Initial results of efficacy and safety of sofosbuvir among Pakistani population: a real life trialhepatitis eradication accuracy trial of sofosbuvir [HEATS]

Objective: The uridine nucleotide analogue sofosbuvir is a selective inhibitor of hepatitis C virus [HCV] NS5B polymerase approved for the treatment of chronic HCV infection with genotypes 1 - 4. The objective of the study was to evaluate the interim results of efficacy and safety of regimens containing Sofosbuvir [Zoval] among Pakistani population with the rapid virologic response [RVR2/4 weeks] with HCV infections

Methods: This is a multicenter open label prospective observational study. Patients suffering from chronic Hepatitis C infection received Sofosbuvir [Zoval] 400 mg plus ribavirin [with or without peg interferon] for 12/24 weeks. The interim results of this study were rapid virological response on week 4. Data was analyzed using SPSS version 21 for descriptive statistics

Results: A total of 573 patients with HCV infection were included in the study. The mean age of patients was 46.07 +/- 11.41 years. Out of 573 patients 535 [93.3%] were treatment naive, 26 [4.5%] were relapser, 7 [1.2%] were non-responders and 5 [1.0%] were partial responders. A rapid virologic response was reported in 563[98.2%] of patients with HCV infection after four weeks of treatment. The treatment was generally well tolerated

Conclusion: Sofosbuvir [Zoval] is effective and well tolerated in combination with ribavirin in HCV infected patients

Comparison of cognitive professionalism in residents of public and private hospitals of Karachi

Objective: To evaluate and compare the cognitive professionalism in resident medical officers [RMOs] of public and private hospitals of Karachi

Study Design: A cross-sectional survey

Place and Duration of Study: Civil Hospital and Ziauddin Medical University Clifton Campus, Karachi, from August to December 2014

Methodology: This survey was conducted in one public and one private medical college. All residents from Gynecology and Obstetrics, Medicine and Surgery departments were included with non-probability purposive sampling. A validated tool [Barry Challenges to Professionalism questionnaire] was used to assess professionalism, containing six challenges to professionalism [acceptance of gifts, conflict of interest, confidentiality, physician impairment, sexual harassment, and honesty] with multiple-choice responses. Data was analyzed with SPSS version 17 and chi-square test was used for determining significant difference between public and private institutes

Results: Forty-three residents from both the places responded. The frequency of acceptable answers to the six scenarios ranged from 0% to 55.8%. Acceptable responses were more from private-sector institute residents than public-sector residents, but no statistical significant difference was seen

Conclusion: Most residents did not provide appropriate responses to professional challenges. The postgraduate training programs are very stringent on medical knowledge and skills. However, it is needed to address formally professional attitudes and behaviors and include them as a competency in the training program

Determine the diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard

Background: HbA1c is now formally endorsed in many countries as a diagnostic test for [type 2] diabetes as well as for monitoring, although some debate still continues regarding its applicability for diagnosis

Objective: The objective of the study was to: Determine the diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard. Study Design: Cross Sectional Study [Validation]. Setting: Medical department, Allied Hospital, Faisalabad. Duration of Study: 6 Months Duration from 25-02-2015 to 25-08-2015

Methodology: A total of 145 cases with more than 40 years of age of either gender were enrolled in the study. Informed consent was taken from each participant of the study from medical department, Allied Hospital, Faisalabad. Information was collected by trainee researcher and comprised age, Gender, address and contact number, HbA1C and Fasting Blood Sugar. HbA1C and Fasting blood sugar was measured by drawing 3cc blood from a peripheral vein after antiseptic measures and sent to pathology laboratory, Allied Hospital, Faisalabad where it was reported by Pathologist. All the information was collected on Performa by Principal Investigator

Results: In our study, 71.72% [n=104] were between 40-60 years while 28.28% [n=41] had >60 years of age, mean +/- sd was calculated as 56.75 +/- 6.45 years, 52.41% [n=76] were male and 47.59% [n=69] were females, frequency of diabetes mellitus on gold standard was recorded as 26.21% [n=38] while 73.79% [n=107] had no findings of the morbidity. Diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard was calculated for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate as 78.95%, 83.17%, 62.15%, 91.75% and 82.07% respectively

Conclusion: We concluded that the diagnostic accuracy of HbA1C at cutoff point more than 6.15% for detection of diabetes mellitus by taking fasting blood sugar as gold standard is high and this modality can be used in our population

Changes in doppler ultrasound indices of hepatic circulation after treatment with beta blockers: a pilot study

