Economic burden of thalassemia on parents of thalassemic children: a multi-centre study

Objectives To determine the economic burden of thalassemia on parents of thalassemic children

Study design, settings and duration: Descriptive nonprobability, purposive sampling done in PHRC Research Centres of Multan, Lahore, Islamabad, Karachi, Peshawar and Quetta from July 2013 to June 2014

Patients and Methods: After taking informed written consent, parents/guardians of thalassemia major children were interviewed. All information was recorded on the pre-tested questionnaire. Data was entered and analyzed using SPSS version 11

Results: A total of 600 guardians/ parents of the thalassemic children were included in the study. There were 57% boys and 43% girls with a mean age of 9.40 +/- 5.66 years. Among them, 47.8% were from rural and 52.2 % from urban areas. Almost 71% children were transfusion dependent. The family history of cousin/interfamilial marriage was present in 78.2% while parental consanguinity was present in 72.8%. Only 1.7% parents got premarital screening for thalassemia. In private sector 56.8% had to pay nothing while others had to pay from Rs. 500 to Rs. 2000 per visit. Expenditure per month in private thalassemia centres showed that 57% had to bear no cost at all, 12.2% had to spend up to Rs. 1000, while 24.8% Rs. 1001 to 5000 and 6% had to pay more than Rs. 5000. In the government sector cost per visit in 35.5% was up to Rs. 500 while others had to pay between Rs. 501 to more than Rs. 2000. Monthly cost at government sector almost doubled. Total expenditure [private and government sector] per month was Rs. 9626 for each patient

Conclusion: Total cost [both direct and indirect] for the management of thalassemia was quite high and this cost puts significant economic burden on the affected thalassemic families. This disease puts social, financial and psychological impacts on suffering families, so prevention-based strategies like premarital screening, prenatal diagnosis and genetic counseling should be adopted in Pakistan. A national screening project for thalassemia is the need of the day

Thyroid dysfunction; during combined peg-interferon Alpha-2a and Ribavirin therapy in patients with chronic hepatitis C

Hepatitis C is a burning issue. Prevalence of hepatitis C virus reported in Pakistan is 5% with areas of high infection in different cities and subsets of population. To find out the frequency of thyroid related dysfunctions in chronic hepatitis C patients on Peg- Interferon Alpha-2a and Ribavirin therapy. A prospective cohort study. Hepatitis Center DHQ teaching hospital Sahiwal from July 2013 to June 2014. We studied 100 patients of chronic HCV infection with baseline level of TSH,T3 and T4. Baseline serum ALT and serum AST were also measured. Patients were put on Peg-Interferon Alpha-2a [180 ug] weekly and Ribavirin [800 to 1000 mg/d] for 24weeks. All patients were followed up for thyroid dysfunction at weeks 0, 12, 18 and 24. Out of 100 treated patients 65 were female and 35 were male. Fifteen [15%] patients developed thyroid dysfunction and out of these 15 patients [11 female [73.3%] and 4 male [26.7%]]. Ten [66.6%] out of 15 patients developed hypothyroidism and 5[33.3%] out of 15 patients developed hyperthyroidism. Seven [70%] out of 10 patients who developed hypothyroidism needed levothyroxine therapy. Two [40%] out of 5 patients who developed hyperthyroidism needed carbimazol therapy for their symptoms and disease control. All patients completed hepatitis C treatment with combined Peg-Interferon Alpha-2a and Ribavirin therapy

Vitamin D deficiency in patients presented in medical OPD with fibromyalgia

Objectives: To determine the prevalence of vitamin D deficiency in patients presented in medical OPD with fibromyalgia/body aches and pains

Study Design: A prospective observational cohort study

Place and Duration of Study: Medical OPD of DHQ teaching hospital Sahiwal from July 2013 to June 2014

Material and Methods: 120 patients 80[66.67%] female and 40[33.33%] male coming to medical OPD of DHQ teaching hospital Sahiwal complaining of body aches and pains and diagnosed as Fibromyalgia according to American College of Rheumatology [ACR] criteria. Patients were not suffering from systemic illness on examination. The reports of serum calcium, phosphate, alkaline phosphatase, CBC and ESR, were normal. Serum level of 25[OH] vitamin D was estimated by Enzyme Linked Fluorescent assay [ELFA technique] using commercially available kit VIDAS[R] 25[OH] vitamin D total [VITD]

