Multinodular goiter; frequency of malignancy

The object of this study was to determine the frequency and type of thyroid carcinoma in Multi nodular goiter [MNG] after surgical resection on histopathological basis. Multi nodular goiter [MNG] is one of the common presentations of various thyroid diseases. Thyroid nodules have been reported to be found in 4% to 7% of the population on neck palpation. Although in comparison to solitary nodule, the risk of malignancy in MNG is low but certain studies are showing significant risk. This prospective, observational study was carried out in the surgical unit I of Ghulam Mohammad Mahar Medical college hospital sukkur from 2007 to 2012. 94 cases with clinical diagnosis of MNG were analyzed during this period. All the patients were admitted through opd with routine investigations plus investigations specific to thyroid including thyroid profile, thyroid scan, FNAC of dominant nodule before being subjected to surgery. All FNACs were carried out at agha khan university hospital Karachi. Histopathology of operated specimen was the main criteria for malignancy. Among the 94 cases which were included in this study, 9 [9.5%] cases containing foci of malignancy. Incidence of malignancy commonly occurs in females, papillary carcinoma is being the commonest entity. The incidence of malignancy in MNG in this study is 9.5% that is quite high. So people should be educated and encouraged to attend the thyroid clinics for proper evaluation and early diagnosis of Malignancy

Diabetic neuropathy; prevalence and risk factors for severity in patients with type 2 diabetes mellitus attending diabetic clinic of Ghulam Mohammad Mahar Medical College Hospital, Sukkur

To estimate the prevalence of diabetic neuropathy [severity wise] and associated risk factors in patients having type 2 diabetes mellitus. A cross-sectional study. Diabetes Clinic, Ghulam Mohammad Mahar Medical College Hospital, Sukkur. From January 2009 to December 2011. A patients based sample of 1401 persons with diabetes [identified as per the WHO criteria] underwent comprehensive eye examination including direct and indirect Fundoscopy for diabetic retinopathy grading. Vibration perception threshold [VPT] measurements were done to assess neuropathy [cut off >/= 20 V]. Severity of neuropathy was graded into three groups based on VPT score as mild [20-24.99 V], moderate [25-38.99 V], and severe [>/= 39 V]. Univariate and multivariate analyses were done to find out the independent risk factors for severity of diabetic neuropathy. In the overall group, the prevalence of diabetic neuropathy was 18.84% [95% CI: 16.79-20.88]. The prevalence of mild diabetic neuropathy was 7.9% [95 CI: 6.50-9.33], and severe diabetic neuropathy was 5% [95% CI: 3.86-6.14]. Increasing age per year [P<0.0001] was a statistically significant risk factor for all - mild, moderate, and severe - types of diabetic neuropathy. For severe diabetic neuropathy, other significant risk factors were duration of diabetes mellitus [P=0.027], macroalbuminura [P=0.001], and presence of diabetic retinopathy [P=0.020]. The results suggested that every fifth individual in a population of type 2 diabetes is likely to have diabetic neuropathy. Nearly 13% had neuropathy of moderate and severe category, making this group vulnerable for complications such as foot ulceration or lower limb amputation

Effects of combined interferon alpha and ribavirin therapy on thyroid functions in patients with chronic hepatitis C attending hepatitis centre Ghulam Mohammad Medical College Hospital Sukkur

To determine the frequency of thyroid dysfunction in patients of chronic hepatitis C during treatment with interferon alpha-2b and ribavirin therapy. A cohort study. Hepatitis Centre Ghulam Mohammad Mahar Medical College Hospital, Sukkur, from February 2009 to January 2010. One hundred and sixty seven non-cirrhotic chronic hepatitis C patients were grouped into treatment group [n=107] and control group [n=60] awaiting treatment. Baseline serum [s.] Alanine Transferase [ALT] and S. Aspartate Transferase [AST] were measured by IFCC method. Serum Thyroid Stimulating Hormone [S. TSH], serum free thyroxine [S. Free T4] and serum total triiodothyronine [S.T3] level were determined by chemiluminescence. Study group patients underwent 24 weeks IFN and ribavirin therapy and were followed-up for thyroid dysfunction at weeks 0, 12 and 24. Control group patients underwent the same tests at weeks 0, 12 and 24. Statistical analysis was done on SPSS 15. Out of 107 patients of treatment group, 20 patients [18.69%] developed thyroid dysfunction. Females were at higher risk with Relative Risk [RR] of 11.25 and Attributable Risk [AR] of 91%. Hypothyroidism was more common than hyperthyroidism. Interferon-alpha and ribavirin therapy induces thyroid dysfunction in chronic hepatitis C patients. Hypothyroidism was more common. Females are at a higher risk of developing thyroid dysfunction

