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OBJECTIVE@#To determine the asymptomatic dengue infection in adults of Pakistani population.@*METHODS@#This study was conducted in five major cities (Islamabad, Karachi, Lahore, Multan, and Peshawar) of Pakistan. A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories. Those who were confirmed for dengue previously were excluded. Of the total, 62.6% (n = 3 276) were male with an average age of 34.6 years. Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue IgG test using enzyme linked immunosorbent assay. The brief information related to age, gender and area was also taken on proforma.@*RESULTS@#Overall 32.3% (n = 1 691) was having asymptomatic dengue infection which was 67.5% (n = 756) in Karachi followed by 39.1% (n = 391) in Islamabad, 29.9% (n = 316) in Lahore and 21% (n = 228) in Peshawar and none from Multan. More males were affected with asymptomatic dengue infection than females. The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups.@*CONCLUSIONS@#The asymptomatic dengue infection is higher in cities i.e. Karachi, Islamabad and Lahore which are at risk of developing secondary dengue infections. There is a need of awareness among the public about secondary dengue infection.
ABSTRACT
Objective To determine the asymptomatic dengue infection in adults of Pakistani population. Methods This study was conducted in five major cities (Islamabad, Karachi, Lahore, Multan, and Peshawar) of Pakistan. A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories. Those who were confirmed for dengue previously were excluded. Of the total, 62.6% (n = 3 276) were male with an average age of 34.6 years. Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue IgG test using enzyme linked immunosorbent assay. The brief information related to age, gender and area was also taken on proforma. Results Overall 32.3% (n = 1 691) was having asymptomatic dengue infection which was 67.5% (n = 756) in Karachi followed by 39.1% (n = 391) in Islamabad, 29.9% (n = 316) in Lahore and 21% (n = 228) in Peshawar and none from Multan. More males were affected with asymptomatic dengue infection than females. The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups. Conclusions The asymptomatic dengue infection is higher in cities i.e. Karachi, Islamabad and Lahore which are at risk of developing secondary dengue infections. There is a need of awareness among the public about secondary dengue infection.
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Background: Pakistan is the 6th most populous country of the world and also among one of the first Asian countries to begin family planning program yet the current contraceptive prevalence rates [CPR] stand at 35%. Men are the critically missing client as focus is always on women
Objectives: To assess the knowledge and attitude towards family planning by educated married men of Islamabad
Study design, settings and duration: Cross sectional study was conducted in twelve public and private sector organizations of Islamabad for duration of 12 months in 2014
Subjects and Methods: Total 300 educated married men age 20 to 60 years who had completed at least 12 years of formal education were enrolled after taking the informed written consent. Data was collected using a structured pre-tested questionnaire through an anonymous interview. Grading scale was used for knowledge and attitude evaluation. 10 marks were given to correct answer and agreement with positive statement. Score less than 70% is categorized as poor, 71-80% fair, 81-90% good and above 90% as very good
Results: Mean age of the study participants was 36 +/- 7 years. About 177 [59%] of the study participants were graduate. Nearly all [99%] participants had heard at least one family planning method while 141 [47%] had poor knowledge. Regarding male contraceptive methods, only 33 [11%] of the study participants know about the permanent birth control methods for men with a misconception that vasectomy decreases male's sexual desire in 267 [89%] of participants. Meanwhile only 18 [6%] study participants are aware that condoms are available both for male and female use. About 193 [64%] study participants were currently using at least one family planning method in an order of with drawl [24%], male condom [13%], and injectables [9%] while 10% don't know that their wives were currently using contraceptive methods or not. Only 3% of the males had poor attitude score. Among the positive attitude males, 99 [33%] had fair score. While 186 [62%] had good score while only 06 [2%] had very good score indicating that generally educated males have positive attitude towards family planning. Overall non response rate was very i.e. 32%
Conclusion: The study reveals positive attitude and poor knowledge of family planning methods among almost half of the study participants who are educated and are resident of urban Islamabad. High non response rate reflects that even educated men are very reluctant to talk and share information's on this topic. Increased use of traditional and temporary family planning methods highlights that positive attitude does not always lead to use to contraceptives
