Aspartate aminotransferase-alanine aminotransferase ratio predicts cirrhosis in chronic hepatitis C patients

Background: Hepatitis C virus infection is on rise in Pakistan

Objective: To evaluate serum aspartate aminotransferase and alanine aminotransferase ratio [AST/ALT ratio] in predicting liver cirrhosis of chronic hepatitis C patients

Patient and Methods: Study Design: Aprospective study. Place and Duration of Study: This study was done in Gasteroenterology department at Sheikh Zayed Hospital Lahore. Duration of study was 6 months from 1[st] January to 30[th] June 2010. Total 80 patients of chronic hepatitis C confirmed by PCR were included in the study. The sera of the patients were tested for AST and ALT. Liver biopsy of each patient was performed. Histological Activity Index [HAI] of the specimens was scored on the basis of Knodell score. AST/ALT ratio was correlated with the histological stage [i.e. degree of fibrosis], and the histological grade [i.e. inflammatory activity]

Results: The mean AST/ALT ratio in 40 cirrhotic patients [1.64 +/- 0.46; p < 0.001]. A ratio = 1 has 96.38% specificity and 93.73% positive predictive value in distinguishing cirrhotic from noncirrhotic patients with 88.26% sensitivity and 94.84% negative predictive value. The ratio correlated positively with histological stage but not with the grade. Two patients out of 17 cirrhotic patients [12%] have no clinical or biochemical features suggestive of chronic liver disease except for an AST/ALT ratio more than one

Conclusion: It is concluded that AST/ALT ratio = 1 is highly specific for the presence of cirrhosis in patients with chronic hepatitis C. This ratio reflects the fibrosis stage in these patients. This ratio may be considered as a marker of fibrosis in patients with chronic hepatitis C

Optimum reckoning of contra lateral breast dose using physical wedge and enhanced dynamic wedge in radiotherapy treatment planning system

It was intended to investigate the effect of physical wedge [PW] and enhanced dynamic wedges [EDW] on contralateral breast dose during primary breast irradiation in radiotherapy treatment, using high energy photon beams. The Varian's Clinac dual mode linear accelerator model 2100 C/D and Siemen's Primus accelerators were used for radiation doses with 6 MV and 15 MV. Doses were delivered using Tangential field techniques and asymmetric collimator jaws. Eclipse three-dimensional Treatment Planning System [3DTPS] was used to measure contralateral breast dose for all fiend settings. Sixty five patients [with cancerous breast as well as chest wall] were taken and their contralateral breast doses were measured at a point 5 cm across, at 2 cm depth from the end of the medial field. The contralateral breast dose mean difference was 0.25 cGy and 0.24 cGy during the comparison of PW and EDW on Varian's Clinac and 0.19 cGy and 0.18 cGy were found for medial EDW and without medial EDW for the same machine in breast cases and chest wall cases respectively as per total prescribed dose. The mean difference for PW [Clinac] and PW [Primus] was found 0.08 cGy and 0.31 cGy and during the comparison of medial PW and without medial PW on primus machine this mean difference was 0.25 cGy and 0.51 cGy in breast cases and chest wall cases respectively as per total prescribed dose. The investigation demonstrates the significance that the EDW produces less scattered dose, which can cause second breast malignancy, compared to PW. Furthermore, the medial wedge, too, can cause second breast malignancy and should be avoided in planning

Impact of anthropmetric measures on sural nerve conduction in healthy subjects

Nerve conduction studies are an invaluable aid to investigate and quantify the physiological activity of peripheral nerves. These include measurement of sensory and motor conduction velocities and latencies of peripheral nerves. These nerve conduction parameters may be affected by anthropometric factors like age, sex, height, weight and BMI. In this observational study the impact of these anthropometric parameters was measured on sensory nerve conduction velocity [SNCV] and sensory latency [SNSL] of sural nerve. Sural nerve conduction studies were conducted in EMG room of Neurology section of Medical Unit 1 at Sir Ganga Ram Hospital, Lahore on Electromyograph by Nihon Kohden MEB-5304K. After following strict exclusion criteria by careful history and physical examination 25 normal healthy subjects recruited from local population by random sampling technique. The age range was 40-70 years with mean age 47.2 +/- 9.23 years. Gender distribution was 60% females and 40% males. The mean SNCV was found to be 53.16 +/- 5.68 meter per second [m/sec] and mean SNSL was 2.81 +/- 0.45 milliseconds [msec]. It was found that the mean sural nerve conduction velocity was higher and the mean sensory latency was shorter in healthy subjects than that of the Western races. Moreover, the SNCV decreases and SNSL increases significantly with age

Combined persistent Mullerian duct syndrome, transverse testicular ectopia and mosaic Klinefelter's syndrome