Results: Out of 120 patients, 80[66.67%] were female and 40[33.33%] male patients. 56[70%] out of 80 female patients had vitamin D deficiency [<20 ng/mL] and 14[17.5%] out of 80 patients had vitamin D insufficiency [21-29 ng/mL]. 25[62.5%] out of 40 male patients had vitamin D deficiency [<20 ng/mL] and 8[20%] out of 40 male patients had vitamin D insufficiency [21-29 ng/mL]. So, out of 120 patients 81[67.5%] had vitamin D deficiency [<20 ng/mL] and 22[18.33%] patients had vitamin D insufficiency [21-29 ng/mL]. Total 103[85.83%] out of 120 patients were suffering from vitamin D deficiency/insufficiency [<30 ng/mL]. 17 [14.13%] out of 120 patients had sufficient levels of vitamin D [>30 ng/mL]

Conclusion: Fortification of food especially milk and ghee should be done with vitamin D to improve vitamin D deficiency state in the people. Government health authorities should ensure this practice for decreasing the bony problems in the community

3rd trimester of pregnancy; frequency of anemia

To see the frequency of anemia in pregnant ladies and its possible outcomes. Descriptive cross sectional study. Fatima Jinnah Women Hospital, Multan. Six months. This prospective cross sectional study was conducted at Gynae and Obst. OPD at Fatima Jinnah Women Hospital, Multan. Non probability convenient sampling technique was used. All the pregnant women between 20-35 years irrespective of gestational age or any concurrent illness having parity upto 5 were registered for the study after getting written consent for participation. The pregnant ladies were evaluated by asking history of blood loss, parity, multiple pregnancy, worm infestation, use of NSAIDS and blood transfusion. They were especially asked about dietary habits which were rated as good, average and poor. Their socio economic status was assessed and was placed into high, middle and low income groups. Blood samples were drawn for blood counts and hemoglobin estimation in all the women presenting at hospital. Reflotron photometer, Roche Diagnostic was used for the blood testing. A cut off value of< 11 g/dl irrespective of duration of pregnancy was used for anemia. Peripheral blood film was examined for RBC morphology. Mean corpuscular volume [MCV] was used to categorize into micorcytic [< 76fl], macrocytic [>98fl] and normocytic [78-98fl]. Fetal well being was evaluated by serial abdominal ultrasounds. Three hundred pregnant women attending Gyne and Obst. OPD, Fatima Jinnah Women Hospital, Multan, were registered according to the study protocol. The duration of the study was 6 months. Maternal age was between 25-35 years. 86 % women were multiparous, 79% women presented during 3rd trimester, 15% during the 2nd trimester and 6% during 1st trimester. Thirty eight percent women had hemoglobin 8-9.9 g/dl, 48% had from 7-7.9 g/dl and 10%were falling between 5-7 g/dl. Eighty eight percent had microcytic hypochromic anemia, 12% with dimorphic picture and 4% were having low MCV and MCH but normal MCHC and these were referred for hemoglobin electrophoresis. Fifty eight percent had monthly income 2-4 thousands rupees and only 10% were earning 4-10 thousands per month. Seventy eight percent had poor diet and 22% had an average and no women were fit into the criteria for good diet. History of breast feeding was positive in 92% of the women. History of use of iron supplement was also asked, 28% had used various preparations of iron and folate for a variable period from 1-4 months, 72% never used hematinic supplements. History of previous blood transfusion during pregnancy and labour was present in 16% of the women. Three percent had fetal growth retardation. Prevalence of anemia during 3rd trimester of pregnancy in is high our society. It can have significant effects on maternal and fetal out come. It is a preventable cause which can be treated easily. Poverty and lack of education are the most important causes of anemia during pregnancy

Acute myocardial infarction; frequency of family history of ischemic heart disease [IHD] and related risk factors in the first degree relatives