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To assess the economic burden of dengue infection by calculating cost per patient and disability adjusted life years lost. The cross-sectional study was conducted in Islamabad, Lahore, Faisalabad and Karachi from July 2012 to March 2013. Residential addresses and telephonic numbers of dengue patients were taken from the records of Pakistan Institute of Medical Sciences, Islamabad, Mayo and Ganga Ram Hospital, Lahore, Civil Hospital, Karachi, and Allied Hospital, Faisalabad. A total of 250 dengue confirmed cases - 50 from each hospital - were randomly selected. Information regarding duration of illness and out-of-pocket expenses were collected to estimate the direct cost, while indirect cost [number of work days missed by the patient] was calculated from disability adjusted life years using Murray's formula. Overall, there were 162[65%] men and 88[35%] with a mean age of 30.4 +/- 13.5years. More than half 138[55%] were below 30 years of age. Socio-economically, 145[58%] belonged to low, 70[28%] middle and 35[14%] to high socioeconomic groups. Of the total, 210[84%] cases had dengue fever followed by 32[12.8%] dengue haemorrhagic fever and 8[3.2%] dengue shock syndrome cases. Average duration of illness was 32 +/- 7.1 days. Overall direct cost per patient was Rs.35, 823 [US$358] and average pre-hospitalisation, hospitalisation and post-hospitalisation was Rs.6154, Rs.21, 242 and Rs.8, 427 respectively. The overall disability adjusted life years per million population was 133.76. Although the government had provided free treatment for dengue in public-sector hospitals, still patients had to pay Rs.21, 242 during hospital stay, resulting in substantial burden which needs to be addressed
Subject(s)
Humans , Male , Female , Cost of Illness , Cross-Sectional Studies , Severe DengueABSTRACT
Hepatitis E virus [HEV] is endemic in Pakistan with 16-19% seropositivity of HEV IgG antibodies. The HEV is considered fatal during pregnancy as compared to general population. The objective of the study was to determine the maternal and fetal morbidity and mortality in HEV IgM positive pregnant cases. The study was conducted in four hospitals i.e. Pakistan Institute of Medical Sciences, Islamabad, Isra University Hospital Jamshoro, Sindh, Lady reading Hospital and Hayatabad Medical Complex, Peshawar, Khyber Pakhtoonkhwa. The medical record of pregnant cases from 2008 to 2011 was retrieved who were positive for HEV IgM. Information about age, gestational age, viral markers [HEV IgM, HBsAg, anti HCV], complications during pregnancy and outcome were recorded on pre design questionnaire. Data was analyzed using SPSS version 15. Medical record of 70 HEV positive pregnant cases was retrieved and out of these, 34 were found complete and analyzed further. The median age was 26 years. Twenty six pregnancies [76%] were in 3[rd] trimesters, 05 in 2[nd] trimester and 01 in 1[st] trimester. Pruiritis was the commonest symptom [28 cases], followed by jaundice [27], nausea/ vomiting [25] and encephalopathy [18]. Of 34 cases, 12 were artificially induced, 08 had premature labor, 04 delivered spontaneously [full term], 04 died undelivered and 04 continued till term. One got delivered at home and another had an abortion at home before coming to hospital. A total of 12 mothers along with their undelivered babies died, of these 08 were in 3[rd] trimester and 04 in 2[nd] trimester. Four out of 07 babies who were delivered prematurely also died. Maternal mortality was directly associated with delivery as 24 out of 34 mothers survived who were delivered either naturally or were induced while 12 out of 34 who continued their pregnancy died [p<=0 .004]. Third trimester had the highest maternal death. Acute hepatitis E during pregnancy led to 35% maternal and 47% fetal mortality. Acute hepatitis in pregnancy should always be screened for HEV and if found positive should be vigilantly followed to save mother and child
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The signs and symptoms of acute dengue infection are well defined and characterized. However, little data is available about the persistence of these symptoms which depends upon the disease management and patient care. This study was conducted to determine the persistence of dengue symptoms in admitted cases who were discharged from hospital. Data of dengue cases who were admitted in 2 public sector hospitals was retrieved along with their complete addresses. Patients were approached and interviewed after getting the written informed consent. A pre-designed questionnaire was used to collect information about the persistence of dengue symptoms in the patients after they were discharged from hospital. Of 41 cases interviewed, 31 were males and overall mean age was 31 years. The case record showed that 15 cases had dengue shock syndrome, 14 dengue hemorrhagic fever and 12 dengue fever. The average period of illness after getting discharged was 19 days which was significantly higher in females [23 days] as compared to males [18 days]. Majority of the cases [except 04] reported persistence of dengue symptoms in which joint pain [29 cases], itching [17 cases] and exhaustion [14 cases] were more common. The persistence of joint pain after discharge was significantly associated with dengue shock syndrome. The current study showed significant association between joint pain and DSS which could be overcome through proper case management. Furthermore there is a need to follow admitted dengue cases after getting discharged from the hospital to avoid any complications
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Objectives: To determine the etiological spectrum in patients of Liver cirrhosis presenting to a tertiary care hospital of Pakistan
Study: A descriptive case series conducted from December, 2006 to December, 2007 at Services Hospital Lahore
Patients and Methods: One hundred patients of liver cirrhosis presenting in emergency or outpatient department of Services Hospital Lahore, were enrolled. Diagnosis of cirrhosis was made by combination of clinical and ultrasonographic findings. ELISA testing for Hepatitis B surface antigen and Hepatitis C virus antibodies was performed
Results: Amongst the 100 patients 59% were male and 41% were females, majority of these had urban [82%] background. The etiology of cirrhosis was mainly viral [83%], out of which 81% had hepatitis C, 1% hepatitis B and 1% both hepatitis B and hepatitis C. The mean age [years] was 55.79 +/- 13.545 [SD] and mean weight [kilograms] was 62.49 +/- 8.02 [[SD]