Persistent Mullerian Duct Syndrome [PMDS], a rare form of male pseudohermaphroditism, is characterized by the persistence of Mullerian duct structures [uterus, fallopian tubes and upper two-thirds of vagina] in otherwise normally-virilized males [Karyotype 46XY]. Patients suffering from PMDS present with cryptorchidism, inguinal hernia and infertility. Diagnosis is established when Mullerian duct structures are discovered either during ultrasonography for localization of undescended testis[s], during surgical exploration for cryptorchidism or herniorrhaphy [hernii uteri inguinalis]. Presence of both testes on one side of the scrotum is known as Transverse Testicular Ectopia [TTE]. Co-existence of PMDS and transverse testicular ectopia in a patient of mosaic Klinefelter's syndrome [Karyotype 46XY/47XXY] is a unique genetic association

A modified formula for defining tissue phantom ratio of photon beams.

Tissue phantom ratio (TPR), for square fields of various dimensions has been determined at varying depths in water. The dose in water has been measured at a fixed source-to-surface distance (SSD) of 100 cm and reference depth of 5 cm for 6 MV photon beam of Siemens Linear Accelerator Primus 11 in German Cancer Research Center (DKFZ), Heidelberg, Germany. A modified formula has been developed to calculate the TPR value for isocentric treatment. The present article describes the conversion of the measured data values into a comprehensive and consistent data set by the modified formula, that gives the TPR from Percentage Depth Dose (PDD) with depth as a function of field sizes from 10 mm x 10 mm upto 300 mm x 300 mm) and depth (from 0 mm to 300 mm).

effect of fasting on QT Interval

QT interval reflects the total duration of ventricular depolarization and repolarization in the ECG. Experimental hypoglycaemia and spontaneous clinical episodes of hypoglycaemia lead to the lengthening of the heart rate corrected QT interval or QTc. This is associated with elevated risk of sudden death. To find out the effect of fasting blood glucose levels on QT interval and the corrected QT interval [QTc]. Fasting and post prandial blood glucose levels and ECG of healthy young adults were studied and QT interval, RR interval and QTc were determined. The fasting QTc came out to be 0.408 +/- 0.020 as compared to the post prandial value of 0.380 +/- 0.019. The student's t test showed a highly significant value [p<0.0001]. There is significant prolongation of QT interval and QTc during fasting but within normal physiological limits

Foreign body rectum

A case report of 16 years old male is presented who was brought to the emergency with a foreign body [a medium sized steel glass] in the rectum introduced after the act of sodomy

Socioeconomic status and breast cancer survival in Pakistani women

No data is available from developing countries correlating socioeconomic status [SES] with survival in female breast cancer patients. We decided to test the hypotheses whether SES is an independent determinant for disease stage, access to minimal expected treatment [MET] and survival. Two hundred eighty six patients diagnosed with breast cancer were recruited between April 1996 to May 1998. Patients were divided into three groups according to their SES. Prognostic factors analyzed were age, tumor size, nodal status; stage at presentation, estrogen receptor status, time elapsed before diagnosis and access to MET. Disease free survival [DFS] and overall survival [OS] were determined according to the SES of the patients. Patients were categorized into three socioeconomic groups, high [21%], middle [44%] and low [35%]. Mean age of all patients was 46 years, in patients from lower SES mean age was 43 years compared to 50 years in high SES. Mean time elapsed before diagnosis for women from high-income group was 4.3 months versus 10.6 months in low-income group. Early breast cancer was more common in affluent strata, 70% versus 41% in the lower strata. Eighty-nine% patients received MET from the affluent group compared to only 43% patients in the lower strata. Literacy rate of patients from high SES was 73.7% compared to 15% in the low SES. Five year DFS and OS are 79% and 86% for high income group, 48% and 68% for middle income group and 31%,49% for lower strata which were statistically significant [P=.0001 and P<.0001]. In our cohort of patients strong association was noted between low SES and advanced disease, delay in diagnosis, limited access to MET and inferior DFS and OS. The outcome of these patients may be improved by patient education and availability of better health care facilities

Incidence and morphometry of bony projections on the cerebral aspect of the petromastoid part of temporal bone in adult human skulls

To find out the incidence, side, position and morphometry of bony projections on the cerebral aspect of the petromastoid part of the temporal bone of dry adult human Bangladeshi skulls. It is an observational study. The incidence, side and position of the bony projections on the cerebral aspect of petromastoid part of temporal bone was ascertained by observation. The size of the bony projection was measured by millimeter scale. Department of Anatomy, Rajshahi Medical College, Rajshahi, Bangladesh. Out of total 100 petromastoid part of temporal bone [50 human skulls] bony projection was present in 44 [44%] close to the upper part of the groove for the sigmoid sulcus. The bony projection was unilateral and bilateral in 12 [27.3%] and 32 [72.7%] cases respectively and the incidence was equal [50%] on both right and left side. The projections were small, medium and large size in 26 [59.1%], 15 [34.1%] and 3 [6.8%] cases respectively. Position of the superior petrosal sulcus was superior and inferior to the bony Projection in 34 [77.3%] and 6 [13.6%] cases. In 4 [9.1%] the sulcus was inconspicuous. For an extensive exposure of clivus and petrous regions and their associated neural and vascular structures the tentorium cerebelli has to be dissected. The bony projection is closely related to the attachment of tentorium cerebelli and to the superior petrosal and sigmoid sinus. Thus awareness about its incidence and nature is important for the neurosurgeon and neurootologist to avoid any neurological and vascular accident

