Paediatric living donor liver transplantation: a single centre experience from Pakistan

Objective: To determine the outcomes of paediatric living donor liver transplantation [LDLT] recipients from Pakistan in terms of 90-day morbidity and mortality

Study Design: Cohort study

Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, between April 2012 and April 2015

Methodology: All patients in paediatric age group [17 years] who underwent LDLT with a minimum follow-up of 3 months, were included. All grade 2 and above complications on Clavien-Dindo system were included as morbidity. The main outcome measure was 90-day morbidity and mortality

Results: Fourteen paediatric LDLTs were performed. Median age of the recipients was 8.5 years ranging between 6 months and 17 years. Wilson's disease and cryptogenic cirrhosis were the most common etiologies [28.6% each]. Acute liver failure was present in 5 [35.7%] patients. Overall 90-day morbidity and mortality was 71.4% and 14.2%; both were attributable to pulmonary infection. No difference was observed in morbidity [21.3% vs. 42.8%, p=0.3] and mortality rates [20% vs. 11%, p=1.0] between patients with acute and chronic liver failure. Estimated 3-year survival was 85%

Conclusion: Paediatric LDLT offers a promising treatment option for acute and chronic liver failure. Mortality was attributable to post-transplant pulmonary infections

Histomorphological features of placentae in pregnancies complicated with intrauterine growth restriction

Fetal growth retardation is most commonly caused by placental letdown to meet the increasing demand for oxygen and nutrients of the developing fetus. Intrauterine growth restriction [IUGR] is common happening in Pakistani setup especially in rural areas. Current literature suggests that placental causes are more common than the maternal causes in intrauterine growth restriction. Macroscopic and microscopic examination of placenta can help us to identify the patho-physiology of placental involvement. This is reasonable especially in those cases of intrauterine growth retardation which are not perplexed by maternal causes. To identify macroscopic and microscopic features of placenta in pregnancy complicated with IUGR. Descriptive study. This study was conducted at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan in collaboration with Department of Pathology Quaid-e-Azam Medical College, Bahawalpur and Anatomy Department, Nishtar Medical College, Multan. Study duration was two years from July, 2010 to June, 2012. One hundred and fifty placentae, 85 from cases of intrauterine growth retardation and 65 from normal [control] were enrolled for the study. Fetal and placental weights and placental diameter and thickness were measured. Tissue for histological examination was obtained from: i] Umbilical cord ii] membranes and iii] three placental zones. The tissues were processed and stained with Haematoxlyin, Eosin and Mallory's Trichrome. The prepared tissues were studied microscopically for villous and intervillous lesions utilizing various criteria. Macroscopically there was significant decrease in placental weight, fetal weight, and placental diameter and thickness. Microscopic findings were increased fibrinoid necrosis [46.7%], increased perivillous fibrinoid deposition [16.7%], increased syncytial knots [60%] and increased placental infarction [1.8%]. These findings document comparatively higher frequency of fibrinoid necrosis and perivillous fibrinoid deposition. This draws ours attention to the predominant role of placental causes in cases of idiopathic intrauterine growth retardation

Surgical site infections in general surgical wards at a tertiary care hospital

Surgical site infections are important cause of morbidity and mortality in admitted patients world over. To determine the pattern of surgical site infections in General Surgical ward of a tertiary care hospital. Analytical cross-sectional study conducted at Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad for two years from January 2010 to December 2011. All cases were admitted in surgical ward with various surgical problems either as elective or emergency cases who developed wound infection later were included in the study. Cases of wound infection operated elsewhere, diabetic foot, and abscesses were excluded. Data collected included age, gender, primary diagnosis, mode of admission, comorbid factors, type and duration of surgery, expertise of the surgeon, use of antibiotics and hospital stay. After operation, wound was examined for evidence of infection from third post-op day onward. Any discharge was submitted for bacteriological examination. The wounds were followed till healed. A total of 1913 patients underwent surgery, including 983 cases [51.5 %] operated as elective and 932[48.5 %] as emergency. Postoperative wound infections occurred in 165 cases giving an overall incidence of infection in 8.6% cases. Infection rate in elective cases was lower [4.6%] than that in the emergency [12.7%] cases. Sixty one patients [37%] developed minor infection or stitch abscess, 104[63%] has frank suppuration requiring opening and drainage of wound; while 5[3%] cases developed deep seated infection of intra-abdominal spaces. E. coli was the commonest bacteria for wound infection [39%]. Post operative wound infection rate was 8.6%. The infection was significantly higher in cases who underwent emergency surgery and E. coli was the commonest pathogen to cause infection