Conclusion: We conclude that etiology of Liver Cirrhosis is mainly Hepatitis C in our areas and males are more vulnerable to acquire
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Accidental, suicidal or homicidal ingestion of various substances is quite common in patients who often present as [Coma of unknown origin]. The pattern of drug used in our society differs from the West. The knowledge of more popular substances in local community can be helpful in early diagnosis and management of these patients. In an ICU setup we studied the etiological distribution of coma resulting from poisoning and its outcome. Poisoning was the most frequently encountered cause [70 cases] comprising 19.18% of all cases of coma. There were a total of 218 patients with metabolic causes of coma, and out of these poisonings contributed the largest chunk [making up 32.11% of metabolic comas]. Taken as a whole, poisoning has a relatively favourable outcome [25.71% mortality]. The leading cause of poisoning encountered in our study was benzodiazepine poisoning i.e. 20 patients [28.57%] and all recovered. The second largest group was wheat preservative poisoning [15 patients, 21.42%], 07 patients died, with a mortality of 46.67%. Seven patients with narcotic overdose were all discharged, while one out of 04 patients of organophosphate poisoning [5.72%] and 05 out of 08 copper sulphate poisoning patients [11.43%] could not survive. In 07 patients, the agent could not be identified. Most poisonings encountered in our study were nonaccidental, and many were [27 patients, 38.57%] those patients who were victims of robbers. The favourite agent of these people was benzodiazepines [15 cases], Dhatura [4 patients], narcotic drugs [1 patient] and an unknown agent in 07 cases. Suicidal poisoning was the largest group with 31 cases [44.28%]. We conclude that poisoning is the single largest cause of coma at our hospital emphasizes the need for poison information centres in our country, on the pattern prevalent in the West
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Octreotide infusion is usually instituted before injection sclerotherapy to patients having variceal bleed. We studied whether this practice bas any beneficial effects on subsequent sclerotherapy in patients with portal hypertension and liver cirrhosis. Desipn: A non-randomized open comparative study. Mace and Duration of Study: The study was conducted at Mayo Hospital, Lahore during July to November 1999. fleets and The patients, presenting with first episode of variceal bleed were divided into two groups. Group A patients [n=10] were given octreotide infusions for 48 hours prior to sclerotherapy after a bolus of 50 mcg. Group B patients [n=14] did not receive octreotide due to non-affordability and the injection sclerotherapy was performed within 24 hours of admission. There was no statistically significant difference between the two groups as far as age, systolic blood pressure, hemoglobin and severity of liver disease were concerned. Two groups were compared for blood transfusion requirement, number of sclerotherapy sessions per patient and amount of sclerosant required per patient per session to achieve the satisfactory variceal obliteration. Group A patients required less amount of blood transfusion [1.79 ' 1.41 pint vs 3.0 + 0.8 pint] per case [p <0.01], lesser follow-up sclerotherapy sessions [3.02 ' 0.55 vs 3.21 ' 0.89] per patient [p < 0.05] and less volume of sclerosant [28.6 ' 2.19 ml vs 37.48 ' 6.85 ml], [p < 0.005] per patient per session as well as in all sessions for variceal obliteration [66.00 ' 15.61 ml vs 92. 71 + 12.01 ml], [p < 0.005]. Pre-sclerotherapy infusion of octreotide has added benefits in the management of esophageal variceal bleed
Subject(s)
Humans , Male , Female , Octreotide , Gastrointestinal Hemorrhage/therapy , Sclerotherapy , Hypertension, Portal , Liver CirrhosisABSTRACT
Type-2 diabetics suffer from lipid abnormalities. Even though these are mild in most patients, they contribute to the increased cardiovascular morbidity and mortality seen in this disease, especially in South Asians. We report the effect of HMGCoA reductase inhibitor, FLUVASTATIN in lowering lipid levels in type 2 diabetes mellitus in urban Pakistanis from Punjab. Such data does not exist before. Type 2 diabetes with stable disease were entered into the study if the level of lipids remained elevated following period of 8 weeks on diet placebo oral medications. They entered into the next phase [week 0] only if they demonstrated a persistently raised total cholesterol [250 mg/dl] despite the lipid lowering diet. In phase 2, the subjects received FLUVASTATIN 40 mg per day for twelve weeks, lipid levels were estimated at week 0, 6, 12. Monitoring for side effects both clinical and biochemical, was carried out. 50 out of 85 patients were found to have a total cholesterol of less than 250 mg/dl after 8 weeks on a lipid-lowering diet. 35 patients [9 male, 26 female] entered phase two. Their mean age was 46.7 years and mean body mass index 28.6 kg/m[2]. After 12 weeks of treatment with FLUVASTATIN there was no change in fasting blood glucose. However mean total cholesterol was reduced from 313.3 mg/dl to 233 mg/dl [-34.3%]; LDL cholesterol fell from 185.2 mg/dl to 160.6 mg/ dl [-15.4%]. The mean HDL cholesterol level increased from 46.6 mg/dl to 56.1 mg/dl [+17.2%]. Side effects were insignificant. FLUVASTATIN effectively and safely lowers total cholesterol, LDL cholesterol, triglycerides in urban Pakistanis suffering from type 2 diabetes mellitus, presenting at Mayo Hospital, diabetic clinic. It also increases the level of HDL cholesterol