Pancytopenia; study for clinical features and etiological pattern at tertiary care settings in Abbottabad

Pancytopenia is an important hematological problem encountered in our day-to-day clinical practice. The aim of our study was to evaluate clinical features and etiological pattern of pancytopenia at tertiary care settings in Abbottabad. This prospective study was conducted at Northern Institue of Medical Sciences [NIMS] and Ayub Teaching Hospital Abbottabad from 25th August 2009 to 31st July 2010. A total of 85 patients fulfilling the criteria of pancytopenia were randomly selected by time-based sampling. Pancytopenia was diagnosed by anemia [hemoglobin

Frequency and pattern of retinopathy in newly diagnosed type 2 diabetic patients at tertiary care settings in Abbottabad

Retinopathy is one of the most frequent and serious complication of diabetes mellitus and leading cause of blindness worldwide. The objective of this study was to determine frequency and pattern of retinopathy in newly diagnosed type 2 diabetic patients at tertiary care settings in Abbottabad. This was a descriptive cross-sectional comparative study being conducted at Ayub Teaching Hospital and Northern Institute of Medical Sciences Abbottabad. It included 100 newly diagnosed type 2 diabetic patients who were attending diabetic clinics of these tertiary care hospitals. Already diagnosed type 2 patients taking anti-diabetic medication, type 1 diabetes mellitus, hypertension, retinal vasculitis, retinal vessel occlusion, and sickle cell retinopathy were excluded. After pupillary dilatation, detailed fundoscopic examination was carried out via direct ophthalmoscopy and further confirmed by an ophthalmologist. According to fundoscopic findings, retinopathy was graded into background, pre-proliferative and proliferative types. Total 100 patients were included, with mean age 45.1 +/- 3.2 years, 60% of them were females. Overall, 17% of type 2 diabetic patients had retinopathy within one month of diagnosis. Background retinopathy was predominant [12%] followed by pre-proliferative [4%] and proliferative [1%] lesions. Frequency of retinopathy in newly diagnosed type 2 diabetic patients seems to be higher than previous reports and background lesions were predominant. Detailed fundoscopic examination of all newly type 2 diabetic patients at the time of diagnosis is of paramount importance.

Peripheral arterial disease. [PAD] in type 2 diabetic patients

The increase in prevalence of type 2 diabetes and its complication is alarming. The incidence of diabetic foot ulcers due to peripheral arterial disease, which leads to foot amputations far too often, is unacceptably high especially in developing countries. This study has been conducted to find out frequency and degree of peripheral arterial disease in type 2 diabetics having foot ulcers at tertiary care settings in Abbottabad. This was a prospective descriptive study-being conducted at Northern Institute of Medical Sciences [NIMS] and Ayub teaching hospital Abbottabad from August 2009 to June 2010. Type 2 diabetics with non-healing foot ulcers lasting longer than then days, were selected for this study by non-probability purposive sampling method. All study subjects have undergone for palpation of peripheral arterial pulses in the lower limbs. Ankle-brachial index [ABI] is the ratio of the systolic blood pressure at the ankle to that in the arm Peripheral arterial disease [PAD] was considered to be present if ABI was less than 0.90. It was further graded as mild, moderate and severe according to ABI values between 0.70-0.90, 0.50-0.69 and less than 0.49 respectively, as per recommendations of American Diabetes Association. A total of 83 type 2 diabetics with foot ulcers were enrolled during eleven months period of this study. The mean age of study subjects was 53.68 +/- 9.51 years. There were 33 [39.75%] males and 50 [60.24%] females with M to F ratio of 1: 1.51. Mean duration of diabetes was 13.67 +/- 5.80 years [ranging from 9-23 years]. Majority 57 [68.67%] of our patients were obese having poor glycemic control. Peripheral arterial disease has been fond in 35 [42.16%] patients, out of them 18[51.42%] had mild PAD as their ABI values remained between 0.70-0.90, 15[42.85%] had moderate PAD due to their ABI values between 0.50- 0.69 and 2 [5.71%] had severe PAD as their ABI values lie below 0.49. Ankle-brachial index is a non-invasive, inexpensive and office-based diagnostic tool for peripheral arterial disease in type 2 diabetics having foot ulcers, Healthcare professionals must be trained about early referral and regular feet care of these patients

Dengue infection; study for evaluation of enzyme immunoassay [EIA] test for rapid diagnosis

Dengue fever [DF] has emerged as a major public health problem across the world in terms of health cost, morbidity and mortality. The objective of our study was to determine frequency of seropositive dengue virus infection by using enzyme immunoassay [EIA] test in patients with probable dengue infection at a tertiary care hospital of Hyderabad. This crosssectional, observative, hospital-based study. Liaquat University Hospital Hyderabad. 1st June 2010 to 31st December 2010. Patients presenting with acute febrile illness [i.e. documented fever of>38°C], skin rashes with or without bleeding manifestations [petechiae, epistaxis, hematemesis, menorrhagia or malena] plus cytopenias [leucopenia and/or thrombocytopenia] on peripheral smear examination, were evaluated for probable dengue virus infection. Serologic diagnosis has been carried out by using enzyme immunoassay [EIA] test with differential detection of IgM and IgG. Out of 340 cases who fulfilled WHO criteria of probable dengue fever, 152[44.70%] were enzyme immunoassay [EIA] test reactive, while 188[55.29%] EIA non-reactive. The primary dengue infection was found in 102[67.10%] patients and secondary infection in 50[32.89%]. Among both groups, males were predominantly affected. Majority of patients were hospitalized during the month of October. In addition, large number of patients aged between 13-35 years. Only two patients expired due to dengue shock syndrome and they were suffering from secondary dengue infection. Case fatality rate was 0.3% in our study. On conclusion, early detection of primary and secondary dengue virus infections via enzyme immunoassay [EIA] being important, as it is simple and rapid diagnostic tool having high sensitivity. This is especially valuable in alleviating psychological fear, disease-progression and mortality associated with dengue fever epidemics