Comparison of hyperuricemia in type 2 diabetics on low dose aspirin and not on low dose aspirin

To compare the frequency of hyperuricemia in type 2 diabetes patients who are taking low dose aspirin with those patients who are not taking low dose aspirin. Quasi experimental study. This study was carried out at Military Hospital Rawalpindi for a period of two years [June 2006-May 2008]. Sixty diabetic patients were selected who were taking low dose aspirin comparing group A and sixty diabetic patients who were not taking aspirin were placed in group B. These patients were selected from the OPD through non probability convenience sampling. All these patients were being followed up in medical outpatient quite regularly on fort-nightly basis. Data had been collected through a carefully designed questionnaire. In group A, 90% of the patients had uric acid less than 445umol/l and 10% of the patients had uric acid more than 445umol/l. whereas in group B 100% of the patients had uric acid less than 445umol/l, there was a statistically significant difference between the two groups [p< 0.05]. Aspirin in low doses cause hyperuricemia and regular monitoring of uric acid is mandatory to prevent its adverse effects

Candidate genes prediction in pakistani families with hearing impairment by using bioinformatic approach / Predição de genes candidatos em famílias paquistanesas com deficiência auditiva utilizando uma abordagem de bioinformática

Multiple factors such as genetic and environmental, are involved in causing hearing impairment (HI). Severe or profound hearing loss affects approximately one in 1000 children worldwide and half of these cases are due to genetic factors. In case of hereditary nonsyndromic HI, approximately 75­80% of cases are involved in autosomal recessive inheritance and 15% of cases involve autosomal dominant inheritance. HI represents extreme genetic heterogeneity. In nonsyndromic deafness, 135 loci have been mapped till now including 77 autosomal recessive genes of which only 29 corresponding nuclear genes have been cloned. This study was designed to apply bioinformatic approach for reducing large number of candidate genes responsible for deafness to a handy number for their mutation analysis. Databases of expressed mouse inner ear genes and the expressed human cochlear genes were used to cross-reference all genes present in particular locus predicting candidate genes for phenotypes of nonsyndromic hereditary HI. These candidate genes are a source of starting point for mutation analysis along with genetic linkage to refine the loci. After characterization, it was observed that KIAA119 and EDN3 are candidate genes for deafness. In present study, there were total 14 loci and two genes KIAA119 and EDN3 were identified as candidate genes in locus 48 and locus 65 respectively. If mutation analysis of the two characterized genes is done, it will not be a comparatively time taking and labor-intensive process as these genes are only two in number.

Diversos fatores, tais como genéticos e ambientais, estão envolvidos na causa da deficiência auditiva (HI). A perda auditiva severa ou profunda afeta aproximadamente uma em cada 1000 crianças em todo o mundo e metade destes casos são devidos a fatores genéticos. Em relação a HI não-sindrômica hereditária, cerca de 75-80% dos casos estão envolvidos na herança autossômica recessiva e 15% dos casos envolvem herança autossômica dominante. HI representa extrema heterogeneidade genética. Em casos de surdez, 135 loci foram mapeados até agora, incluindo 77 genes autossômicos recessivos das quais apenas 29 genes correspondentes nucleares foram clonados. Este estudo foi desenhado para aplicar abordagem de bioinformática a fim de reduzir o grande número de genes candidatos responsáveis pela surdez a um número útil para a análise de mutação. Bases de dados de genes expressos do ouvido interno em camundongos e de genes expressos na cóclea em humanos foram usados para cruzar todos os genes presentes no locus específico prevendo genes candidatos para os fenótipos de HI não sindrômica hereditária. Estes genes candidatos são uma fonte de ponto de partida para a análise de mutação, juntamente com a ligação gênica para refinar os locos. Após a caracterização, verificouse que KIAA119 e EDN3 são genes candidatos para a surdez. No presente estudo, houve um total de 14 locos e dois genes KIAA119 e EDN3 foram identificados como genes candidatos no locus 48 e locus 65, respectivamente. Se a análise de mutação dos dois genes caracterizados for feita, não será um processo comparativamente longo e trabalhoso uma vez que são apenas dois genes.

