Frequency of Hepatitis C in hospitalized patients with chronic kidney disease

Background and Objectives: Hepatitis C and chronic kidney disease [CKD] are major global health problems and are highly prevalent in Pakistan. There is limited information on prevalence of hepatitis C in patients with CKD not yet on dialysis. The objective of this study was to determine the frequency of hepatitis C in hospitalized chronic kidney disease patients at a tertiary care center in Pakistan

Methods: The study design was cross-sectional in nature. Patients between ages of 20-80 years with CKD not previously on renal replacement therapy and who were admitted to nephrology ward at a tertiary care facility were included. Hepatitis C was tested using 3[rd] generation enzyme linked immunosorbent assay [ELISA]. Hepatitis C RNA was tested by polymerase chain reaction [PCR] in patients with positive ELISA

Results: A total of 180 patients were included in the study. Mean age of patients was 48.7 +/- 14.9 years. Of all patients, 105 [58.3%] were males and 75 [41.7%] were females, 152 [84.4%] had hypertension, 113 [62.8%] had diabetes mellitus and 26 [14.9%] had known cardiovascular disease. Mean eGFR of patients was 11.4 +/- 9.4 ml/min/1.73 m2. Of all patients with CKD, 49 [27.2%] had hepatitis C test positive by ELISA. Hepatitis C PCR testing was done in 39 patients with hepatitis C ELISA positive status and 29 [74.4%] tested positive. Risk factors and clinical characteristics of patients with and without positive hepatitis C antibody by ELISA were similar

Conclusion: A significant proportion of hospitalized CKD patients have hepatitis C. Strict universal infection control measures should be implemented in nephrology wards to prevent transmission of hepatitis C infection

Response rate of standard interferon therapy in chronic hepatitis C

Interferon combination therapy is used to eradicate the Hepatitis C Virus from infected individuals. HCV [hepatitis C virus] infections respond to standard conventional interferon [INF] therapy along with ribavirin [RBA].The aim of study was to look for response of chronic HCV infections to standard conventional combination interferon therapy and ribavirin. Interventional non randomized trial. This study was carried out at Azad Kashmir Combined Military Hospital [AK CMH]/Sheik Khalifa Bin Zyad [SKBZ] Muzaffarabad [MZD] from June 2009 to July 2012. A total of 210 patients were selected for interferon combination therapy. After confirmation of active HCV infection by PCR-RNA, conventional interferon alpha 2a with ribavirin [RBA] was given to patients for 6 months. After end of treatment [ETR], the efficacy was defined as sustained virological response [SVR] if HCV-RNA remained undetected 6 months after stoppage of combination interferon therapy. Out of total 210 patients, 144 [68.6%] showed SVR and 66 [31.4%] did not show SVR. Hence out of 68.6% were negative and 31.4% were positive for HCV RNA after 6 months of therapy. The non parametric chi squared showed age [p=<0.001], [age category p=<0.001], gender [p=<0.006], and HCV PCR response [p=<0.001] had statistical significant association. Conventional Interferon and ribavirin combination therapy [INF-RBA] remains effective in chronic hepatitis naïve patients. HCV-RNA qualitative PCR test at 6 month of ETR is important predictor of SVR. The response of antiviral therapy against HCV infection in chronic HCV patients is 68.6%. The high response rate may be due to the prevalence of IFN-responsive HCV genotypes type 3 in our country

Correlation of BMI with cholesterol and sugar in adults

This study was aimed to find the correlation of BMI with cholesterol and sugar level in adult. This study was carried out in Department of Medicine, Combined Military Hospital [CMH] Quita from 2006 to 2009. Prospective observational cross sectional studies. Individuals with different ages, sex were selected as study population. The cholesterol and fasting blood sugar were measured according to standard protocol. Height in centimeter and weight in kilograms of each individual was recorded and BMI calculated as kg/m[2]. Physical examination was done for everybody. The SPSS-20 was used for statistical significant analysis. The frequencies of variable and correlation between BMI, heights, weight, sugar and cholesterol were comprehensively analyzed. A total of 2,174 adults, 1,947 [89.56%] male and 227 [10.44%] female were included in study. Age range was between 20 and 55years.The mean age was 38.47 +/- 12.66. Mean BMI was 23.57 +/- 2.58.Mean cholesterol was4.57 +/- .60. Mean fasting blood sugar [FBS] was 4.67 +/- .75.Mean weight 70.32 +/- 9.1 Mean height 172.73 +/- .7.85.The correlation analysis revealed that weight, fasting blood sugar [FBS] and cholesterol had positive correlation with BMI [correlation coefficient of 0.734 [p<0.000], 0.167 [p<0.000], 0.164 [p<0.000] respectively and height had negative correlation with BMI [-0.123 [p<0.000]. BMI is positively correlated with weight, RBS and cholesterol. The effect of age, sex, exercise and current medical status, this correlation is reduced

