Liver biopsy in patients infected with chronic hepatitis C and persistently normal serum ALT levels

Introduction: Approximately 30 to 40% of patients with Chronic Hepatitis "C" [CHC] have persistently normal serum alanine aminotransferase [ALT] levels. Historically, these patients have been classified as healthy or asymptomatic and have not received any treatment for CHC infection. However, definition and clinical significance of persistently normal ALT in CHC have been recently revised as new information on liver disease which is now getting available

Aims: To evaluate the histological feature of liver of patients suffering from CHC with persistently normal ALT levels

Methods: In this prospective observational study we recruited consecutive patients infected with CHC with persistently normal ALT since last six months, visited our hepatology clinic from September 2004 to April 2005. The METAVIR scoring system was used for liver histology grading [degree of inflammation] and staging [degree of fibrosis]

Results: A total of 55 patients were recruited from outpatient clinic with normal ALT during a follow up of six months. Mean age of these patients was 36.7+/- 9.78 years; out of these 39 [70.9%] were male. All these patients were diagnosed to have hepatitis C by HCV RNA PCR method. There were 24 [43.6%] patients with stage [fibrosis] equal or greater than 2 and 33 [60%] had biopsy grade equal or greater than 2. Eighteen [32.7%] patients had steatosis on liver biopsy. Twelve patients with stage > 2 had steatosis while 6 patients with stage < 2 had steatosis [p< 0.01]

Conclusion: There was no correlation found between the transaminase level and biopsy scores. Approximately 44 % of the patients have fibrosis equal to or greater than stage 2. The extent of steatosis is directly related to the biopsy score of the patients

Niacin is a major drug for lowering LDL-Cholesterol

Objective: Study was planned to examine the effects of Niacin [Vitamin B-3] on serum LDL Cholesterol levels

Patients and Methods: Study was conducted at department of Pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Karachi, from January 2002 to July 2002. Forty hyperlipidemic patients were included, among which 20 patients were on placebo as control group and 20 were on tablet Niacin, 2 gram daily, in divided doses for a period of three months. Patients with diabetes mellitus, peptic ulcer, renal disease, hepatic disease, hypothyroidism and alcoholism were excluded from the study. Serum LDL-cholesterol was calculated by Friedwald formula [LDL-Cholesterol Total Cholesterol-[Triglycerides/5 +HDL-Cholesterol] described by Delong et al [1986] and Beamount et al [1970]. Data were expressed as the mean +/- SD and "t" test was applied to determine statistical significance of the difference. A probability value of <0.05 was the limit of significance

Results: Three patients were dropped from the study due to side effects of Niacin. Niacin decreased the levels of LDL-Cholesterol froml82.58+/-8.74 mg/dl to 119.29+/-4.08 mg/dl, which was highly significant [p<0.001], when compared statistically by paired "t" test. Overall percentage [%] changes from day-0 to day-90 were -34.66

Conclusion: Niacin decreases the risk of CHD by decreasing LDL-Cholesterol

Amino acid variations in urine of urinary tract infection patients

Background/Objectives: Majority of urinary tract infection [UTI] patients received at Liaquat University Hospital Jamshoro and Hyderabad belong to adjoining rural areas of Sindh province. As only reliable clinical laboratory test available for diagnostic purpose is urine culture and sensitivity which is lacking in these areas due to complexity of tests, expertise and non-availability of electric facility. Hence, present study was conducted to device alternate method, which must be simple, easy and does not require much expertise

Patients and methods: In all, 106 patients and 25 normal controls were selected for this study. Morning urine samples were collected and analyzed for amino acids by paper chromatography using two different solvent systems

Results: Different amino acids were found missing in urine of UTI patients. Greater percent of them was aromatic amino acids like tryptophan [90.56%], phenylalanine [71.69%], tyrosine [70.75%] and methionine [91.5%]

Conclusion: Ordinary urine chromatographic separation test of amino acids shows aromatic and essential amino acids absent from urine, which can provide basis for screening test of UTI in areas with lesser facilities

Beta Blocker Eye Drops Related Airway Obstruction

OBJECTIVE: To assess the awareness among chest physicians, ophthalmologists and patients about use of eye drops with particular reference to beta blockers such as timolol as an agent of aggravating breathlessness in predisposed subjects. DESIGN: Cross-sectional study. METHOD: A survey of 20 chest physicians, 20 ophthalmologists and 200 patients suffering from obstructive airway disease was conducted in 2 hospitals and a welfare center of Karachi from August to September 1997. The results indicate that ophthalmologists showed more awareness than chest physicians regarding use of beta blocker eye drops by patients with obstructive airways disease [p = 0.004]. Patient awareness was low as well. There is a need to update doctors and educate general public about the side effects of beta blocker eye drops in patients with obstructive airway disease

Why physician and lay people smoke and how can it be reduced?