Comparison of scar with polypropylene and polyglactin 910 in thyroid incisions

To compare quality of scar after subcuticular stitches between Polypropylene [Prolene], a non-absorbable suture, with Polyglactin 910 [Vicryl], an absorbable suture after thyroid surgery. Randomized controlled trail [RCT]. Department of Surgery Combined Military Hospital and Military Hospital Rawalpindi from 1 Jan 2007 to 31 Dec 2007. Sixty patients undergoing elective thyroid surgery were included and randomly divided into two groups using random number tables. Informed written consent was obtained from each patient. The neck wound was closed by subcuticular suturing technique and the suture material was used according to the sampling technique. The patients were followed up in OPD on 10[th] post operative day and twelve weeks after surgery for the quality of scar. After 10 days, 1 patient in each of the Polypropylene group [3.3%] and Polyglactin 910 group [3.3%] had a bad scar [p = 1.000]. After twelve weeks of surgery, 2 patients in the Polypropylene group [6.7%] and 3 patients in the Polyglactin 910 group [10.0%] had bad scars [p = 1.000]. There is no significant difference between the frequency of bad scar formation in the Polypropylene and Polyglactin 910 group. It is thus recommended that absorbable Polyglactin 910 sutures should be used for wound closure after thyroid surgery as it does not require suture removal and thus prevents patient anxiety and discomfort and also saves surgeon and staff's time

Cervical lymphadenopathy: a common diagnostic dilemma

To determine the diagnostic accuracy of fine needle aspiration cytology [FNAC] in cervical lymphadenopathy using histopathologic examination of the excised lymph node as gold standard. Cross sectional study. Combined Military Hospital Rawalpindi in collaboration with Armed Forces Institute of Pathology [AFIP] Rawalpindi, from January 2007 to January 2008. A total of 70 patients suffering from cervical lymphadenopathy were selected. After obtaining informed consent FNAC was obtained from the lymph node. Afterwards same lymph node was removed under local anesthesia for histopathology. All specimens were sent to AFIP for histopathology reporting. Sensitivity, specificity, positive and negative predictive values and diagnostic efficacy for both the modalities were calculated. Data was analyzed using SPSS version 10. Mean and standard deviation for age and gender were calculated. Mean age of the patients was 38.14 +/- 16.88 year. FNAC findings showed a sensitivity of 79.5%, specificity 47.61%, positive predictive value 78%, negative predictive value 50% and diagnostic efficacy 70%. FNAC appears well established method of diagnosis, as its results compared favorably in many respects with those obtained from traditional surgical biopsy.

Comparison of tramadol with bupivacaine as local anaesthetic in postoperative pain control

To determine the effectiveness and duration of postoperative pain relief after local infiltration of tramadol in comparison with bupivacaine, in adult hernia surgery. Quasi experimental study. Department of Surgery, Combined Military Hospital Rawalpindi. Study was conducted on 60 patients aged between 20-60 years with elective mesh repair of inguinal hernia. Patients were divided into two groups of 30 patients for 0.25% bupivacaine [group A] and tramadol [group B]. Patients were assessed for pain at 1, 6, 12, 18 and 24 hours following surgery using visual analogue pain score [VAPS]. Patients with score =5 were given rescue analgesia in the form of 75 mg intramuscular diclofenac sodium. Comparison of first analgesia requirement time and the VAPS between the two groups was done using "t" test taking a p-value of <0.05 as significant. Patients in group A had a mean age of 46 +/- 11.03 years whereas in group B the mean age was 46 +/- 11.39 years. Mean visual analogue pain score after 1 and 6 hours of operation was 2.73 and 4.7 respectively in group A while it was 1.43 and 3.43 in group B. VAPS after 24 hours of operation was 3.47 in group A and 2.53 in group B. Mean time when 1st dose of rescue analgesic used was 8.20 hours in group A and 11.60 hours in group B. independent sample t-test for VAPS between the 2 groups revealed a highly significant difference [p-value <0.05] at 1, 6, 12 and 24 hours but no significant difference was seen at 18 hours. Independent sample t-test for time required for rescue analgesia and total number of doses required was also highly significant [p-value <0.05] between the two groups. Locally infiltrated tramadol provided an improved postoperative analgesia in comparison to bupivacaine and decreased the requirement of postoperative analgesics with early patient mobility and discharge