To determine the frequency of family history of IHD and related risk factors in the first degree relatives of patients suffered from acute myocardial infarction [AMI]. Descriptive study. PMRC Research Centre, Nishtar Medical College, Multan, Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology, Multan. One year from July 2011 to June 2012. In this descriptive study 331 patients of AMI of either sex and age >/= 20 years admitted in Cardiology unit of Nishtar Hospital Multan and Chaudhary Pervez Elahi Institute of Cardiology Multan were registered. For data collection non-probability convenient sampling technique was used. Informed consent was taken from each patient. The information were recorded in a pre-designed questionnaire. The data were analyzed through SPSS-11. Mean age of the study cases was 54.99+/-11.25 years [Minimum age was 20 years and maximum was 90 years]. Two hundred sixty four [79.8%] were male and 67 [20.2%] were female patients and male to female ratio was 3.9:1. Out of these 331 patients 111 [33.6 %] were having positive family history of IHD. In these 111 [33.6 %] cases history of diabetes was seen in 45 [40.5 %], 43[38.8 %] had history of hypertension and history of hyper-cholesterolemia was present in 23 [20.7 %] of cases. The family history of IHD in addition to traditional risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking is itself an important risk factor for IHD. Relatives of the young patients with IHD should be considered as high risk group and it calls for close surveillance of their first degree relatives and early intervention. All their family members should be advised life style modification, appropriate management of risk factors and regular follow up of even apparently healthy descendents

Transmission of Anti-HCV from mother to infant and its natural course

Background: Anti HCV is transferred from positive mother to her newborn. To prevent this transfer of anti HCV, many health care providers stop the mother from breast feeding and recommend the checking of the newborn for anti HCV. If found positive, they take it as a chronic infection and recommend treatment of the child as soon as possible. Prohibition from breast feeding not only pushes these neonates towards nutritional deficiencies but also make them prone to infections. The testing also stigmatizes the mother and her newborn for life. The literature proves that this antibody transfer is passive and clears in majority of cases without any residual disease. Mother to infant transfer of anti-HCV and its natural course in Pakistani population is not known

Objectives: To determine the frequency of anti-HCV positivity and its natural course in infants born to anti-HCV reactive mothers

Subjects and Methods: Anti-HCV reactive mothers were registered from gynecology department and labor room of Nishtar Hospital Multan from 07-10-2010 to 07-04-2011, using non probability purposive sampling. The ALT of mothers was also checked. The babies born to these mothers were checked for anti- HCV by ELISA and ALT at 0 day [at the time of birth] and then at 6, 12, 18 and 24 months using venous blood samples. Data was entered and analyzed using SPSS-11

Results: Out of 35 anti-HCV reactive mothers; only one had ALT above the upper limit of normal [> 40 IU/L]. A total of 35 babies were born to these mothers, out of whom 34[97.1%] were reactive to anti-HCV at the time of birth and only one was non reactive. At 6 months 2 babies had expired and 3 were lost to follow up, leaving 30 babies. Out of these 30 babies 11 became non-reactive and 19 were still reactive for anti-HCV at 6months. At 12 months, all 19 anti-HCV reactive cases became non reactive, indicating passive transfer of antibodies from the mother to these neonates which they lost by 12 months. ALT of all babies except 3 was raised at 6 months [> 40 IU/L] which became normal during the subsequent visits

Conclusion: Almost all children born to anti-HCV positive mothers were reactive at the time of delivery but they all became non-reactive by the age of 12 months indicating passive transfer of anti HCV from the mother to the neonate

Painless myocardial infarction; its frequency in patients of acute coronary syndrome

To determine the frequency of painless MI in patients with acute coronary syndrome. Descriptive cross-sectional study. Setting and duration: This study was conducted at cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan. The study duration was 1 year starting from July 2011 to June 2012. This descriptive study included 331 patients of AMI of either sex and age which were admitted at "Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan" using non-probability convenience sampling technique. Informed verbal consent was taken from each patient for participation. Out of these 331 patients 308 [93.1%] patients reported chest pain as the presenting complaint. Remaining 23[6.9%] presented with clinical feature other than chest pain. Of these 23 patients who presented without chest, minimum age was 30 years while maximum was 90 years with mean age 54.82 +/- 12.28 years. Patients with painless AMI presented with variety of symptoms. Most common symptoms seen in patients of AMI without chest pain were generalized weakness and cold sweats. Out of 23 patients with painless AMI, 15[65.22%] patients were male and 08[34.8%] were female. Diabetes mellitus was present as co-morbid condition in 16[69.56%] while 7[30.44%] patients were non diabetic. Hypertension was present in 8[34.78%] patients with painless AMI. Painless AMI or atypical presentation of AMI is seen in substantial proportion of ischemic heart disease patients. Absence of chest pain in AMI patients may misguide the doctors and diverts his attention towards other diagnosis which can lead to considerable delay in the essential therapies required in the management of AMI. It definitely affects morbidity and mortality of emergency department. Health care professionals particularly those working in emergency set up must keep in mind that absence of chest pain in suspected cases of ischemic heart disease does not necessarily rule out AMI. Features of AMI other than chest pain should also be kept in mind while dealing with a suspected case of ischemic heart disease. Further research work on painless AMI and presentation of AMI other than chest pain is needed