Background: Portal hypertension is a serious complication of liver cirrhosis. Doppler ultrasound assessment may be a non-invasive and cost-effective means of evaluating portal hemodynamics in patients with portal hypertension

Aims and objectives: To assess efficacy of Doppler ultrasound in detecting changes in hemodynamics of hepatic circulation after beta-blocker administration

Methodology: 11 patients with liver cirrhosis and portal hypertension were included. All underwent Doppler assessment of portal vein velocity [PVV], spleno-portal index [SPI], congestive index [CI], liver vascular index [LVI], dampening index [DI], hepatic artery velocity [HAV], splenic artery velocity [SAV], hepatic artery resistive index [HARI] and splenic artery resistive index [SARI]. They were started on beta-blocker carvedilol 6.25 mg once daily and recalled after two weeks for repeat assessment

Results: Out of 13 enrolled, 4 were lost to follow up and one stopped carvedilol. 8 remained. The changes in parameters were: PVV: reduction in 3 [37.5%], no change in 1 and increase in 4[50%] patients; SPI: reduction in 3 [37.5%] and increase in 5 [62.5%]; CI: reduction in 3 [37.5%], no change in 1 and increase in 4 [50%]; LVI: decrease in 3 [50%], no change in 1 and increase in 2; DI: decrease in 5 [62.5%] and increase in 3 [37.5%]; HAV: increase in 4 [50%], no change in 1 [12.5%] and decrease in 3 [37.5%]; SAV: decrease in 4 [50%] and increase in 4 [50%]; HARI: increase in 7 [87.5%] and decrease in 1 [12.5%]; SARI: reduction in 3 [37.5%] and increase in 3 [37.5%]. 3 patients achieved reduction in 5 [PVV, LVI, DI, SARI and SAV] parameters. DI had the largest number of patients with observable reduction and HARI with the largest number showing observable increase in measured parameters

Conclusion: Doppler ultrasound represents a cost effective means of assessing the hemodynamics of hepatic circulation and any associated changes due to diseases and drugs

Acute ischemic stroke; correlation between higher total cholesterol level and high barthel index score in patients

Among all deaths, 40-50% are due to vascular events and out of these 10% are due to stroke. More than 66% of the global stroke occurrence is in developing countries, where the average age of patients with stroke is 15 years less than in developed countries. Objectives: To determine the correlation between higher total cholesterol level and high Barthel Index score[estimate of functional daily independent activity level] in patients with acute ischemic stroke. Design: Cross sectional study. Period: May 2013 to Apr 2014. Setting: Medical Units of DHQ and Allied Hospital, Faisalabad. Methodology: Sample size of 200 patients was collected and patients were included through Consecutive [non-probability] sampling technique. All patients underwent CT scan Brain from the radiology department of the hospital to determine the respective changes [hypo dense area] of the ischemic stroke. Fasting serum cholesterol was measured in all patients after an overnight fast of 12 hours. Then patients were assessed by using Barthel Index score [BI]. The data was analyzed by using SPSS version 16.0. Spearman Rank correlation coefficient was calculated to BI score in patients with ischemic stroke. Results: The mean age of the patients was noted as 61.76+/-11.55 years. In this study 55.50% were males and 44.50% patients were females. The mean total cholesterol value of patients was noted as 251.58+/-71.15 mg/dl. Out of 200 patients, 111[55.5%] patients had high cholesterol [>200mg/dl] whereas 89[44.5%] patient had low cholesterol of[<200mg/dl].In statical analysis the results showed that the mean value of total Barthel index score was 57.50+/-19.52. The study results described that 51.50% patients had high Barthel index score [>53] whereas 48.50% patients had low Barthel index score [<53]. Spearman correlation coefficient was calculated between high TC and high BI score as r= 0.641. This value was statistically significant i.e. p-value=0.000*. Conclusions: With the help of this study, we found a significant positive relationship between high TC and high BI score inpatients presented with ischemic stroke. Now we can better prognosticate the functional outcome of ischemic stroke in our patients.