Knowledge, attitude and practices about needle stick injuries in healthcare workers

To assess knowledge, attitude and practices about needle stick Injuries in health care workers. Hospital based study carried out at Pakistan Institute of Medical Sciences, Islamabad, from August 2010 to November 2010. A self administered 19 items questionnaire was prepared which contained information about needle stick injuries, its awareness, frequency of injury and the protocols that were followed after an injury had occurred. These questionnaires were given to 500 health care workers working in different wards and theaters of the hospital after obtaining their informed written consent. The health care workers included doctors, nurses and paramedical staff of Pakistan Institute of Medical Sciences, Islamabad. The data was entered and analyzed using SPSS version 15. A total of 500 health care workers filled the questionnaire and returned it. Out of these 416[83.2%] reported ever experiencing needle stick injuries in their professional life. Health care workers working in Emergency department were most frequently affected [65%] followed by those working in different wards [27%] and operation theatre [8%]. Most [93.6%] workers had knowledge about needle stick injuries and only 6.4% were not aware of it. Needle stick injury occurred from a brand new [unused] syringe in 51.2% cases, while in 32.8% cases, the needle caused an injury after it had been used for an injection. In 5% cases, injury occurred with blood stained needles. The commonest reasons for needle injury in stick injuries were heavy work load [36.8%] followed by hasty work [33.6%] and needle recapping [18.6%]. About 66% health care workers were already vaccinated against hepatitis B. Only 13% workers followed universal guidelines of needle stick injuries and no case was reported to hospital authorities. Health care workers had inadequate knowledge about the risk associated with needle stick injuries and do not follow standard preventive measures. A standard protocol regarding the training and compliance to follow preventive measures should be followed in all health care institutions

Use of internet by medical students in their basic and clinical skills

The potential of using internet for medical education is widely accepted in enhancing their knowledge, skill and attitude. To assess the ability, accessibility and attitudes of medical students about use of information technology for e-learning in improving their basic and clinical skills. A qualitative descriptive study carried out at Gynae Unit II and ENT Unit I, Allama Iqbal Medical College/Jinnah Hospital, Lahore from January 2007 to April 2007. One hundred and fifty medical students each from last three years of MBBS were included in the study. A self-administered questionnaire was applied to them which included their demographic details and perceived level of IT [information technology] ability and accessibility. Four hundred fifty undergraduate students participated in the survey. There were 49% females and 51% males with similar average age. Among students 88.5% were using internet for educational purposes either at home or in college computer lab. However, the average use per week was 3.4 hours. Google, Yahoo and Ask were three most commonly used search engines. Majority [90%] of the students said that they are not getting input from their teachers on e-medicine should be the part of education from first year onwards. Undergraduate medical students have a reasonable access and perception for internet based learning and this should become a part of medical curriculum from the first year of MBBS. Medical teachers should facilitate the use of internet as an important tool of learning. Internet facilities should made widely available in the medical colleges to help them in enhancing their skills

Huge sub-mandibular gland tumour

Salivary gland neoplasms are a diverse group of tumours and appropriate treatment depends on adequate understanding of the pathophysiologic behaviour of each tumour type. Most [95%] salivary glands occur in adults. Benign tumours are slow growing tumours and attain a considerable size before presenting to surgeon. We report a case of huge tumour of left submandibular gland that presented in our surgical outpatient department, and had developed over last twenty years. It was diagnosed as a benign mixed tumour of salivary gland and was successfully excised. Histopathology confirmed it to be a benign pleomorphic adenoma