Chronic liver disease [CLD]; frequency in patients presenting with upper gastrointestinal bleeding [UGIB] at Nishtar hospital, Multan

To determine the frequency of chronic liver disease in patients presenting with upper gastrointestinal bleeding [UGIB] at Nishtar Hospital, Multan. Descriptive case series. Six months from August 2009 to January 2010. Department of Internal Medicine, Nishtar Hospital Multan. A total of 88 patients with upper GI bleed were registered. Prior permission was taken from Institutional Ethical Committee to conduct this study. Informed consent was taken from each patient. Upper GI Endoscopy was done to find out the source of bleeding. For identification of each patient, personal data was collected. All the data collected were entered and analyzed using SPSS-10. Mean age was 41.64 +/- 13.56 years with 49 [55.70%] male patients and 39 [44.30%] female patients. Majority of the patients 38[43.18%] were between 36-50 years of age. In our series frequency of chronic liver disease was 56.82%. Chronic liver disease is the most common cause of upper GI bleeding in our setting

Frequency of various causes of upper gastrointestinal bleed [UGIB] at a tertiary care hospital

To determine the frequency of various causes of upper gastrointestinal bleed [UGIB] at Tertiary Care Hospital. Descriptive cross-sectional study. This study was conducted at the Department of Internal Medicine, Nishtar Hospital Multan from August 2009 to January 2010. A total of 88 patients with upper GI bleed were registered. Prior permission was taken from Institutional Ethical Committee to conduct this study. Informed consent was taken from each patient. Upper GI Endoscopy was done to find out the source and cause of bleeding. For identification of each patient, personal data was collected. All the data collected were entered and analyzed using SPSS-11. Mean age was 41.64 +/- 13.56 years with 49 [55.70%] male and 39 [44.30%] female patients. Majority of the patients 38[43.18%] were between 36-50 years of age. In our series the commonest cause of UGIB was oesophageal varices in 56.82% of cases followed by peptic ulcer disease in 38.63% of patients. Oesophageal varices followed by peptic ulcer disease are the commonest causes of UGIB in our setting

Assessment of knowledge, attitude and practices pattern of hand washing in some major public sector hospitals of Pakistan [a multi-center study]

To assess knowledge, attitude and practices of hand washing in major Public sector Hospitals of Pakistan and see the differences in practices in different levels of health care workers. Cross sectional hospital based survey conducted in all provinces of Pakistan in major tertiary care hospitals. A Cross sectional hospital based survey was conducted on knowledge, attitude and practices of hand washing in doctors, nurses and paramedical staff. From each hospital 10 OPD's and 10 wards i.e. 2 medical, 2 Surgical, Gynae, Peads, Dermatology, Eye, ENT, and Causality/ICU were selected and from each unit. Four doctors, four nurses and two paramedical staff were interviewed. A total of 3243 respondents were interviewed. Of these 87.3% had knowledge of hand washing. Hand washing facilities were available at 75% places and 69% respondents practiced hand hygiene, but only 58.8% washed their hands for more than 20 seconds. Majority used antibacterial soap bought by them. Rush of the patients, shortage of time, non availability of soap and water and lack of encouragement by seniors were the major causes for low hand hygiene practice. Almost 25% sites in major public sector tertiary hospitals did not have hand washing facilities but where available most health care providers were using them. Majority despite having knowledge, need motivation and continuous education of hand hygiene. Facilities of hand hygiene should be made available