Occipital emissary foramen in Bangladeshi skulls

To ascertain the incidence and position of the emissary vein in the squamous part of the occipital bone from the posterior margin of the foramen magnum to occipital protuberance. Design: It is an observational study to evaluate the incidence of emissary vein in the squamous part of the occipital bone in Bangladeshi skulls. Setting: Department of Anatomy, Rajshahi Medical College; Bangabandhu Sheikh Mujib Medical University [BSMMU], Dhaka; Bangladesh College of Physician and Surgeon, Dhaka; Shahid Ziaur Rahman Medical College, Bogra; Khulna Medical College; North Bengal Medical College, Sirajgang, Bangladesh. Out of total 150 dry human adult skulls occipital emissary foramen was present in 21 [14%] skulls. Left and right-sided foramen were 7 [4.66%] and 10 [6.66%] respectively but the median foramen was 4 [2.66%]. The incidence and positions of the occipital emissary veins are important for the neurosurgeons during their such occipital surgery as these will given them awareness to avoid the excessive bleeding

Variation in shape of the lingulae in the adult human mandible of Bangladeshi skulls

To ascertain the prevalence and forms of presentation of lingula in adult human mandible. Design: It is an observational study to evaluate the incidence and forms of presentation of lingulae in adult human mandible in Bangladeshi skulls. Setting: Department of Anatomy, Rajshahi Medical College; College of Physician and Surgeon, Dhaka; North Bengal Medical College Sirajganj, Bangladesh. The lingula of both sides of total 208 dry human mandibles are 171 males and 37 females. Depending on shape they were 3 types: 1- triangular 292 [70.2%]; 2- truncated 84[20.2%]; 3-assimilated 40 [9.6%]. Bilaterally lingula were found triangular in 139, truncated in 37 and assimilated in 18 mandibles. Of the remaining 14 mandibles with different appearances on the two sides. Triangular had on left [11] and right [3] sides, truncated on left [2] and right [8] sides respectively. It is noted that, unilateral presentation of truncated type solely confined in male. But in assimilated type left [1] and right [3] sides. The incidence of different types were more common in male than female. As a whole the assimilated type is least common in female. The incidence and forms of presentation of lingula could be used as anthropological markers to assess different populations and races. Because of intimate relationship to the inferior alveolar nerve, it is clinically significant for the orodental surgeon

Denitrogenation: a comparison between two techniques

Denitrogenation of the lungs with 100% oxygen before or during induction of anaesthesia is now routine practice. It helps to prolong the duration of safe apnoea by maintaining acceptable SpO[2] values. We have compared three groups of patients each comprising of 25 patients. Group A patients breathed room air during induction whereas group B received preoxygenation for 3 minutes [8 litters/minutes O[2]] and group C patients were given five tidal volume puffs after injection of suxamethonium. The mean SpO[2] in group A at endotracheal intubation was significantly different from group B and C [P=0.000001]. We conclude that five tidal volume puffs during the apnea after injection of suxamethonium are equally safe and practicable compared to 3 minutes preoxygenation in fasting patients undergoing elective surgery

Future needs for physicians and beds in the accident, Bahrain

The objective of this research is to provide forecasts to support managerial decision making in the department. The study provides forecasts for the patient load, physicians and beds needed with analysis of their current status. Historical data analysis indicates shortages in the number of physicians and beds which cause overcrowding. According to the forecasts the problem of overcrowding will reach alarming proportions. Therefore, immediate action should be taken to reduce the load on the department and divert the attendants with non-urgent or stable conditions to a complementary health centre

Comparative study of antisecretory activity of four anticholinergic drugs and cimetidine on basal gastric secretion in pylorus ligated intact rats

Antisecretory effect of four anti-cholinergic drugs-atropine sulphate, propantheline bromide, oxyphencyclimine hydrochloride and hyoscine-N-butylbromide, and H2-histamine receptor antagonist cimetidine were compared on basal gastric secretion, volume and acidity, in pylorus ligated rats and their ED50 determined. Atropine was found to be the most potent followed in that order by propanthieline, cimetidine, oxyphencyciimine and hyoscine-N-butyl, Relative importance of acetylcholine in normal gastric secretion is also discussed