Comparison of electrocardiography with echocardiography in terms of concurrence of results in the diagnosis of left ventricular hypertrophy

Introduction: Left ventricular hypertrophy, common in hypertension, is an adaptive state of the heart to increase in wall stress. LVH has important prognostic implications for patients with hypertension. In detection of LVH, Echocardiography is considered to be superior to electrocardiography in patients with hypertension

Objectives: To compare the findings of electrocardiography with echocardiography in terms of concurrence of results in the diagnosis of left ventricular hypertrophy

Study Design: Cross - sectional study

Place and Duration of Study: Medical Department of Allied Hospital and PINUM Faisalabad from 14-02-2014 to 13-08-2014

Material and Methods: A total of 88 patients were included in this study. After detailed history and examination, all patients had first ECG and then echocardiography

Results: Mean age of the patients was 50.85+6.3 year. Out of 88 cases, 55 patients [62.5%] were male while remaining 33 patients [37.5%] were female. Mean height of the patients was 1.69+0.10 meter, mean weight was 66.1+9.86 kg and mean BMI was 23.38+1.20. Out of 88 cases, 67 cases were positive on echocardiography and 39 cases were positive on electrocardiography [ECG]. Out of these 39 cases 37 cases were true positive, 2 cases were false positive

Conclusion: The results show that electrocardiogram has low sensitivity and low NPV for detecting LVH as compare to echocardiography. These findings are relevant for physiological LVH and should not be extrapolated to detection of hypertrophic cardiomyopathy. In clinical practice, echocardiography alone should be used to exclude LVH

Chronic hepatitis C virus infection; association with type 2 diabetes mellitus

[1] To seek the association between chronic HCV infection and type 2 diabetes, mellitus. [2] To verify the effect of age, sex, socioeconomic status, obesity and presence of cirrhosis on the association of chronic HCV infection. Case control study. DHQ Hospital, Faisalabad. The subjects were divided into two groups. One was with positive anti-HCV antibody on ELISA method and other was without liver disease and negative for anti-HCV. Both the groups contained 500 subjects each and were selected according to the inclusion and exclusion criteria. After a brief interview regarding age, residence, family history of diabetes, socioeconomic status, both the groups underwent weight and height measurements. The body mass was calculated according to the formulae. Ultrasonography of abdomen was done of all the patients of study groups to assess the liver status. Chi - square test was applied to see the association and then odds ratio was calculated to check the strength of association. Diabetes mellitus was detected in 174 patients [34.8%] out of 500 patients in the group Aas compared to 30 patients [6%] out of 500 patients in the group B. having chi-square value of 127.69 and significance of 0.000 with HCV +/ HCV- Odds ratio 0.120 and 95% C 10.079-0.181. There is strong association between HCV infection and type 2 diabetes mellitus. Severity of Liver Disease was strong associated factor

Prevalence of H. pylori

Acid peptic disease is a world wide problem among all the age groups and both sexes. Duodenal ulcer is common as compared to gastric ulcer. Its prevalence being 4:1 in USA and UK and 5:1 in Pakistan. Etiology of peptic ulcer is almost certainly multi-factorial. Basic paradigm for ulcer disease is the imbalance between the digestive activity of acid and pepsin and the protective mechanism in place to resist mucosal digestion. Over the past few years a new line of thought has been evolved after isolating spiral campylobacter like organism from antral biopsy specimens. H pylori is now considered to be an important if not the only causative agent of gastritis and peptic ulcer disease. The dictum; No acid - No ulcer summarized the pathogenesis of peptic ulcer disease but new dictum seems to be; No H. pylori -No ulcer, as over 90% of Duodenal ulcer and 70% of Gastric ulcer patients are infected by H. Pylori. Aim of the study was to evaluate the prevalence of H. pylori among duodenal ulcer patients at Faisalabad District and its suburbs. Descriptive Study. From Mar 2008 to Oct 2008. 50 patients [40 males, 10 females] belonging to Faisalabad District and surrounding areas with upper gastrointestinal symptoms of acid peptic disease and endoscopy proved duodenal ulcer were subjected to gastric antral mucosal biopsies for evaluation of the H. Pylori status with the help of unease test and histological examination of biopsy specimen. Epigastric pain was the most frequent symptom 90%. [46 out of 50 patients]. 92% showed evidence of H. pylori infection. Maximum incidence of H. pylori was recorded in age group IV [46-55 years]. Maximum number of patients was skilled workers [35 out of 50] 70%. 80% of the patients belonged to lower and middle class. Percentage of H. pylori positivity was 89.1% and 84.34%. Acceptance of contributory role and high prevalence rate of H. pylori instigates us for addition of antimicrobial treatment to the conventional treatment with H2 Blockers and PPls which is cost effective and alter the course of the disease