Hypoalbuminemia; frequency of low voltage QRS amplitude in patients

To determine the frequency of low voltage ECG in hypoalbuminemic patients. Descriptive crosssectional study. Nishtar Hospital Multan. April 2010 to September 2010. Non-probability purposive sampling. One hundred and fifty patients of hypoalbuminemia were registered after taking informed consent for participation. Serum albumin was done in all the cases. All the patients under went ECG. QRS wave amplitude was measured from standard 12 leads ECG's using clippers and magnifying glass within 24 hours of test for serum albumin. All information were entered in a specially designed proforma. Data entered and analyzed through SPSS-11. One hundred and fifty patients of hypoalbuminemia were included in the study. The age range was 18-90 years with mean of 47.28 +/- 21.80 years. There were 87 male and 63 female patients. Sixty eight [45.33%] patients with hypoalbuminemia developed low voltage ECG. Among them 37 [54.41%] were male and 31 [45.58%] female. Liver dysfunction, renal dysfunction, malnutrition and pre-eclampsia were common causes of hypoalbuminemia and present in 47 [31.33%] ,35[23.33%] ,15[10.00%] and 7[4.66%] of patients respectively. Low voltage ECG can be seen in hypoalbuminemia. So while interpreting low voltage ECG, the physician should keep in mind the hypoalbuminemia as one of the causes and should detect it first rather than undertaking sophisticated and unnecessary expensive investigations to rule out cardiac pathology

Anemia in pregnancy; related risk factors in under developed area

To see frequency of anemia and its related risk factors in pregnant women in an under developed area of Southern Punjab. Descriptive study. Ante natal outpatient clinic Tehsil Headquarter Hospital Kabirwala [Khanewal]. October2006 to March 2007. Sampling technique: Non-probability purposive. Two hundred and fifty pregnant ladies attending ante natal outpatient clinic at Tehsil Headquarter Hospital Kabirwala [Khanewal] irrespective of reproductive age, socio economic, educational and residential status were included in this study. After taking consent a pre-designed proforma was filled in. Hemoglobin level was checked. Subjects were categorized according to the hemoglobin levels into mild [10.0-10.9 g /dl], moderate [8.0-9.9 g/dl] and severe [< 8.0 g/dl] anemia. Two hundred and fifty pregnant women were studied. Mean age of the pregnant women was 28.28 +/- 5.20 years. Out of these 250 pregnant women, 138 [55.2%] were anemic and out of these 83 [60.14%] were moderately anemic while 55 [39.86%] had mild anemia and none of these had sever anemia. Among participating pregnant women, 28 [11.2%] were in 1st trimester, 85 [34%] in 2nd trimester and 137 [54.8%] were in the 3rd trimester. Anemia was observed in 10 [35.71%] women in first trimester, 35 [41.18%] in 2nd trimester and 93 [67.88%] in 3rd trimester. One hundred and thirty two women were from rural background, out of these, 83 [62.88%] were anemic. Seventy were uneducated and out of these, 58 [82.88%] were anemic while 180 women were educated and of these 81 [45%] were anemic. Ninety five [38%] were having poor dietary habits and out of these, 78 [82.10%] were anemic. One hundred eight pregnant ladies were not taking any iron supplement, out these 83 [76.85%] were anemic while 142 [56.8%] pregnant ladies were taking iron supplements, out of these 55 [38.73%] were anemic. Twenty one pregnant women were with gravida more than 6 and out of these 19 [90.47%] were anemic, of these 11 [57.89%] had moderate anemia while 8 [42.10%] were mildly anemic. The results of present study showed high frequency of anemia in the targeted population. Anemia was related with poor dietary habits especially poor iron intake. Anemia was more related with multi gravidity

Presentation of complications of chronic liver disease at a tertiary care hospital

