Oral submucosal fibrosis in rural sindh

OBJECTIVE: To determine the frequency of complications in Oral Submucus Fibrosis and to evaluate the major risk factors involved in OSF

STUDY TYPE: Observational Descriptive study

SETTING AND DURATION: Dr. Moula Bux Jaffery Memorial Hospital Badin, Sindh from January 2010 to September 2011

METHODOLOGY: Two hundred and eighty cases of OSF diagnosed on clinical base, detailed history and proper clinical examination of all the patients was conducted in ENT clinic and functional fibrosis grading system had applied in study, all the related information was documented on prescribed proforma

RESULTS: Majority of patients was related with more youthful age bunch with male prevalence

Most of the patients found 2nd and 3rd stage fibrosis. 99% patients had a history of taking Paan, CHHALIA and Gutka, 29% patients had developed recurrent mouth ulcers and 2% patient had developed neoplasia while 85% patients have history of recurrent throat infections

CONCLUSION: Major cause of OSF is use of Pan CHHALIA and Guttka. Young age group is more vulnerable. Recurrent throat infection is another burden over society

MELD Era: is this time to replace the original child-pugh score in patients with decompensated cirrhosis of liver

To compare the predictive value of MELD [Model of end stage liver disease] and Child-Pugh [CP] scores in patients with decompensated cirrhosis of liver. Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007. This study included 110 consecutive patients with decompensated cirrhosis of liver diagnosed either clinically or radiologically were followed-up during hospital stay. Studied variables included demographic data, cirrhosis related complications and investigations. Patients were classified according to original CP classification into A, B and C. MELD score was estimated from serum bilirubin, serum creatinine and INR [International normalized ratio] of the patients. Duration of hospitalization and in-hospital mortality were made as the end points of the study. T-test and Chi-square test were done for continuous and categorical data. Original CP and MELD score were compared by the ROC curve. 0.05 was kept as the level of significance. There were 110 patients with decompensated cirrhosis of liver. Mean age was 46.76 +/- 12.93 years. There were 72 [65%] male and 38 [35%] females patients. Hepatitis C was the most prevalent cause of cirrhosis of liver present in 60/110 [60%] cases. Ascites was present in 93/110 [83%] patients. The mean MELD scores were 2.23 +/- 0.712 [95% CI 2.09-2.36] and for CTP 2.52 +/- 0.586 [95%; CI 2.41-2.63]. The outcome of the patients were 12 deaths [11%]; 54 [49%] remained hospitalized for up to 14 days and 44 [40%] for>14 days. The majority of deaths and prolong hospitalization were found in patients with MELD score>15 as well as with Child-Pugh grade C. The c-statistic was 0.726 [p=0.001] for CP score, and 0.642 for MELD score [p=0.021]. The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study

Stroke localization: clinical correlation versus findings of CT scan brain in patients admitted at Liaquat University Hospital Hyderabad/Jamshoro

Objective: to study clinical localization of stroke and correlate with findings on C-T Scan of Brain

Design: observational study

Place and Duration of study: the study was conducted at the Medical Department of Liaquat University Hospital Hyderabad/Jamshoro from January 2006 to December 2006

Material and Methods: total 110 patients with features of stroke were included in this study. These patients were further evaluated for clinical correlation with findings on CT scan brain, done within 24 hours after the development of focal neurological deficit. Brain tumor, meningitis, viral or bacterial encephalitis, multiple sclerosis and metabolic derangements that could explain focal neurological deficit e.g hypoglycemia were` the exclusion parameters

Results: total of 110 patients, 60 [54.5%] were males and 50 [45.5%] were females. Age of patients ranged 22-84 years with mean +/- SD age of 53 +/- 5 years. On clinical ground cerebral infarction was suspected in 89 [80.9%] and cerebral hemorrhage in 21 [19.1%] patients. In 74 [83%] patients infarction was confirmed by CT scan brain, whereas cerebral hemorrhage was proved in 10 [47.6%] out of a total of 21 patients. These patients were further evaluated for clinical localization of area of stroke. Clinically left parietal / temporo parietal lobe infarction was suspected in 43 patients and right parietal / temporo parietal lobe in 25 patients. Left frontal lobe infarction in 7 patients right frontal lobe infarction in 8 patients, left internal capsule infarction in 2 patients and right internal capsule infarction in 4 patients. Comparing with the CT scan brain findings: left parietal / temporo parietal lobe infarction was confirmed in 41 [95.34%] patients, right parietal / temporo parietal lobe in 19 [76%], left frontal lobe in 5 [71.4%], right frontal lobe in 4 [50%], left internal capsule in 2 [100%] and right internal capsule in 3 [75%] patients. Left middle cerebral artery territory involvement was observed in 43 [58%] patients and right middle cerebral artery territory in 22[30%] patients. No Significant difference was observed in other cerebral artery territories

Conclusion: it was concluded from the study that cerebral infarction was more common than hemorrhage and middle cerebral artery territory infarction of both sides was more common than other cerebral artery territories. Localization of stroke on clinical basis is not always easy. Confident diagnosis requires careful case history taking, extensive neurological assessment and with the help of focal neurological deficit of a particular area

Category: internal Medicine

Validation of three non-invasive markers in assessing the severity of liver fibrosis in chronic Hepatitis C

To compare various biochemical markers i.e. APRI [AST to platelet ratio index], aspartate aminotransferase [AST] alanine aminotransferase [ALT] ratio, FIB-4 [AST, platelet, AST and age] with biopsy for assessing the severity of hepatic fibrosis in patients with hepatitis C. Study Design: Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2005 to March 2007. Consecutive hepatitis C virus RNA positive and previously untreated patients were studied. Liver biopsy with histological evaluation and AST/ALT ratio, AST to platelet ratio index and FIB-4 were assessed in all patients. Receiver operative curves were developed. There were 158 patients [109 males, 49 females]. On histological grounds non-advanced fibrosis [F0-1] was present in 74 [46.5%] of cases, whereas 84 [53.5%] patients had advanced [F2-4] fibrosis. The area under the receiver operating characteristic curves of APRI < 0.05-1 and FIB-4 < 1.45 were 0.7 and 0.74 respectively, which means that APRI < 1 and FIB-4 < 1.45 will exclude advanced fibrosis in 70% and 74% of patients respectively. An APRI of > 1 and FIB-4 will predict advanced fibrosis in 87% and 98% of patients respectively. AST/ALT ratio was inferior to both of these biomarkers. Both APRI and FIB-4 not only exclude minimal fibrosis but can predict advanced fibrosis in the majority of the patients. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy