Frequency and clinical presentations of hepatitis B and C virus co-infection in tertiary care hospital

To study the frequency and clinical presentations of hepatitis B and C virus co-infection in a tertiary care hospital. This descriptive study was conducted at Lady Reading Hospital Peshawar, Pakistan from January 2011 to January 2012. A total of 52 patients with positive HBsAg and anti HCV antibodies were included in the study. Clinical, demographic, laboratory data and results of the liver and abdominal ultrasound were recorded. Furthermore, both qualitative and quantitative PCR were performed. Data was analyzed using SPSS v 16. P

Medical record documentation of patients admitted to a medical unit in a teaching hospital

To compare the standards of documentation with audit study 2005 and to determine that changes have been implemented. This descriptive audit study was conducted in the medical C unit of Lady Reading Hospital, Peshawar - Pakistan from 1[st] January 2010 31[st] December 2010. Out of 3684 patients admitted during the year2010. 200 case notes were randomly selected and subjected to re-audit. The clinical notes were broadly analysed for documentation of six parameters. Each parameter's documentation was to be graded as very good, good, average, poor or not documented. Personal bio-data was documented average in 195[97.5%] cases; History and examination were average in 98[49%] cases and good in 85[42.5%] cases; Investigations were documented good in 140[70%] and average in 13[6.5%] cases. Progress notes were good in130[65%]cases and treatment was documented good in194[97%]cases.In105[52.5%]charts, one or more of the six selected items were not documented at all. Progress notes were not written in 48[24%], investigations in35 [17.5%].diagnosis in16 [8%], history and examination in4[2%],bio-data in 2[1%]and treatment in1[0.5%] of the case notes. For comparison between audit 2005 and present audit 2010,the P value was 0.05. No change was made in the previous five years and no steps of improvement have been implemented

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

Percutaneous needle peritoneal biopsy in the diagnosis of exudative ascites

Percutaneous needle peritoneal biopsy in diagnosis of exudative ascites has gained wide acceptance and many workers have utilized it with a high diagnostic yield and no significant complications. Present study has been carried out to determine the efficacy of percutaneous needle peritoneal biopsy in the diagnosis of exudative ascites of unknown aetiology. It is a descriptive case study conducted in Medical 'C' Unit, Lady Reading Hospital, Postgraduate Medical Institute, Khyber Medical University Peshawar over a period of 2 years, i.e., from Nov, 2003 to December 2005. A total of 45 patients having unexplained exudative ascites underwent blind needle peritoneal biopsy. The biopsy specimen was subjected to histopathology. Ascitic fluid was also obtained for analysis. Post biopsy patients were observed for 24 hours for any untoward complications. A total of 45 patients [17 male and 28 female] with age range from 20 to 65 years and having exudative ascites were studied. The commonest presentation of our patients was abdominal distension [93.3%], pain abdomen [46.67%], fever [44.4%] and weight loss [33.3%]. Histopathology of the peritoneal biopsies was reported as follows. Eighteen cases [40%] showed non specific chronic inflammation, 10 [22.2%] cases showed caseating granulomatous inflammation suggestive of tuberculosis and 6 [13.3%] cases showed metastatic adenocarcinoma. In one patient peritoneal mesothelioma was reported. In the remaining10 patients [22.2%] biopsies were either non representative or inconclusive. The ascitic fluid showed predominantly lymphocytes in 86.6% of cases. Only three patients were reported to be having atypical cells on fluid cytology. The procedure was found safe. No patient was lost due to complications related to the procedure. Only one patient had evidence of intra peritoneal bleed. The commonest problem post biopsy was pain [91.1%] and mild swelling [53.3%] at biopsy site. Peritoneal biopsy is fairly safe and inexpensive procedure with good diagnostic efficacy in patients with undiagnosed exudative ascites

Audit of medical record documentation of patients admitted to a medical unit in a teaching hospital NWFP Pakistan