Outcome of 7-S, TQM technique for healthcare waste management

To assess the present waste management system of healthcare facilities [HCFs] attached with Shalamar Hospital, Lahore by applying the 7-S technique of Total Quality Management [TQM] and to find out the outcome after imparting training. Interventional quasi-experimental study. The Shalamar Hospital, Lahore, Punjab, Pakistan, November, 2009 to November, 2010. Mckinsey's 7-S, technique of TQM was applied to assess the 220 HCFs from Lahore, Gujranwala and Sheikhupura districts for segregation, collection, transportation and disposal [SCTD] of hospital waste. Direct interview method was applied. Trainings were provided in each institution. After one year action period, the status of four areas of concern was compared before and after training. The parameters studied were segregation, collection, transportation and disposal systems in the 220 HCFs. Each of these were further elaborated by strategy, structure, system, staff, skill, style and stakeholder/shared value factors. Standard error of difference of proportion was applied to assess significance using 95% confidence level. There was marked improvement in all these areas ranging from 20% to 77% following a training program of 3 months. In case of disposal of the waste strategy, structure and system an increase of 60%, 65% and 75% was observed after training. The 7-S technique played a vital role in assessing the hospital waste management system. Training for the healthcare workers played a significant role in healthcare facilities

Mass closure and layered closure in major abdominal laparotomies - a comparative study

To compare the number of complications after continuous layered closure with continuous mass closure in major abdominal laparotomies and to describe the frequency and types of complications after each procedure. The study was conducted in Surgical Unit-I in Nishtar Hospital, Multan from January 2008 to December 2008. A total of 50 patients included in two equal groups were included in the study. It was be comparative/descriptive study. Patients were admitted in surgical unit-I, Nishtar Hospital, Multan through emergency and outpatient department. They were operated by a consultant surgeon and senior staff. The patients were equally divided between the two methods of closure. In group-A, 17 [70%] were male and 8 [30%] were female while in group-B there were 16 [64%] male and 9 [36%] female. Age of the patient varied from 13 years to 30 years. In group-A 11 [44%] patients were from elective laparotomies and 14 [56%] from emergencies, while in group-B 8 [32%] patients were from elective operation and 17 [68%] from emergency. In group-A, 6 [24%] had midline incisions while 19 [76%] had paramedian incisions. In group-A clean wound were 12 [848%] and clean contaminated were 12 [52%]. In group-B clean wound were 9 [36%] and clean contaminated were 16 [64%] patients. Group-A had 2 [8%] patients with chest infection and cough in 5 [20%], while in group-B had 1 [4%] patient with chest infection, 2 [8%] with haemorrhage. In group-A small bowel 8 [32%], stomach and duodenum 2 [6%], billiary tract 6 [24%], major abdominal vessels 2 [8%], liver and spleen 1 [4%], colon 3 [12%] and miscellaneous 3 [12%]. In group-B the corresponding figures are small. In group-A wound dehiscencc occurred in 2 [8%] patients out of 25 whereas in group-B the dehiscence occurred in none of 25 patients. Using non-absorbable monofilament polyprophylene [prolene] is better than the conventional layered closure with regard to gain of early and late wound strength