Biodata on chronic lymphoproliferative disorders in the Sulaimaniyia province of Iraqi Kurdistan

Chronic lymphoproliferative disorders [CLPD] are a diverse group of malignant disorders with a high incidence and a soaring prevalence affecting mainly the elderly population. The prevalence in the developing world is quite high but the scope and burden of these disorders has not been studied, especially in our locality. We hope that this study could lead us in the right direction in establishing the magnitude and burden of different malignancies in our nation. In this retrospective study, 237 cases of CLPD who were diagnosed and recorded from January 1[st] 2007 to December 31[st] 2008 in Hiwa Cancer Hospital, Sulaimaniya, IRAQ have been studied. Cases included chronic lymphocytic leukemia [CLL], multiple myeloma [MM], Hodgkin lymphomas [HL] and all other types of chronic B and T cell non-Hodgkin lymphomas [NHL]. Special consideration has been given to CLL and MM regarding clinical and laboratory data analysis at initial presentation, since other diseases were critically analyzed through parallel projects. One hundred and sixty of the patients were from Sulaimaniya and 77 cases came from the nearby areas. NHL was the commonest kind of CLPD with 99 patients and a relative frequency of 42%. Hodgkin Lymphoma, CLL and MM formed 26%, 2 1% and 11% respectively. Mean age at diagnosis was 63 years for CLL, 61 for MM, 43 for NHL and 3 1 for Hodgkin Lymphoma. Male to female ratio was almost double for NHL, 2.5 for CLL, near to equity for MM and just above unity for HL. Results are available in detail regarding clinical, laboratory data for both multiple myeloma and chronic lymphocytic leukemia; outcome was found comparable to that of internationally published studies. NHL was found to be the main type of CLPD, especially if the new WHO classification is used, where CLL is included with small lymphocytic lymphoma in one category within the entity of NHL. Sex ratio and mean age at diagnosis for each entity were nearly similar to Surveillance, Epidemiology and End Results [SEER] in USA and some other countries like Greece and China. Clinical, laboratory data analysis for both multiple myeloma and chronic lymphocytic leukemia were comparable with those published internationally

evaluation of use of Trans-Obturator Tape [TOT] sling procedure in the current surgical management of female stress urinary incontinence

To assess the role of TOT sling procedure in current surgical management of female Stress Urinary Incontinence [SUI] in terms of post-operative results, cost effectiveness, pt acceptance and complications. From June 2006 to September 2008, 30 patients of SUI were treated surgically by TOT-sling procedure. Pre-operatively the patients were evaluated by thorough history taking, clinical examination and different diagnostic test depending upon the individual clinical scenario. Patients were explained in their own language the nature of procedure and the principle behind it. Any complication[s] [intra/postoperative] were noted. After discharging the patients they were followed up by at least 3 visits [follow-up visits] at 1,3 and 6 month interval. Any complications of the procedure and patient acceptance were evaluated at each follow-up. The mean age of the total patients [n=30] was 39.5 yrs and 28 [93.33%] were multiparous. Involuntary loss of urine on straining was the most common complaint present in 25 [83.33%] patients and 22 [73.33] patients were having duration of symptoms less than 3 yrs. 9 [30%] patients were having mild cystocele pre-operatively which resolved after surgery. All the 30 [100%] patients were continent post-operatively while 7 [23.33%] were having lower urinary tract symptoms [LUTS]. No major intra/post-operative complication was seen but, urgency, dysuria, fever and haematuria was seen post-operatively which resolved after few days. The operative time was 24 +/- 3.8 months and catheter was removed on 2.7 +/- 1.7 days post-operatively. Hospital stay was 6 +/- 2.4 days [3-11] and app. Cost of the treatment was Rs 3253 +/- 360 [2700,3900]. TOT Sling procedure is currently the Gold Standard for management of female SUI. It is very important to diagnose SUI and rule out other causes of incontinence because only the former one [Genuine SUI] is improved by TOT sling and other types may be even worsened by this procedure