To see presentations of various complications of chronic liver disease at a tertiary care hospital. Retrospective study. This Study was conducted at Medical Unit 1, Nishtar Hospital, Multan for a period of 6 months from 01-01-2010 to 30-06-2010. Patients admitted at Medical Unit 1, Nishtar Hospital, Multan were included in the study. The medical record of these patients was checked. The data obtained were entered in SPSS-11 and analyzed. A total number of 50 patients were studied, 30 [60%] were male and 20 [40%] were female. Age of the patients ranged from 36-58 years. Mean age of the patients was 45.39 +/- 4.77 years. All the patients presented with fatigue, generalized weakness, oedema feet, anorexia and nausea. Twenty [40%] patients presented with jaundice. Abdominal distension was present in 42 [84%] patients. Twenty two [44%] patients were having altered consciousness. Twenty three [46%] patients presented with haemetemesis and 28 [56%] with melena. Low grade fever was present in 26 [52%] patients. Epistaxis was present in 2 [4%] patients. Previous history of jaundice was present in 40 [80%] patients and history of alcohol intake was present in 12 [24%] cases. On examination, all the patients were found emaciated with protuberant abdomen. Twenty [40%] were clinically jaundiced. Oedema feet was detected in 48 [96%] patients. Palmar erythema was present in 26 [52%]. Hepatic flaps were present in 24 [48%] patients. Shifting dullness and fluid thrill was present in 46 [92%] patients and engorged paraumblical veins were present in 36 [72%] patients. Splenomegaly was seen in 36 [72%] patients. Laboratory investigations revealed raised serum bilirubin in 26 [52%] patients and level of bilirubin was 3-6 mg/100 ml in most of the cases. ALT levels were raised in 33 [66%] patients above the twice of the upper limit of the normal value. Serum alkaline phosphatase was raised only in 1[2%] of patients. Platelet count was below 70000 in 32 [64%] patients. Anti HCV and HBsAg were detected in 38 [76%] and 12 [24%] patients respectively. Prothrombin time was prolonged 25 seconds [than control] in 36 [72%] patients. Serum albumin was less than 3 g/100 ml in all cases. Abdominal ultrasonography revealed coarse echotexture with nodular liver in 46 [92%] patients. Ascites was detected in 48 [96%] patients. Two patients [4%] had hepatic mass. Upper GI endoscopy revealed esophageal varices in 33 [66%] patients, fundal varices in 12 [24%] patients, gastric ulceration in 17 [34%] patients and duodenal ulceration in 11 [22%] patients. Patients of chronic liver disease present in tertiary care hospital at a very late stage of the disease and most common presentations are ascites, hepatic encephalopathy, upper GI bleeding and low grade fever. Awareness may be created to motivate the patients to report to tertiary care hospital at an early stage, so that development of these complications can be managed at the very initial stage

Frequency of anti-HCV, HBsAg and related risk factors in pregnant women at Nishtar Hospital, Multan

Viral hepatitis is a global issue. Among the hepatitis viruses hepatitis B and C are important in South Asia including Pakistan. There are various modes of transmission of these viruses. Vertical transmission is also gaining importance. Antepartum screening for HBV and HCV would help the infected women for appropriate antiviral therapy at appropriate time as well as for taking proper care of the newborns. The present study was designed to see the frequency of HBsAg and anti-HCV in pregnant women at Nishtar Hospital, Multan. This was a cross-sectional study carried out using non-probability purposive sampling technique. The period of the study was from June 2006 to August 2007. Five hundred [500] pregnant women attending outpatient department of Gynaecology and Obstetrics were included. Informed consent was taken. A specially designed proforma was filled in. Anti-HCV and HBsAg were tested by device method. Data were analyzed on SPSS-11. Out of 500 pregnant women 35 [7.00%] were found to be anti-HCV positive and 23 [4.60%] were positive for HBsAg. Mean age was 26.7 +/- 4.8 years. Majority of the patients 263 [52.60%] were in the age group 26-35 years. 138 [27.60%] women were nulliparous and 282 [56.40%] were para 1-4 and anti-HCV and HBsAg were common in this parity group. Only 80 [16.00%] women were para 5 or more. All anti-HCV and HBsAg positive women were house-wives. Most of them were belonging to rural areas having poor socio-economic status. Among 35 anti-HCV positive women, 20 [57.14%] had history of previous surgery, while 13 [37.14%] had history of multiple injections, 5 [14.28%] received blood transfusion, 4 [11.42%] had ear/nose piercing while tattooing was seen in only 2 [5.71%]. Among 23 HBsAg positive women, 10 [43.47%] had history of previous surgery. History of multiple injections was present in 6 [26.08%] patients, 4 [17.39%] patients had history of blood transfusion, tattooing, ear/nose piercing, history of dental procedure, history of sharing needles was observed in 1 each. Frequency of anti-HCV is more common than HBsAg in our study population. Previous history of surgery, multiple injection therapy and blood transfusion were observed as risk factors among anti-HCV and HBsAg positive pregnant women

Hepatitis B, hepatitis C and HIV: knowledge among general public of peripheral areas of Multan