Metabolic syndrome in type 1 diabetes

The aim of this study was to assess the prevalence and effects of the presence of metabolic syndrome in patients with type 1 diabetes. Retrospective analysis of data from a one year period of patients attending annual review clinic was undertaken. Body weight, height and blood pressure were measured along with assessment of micro-/macro-vascular complications. HbAlc, urea, cholesterol, triglyceride, urinary albumin: creatinine ratios were also measured. Patients were divided into those with and those without metabolic syndrome. Data from 365 type 1 diabetic patients was analysed. Hundred and twelve had metabolic syndrome. There was no difference according to gender or smoking. Type 1 diabetic patients with metabolic syndrome had longer duration of diabetes, were significantly older, heavier, had higher blood pressure, higher triglyceride and lower HDL cholesterol levels. There were significant increases in mean BMI, urea, serum creatinine, urinary albumin: creatinine ratio, cholesterol and triglyceride in the group with metabolic syndrome even after controlling for both age and duration of diabetes. Neuropathy and macro-vascular complications were commoner in patients with metabolic syndrome. Patients with metabolic syndrome were more likely to be on statins, ACE inhibitors and angiotensin receptor blockers and had a significantly higher mean insulin dosage requirement per kg. This study highlights the importance of the presence of the metabolic syndrome in patients with type 1 diabetes. It shows that metabolic syndrome is associated with a higher incidence of diabetes-related complications, a need for higher insulin doses and a more aggressive multifactorial intervention

CSOM; ossicular damage in atticoantral variant

The current study aims to find the extent of ossicular chain damage in patients with chronic suppurative otitis media, associated with cholesteotoma and/or granulation tissue formation. Descriptive study. The study was conducted at the department of ENT unit 1, Jinnah hospital/ Allama Iqbal Medical College Lahore from March, 2007 to March, 2008. A total of fifty consecutive patients presenting with atticoantral disease of different age groups were included in the study. All patients were examined clinically and under microscope. X- rays mastoids and pure tone audiometry was done in all patients. Mastoid exploration was done in all the patients and ossicullar status was assessed peroperatively. Canal wall down procedure was adopted in all the patients. Among different age groups included, majority [more than 70%] of them, were below 30 years of age, showing that atticoantral variant of CSOM is a disease of the young people. Males were more in number [70%]. Duration of the symptoms was usually prolonged. On radiological examination, 39 cases [78%] had sclerotic mastoid. Audiological records of patients showed the air bone gap of more than 40 dB in most of [78%] of patients. Perforation was marginal in most of the patients [64%]. In gross pathologic findings, cholesteotoma only, was seen in 21 cases [42%], granulations seen in 13[26%] cases, while cholesteotoma and granulations seen in 16 cases [32%]. All cases showed erosion of the ossicles, complete or partial. Incus was a most commonly involved ossicle. Chronic suppurative otitis media, atticoantral variant do commonly damage the ossicles and routinely it is multiossicular damage. Incus, is damaged most with involvement of its long process

Two-port laparoscopic cholecystectomy-a new technique

Laparoscopic cholecystectomy is now the procedure of choice in all the gall bladder diseases and there is increase in the skills of surgeons with newer equipment. Normally the laparoscopic cholecystectomy is performed by using four ports or three ports. Two ports laparoscopic cholecystectomy is rarely performed as it demands greater expertise and skills. Also this technique is less expensive and less scar formation than four port laparoscopic cholecystectomy. We present a case of a middle aged female who underwent successfully laparoscopic cholecystectomy by using only two ports

Psychological well being and work motivation amongst medical professionals

The study examines the relationship of psychological well-being and work motivation in a sample of Pakistani medical professionals. Cross sectional comparative study. The study was conducted in private [Alshifa International Hospital, Islamabad, and Islamabad Private Hospital] and public sector hospitals [Pakistan Institute of medical Sciences and Rawalpindi General Hospital] in the twin-cities of Islamabad and Rawalpindi, Pakistan during 2002. A sample of 120 medical professionals belonging to the private and public sector hospitals [n=60 in each] participated in the study. They were selected on the basis of purposive convenient sampling technique. The data was collected with the help of Psychological Well-Being Scale [Wb] and Work Preference Inventory [WPI] and a separately devised demographic sheet containing information about age, experience and private and public sector affiliation. The age range of the sample was between 30-60 years [M=42.97, SD=7.96]. The range of experience in service was 1-42 years [M=16.28, SD=8.43]. Scores of psychological well being had a significant inverse co-relation with extrinsic motivation [r=-0.26, p < .01]. Public and private sector doctors showed a highly significant difference in their motivational orientation [p < .01]. The relation of age with scores of well being and motivation showed a significant difference, [t=3.9, p<.001] and [t=2.41, p<0.05] between those aged 53 and above and those 41 years of age or less respectively. Compared to the private sector, the environment of public sector is perceived to be more challenging. Similarly, older medical professionals seem to be having higher psychological well-being and work motivation, compared to the younger medical professionals. However, these findings suggest the need for further exploration of some interrelated variables, which might give us insight for future policy implementation, suggesting ways for further improvement in the psychological facets of the work environment of this dynamic group of professionals