Scope of Mitral Valve Surgery in Libya

Over a period of 10 years [1992-2002], a total of 261 patients [145 females, 116 males; age range 10-70y; mean 32y] with mitral valve disease underwent 275 operations on their mitral valves. Mitral valve replacement [MVR] was performed on 172 [63%] patients, open mitral valvotomy [OMV] on 76 [28%] patients, closedmitral valvotomy [CMV] on 20 [7.2%] patients and mitral valve repair [MVRp] on 7 [2.5%] patients. Mitral stenosis [MS] was the predominant lesion in 162[59%] patients with 66[41%] patients requiring valve replacement, whereas mitral regurgitation [MR] was predominant in 113 [41%] patients, out of which 106 [94%] patients required valve replacement. Redo surgery was performed on 32 [12%] patients. Concomitant operations were performed on 46 [17%] patients, mainly aortic valve replacement [30 patients]. Left atrial [LA] thrombus was present in 19 [11.7%] patients out of 162 patients with mitral stenosis. Overall early mortality [EM] occurred in 13 [6%n] patients. Closed mitral valvotomy carried a 0% EM but high [35%]reopoation rate, whereas OMV carried a 2.6% EM and 35% reopermion rate. MVR had a low EM of 2% when performed for predominant MR but a high EM of 11.3% when performed for predominant MS. The presence of an LA thrombus was an independent predictor of high mortality, being 1%. Mitra valve repair for rheumatic MR carried a low EM 0% but a high reoperation rate of 55%. For patients with rheumatic MR, MVR is superior to valve repair and carries a low EM. Whereas for patients with MS. the primary aim is for an OMV, with valve replacement as a second choice since it carries a higher EM. Closed mitral valvotomy is indicated when facilities for ballon valvuloplasty/pen valvotomy are lacking. Patients with an LA thrombus should be recognized as high risk

Assessment of knowledge and practices of health workers regarding surveillance activities of adverse events following immunization and the cold chain system in Alexandria

The aim of this study was to assess the knowledge and practices of health workers dealing with immunization services about the appropriate management of cold chain system. Their knowledge and practices concerning the surveillance activities of adverse events following immunizations [AEFIs] were also evaluated. A cross sectional study was conducted in all health offices providing immunization services in Alexandria. The required data were collected through an observational checklist and two interviewing questionnaires. This study concluded that the knowledge of health workers regarding immunization and cold chain is still low. The knowledge and practices regarding AEFIs is also poor. Extensive health education and training are needed to ensure that everyone involved in cold chain is familiar with all its facets. The study recommended provision with equipments, such as electric generators, solar refrigerators and cold chain monitors, which are considered important components for the safe storage of vaccine and successful immunization program

Assessment of job satisfaction among primary health care providers in Alexandria, Egypt

This study was carried out on a sample of 538 health care providers. One quarter of the studied health care providers were physicians, more than half of them were nursing staff, while paramedical personnel constituted 20.2%. Generally, job dissatisfaction was highly prevalent among the studied sample with a median job satisfaction score [JSS] of -42. Dissatisfaction was high for external dimension compared with the internal one. Moreover, overt dissatisfaction was highly prevalent regarding the 18 dimensions of job satisfaction, where the percentage of dissatisfaction ranged from 47.2% to 77.3% of the sample. Moreover, primary health care [PHC] providers were least satisfied with the available facilities, morality, financial advantages, work environment and work regulation systems. On the other hand, PHC workers were most satisfied with gratitude and esteem, autonomy, social advantages, self-expression, work style and work group. Exploring the relation between the demographic and job characteristics separately with job satisfaction revealed that the older health workers, males, physicians and senior workers had significantly a higher median JSS compared with their counterparts. Multiple logistic regression results and stepwise models revealed that being male was a predictor for being a satisfied physician; having bachelor certificates and the increasing age were predictors for being a satisfied nurse as well as increasing age, decreasing duration of work and having certificate less than bachelor degree were predictors for being a satisfied paramedical personnel. It was recommended that workload should be reduced through reforming the primary health care system and PHC workers should be provided by in-service vocational training, adequate salaries and incentives as well as adequate administrative support

Laser trabeculoplasty in pakistani patients

Argon laser trabeculoplasty [LTP] was performed on one eye each of 13 phakic patients with bilateral open angle glaucoma. Initial results of a 10-month follow-up showed it effective in lowering of intraocular pressure and, hence, in reduction or discontinuation of other antiglaucoma medication in eight [61.5%] patients. One patient [7.6%] showed no change and four [30.8%] needed filtering procedure following LTP. However, the long-term efficacy of laser trabeculoplasty in these Pakistani patients in the first group remains to be fully determined