To assess the level of knowledge regarding hepatitis B hepatitis C and HIV among general public of peripheral areas of Multan. Cross-sectional study. Peripheral areas of Multan, village Budhla Sunnat, kusba Ayazabad Marrhal and PMRC Research Centre Nishtar Medical College Multan. From 01.05.2007 to 30.04.2008. Medical camps were established in peripheral areas of Multan, village Budhla Sunnat and kusba Ayazabad Marrhal. It was a cross-sectional study which was carried out using non-probability convenient sampling technique. Subjects of both sexes and adult age attending these medical camps were included in the study. Informed consent was taken and confidentiality of the personal information was ensured. Specially designed Proforma was filled in by the Research Officers and data entered in SPSS-11 and analyzed. Three hundred and eight subjects were interviewed. The age of subjects varied from 15-70 years. The mean age was 37.06 years +/- 15.59 years. Two hundred and twenty three [72.4%] were familiar with hepatitis B, 196 [63.6%] with hepatitis C and 146 [47.4%] with HIV and 133 [43.2%] were familiar with all three viruses while 81 [26.5%] were unfamiliar with these viruses. Most of the subjects 93 [30.2%] knew about the transmission through injection by un-sterilized syringes, 90 [29.2%] were knowing that infected blood is important source of spread while 87 [28.2%] of the subjects were knowing that these are spread through infected razors, 84 [27.2%] were knowing unsafe sex as a mode of transmission. Sharing objects can be the source of spread was known to very less number of people, 9 [2.9%] were aware that these can spread through sharing infected tooth brushes, 7 [2.3%] with sharing infected [Miswaks] and only 3 [1%] were aware that these can spread through infected combs. Electronic media was the major source of knowledge 82 [26.6%], interpersonal communication 69 [22.4%] and newspapers in only 1 [0.3%]. knowledge about hepatitis B, hepatitis C and HIV is low in our study population. The results of the study have shown that many people still think that HIV is the only virus which is transmitted through sexual contacts and hepatitis 8 and C through contaminated blood. The knowledge about the modes of transmission is lower in the rural and un-educated community. General public has very little knowledge that infected combs, infected toothbrushes and infected [Miswaks] can also lead to transmission of hepatitis B and C. Electronic media particularly television and radio and newspapers are the main source of knowledge and awareness for the urban population while in rural population it is not the case. Effective health awareness campaigns are needed to be started among rural population

Etiological pattern of ascites in patients admitted in medical units

Ascites is a very common problem in medical wards. It is the most common complication of cirrhosis of liver which is very alarming problem in this society due to increased transmission of hepatitis B and Hepatitis C virus. To determine the etiological diagnosis in patients presenting with ascites and the frequency of Hepatitis B and Hepatitis C in patients of ascites due to hepatic cirrhosis. It was a descriptive study with convenience non probability sampling technique. The study was performed on cases with ascites presenting at Bahawal Victoria Hospital, Bahawalpur in all four medical units from December 2006 to May 2007for a period of 6 months. A total of 50 patients with ascites were studied for the different causes of ascites, their clinical presentations and the frequency of Hepatitis B and C and the data obtained were statistically analyzed with descriptive statistic. There were 37 males and 13 females, with mean age of 58.8 +/- 15.9 years. Liver cirrhosis accounted for 84% of cases [hepatitis B cirrhosis 38%, hepatitis C cirrhosis 42%, both 4%] followed by peritoneal tuberculosis 6%, malignancy 6%, congestive heart failure 2%, and nephrotic syndrome 2%. As regards the clinical presentation, 25 patients presented with gastrointestinal bleeding due to esophageal varices, 20 with fever, 18 with jaundice, 7 with abdominal tenderness, 4 with breathlessness, 3 with abdominal masses, 2 with generalized edema and 1 patient of ascites was asymptomatic. The study concluded that in this area the most common cause of ascites is the liver cirrhosis. Hepatitis B and C infections are playing this havoc role. The common clinical presentations seen were gastrointestinal bleeding and fever

Frequency of non alcoholic fatty liver disease [NAFLD] and its biochemical derangements in type-2 diabetic patients