Evaluation of typhidot [IgM] in early and rapid diagnosis of typhoid fever

Typhoid fever is widely recognized as a major public health problem in developing countries. A simple, reliable and rapid diagnostic test is needed for clinicians especially in areas where laboratory services are limited. To evaluate sensitivity and specificity of typhidot [IgM], a serological test to identify IgM antibodies against salmonella typhi. This was a prospective study. Northern Institute of Medical Sciences [NIMS] and Ayub Teaching Hospital Abbottabad. 1[st] November 2009 to 31[st] August 2010. A total of 100 patients with clinically suspected typhoid fever were studied and divided into three main groups as A, B and C, with definite typhoid fever, typhoid suspects plus non-typhoidal illnesses and healthy controls respectively. Blood culture and typhidot [IgM] tests were conducted for all subjects included in the study. The validity of typhidot [IgM] test has been evaluated by determining the sensitivity, specificity, positive and negative predictive values. In our study, majority [75%] were males and [25%] females with M to F ratio of 3:1. The mean age of study group was 26.31 +/- 11.8 [SD] years. Among 100 clinically diagnosed typhoid fever patients, 19 had positive blood culture for S.typhi and 71 were typhidot [IgM] positive. Out of 19 culture positive patients, 18 [94.73%] were true typhidot [IgM] positive, which was also falsely positive in 05 [20.83%] among 24 non- typhoidal febrile controls. None of the healthy controls was positive for typhoid [IgM] test. The sensitivity, specificity, negative and positive predictive values of typhidot [IgM] test using blood culture as gold standard were 94.73%, 90%, 97.72% and 78.26% respectively for patients having typhoid fever. Typhidot [IgM] test is a simple, reliable, rapid and valid diagnostic tool for typhoid fever especially in areas where laboratory services are limited

Thrombocytopenia; frequency and degree in patients with falciparum malaria

Malaria is usually associated with reduction in blood cell counts and mild to moderate thrombocytopenia is a common feature of falciparum infection. This study has been conducted to find out frequency and degree of thrombocytopenia in patients suffering from falciparum malaria at a tertiary care hospital of Abbottabad. It was a descriptive case-control study being carried out at Ayub teaching hospital and Northern institute of Medical Sciences [NIMS] Abbottabad over a period of ten months. All patients with acute febrile illness without localizing signs were considered for study. A total 250 patients having falciparum malaria diagnosed by peripheral blood film examination have been studied. Complete blood counts were performed by Automated Beckman Coulter Analyzer. Blood films were examined by clinical pathologist for plasmodium falciparum via light microscopy using oil-immersion lens. Out of 250 patients, 155 [62%] were females and 95[38%] males with M: F ratio of 1:1.5. Mean age was 36 +/- 1.2 years [range 17-58 years]. Out of 250, 175[70%] had thrombocytopenia [p<0.05] while 75 [30%] had normal platelet counts. Thus mild, moderate and severe thrombocytopenia had been observed in 121[48.4%], 41[16.4%] and 13[5.2%] respectively [p<0.05]. Fever appeared to be most common symptom observed in all patients [100%] followed by vomiting and nausea [88%]. Anemia was the commonest sign present [80%] during our study. We discovered high frequency of mild thrombocytopenia in falciparum malaria. Therefore, thrombocytopenia can be supportive in diagnosis of plasmodium falciparum infection

Study of snake bite cases at Liaquat University Hospital Hyderabad/Jamshoro

Envenoming resulting from snakebites is an important public health hazard in many regions. It is common in rural areas not to delay access to life saving anti-venom. The objectives of this study were to know about common types of snakes in local areas, clinical features in snakebite victims, complications in snakebite case, and mortality rate in snakebite victims in rural Sindh. This descriptive study was conducted at 4 medical wards of Liaquat University Hospital Hyderabad/Jamshoro, Sindh from 1st January 2006 to December 2006. One hundred cases with history of snakebite were analysed. Both genders were included in study. Patients with history of trauma, insect bite or thorn prick were excluded from the study. Clotting time [CT] was the main bedside procedure, to assess the degree of envenomation. One hundred [100] cases from both genders, from 8 to 55 years age were reviewed. There were 57 [95%] viper bites [haemotoxic] having haemostatic abnormalities and 3 [5%] elapid [neurotoxic] bites presented with neuroparalytic symptoms. Most cases were from Tando Mohammad Khan and Hyderabad [rural] districts of Sindh. All victims had localized oedema at the site of bite. Fang/teeth marks were noted in [90%] cases. Majority [80%] were bitten on the legs below knee. Some 40% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.5 and male to female ratio was 4:1. Mean time to arrival at our hospital after the bite was 3 hours and mean duration of hospital stay was 4 days. One patient had acute renal failure [ARF] and disseminated intravascular coagulation [DIC], 3% cases of elapid bites were shifted to ICU for assisted ventilation, 4 patients [5.5%] had adverse effects after anti-venom administration and needed intravenous hydrocortisone, promethazine and subcutaneous adrenaline. The average dose of anti-venom was 60 vials for viper bites and 10 vials for elapibites. Overall mortality rate was 4%. Snakebites are common in the rural population of developing countries. There is need to educate the public about the hazards of snake bite, early hospital referral and treatment