Use of exercise tolerance test and thallium stress test in the diagnosis of ischemic heart disease in soldiers

To determine the role of Exercise Tolerance Test [ETT] and Thallium Stress Test [TST] in the detection of Coronary Artery Disease [CAD] among soldiers. Descriptive study. This study was conducted at Combined Military Hospital [CMH], Multan, Pakistan, from 2002 to 2004. There were 291 male soldiers between ages 30 and 45 years who presented with chest pain and had normal resting ECG. All patients were subjected to ETT. Positive ETT cases had Coronary Angiogram [CA] as the gold standard. Negative cases were subjected to TST. Normal CA cases also had TST to rule out microvascular disease. Those with normal ETT and positive CAD risk factors also had TST. Those with negative TST had CA as service requirement. All 291 cases had ETT, 130 cases were found positive, 161 had negative ETT. When CA was done on 130 positive cases, 95 had CAD [true positive, TP] and 35 had normal coronaries [false positive, FP]. Out of the 161 negative ETT cases, 128 had normal coronaries [true negative, TN] and 33 had CAD [false negative, FN]. TST was conducted on 196 cases, out of which 78 cases were found positive and 118 had negative TST. When subjected to CA, out of 78 positive cases, 30 had CAD [TP] and 48 had normal coronaries [FP]. Out of 118 negative TST cases, 115 had normal coronaries [TN] and 3 had CAD [FN]. ETT was found to have sensitivity of 74.2%, specificity of 78.5%, Positive Predictive Value [PPV] of 73.1%, Negative Predictive Value [NPV] of 79.5% and test accuracy of 76.6%. TST had sensitivity of 90.9%, specificity of 70.6%, PPV of 38.5%, NPV of 97.5% and accuracy of 74.0%. TST was found to be more sensitive and less specific than ETT in the diagnosis of CAD

Efficacy of interferon therapy in patients of chronic hepatitis B viral infection treated at MH Rawalpindi

The consequences of acute and chronic HBV infection are major public health problems. These infections may progress to cirrhosis, liver failure, and Hepatocellular carcinoma Treatment of chronic replicative hepatitis B virus [HBV] infection is aimed at stopping viral replication and preventing the development of chronic liver disease. To determine the efficacy of Interferon therapy in patients of chronic Hepatitis B treated at MH Rawalpindi, by comparison of PCR for HBV DNA before and after Interferon therapy. Quasi-experimental study. Military Hospital, Rawalpindi from July 2003 to December 2005. The efficacy of a 4-month course of subcutaneously administered human recombinant interferon Alfa was studied. A total of 50 patients of proven chronic viral hepatitis B with presence of hepatitis B surface antigen and hepatitis B virus DNA [HBV DNA] in the serum were enrolled over the span of 30 months. All patients were treated with 5 mega units of recombinant interferon alfa-2b subcutaneously once daily for 4 months. PCR for HBV DNA was performed at the end of fourth month in treated patients as a predictor of response to interferon therapy. The treatment was well tolerated, only in three patients treatment was ceased due to severe depression while none of the other patient required dosage reduction or cessation of treatment because of side effects. In 22 treated persons [44.0%] PCR for HBV DNA becomes negative showed response to treatment. This finding is statistically significant [p less than 0.05]. Interferon Alfa has significant efficacy in chronic Hepatitis B. Patients of chronic Hepatitis B in whom Interferon therapy is not contraindicated should be treated with Interferon Alfa to avoid long term complication of infection