To audit the medical record documentation of patients admitted to a medical unit in year 2005 at a teaching hospital NWFP Pakistan. The retrospective audit was conducted in the Medical [C] Unit of Government Lady Reading Hospital Peshawar from 1st January 2005 to 31st December 2005. Out of 3944 patients admitted during 2005, 200 case notes were randomly selected and subjected to audit. The clinical notes were broadly analysed for documentation of six parameters. Each parameter's documentation was to be graded as very good, good, average, poor, or not documented. Personal bio-data was documented good in 194 [97%] cases; history and examination were good in 22 [11%] cases; diagnosis was very good in 48 [24%] cases; Investigation were documented very good in 18 [9%] cases and good in 134 [67%] cases; Progress notes were good in 156 [78%] cases and treatment was documented good in 186 [93%] cases. In 82 [41%] charts, one or more of the six selected items were not documented at all. Investigations were not written in 20%, progress notes in 12%, history and examination in 9%, diagnosis in 6%, treatment in 3% and bio-data in 1% of the case notes. Documentation of important clinical information is poor even in the hospital charts of patients admitted in tertiary care hospital. Poor documentation in medical records might reduce the quality of care and undermine analyses based on retrospective chart reviews

Upper gastrointestinal endoscopic findings in patients with dyspepsia

The aim of the study was to evaluate oesophagogastroduedensocopy [OGD] findings in patients presenting with dyspepsia. This retrospective, observational study was conducted in Medical "C" unit. Department of Medicine Post Graduate Medical Institute Government Lady Reading Hospital Peshawar from August 2002 to September 2005. Adult patients who underwent upper gastrointestinal [GI] endoscopies for dyspepsia during the period were included in the study. The endoscopies were performed as per the standard protocol with diagnosis based on accepted criteria. A total of 765 patients with dyspepsia had endoscopy. Amongst them 49.8% [n=381] were female and 50.2% [n=384] male. The mean age of the study population was 39.43 years [SD+ 17.46]. A single endoscopic diagnosis was made in 57.2% [n=438] of the studied patients. In 12.8% [n=98] combinations of lesions were seen. Gastritis [13.85%, n=106], oesophagitis [11.1%, n=85], duodenal ulcer [8.1%, n=62], hiatus hernia [7.32%, n=56], duodenitis [7%, n=54%] and gastric ulcer [3.4%, n=26] were the common finding on endoscopy. Duodenal ulcer was more common as compared to gastric ulcer [8.1% vs. 3.4%]. Endoscopy was normal in 30% [n=229] of patients. These patients apparently had functional dyspepsia. Gastro-duodenitis, oesophagitis, peptic ulcer disease and hiatus hernia are the commonest endoscopic diagnosis in patients with dyspepsia. Upper GI endoscopy is a useful diagnostic modality in elucidation of the causes of dyspepsia

Frequency of hepatoma in hepatitis B and C positive cirrhotic patients

To find out the frequency of hepatoma in hepatitis B and C positive patients with liver cirrhosis. This descriptive study was conducted at Medical 'C' unit of Postgraduate Medical Institute Lady Reading Hospital Peshawar on patients admitted from January 2004 to June 2006. Seven hundred and forty patients who had hepatitis B and C positive liver cirrhosis were included in the study. Patients were interviewed according to the proforma after fulfilling the inclusion and exclusion criteria. Blood tests including liver function tests, coagulation profile and hepatitis B, C virus profile, ultrasound, serum alpha-fetoprotein level were done. Data was analyzed at the end of study. Out of 740 patients with liver cirrhosis, 52 [7.03%] patients had hepatoma. Mean age was 62.3 years. Male to female ratio was 6.4:1. Thirty two percent of the patients were Hepatitis B surface antigen positive while anti HCV antibody was found positive in 68% of the patients. Alpha-fetoprotein level was elevated in all the cases. Mean alpha-fetoprotein level was>653.82. Mean tumour size was 5.41cm. Tumour was unifocal in 48% of the patients while 52% of the cases had multifocal involvement. Right lobe was involved in 44%, left lobe in 6% while 50% of the patients had both lobes of the liver involved. This study demonstrates that hepatoma is more common in HCV related cirrhosis liver. It is a tumour of advanced age