Chronic hepatitis C-infected patients; Assessment of relationship between serum alanine aminotranferase levels and liver histology

In our region the sensitivity of serum alanine aminotransferase [ALT] levels in predicting the severity of hepatitis C virus [HCV] infection is unclean To compare histologic scoring of liver pathology in patients with chronic HCV infection with normal or elevated serum ALT. Prospective observational study. Liver clinic, Ghulam Mohammad Mahar Medical College Hospital, Sukkur, between January 2010 and December 2010. Liver biopsies were performed in patients with HCV infection and either normal [n=40] or elevated [n=76] serum ALT levels, and scored for activity and fibrosis using the modified histological activity index. Patients with normal ALT and elevated ALT had similar demographic features. Median [range] histological activity grade was higher in patients with elevated ALT than in those with normal ALT [6 [1 -15] vs. 5 [0-11], respectively; p = 0.001], as was the fibrosis stage [2 [0-6] vs. 1 [0-6]; p = 0.02]. Two patients with normal ALT and 4 with elevated ALT had liver cirrhosis. Among patients with chronic HCV infection, liver lesions are milder in those with normal serum ALT levels than those with abnormal ALT levels. However, some patients with normal ALT too may have advanced liver disease

Comparison of oral and intravenous proton pump inhibitor in patients with high risk bleeding peptic ulcers

To compare the efficacy of oral omeprazole vs intravenous omeprazole in decreasing risk of re-bleeding in peptic ulcer patients. This prospective, randomized, controlled clinical trial was conducted at Ghulam Mohammad Mahar Medical College Hospital, Sukkur, Pakistan from January 2010 to December 2011. One hindered and six patients with high risk peptic ulcer were randomized to receive either oral omeprazole [80mg BID for 3 days] or IV omeprazole [80mg bolus and 8mg/hour infusion for 3 days] followed by omeprazole [20mg each day for 30 days]. All patients underwent upper endoscopy and endoscopic therapy within 24 hours. Seventeen patients were excluded from the study. Forty four patients were randomly allocated into oral omeprazole group and 41 to IV omeprazole group. Both groups were similar for factors affecting the outcome. Bleeding reoccurred in five patients of oral omeprazole group and four patients in IV omeprazole group [11.4% vs 9.8%]. The mean hospital stay and blood transfusion were not different in both groups. Oral omeprazole and IV omeprazole had equal effects on prevention of re-bleeding after endoscopic therapy in patients with high risk bleeding peptic ulcers

Association of anthropometric indices of obesity with diabetes, hypertension and dyslipidemia

To study the association of selected established anthropometric indices of obesity viz body mass index [BMI], Waist circumference [WC] and waist-hip ratio [WHR] with diabetes, hypertension and dyslipidemia in population residing at Sukkur, Pakistan. In this cross sectional descriptive study, participants were selected from out- patients setting of Medicine at Ghulam Mohammad Mahar Medical college teaching hospital, Sukkur through consecutive sampling from July 2011 to June 2012. Structured Questionnaire, anthropometric measurements and bio-chemical tests were administered to 369 participants. WC was associated with hypertension, diabetes and dyslipidemia in male and dyslipidemia in female. WHR showed association with dyslipidemia in female while BMI with hypertension [male] and dyslipidemia [female]. Waist circumference as obesity index may have a more reliable association with of cardiovascular disease risk factors viz. hypertension, diabetes and dyslipidemia among general population compared with BMI and WHR

Occupational exposure to blood and body fluids amongst health care workers in a teaching hospital of the Sukkur, Sindh