OBJECTIVE: The objective of this study was to find out the level of knowledge the physicians and lay people have pertaining to the effect of cigarettes, why certain physicians smoke and what measures could be applied to reduce the rate of smoking. METHODS: A questionnaire was administered to the one hundred physicians who smoke, one hundred non-smoking physicians and one hundred lay people who smoke to determine their attitude towards this addition. Subjects were chosen using convenience sampling. The physicians were picked from six hospitals of Karachi. When the smoking physicians were asked what could motivate them to stop smoking, majority of them said that an occurrence of a smoking related illness would. Majority of the physicians who do not smoke felt that individual will was the greatest force keeping them from smoking. When asked how smoking can be reduced in Pakistan, majority of the physicians, both smoking and non-smoking, favoured mass health education. Lay smokers expressed marked ignorance about deleterious effects of cigarette smoke. Like smoking physicians, majority of them said that occurrence of an illness related to smoking would effectively motivate them to stop smoking. Based on this survey we conclude that mass health education and enforcement of the ban on smoking in public places will effectively reduce the number of smokers. There is a need to educate physicians and the general public about the cardiac and carcinogenic effects of smoking

value of flexible cystoscopy in combination with urine cytology in the diagnosis of recurrent transitional cell carcinoma of the urinary bladder

Specimens of early morning and freshly voided urine of 58 consecutive patients with known Transitional Cell Carcinoma [T.C.C.] were submitted 10 days before check cystoscopy. The urine spectimens were analysed by two pathologists, with no knowledge of the patients history. All patients then underwent cystoscopy under general anaesthesia. Findings of cystology were correlated with cystoscopy findings. Urine Cytology predicted 85% of all recurrent tumours found subsequently at cystoscopy. 88.5% with negative urine cytology had no recurrent tumours. Only 53% of patients with positive cytology were shown to have recurrent T.C.C. Urine cytology is a good adjunct to assessing the suitability of flexible cystoscopy in the followup of patients with transitional cell carcinoma [T.C.C.] of urinary bladder. Thus we concluded that achieving bony stability in intertrochanteric fractures is of prime importance in prevention of complication of fixation

Serosurveillance of HIV infection in people at risk hyderabad Sindh

Random screening of 2000 serum samples of various low and high risk groups was carried out at WHO focal point, Department of Pathology, Liaquat Medical College, Jamshoro, Sindh, during the period between 1994 and 1995. This was done to evaluate the seropositivity. The sample contributors included 600 blood donors, 575 prisoners, 500 tuberculosis patients, 100 truck drivers, 50 hepatitis-B patients, 100 members of Nursing staff and 50 patients with sexually transmitted diseases [STD]. One sample was found to be positive for HIV. This belonged to a prisoner with history of heterosexuality. This low positive ratio can be attributed to social and religious restrictions in sexual relations

Transurethral resection of prostate versus open prostatectomy

A study on 150 cases of benign prostatic hypertrophy was carried out from January, 1990 to December, 1992 at the Urology Department of Liaquat Medical College, Jamshoro to compare the results of two operative procedures viz. TURP [75 cases] and open prostatectomy [75 cases]. The ages of the patients ranged from 50 to 100 years with maximum incidence [86.67%] between 50 to 70 years. Ninety five [63.33%] cases presented with urinary retention. Secondary haemorrhage seen in 10 [13.33%] cases of TURP and 15 [20%] cases of open prostatectomy and transient incontinence in 12% cases in TURP and 22.67% cases in open prostatectomy were the most common complications encountered. Wound infection [28%] and urinary leakage [6.67%] were only seen in open procedures. The average hospital stay with TURP was 8.3 days as compared to 22.4 days in open prostatectomy

Post-BCG axillary abscess: results of excision vs simple drainage

A prospective study was carried out in 80 patients with axillary abscess following BCG vaccination to compare the results of surgical excision versus incision and drainage, together with six months anti-tuberculous chemotherapy in both groups. Four [10%] out of 40 patients who underwent simple incision and drainage required re-operation for residual lymph glands and/or persistent sinuses. On the other hand all 40 cases who underwent total excision had no postoperative problem

Breast cancer: epidemiological, pathological and clinical presentation

Out of the 100 patients studied breast cancer was seen in 99 females, mostly [63%] in the age growth of 31-50 years, and one male. A lump was palpable in all women with involvement of left breast in 56% cases. Majority of the women [90.90%] were married, parous [84.84%] and had breast fed [80.80%] their children. Awareness regarding breast cancer is increasing as is evident by the earlier presentation i.e. in stage-I [35%] and stage-II [44%]. On histopathology invasive duct cell carcinoma [72%] was the commonest type of breast cancer seen in this study

Gastro-intestinal perforation - frequency, presentation and management

This study includes 165 [105 males, 60 females] cases of Gastro-intestinal perforation who presented as acute surgical emergency at Liaquat Medical College Hospital, Hyderabad from January, 1992 to December, 1993. Their age ranged from 1-70 years and majority [61%] were from areas of Sindh. One hundred and twenty two [74%] patients had pathological and 43 [20%] had traumatic perforations. Of the pathological perforations, 90 [74%] had typhoid perforation, 15 [12%], perforated appendix and 7[6%] perforated peptic ulcer. Wound infection occurred in 36 [55%] patients Mortality rate was 10%

