in the study. The age range of the patients was from 11 years to 57 years. Relevant information was recorded from patients and treatment chart of the patients on a questionnaire designed in accordance with the objectives of the study. Out of a total of 72 patients. 46 [63.89%] patients were males and 26 [36.11%] were females, with a male to female ratio of 1.7:1. Chief complaints were: colicky abdominal pain [91.66], nausea and vomiting [73.61%], anorexia [76.38] and fever [59.12%]. On examination the findings recorded were: abdominal tenderness [83.33], rebound tenderness [75], pyrexia low grade [59.12], pulse rate more than 80 [54.16], guarding [58.33], positive revising sign [43.05], positive psoas sign [13.88], and positive obturator sign [8.33]. The Alvarado score [AS] was studied in all patients to support the diagnosis. Out of total, 52.77% had AS<4 [Group III], 40.25% had AS: 5-7[Group II] and 6.94% with AS>7/10 [Group I]. We observed that acute appendicitis is more commonly seen in the upper social class people [62.5%] in our setup. Acute appendicitis was more commonly observed in younger age. The classical signs of the disease are not always present, however, the scoring systems [like Alvarado scoring system] and laboratory investigations improve the diagnostic accuracy

Comparative analysis of risk factors and complications of hepatitis B and C infections at Khyber Teaching Hospital, Peshawar

To analyze comparatively the risk factors and complications of hepatitis B and C infections at Khyber Teaching Hospital, Peshawar. A cross-sectional observational study was conducted in Department of Medicine, Khyber Teaching Hospital, Peshawar, from March 2005 to October 2006. Relevant information's were obtained from the patients with the aid of a pre-designed questionnaire prepared in accordance with the objectives of the study. A total of 432 patients with positive anti-HCV antibody 252 [58.33%] and positive HBs Ag 180 [41.66%] were included. The age range of the patients with anti-HCV antibody was from 11 to 84 years with the mean age of 47.5 years, while in HBV cases was 50.5 years [range: 7 to 87 years]. In HCV positive cases, 165 [65.47%] were males and 87 [34.52%] were females while in HBV patients, 123 [68.33%] were males and 57 [31.67%] were females. The risk factors of HCV patients were: intravenous drug users, 23.81%; HCV positive sexual partners, 15.07%; blood or blood products transfusion, 13.49%; and occupational acquired-HCV, 7.14%. The major risk factors of HBV were: intravenous drug users, 33.88%; HBsAg positive sexual partners, 23.33%; blood transfusion, 14.44%; and dental procedures [tooth extraction or root canal treatment], 9.44%. Unknown source of infection was recorded in 25% of HCV and 10.56% of HBV patients. Complications consequences in HCV patients were: chronic hepatitis, 34.52%; liver cirrhosis, 16.26%; hepatocellular carcinoma, 0.79%; fulminant hepatitis, 0.79%; while 47.61% were asymptomatic or sub-clinical symptomatic. In HBV patients, complications were acute hepatitis, 5.56%; fulminant hepatitis, 0.5%; chronic healthy carriers, 31.67%; chronic hepatitis, 24.44%; liver cirrhosis, 6.11%; and hepatocellular carcinoma, 1.10%; while 40.55% were clinically asymptomatic or with sub-clinical disease. Coexistence of HCV and HBV were recorded in 52 [12.03%] patients. History of sexual transmission favors HBV infection while blood transfusion and occupational exposure were recorded mainly in HCV positive patients. Chronic persistent hepatitis and liver cirrhosis were recorded more significantly with HCV infection while HBV favor carrier state or presents as a sub-clinical disease