Pregnancy induced rhinitis

Objective of this prospective study was to evaluate the occurrence of nasal congestion during pregnancy. Nasal congestion during pregnancy in 54 patients was evaluated at 12, 20, 28 and 36 weeks and was correlated to age, parity and body mass index. Results were recorded on the basis of subjective experience of patients. The prevalence of nasal congestion increased during pregnancy and occurred in 16% of women at 12 weeks of gestation, in 25% at 20 weeks, in 29% at 28 weeks and in 30% at 36 weeks. It was more common in multiparous women. Age and body mass index were not associated with nasal stuffiness. More than half of the patients reported nasal congestion for more than two weeks during pregnancy. Nasal congestion should be recognized and referred for treatment to improve the quality of pregnancy

Prevalence of hepatitis C virus and its serotypes in Bahawalpur divison

To find the prevalence of hepatitis C virus serotypes in Bahawalpur division Design: It was a prospective study to asses the frequency of HCV serotyping Settings All the patients coming for the treatment of liver disease from Jan 2000-Dec 2002 in the departments of medicine and consultants in BVH Bahawalpur Subjects and Methods 125 patients of chronic liver disease, with persistently raised SGPT and positive anti HCV and HCV RNA, were included in this study. All these sera were serotyped using Murex Serotyping 1-6 assay system. Of 125 patients sera 105 [84%] were typable and 20 were [16%] untypable, no multiple serotypes were seen. Serotype 3 were 69.6% and serotype 1 [6%]. Serotype 2,4,6 were also detected 4.8%, 2.4% and 0.8 respectively, No serotype 6 was seen. The disease state was compared to different HCV serotypes by and more cirrhosis was observed in serotype 1 as compared to serotype 3. Cirrhosis was also observed in non-typable cases. Risk factors identified from data were transfusions [29%], parentral therapy [20%], Health workers 25[20%], sharing blades, Homosexuality 10 patients [08%], Intravenous drug abusers [04%], previous surgery [6.8%], dentists [7.2%]. No vertical group was seen in this study. Few other miscellaneous risk factors were pricking for ears and noses tattooing [in female groups]. One patient returned from USA, developed cirrhosis due to serotype 1 gave the history of out of family sex contact. No significant difference was noted in different groups of serotypes for HCV. HCV serotypes 3 were more common and serotype 1 was related to more sever disease. Risk factors are more important to control the spread of HCV

Iatrogenic bile duct injuries: Experience at PIMS

Cholecystectomy is one of the most familiar and commonly performed elective operation in general surgery. However, bile duct injury is a rare but one of the worst complications of this procedure. Although infrequent in expert hands, it is usually encountered when comparatively inexperienced surgeons are operating. These injuries present at variable time after the primary surgery. The prompt recognition and active management affects the morbidity and mortality associated with it. We evaluated the data of the hospital to find out the nature of injuries inflicted to extra hepatic bile duct and its management. This is a study of 20 cases of iatrogenic bile duct injury managed at the Department of Surgery Unit 1, PIMS. The study includes cases that had undergone cholecystectomy, open or laparoscopic in previous 11 years and sustained injury to the biliary tree and were managed accordingly. Patients with hepatobiliary malignancy were excluded. Twenty cases were found to have various types of bile duct injuries. All patients were females, and their average age was 35 years. In four cases the injury occurred during surgery at our hospital, while remaining 16 cases were referred from other hospitals. All the patients were explored and managed accordingly. They had uneventful recovery and had good outcome at 6 months. Although the fact is that, the sooner an injury is recognized and treated, the better is the outcome. However, in this study the duration of injury had no effect on final outcome