HCV in Punjab; zonal molecular distribution

Background: HCV is the foremost cause of liver cirrhosis and hepatocellular carcinoma and its prevalence is increasing in developing countries like Pakistan. Present study is focusing on its frequency in different districts of the Punjab of Pakistan

Setting: Different districts of Punjab

Period: Jan 2010 to Dec 2010

Material and methods: 5ml venous blood was collected from each donor by using disposable syringes. Sample is transferred to vials containing anticoagulant, centrifuged and plasma was separated for further analysis.140 ul plasma of every patient was analyzed for HCV RNA Virus by Real time PCR using Artus HCV Quantification kit [Germany].For statistical analysis SPSS 16 was used

Results: A total count of 3262 samples was collected from 32 districts of the Punjab and all these samples were both rapid HCV screening and Anti HCV by Elisa positive. Out of which 2041 [62.57%] patients were detected positive for HCV, 1221 [37.4%] were not detected.49.5%patients were male while50.5% were female. 30.99% males were detected positive including patients with low viral load. 31.58% were detected positive for HCV including low positive female patients.30.71% females were detected positive for HCV, 37.5% were not detected for HCV

Conclusion: Highest prevalence of HCV among different age groups is found in age group of 36-40 years with 12.23% and lowest is found in age group > 15 years with 0.31% [p=0.009]

Morphologial patterns in children with ganglion related enteric neuronal abnormalities

Background: Hirschsprung's Disease [HD] is a developmental disorder of enteric nervous system characterised by the absence of ganglion cells in submucosal [Meissner's] and myenteric [Aurbach's] plexuses of distal bowel. The purpose of the present study was to observe and report the morphological patterns of ganglion related enteric neuronal abnormalities in children presented with clinical features of [HD] in a Pakistani population. Methods: A total of 92 patients with clinical presentation of HD wereenrolled between March 2009 and October 2009. Among them, 8 were excluded according to the exclusion criteria. After detailed history and physical examination, paraffin embedded H and E stained sections were prepared from the serial open biopsies from colorectum. The data was analysed using SPSS-17. Frequencies and percentages are given for qualitative variables. Non-parametric Binomial Chi-Square test was applied to observe within group associations and p<0.05 was considered statistically significant. Results: Among 84 patients, 13 [15.5%] proved to be normally ganglionic whereas 71 [84.5%] showed ganglion related enteric neuronal abnormalities namely isolated hypoganglionosis 9 [12.7%], immaturity of ganglion cells 9 [12.7%], isolated hyperganglionosis [IND Type B] 2 [2.8%] and Hirschsprung's disease 51 [71.8%]. Among HD group, 34 [66.7%] belonged to isolated form and 17 [33.3%] showed combined ganglion related abnormalities. Conclusions: Hirschsprung's disease is common in Pakistani population, followed by hypoganglionosis, immaturity of ganglion cells and IND type B. The presence of hypertrophic nerve fibres was significant in HD, hyperganglionosis and hypoganglionosis, whereas, no hypertrophic nerve fibres were appreciated in immaturity of ganglion cell group. Keywords: Hirschsprung's disease [HD], hypoganglionosis, immaturity of ganglion cells [IGC], intestinal neuronal dysplasia [IND]

Empyema thoracis; possible factors for predicting this complication in children with community acquired bacterial pneumonia

Empyema as a complication of community acquired pneumonia [CAP] is relatively common occurrence in developing countries. Prospective study. 4 year Jan 2001- Dec 2004. Department of Pediatric surgery the Children's hospital Lahore. A total of 114 cases of empyema thoracic secondary to CAP were dealt with during this period, while in the same duration a total of 1768 cases of pneumonia were treated at the Children's hospital Lahore. Majority of the patients with CAP [59.61%] were below one year of age whereas the patients who developed empyema, were mainly [45.67%] between 2 to 5 years of age. Patients above 5 years of age having CAP [31.70%] and having repeated attacks of respiratory tract infection were most susceptible to develop empyema. Staphylococcus aureus was the most common organism found [40.35%] in this series. Vaccination, poverty and gender did not significant affected the development of empyema among the patients of CAP. Antibiotic resistance had no role in the development of empyema. Ibuprofen may be a risk factor. All the patients were initially managed with tube thoracostomy and antibiotics. Forty-eight patients [42.10%] needed subsequently operative management. Three patients [2.63%] had fatal course in this series same as seen in patients of CAP [2%]. Immunization against causative organism and modification of out patient treatment may affect the incidence of empyema in children and should be studied prospectively

Congenital oesophageal achalasia

Achalasia is the commonest motility disorder of the oesophagus. It is a very rare disorder, occurring about 6 per 100, 000 population. Out of this very low incidence, only 5% occur in children. Classically, achalasia is disordered peristalsis along with failure of relaxation of the lower oesophageal sphincter. Broadly speaking, it is a disorder of the parasympathetic nerve supply of the oesophagus. The actual lesion however is not fully known. The dorsal vagal nucleus, mysenteric ganglia, fibres in the wall and connections of myofibrils have all been implicated at one time or another but no final verdict has so far been given. We are presenting a report of five cases seen and treated at our department between 1980-87. It includes a report of achalasia in two brothers. Before this report, the total cases of achalasia in siblings reported in literature was 9

Pediatric surgery in Pakistan

Paediatric Surgery is a new speciality in developing countries like Pakistan. This article identifies the problems faced by the speciality and the hurdles in its development. Pakistan has a primitive society and a very low literacy rate. Lack of trained staff, attitude of public and colleagues, scarcity of resources and ill planned health services are major drawbacks. The biggest problem, however, is the explosive increase in population. The speciality was introduced in the country 25 years ago but has not made much progress. The need for Paediatric Surgeons is very pressing and efforts are being made to train Paediatric Surgeons and associated specialists to improve health facilities for the 44 million children of the country

Pediatric agricultural trauma in Punjab

Children constitute 45% of our population of nearly 100 million. As Pakistan is essentially an agricultural country 75% of the population lives in villages where children are exposed to trauma from various agricultural implements. This paper summarises a six-year experience of agricultural trauma in children