Fiberoptic bronchoscopy; diagnostic role, a local experience

To demonstrate the usefulness of Bronchoscopy as a diagnostic tool in various pulmonary disorders. Prospective study. Nawaz Medicare Hospital Faisalabad. June 2004 to December 2007. This study was conducted on 52 patients, 37 were male and 15 were female. Their ages ranged from 26 to 85 years. These patients who under went Bronchoscopy were either suspected cases of bronchogenic carcinoma or had difficult to treat un-resolving pneumonias. Endobronchial biopsies and bronchial aspirates were obtained. In the patients suspected of bronchogenic tumor 66.67% patients turned out to be positive on endobronchial biopsies. Bronchial aspirates were diagnostic in 73.32% cases of un-resolving pneumonias. The commonest symptoms in patients under going Bronchoscopy were haemoptysis and cough. Bronchoscopy is very useful in the diagnosis of suspected cases of bronchogenic carcinoma. Bronchial aspirates are helpful in the diagnosis of un-resolving pneumonias

Bacteriology of spontaneous bacterial peritonitis

Cirrhosis is a major cause of mortality worldwide and is the most common non neoplastic cause of death among hepatobiliary and digestive diseases. Ascites is often among the first signs of de-compensation in patients with chronic liver disease. Spontaneous Bacterial Peritonitis [SBP] [with out any source of infection] occurs in 30% of patients with ascites. Common causative organisms include escherichia coli, pneumococcus, Klebsiella and anaerobes. It has a 25% mortality and recurs in 70% of patients within a year. To determine the pathological agents causing SBP in patients with liver cirrhosis. Descriptive study. Medical Ward Allied and K.M. Hospitals Faisalabad. From 17 Nov 2004 to 15 May 2005. Fifty patients of either sex having cirrhosis of liver and ascites were included according to the criteria i.e ascitic fluid leukocyte count of >500 cells/L or >250 PMN, while results of bacterial cultures of ascitic fluid were pending. Out of 5 0 patients, 27 [54%] were males and 23 [46%] females. Mean age of whole the population was found to be 51 +/- 12.49] yrs. Classical spontaneous bacterial peritonitis was present in 27 patients and Culture Negative Neutrocytic Ascites [CN NA] in 23[46%] patients. Out of 50 patients, 27[54%] samples of ascitic fluid showed positive culture reports. E Coli was isolated in 9[18%] cases. Klebsiella pneumoniae in 6 [12%], streptococcus pneumoniae 4 [8%], staphylococcus aureus 2 [4%], pseudomonas aeruginosa 2 [4%]. Acinobacter 2 [4%] and proteus mirabilis 2 [4%]. E. Coli is the commonest organism followed by klebsiella pneumoniae

Pattern of dyslipidemia CRF in patients with CRF

[1]To find the pattern of dyslipidemias in patients with CRF. [2.]To compare the results with international studies. Prospective observational study. In Medical Unit I, II, III and Nephrology ward of Allied Hospital Faisalabad. [06 Months] From: Nov 2004 to April 2005. Allied Hospital is a teaching hospital attached with Punjab Medical College Faisalabad having 1100 beds. Chronic renal failure, a very common disease, is accompanied by many complications. One of such complications is abnormality of lipids. The lipids are disturbed in a characteristic manner. This disturbed lipid pattern predisposes the patients to atherosclerotic complications and increased mortality due to cardiovascular and cerebrovascular accidents. Present study was conducted to determine the pattern of dyslipidemias in patients of CRF.50 patients diagnosed to have CRF were subjected to fasting lipid profile, irrespective of cause and sex. Maximum patients had elevated triglyceride levels [46%]. A considerable percentage [16%] had decreased HDL levels and a small percentage had elevated LDL [4%]. Total lipids were found to be elevated in 04 patients [8%]. All the patients with elevated total lipid were suffering from diabetes mellitus. Total cholesterol was elevated in 08 patients [16%]. This disturbed lipid pattern has role in atherosclerosis. The patients of CRF who are already having disturbed endothelial function are more prone to it

Diagnostic role of endoscopy; an experience at Faisalabad

To see the usefulness of Endoscopy in patients with various gastrointestinal manifestations. Prospective study. Department of medicine and gastroenterology Allied Hospital Faisalabad January 2005 to July 2005, This study was conducted on 500 patients presented to us with various gastrointestinal manifestations of either sex and between 13-70 years. 260 patients were Males and 237 were Females. Most common indication was epigastric pain. 60.4% of the patients had organic lesion. Endoscopy was maximally positive in inpatients [91.86%]. Most common lesion was in stomach i.e. gastritis. Collectively ulcerative lesions came out to be 27.30%. Diagnostic yield of Endoscopy is undoubtedly very high if the patient selection is done in a meticulous way