Frequency and clinical course of hepatitis E in tertiary care hospitals

To find out the frequency of hepatitis E virus as a cause of acute hepatitis and its clinical course in hospitalized patients. Design: Cross-sectional hospital-based study. Place and Duration of Study: The study was conducted in two tertiary care teaching hospitals i.e., Khyber Teaching Hospital and PGMI Lady Reading Hospital, Peshawar [Pakistan] from January to December 2002. Patients and Amongst the total number of 1922 admitted patients, 148 had history of nausea, vomiting and jaundice and raised serum bilirubin with raised hepatic transaminases [ALT], were screened for HBV [hepatitis B virus], HCV [hepatitis C virus] and subsequently for HEV [hepatitis E virus]. Acute hepatitis A, autoimmune hepatitis and Wilson's disease were excluded by doing appropriate test as and when required. The patients with hepatitis E were then monitored by checking their serial transaminases on day 1,4,8 and day 18 or until their transaminases dropped to normal. They were also clinically assessed and followed-up. Amongst the total admission of 1922 patients during one year period, 148 had acute hepatitis and out of these, 21 patients [14.189%] suffered from hepatitis E. Seventeen patients were below the age of 40. There were increased number of cases during the late summer and early winter seasons. Majority of the hepatitis E patients recovered during the short follow-up period of two weeks. Two patients had fulminant hepatitis. A four months pregnant young female died of her illness despite intensive treatment. Hepatitis E virus is fairly common cause of acute hepatitis in hospitalized patients. Most of the patients are having a benign self-limiting illness

Effect of oral and inhaled cetirizine in mild asthmatic patients

The effect of an inhaled and oral HI antagonist has been compared in the same patients.We have compared the effect of a single dose of nebulised [1 ml - 10 mg /ml] and oral [15mg] cetirizine to a matched placebo in a double blind double blind double dummy cross over study in 10 atopic asthmatics with moderate airflow obstruction mean [sem] age 52 [5.22] years, mean predicted FEV1 59 [3.9%]. The data was analysed by applying the multiple Regression analyses and chi square statistical methods. There was no significant difference in the baseline FEV1 on three study days. The maximum mean percentage increase in FEV1 after placebo, nebulised and oral cetirizine were 11.7 [2.8]; 11.3 [5.5] and 21.8 [3.7] respectively. Significant bronchodilation was observed at 60 [P<0.02], 120 [P<0.02] and 180 minutes [P<0.05] after oral cetirizine compared to placebo. Four patients developed transient bronchocostriction after inhaled cetirizine. These results suggest the presence of a local histamine tone in the airways. Ordinary doses of currently available HI receptor antagonist have minimal bronchodilator and bronchoprotective activity. In severe persistent asthma, HI receptor antagonist have no significant clinical effect, however in moderate asthma clinical benefits of HI receptor antagonist are apparent. The participation of antihistamine in the allergic inflammation including asthma must be reexamined, since the effect of histamine are more widespread and further studies are needed to evaluate its role in the management of asthma

Geographical distribution and histological presentation of gastric carcinoma in NWFP

The purpose of the study was to find out the geographical distribution of gastric cancer in the North West Frontier Province and to study the various histological presentations of gastric carcinoma.Gastric cancer is one of the commonest malignancies affecting our local population including Afghan refugees. This prospective study comprising of fifty patients with diagnosed gastric cancer, was conducted in Medical C Unit of LRH Peshawar. It was found that 30 [60%] patients belonged to the northern part of the Province, 15 [30%] were from southern area, 3 [6%] from the western- area whereas 2 [4%] were from eastern side. Adenocarcinoma was the common [100%] histological type. No gastric lymphoma was found. Gastric cancer is one of the commonest disease in patient coming from the mapped out area and need proper screening