To see the frequency of non-alcoholic fatty liver disease in Type-2 diabetic patients and to see biochemical derangements in NAFLD patients. It is a cross-sectional study, conducted at Diabetic Research Centre and outpatient department Nishtar Hospital and PMRC Research Centre Nishtar Medical College, Multan. One hundred patients of either sex having type 2 diabetes mellitus attending diabetic out-patient department Nishtar Hospital Multan were included in the study. A pre-designed study pro forma was filled with relevant investigations and clinical assessments were carried out in all cases. All the patients underwent abdominal ultrasonography. Data were entered in SPSS-11 and analyzed. Out of one hundred patients, 51 [51%] were female and 49 [49%] were male. Mean age of the patients was 47.93 +/- 8.57 years. Fifty one [51%] of the diabetic patients had fatty liver. Out of these 32 [62.75%] were female and 19 [37.25%] were male. Fatigue was present in 49 [53.26%], generalized weakness in 48 [52.18%], heaviness right upper abdomen in 22 [64.70%] and pain right upper abdomen in 20 [58.82%] of fatty liver patients. Corresponding figure in Non Fatty Liver Patients were 43 [46.74%], 44 [47.82%], 12 [35.30%] and 14[41.18%], respectively. Itching was noted in 19 [44.18%] patients of fatty liver while it was 24[55.82%] in non-fatty liver patients. Serum triglyceride level more than 160 mg/dl in 47 [92.15%] patients of fatty liver while serum cholesterol level more than 200mg/dl was seen in 24[47.05%]. Aspartate amino transferase [AST] more than 35 u/l was noted in seven [13.72%], alanine amino-transferase [ALT] more than 40u/l was noted in 6[11.76%] fatty liver patients while serum albumin and serum billirubin were within normal range in all fatty liver and non-fatty liver patients. Nonalcoholic fatty liver disease [NAFLD] is more commonly seen in Type-2 diabetic patients. Serum triglyceride and serum cholesterol are significantly raised in NAFLD patients. Raised ALT and AST was not a common finding in our NAFLD study patients. Diabetic patients having heaviness or pain right upper abdomen with raised serum triglycerides and cholesterol should be more closely observed for NAFLD and liver complications

Pattern of diseases in a medical unit at Nishtar Hospital, Multan

To assess the frequency and pattern of diseases in a medical unit at tertiary care, [Nishtar Hospital] Multan. Cross-sectional study. Medical Unit-I, Nishtar Hospital Multan. May, 2004 to May, 2005. Patients admitted at Medical Unit-I, Nishtar Hospital, Multan were included in the study. Specially designed proforma was filled, data were collected and analysed on SPSS-10. Total admitted patients in medical unit-I at Nishtar Hospital, Multan from May, 2004 to May, 2005 were 660. 390 [59.1%] were males and 270 [40.9%] were females. Age ranges from 12-70 and above. Mean age was 43.88 years with standard deviation 18.87 years. Mostly [63.5%] patients were from home district. Chief complaints were uncontrolled diabetes mellitus [17.6%], fever [13.6%], weakness of one-half of body [10%], uncontrolled hypertension [9.7%], cough and fever [8.5%], yellowness of eyes [5.8%] and vomiting [4.2%]. Most common disease was diabetes mellitus [19.1%] followed by hypertension [17.9%], cerebro-vascular accidents [10%], chronic liver diseases [9.7%], acute hepatitis [8.9%], pneumonia [7.4%], meningitis [5.9%], chronic renal failure [3.2%], acid peptic disease [2%] and acute myeloid leukemia [1.5%] [Table No. 5]. Study revealed diabetes mellitus, hypertension, ischemic heart disease [IHD] and Cerebro-vascular accident [CVA] are most common diseases. Important measure to control diabetes mellitus and hypertension must be adopted. More detailed and large scale study are needed on pattern of diseases at tertiary care hospital so that disease pattern are known and on these basis strategies for control of diseases and patients care can be derived

Electrocardiographic predictors of mortality in acute stroke

The study was done to see if ECG changes in acute stroke could be used as predictor of in-hospital mortality. Cross-Sectional study done at the Department of Emergency and Medicine Nishtar Hospital Multan, from April 2003 to August 2005. Two hundred patients with acute stroke who presented within 48-hours of the onset of neurological symptoms, were enrolled in the study, irrespective of the co morbid conditions like hypertension, diabetes mellitus, valvular heart disease, coronary artery disease and cardiomyopathy. A non-contrast computerized tomographic scan [CT Scan] of the brain and a 12-lead ECG were recorded at the time of admission to define the stroke type and to determine the ECG variables. Follow-up of the patients was done during their stay in the Medical ward to calculate in hospital mortality. The ECG variables were categorized as, disturbances of heart rate and rhythm, ischemic changes and heart rate corrected QT interval [QTc interval].They were correlated with the death during the hospital stay, by analyzing the data using SPSS-10 version for statistical analysis. Majority of the patients had ischemic stroke, but mortality was higher with hemorrhagic stroke. ECG changes due to variations in heart rate and rhythm were frequent but less helpful than ischemic changes and QTc alterations, in predicting in hospital deaths due to stroke. Hospital mortality in stroke patients is mostly of cardiac origin. ECG changes resulting from QTc prolongation, ischemic changes, and rhythm disturbances were most helpful in predicting the prognosis