ABSTRACT
To find the frequency of hepatocellular carcinoma in cirrhotic patients of our population. Prospective observational study. Medical A Unit Hayat Abad Medical Complex Peshawar. Period: 1st January 2010 to 31st July 2011. Material and All patients were screened for presence of Hepatocellular carcinoma [HCC] by performing Alpha fetoprotein and ultra sound [U/S] abdomen. Contrast enhanced computed tomography scan [CT] of abdomen was done in selective cases. European Association for the Study of Liver Diseases [EASLD] Noninvasive criteria [limited to patients with underlying cirrhosis] was used for diagnosis of HCC i.e. Two coincident imaging techniques that identify a focal lesion more than 2 cm showing arterial hypervascularization or one imaging modality that identifies a focal lesion more than 2 cm in diameter showing arterial hypervascularization and serum AFP levels greater than 400 ng/Ml. A total of 370 patients cirrhotic patients were enrolled in this study. Thirty nine patients [10.5%] were diagnosed as having HCC. Male patients were 30 [77%] and 9[23%] were female. Mean age was 49.2% [range 18 to 72 years]. Abdominal discomfort was predominant symptom present in 94% patients, followed by anorexia present in 90% patients, abdominal distension in 76%, weight loss in 62%, jaundice was present in 46% patients, altered mental status was notice in 36% patients and history of upper gastrointestinal [GI] bleed and malena was extracted from 26% patients. Ultrasound abdomen and CT abdomen showed unifocal lesion in 48.7% patients, multifocal lesion in 30.7% patients and massive lesion in 20.5% patients. Alpha fetoprotein ranged from 45ng/dl to 630ng/dl. Hepatitis C [HCV] was the commonest cause present in 51% patients, Hepatitis B [HBV] in 15.3% patients and HBV and HCV co-infection in 10.25% patients, history of alcoholism was revealed in 5% patients and in 2.5% patients alcoholism was present along with HCV and HBV each, while in 10% cases the cause of cirrhosis remained unknown. Hepatocellular carcinoma is the most common primary hepatic tumor and one of the most common cancers worldwide. It is concluded that HCC is more common in males compared to female cirrhotic patients. Hepatitis C followed by HBV are the leading causes of HCC related cirrhosis in local Population of Khyber pakhtoonkhwa
ABSTRACT
To evaluate the role of cerebrospinal fluid [CSF] polymerase chain reaction [PCR] for Mycobacterium Tuberculosis in rapid diagnosis of tuberculous meningitis [TBM]. Prospective observational study. Medical A unit Hayat Abad Medical complex Peshawar from 1st September 2010 to 30th August 2011. A total of 20 Patients having fever, constitutional symptoms [malaise, vague ill health, headache, vomition], nuchal rigidity with altered mental and behavior changes were suspected as TBM and hence included in the study. Patients were divided into two groups based on direct and indirect evidence of tuberculosis in central nervous system [CNS] of patients. Group 1: Patients having direct evidence of mycobacterial infection in CNS as Acid Fast Bacilli smear positive in CSF. Group 2: Patients with indirect evidence of TB in CNS in form of typical CSF findings of TBM, positive sputum smear for Acid fast bacilli [AFB] or computed tomographic [CT] Scan brain findings suggestive of TBM or evidence of TB in x-ray chest or family History of tuberculosis and/or history of contact with TB patients or positive Mantoux Test or evidence of TB elsewhere in the body. Out of total 20 patients, 3 [15%] belonged to Group 1 having direct evidence of TBM the remaining 17 [85%] patients belonged to Group 2. Female patients were 60% while 40% patients were male. Mean age was 35.8 years. All patients had fever and headache. Productive cough was present in 40% patients. Thirty five percent had lost weight. Contact with TB patients was revealed in 35% patients. Signs of meningeal irritation were elicited in 90% patients. Cranial nerve palsies were seen in 25% patients, 10% had hemiparesis while 35% had impairment of consciousness. X-ray chest was normal in 65%. Computed tomographic scan was showing meningeal enhancement in 30% patients, hydrocephalus in 15% patients. PCR positive for mycobacterium tuberculosis. Of 17 patient in group 2, 64% patients had positive CSF PCR. Tuberculous meningitis is an important serious extrapulmonary complication of TB, related with high mortality and morbidity. The prompt and accurable diagnosis of TBM is a daunting challenge. CSF PCR for Mycobacterium tuberculosis is an excellent test for rapid diagnosis of TBM