Hepatitis 'B' infection: experience in a tertiary care hospital of Peshawar

Hepatitis B virus infection is one of the major health problems in the developing countries including Pakistan. The present study was conducted to determine the symptomatology, risk factors and complications of hepatitis B infection in a tertiary care hospital in Peshawar. A prospective observational study was conducted in the Department of Medicine, Khyber Teaching Hospital Peshawar, from January 2006 to November 2006.A total of 180 HCV positive patients were selected, 123 were males and 57 females. Relevant information was obtained from the patients with the help of a pre-designed questionnaire prepared in accordance with the objectives of the study. A total of 180 hepatitis B surface antigen [Hbs Ag] positive were included. 68.33% were males and 31.67% females. The age range was 7 to 85 years, with mean of 50 years. The risk factors distribution were: intravenous drug abuse 33.88%, Hbs Ag positive sexual partners 23.33%, blood transfusion 14.44%, dental procedures [tooth extraction or root canal treatment [RCT] 9.44%, shaving from community barbers 8.33%, past surgical history 6.67%, medical endoscopy 5.56%, occupational exposure 5%, tattooing 1.6%, and history of homosexuality and hemodialysis 0.5% each. No risk factors were recorded in 10.56% and multiple risk factors were observed in 20% cases. Clinical presentations at time of interview were fever 47.78%, jaundice 43.33%, malaise 37.77%, maculopapular rash 5.56%, urticaria in 3.8% and polyarthritis in 1.66% patients. Multiple complaints were recorded in 9.44%, and 28.88% were asymptomatic. Complications due to hepatitis B infections were: chronic healthy carriers 31.67%, chronic hepatitis 14.44%, liver cirrhosis 6.11%, acute hepatitis 5.56%, acute fulminant hepatitis 0.5%, and hepatocellular carcinoma in 1.10% cases, while 40.55% were clinically asymptomatic or with sub-clinical features. Chronic HBV infection coexistence with chronic HCV infection was recorded in 8.89%. Intravenous drug abuse, positive sexual partners, blood or blood product transfusion and dental procedures are main risk factors for HBV infection. Fever, jaundice and malaise are main symptoms while chronic carrier state, chronic hepatitis and liver cirrhosis are main sequelae of the disease

Significance of trigger point in trigeminal neuralgia

To know the significance of trigger point as an indicator of aberrant vascular loop in patients with trigeminal neuralgia. Material and This study was performed in the department of neurosurgery Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from May 2003 to April 2006. Patients with clinical history of trigeminal neuralgia were admitted for micro vascular decompression. Detailed clinical history, along with clinical findings particularly side and site of trigger point of trigeminal pain were documented. Imaging studies like CT, MRI were done in these cases and per-operative findings were documented after surgical procedure. Forty-three patients with trigeminal neuralgia were operated for micro vascular decompression during the study period. There were 24 [55.8%] males and 19 [44.2%] females with ratio of 1.2: 1, and a mean age of 53 years. Duration of symptoms was from 3 to 7 years. A total of 43 cases of trigeminal neuralgia were recorded. Right side was involved in 19 and left side in 24 cases. Peri-oral and peri-nasal trigger point was observed in 39 [90.7%] cases during examination while offending arterial loop was seen in 35 [81.4%] cases per-operatively, thick arachnoid adhesion in 4 [9.3%] cases and veins in 4 [9.3%] cases. Trigger point during clinical examination indicated the presence of offending arterial loops in patients with trigeminal neuralgia

hospital based study on future approaches to combat cardiovascular diseases

To determine the opinions of the physicians posted in two tertiary care hospitals of Peshawar regarding future strategies to combat cardiovascular diseases [CVD]. Descriptive observational survey. Khyber teaching hospital [KHT], Hayatabad medical complex [HMC] and department of community medicine Khyber medical college Peshawar. From 20th June to 15 august 2006. A total of 60 clinical experts were selected, 48 from KHT/KMC and 12 from HMC. Medical specialists, general physicians and community experts were included. They were interviewed with a pre-designed questionnaire, prepared in accordance with the objectives of the study. According to the clinicians and general physician's opinion the national approaches to combat cardiovascular diseases should be aimed at: tobacco control legislation and its empowerment [60%], national physical activity policy [70%], check on food quality [21.66%], research promotion in the field of CVD [36.66%], conducting workshops and seminars to educate people about CVD [30%] etc. Community approaches should be more specific towards promotion of healthy activities [71.66%], discouraging smoking [96.66%], and conducting local workshops to increase awareness [26.66%]. Individual approaches to combat CVD is to screen their blood pressure, glucose and lipid profile regularly [85%], stop smoking [96.66%], decrease their weight with exercise [75%], take appropriate medicine in time if is patient or at risk [46.66%] and leadership and advocacy to increase awareness and decrease stigma [43.33%]. while establishing a strategy for combating CVD there is need to offer multiple approaches on national, community and individual levels