Transurethral resection versus open prostatectomy

A study of 150 cases of enlarged prostate has been carried out from January 1990 to December 1992 at the Urology Department of Liaquat Medical College Jamshoro. Age range was 50 to 100 years, 86.6% of patients presented between 50 to 70 years. Majority of them presented with retained catheter. Seventy five patients underwent TURP and the same number of patients underwent open prostatectomy. Comparison has been made regarding complications and hospital stay between the two procedures. Secondary haemorrhage seen in 13.3% [10 cases] in TURP and 20% [15 cases] in open prostatectomy and transient incontinence 12.05% [9 cases] in TURP and 22.7% [17 cases] in open prostatectomy were the common complications found in both procedures. Wound infection 28.0% [21 cases] and urinary leakage 6.7% [5 cases] were the complications seen only in open procedures. The average hospital stay with TURP was 8.3 days as compared to open prostatectomy 22.4 days

Interaction of beta2-agonists and volume history in asthmatics and patients with chronic obstructive pulmonary disease

This cross sectional study is aimed [a] to dissect out the beta2-agonit response from volume history [VH] respons in asthmatics and chronic obstrutive pulmonary disease [COPD] patients, [b] to find out whether or not VH response of ariway resistance could be an indicator of the relationship between the airway and lung parenchymal hysteresis. The response of airway resistance' [Raw] as an indicator of airway tone was continously recorded to vairous degree of volume history before and 10 minutes after inhalation of 200 microgram salbutamol [beta2] in 25 asthmatics, 25 COPD patients and 25 healthy volunteers as controls. Important findings from this study are: [a] in athmatics, VH alone decreased the average Raw by 28%. Beta2 decreased it by 39% while VH + beta2 decreased it by 50%. However, 6 asthmatics out of 25 shwoed a bronchoconstrictor response to VH. [b] In Patients with COPD, Raw response to VH, beta2 and VH + beta2 was evaluated to be 20, 12 and 12% respectively. However, 9 COPD patients out of 25 showed brochoconstrictor response to VH. [c] In controls, Raw response to VH, beta2 and VH + beta2 was found to be 45, 5 and 48% respectively. This study shows that both VH and beta2 responses of Raw are additive in controls as well asthmatics. However, such an effect is markedly reduced in patients with COPD. It may be proposed that VH response of Raw could be considered as an indicator of relative airway and lung parenchymal hysteresis determining the degree of airway tone

Post BCG vaccination tuberculous axillary abscess total excision V/s incision and drainage

In 80 patients with axillary abscess following BCG vaccination, a prospective study was carried out to determine the results of surgical treatment by either total excision or incision and drainage. Six months anti-tuberculous chemotherapy was administered to patients in both groups. Four [10%] out of forty patients who underwent simple incision and drainage required re-operation for residual glands with persistant sinus. While all 40 cases who underwent total excision had no postoperative problem

Typhoid perforation of bowel

A retrospective review of 45 patients with perforated typhoid enteritis. Managed operatively from January 1990 to December 1993. There were 39 male and 6 female, presenting symptoms were pain, vomiting, fever and constipation [or loose motions]. Post dehiscence and leaking from suture lines. There were 9 deaths most of the deaths were attributed to overwhelming sepsis. Enteric perforation is a common surgical problem of developing world

Characterization of reed-sternberg cells with granulocyte specific monoclonal antibody

Monoclonal antibody Leu M[1] represents a highly specific marker to locate granulocyte antigen in Reed-Sternberg cells in Hodgkin's disease. Except the L and H variants of Reed-Sternberg cells in lymphocyte predominance variety in which antigens are probably sialylated. All the cases of non-Hodgkin's lymphoma were negative with this marker, because of absence of antigen. Therefore this specific marker characterizes granulocyte origin of Reed- Sternberg cells

Drug resistance in pulmonary tuberculosis at institute of chest diseases Sindh, Kotri

A retrospective study of OPD and ward records of Institute of Chest Diseases Sindh, Kotri showed that 1156 [67.2%] out of 2966 OPD cases were admitted with male to female ratio 3:1 during the year 1991. It comprised of 820 AFB positive and 336 AFB negative cases. 874 [75.6%] completed five drugs short course regimen [SHRZE] for two months while 40 [3.4%] died and 242 [20.9%] left the hospital against medical advise. Only 12 [1%] virgin cases were noted while the rest were on irregular and inadequate chemotherapy before. Out of 792 positive cases, 662 [83.6%] converted to negative while 130 [16.41%] remained positive. The resistance to short course chemotherapy is affecting almost one-sixth population of highly infectious cases and reflects on poor treatment programme because of doctors' error [bad chemotherapy with regard to dosage, rhythm and duration] and patients' poor compliance