Health care workers [HCWs] are at risk of infection with blood-borne viruses in the course of their work. Over 90% of these infections are occurring in low-income countries and most are preventable. However, the situation in the teaching hospitals has always been thought to be much better than the public health facilities in other hospitals. The focus of the study was on assessing the exposure frequency amongst HCWs in a teaching hospital in the Sukkur. Cross-Sectional Study. This study was conducted at Ghulam Mohammad Mahar Medical College Hospital, Sukkur, Sindh from November 2011 to December 2011. A cross-sectional survey amongst HCWs involved in collecting blood samples and administering injections in all wards of the hospital was conducted. Selection of study participants was by simple random sampling. A pre-tested questionnaire was administered by unlinked, anonymous method. Total sample studied was 70. The proportion of HCWs experiencing exposure to blood body fluid splash [BBF] and needle stick injury [NSI] during last one week was 47.1% and 31.43%, respectively. The incidence density of BBF exposure was 537.14 per 100 person years and that of NSI episodes was 228.57 per 100 person years. The reasons for not using personal protective equipment [PPE] ranged from busy schedule [37.14%], non use of PPE by co-workers [67.14%], emergencies [91.43%] risk that patients may get offended by PPE use by HCWs [27.14%] to discomfort while using PPE [24.29%]. All components of PPE were available as per only 34.24 percent. The high level of occupational exposure to blood and body fluids and consequent risk of infection amongst a group of HCWs in the Teaching Hospital highlights the urgent need for interventions to enhance to the occupational safety of workers

Prognosis of acute fulminant hepatic failure. To assess the causes and prognosis of acute fulminant hepatic failure in patients attending medical Unit I, Ghulam Mohammad Mahar Medical College Hospital, Sukkur

Acute fulminant hepatic failure [ALF] is a medical emergency and associated with high mortality rate. Its etiology shows considerable geographical variations. The viral causes are the most common in our region, [whilst acetaminophen [Paracetamol] induced hepatotoxicity forms the most common precipitant in many developed countries]. To assess the causes and prognosis of acute fulminant hepatic failure in patients attending medical unit I, Ghulam mohammad Mahar Medical college hospital, Sukkur. A cross-sectional study. Medical Unit-I, Ghulam Mohammad Mahar Medical College Hospital, Sukkur. From January 2010 to July 2011. a total one hundred twenty [120] patients of ALF were studied during the study period to evaluate the causes and prognosis. Those patients who were admitted during the study period were included in the study. The selected patients presented with jaundice and hepatic encephalopathy of varying grades. Almost all the cases the causative agents were viruses. Among theses, the hepatitis E virus [HEV] was the top most causative agent followed by hepatitis B virus [HBV] in this study. Despite good effort of conservative treatment, the mortality rate was 77.5%. The mortality rate was higher in grade-III and grade-IV encephalopathy patients, whereas the prognosis is better in grade-1 and grade-II encephalopathy patients

Frequency of hepatitis D CO and super infection in hepatitis B patients

To determine the frequency of co/super infection of hepatitis D in patients with hepatitis B related liver disorders. Descriptive study. The hepatitis Centre Ghulam Mohammad Mahar Medical College Hospitals Sukkur and Khairpur, from January 2009 to December 2009. All patient registered for HBV associated infections were selected. Blood was drawn from 200 patients who fulfilled the inclusion criteria. Those with an incomplete test profile were excluded. All clinical conditions were investigated through liver function tests, coagulation profile, abdominal ultrasonography, upper gastrointestinal endoscopy and liver biopsy. Liver cirrhosis and hepatocellular carcinoma [HCC] were diagnosed either on the basis of histology, or on a combination of radiological, endoscopic and laboratory data. Hepatitis B virus DNA was extracted from serum by real time PCR. Descriptive statistics were used for frequency and mean determination. The 129 patients finally selected for statistical analysis included 108 [84%] males and 21 [16%] females. The ages ranged from 6-68 years [mean=31.5 +/- 12.39 years]. There were 70 [54.2%] patients of non-cirrhotic, chronic hepatitis [CLD], 38 [29.4%] carriers, 12 [9.3%] cirrhotic and 9 [6.9%] hepatocellular carcinoma [HCC] patients. Among the 129 patients, 45 [34.9%] were positive for double infection with HDV. These included 35 CLD cases, 7 cirrhotic and 3 carriers. The frequency of co/super infection of hepatitis D was found to be highest in HBV cirrhosis patients compared to patients having chronic liver disease [non-cirrhotics] and carriers