Doppler waveform study as indicator of change of portal pressure after administration of octreotide

Objective: To estimate the effect of portal pressure lowering drug 'octreotide, by observing the Doppler waveform before and after the administration of intravenous bolus of octreotide and thus to assess indirectly its efficacy to lower the portal pressure

Methods: This quassi experimental study was carried out in Medical Department in collaboration with Radiology Department of Jinnah Postgraduate Medical Center Karachi Pakistan from September 10, 2015 to February 5, 2016. Cases were selected from patients admitted in Medical Wards and those attending Medical OPD. Diagnosis of cirrhosis was confirmed by Clinical Examination and Lab and Imaging investigation in Medical Department

Doppler waveform study was done by experienced radiologist in Radiology Department before and after administration of octreotide

Doppler signals were obtained from the right hepatic vein. Waveform tracings were recorded for five seconds and categorized as 'monophasic', 'biphasic and 'triphasic'. Waveform changes from one waveform to other were noted and analyzed

Results: Significant change i.e. from 'monophasic' to 'biphasic' or 'biphasic' to 'triphasic' was seen in 56% cases while 'monophasic' to 'triphasic' was seen in 20% cases. No change was seen in 24% cases. Improvement in waveform reflects lowering of portal vein pressure

Conclusion: Non invasive Hepatic vein Doppler waveform study showed improvement in Doppler waveform after administration of octreotide in 76% cases. Doppler waveform study has the potential of becoming non invasive 'follow up tool' of choice for assessing portal pressure in patients having variceal bleed due to portal hypertension

Needle stick injuries: knowledge, attitude, practices [KAP] and frequency of hepatitis B and C among nursing students in Karachi

Objective: The objectives were to determine the Knowledge, Attitude, Practices regarding needle stick injuries [NSI] and frequency of Hepatitis B and C among nursing students at two tertiary care hospitals of Karachi

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the Department of Medicine, DMC, JPMC and Hilton Pharma, Karachi from January 2014 to June 2014

Materials and Methods: This study was carried out on NSI exposed 214 nursing students from 1[st] year to 4[th] year, visiting their respective hospitals and engaging in clinical activities. A hundred of those students who reported needle stick injuries randomly selected and screened for Hepatitis B surface antigen [HbsAg] and anti-HCV in sera

Results: Approximately thirty four percent [34%] of the students reported to have NSI one time. Out of the 214 students only 143 [66.8%] of the students were aware of the Universal Precaution Guidelines while 71 [33.2%] were unaware of it. After getting NSI only 18.2% reported it to the infection control team while 81.8% failed to report it. Of the 100 students randomly selected for screening, four tested positive for HbsAg and two tested positive for Anti-HCV

Conclusion: Allowing nursing students to practice without prior knowledge of their immune status poses a major risk of acquiring hazardous infections. Prior to practice, students should be ingrained with the universal precaution guidelines and screened for blood borne infections that should be followed up every year

unusual case of crimean congo hemorrhagic fever: prolonged bleeding with successful recovery

Crimean Congo Hemorrhagic Fever [CCHF] is a tick-borne viral disease with a major reservoir in both domestic and wild animals. In Pakistan, it is endemic largely in rural areas and most cases occur in spring and autumn. Recently, cases are being reported throughout the year, including winter months, with some even from urban areas. Death from CCHF is most likely to occur during the hemorrhagic phase. We report a case presenting from an urban locality in December. Clinical presentation was characterized by a prolonged hemorrhagic phase and a delayed normalization of platelet counts

Effect of carvedilol on portal pressure estimated by hepatic vein doppler ultrasound waveform and damping index in cirrhotic patients

To assess the effect of Carvedilol in reducing portal pressure estimated non-invasively by studying Doppler ultrasound waveforms [DUS] and hepatic vein Damping Index [DI]. Quasi-experimental study. Department of Medical ICU in collaboration with Department of Radiology, JPMC, over a period of 6 months [June 1st to 30th November, 2008]. Of the enrolled 65 patients, 47 patients [33 males and 14 females] completed the study. The mean age was 47.4 years. Cirrhotic patients of Hepatitis B, C, D [delta], B and C combined, B and D combined with varying degrees of portal hypertension were included in the study. Cirrhotic patients with bronchial asthma, congestive heart failure, Insulin dependent Diabetes, portal vein thrombosis and hepatorenal syndrome were excluded from the study. The patients were examined by color flow Doppler of the right hepatic vein before and after administration of Carvedilol. Their waveforms and Damping Index [Dl] were recorded and compared by Wilcoxon signed ranks test through SPSS version 12.0. Responders were described as those showing a positive change in wave forms or a decrese of 0.10 or more in Dl. Of the 47 patients, 30 [63%] showed a positive response and 10 [21%] showed no favorable response to Carvedilol, while 7 [14%] patients showed deterioration. The mean Dl on DUS dropped from 0.62 to 0.41 in responders after treatment, while in the non-responders it ranged between 0.42 and 0.57. Ultrasonography Carvedilol reduced portal pressure of cirrhotic patients, as measured indirectly by the damping index of hepatic waveform by Doppler

Determnation of total globulin in serum by direct method in patients with hepatitis-B and C

To establish a convenient and practicable direct method for estimation of globulin in the serum. The study was carried out in the Department of Biochemistry. Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center Karachi. This was a prospective study performed during the period of January 2008 to June 2008. A single, convenient and stable method has been developed for the direct spectrophotometric analysis of globulin in the serum, which has good conformance to Beer's law and is also reproducible. The analysis is based on Hopkins-Cole reaction, which is a direct method for the estimation of total globulin in the serum. The method is based on the estimation of serum tryptophan levels. There is a direct correlation between total serum globulin and total serum tryptophan levels. Globulin differs markedly from albumin in the proportion of their tryptophan content. The glyoxylic acid condenses with tryptophan residues present in globulin and produces purple colour in the presence of copper in an acidic medium. The intensity of colour produced is directly proportional to the concentration of globulin present. The method has no statistical difference with indirect method, both in normal and diseased subjects. In patients when only globulin estimation is required, it can be done by direct method, which is convenient, fast, simple and is not laborious and saves time by avoiding double test performance

Clinical features, diagnostic techniques and management of dual dengue and malaria infection

To find out clinical features, diagnostic techniques and management outcome of patients having dual dengue and malaria infection. A case series. Medical Unit-III, Ward- 7, Jinnah Postgraduate Medical Centre, Karachi, from September 2007 to January 2008. Patients presented with fever of less than or equal to 10 days duration, severe body aches, rash and bleeding manifestations were included. Patients with obvious features of other diseases like typhoid, hereditary bleeding diathesis and hematological malignancies and only malarial parasite positive with high grade intermittent fever without rash and myalgia were excluded from the study. Diagnosis of dengue and malaria was based on history, clinical features, laboratory parameters and malarial parasite test by thin and thick films. Serological evaluation was done by dengue IgM and IgG by ELISA test kit. Patients were divided into three groups. Group A was dengue IgM positive plus MP positive, group B was dengue IgM positive and MP negative and group C was dengue IgM negative and were clinically suspected dengue and malaria. The clinical manifestations and laboratory parameters of dual dengue and malaria positive patients were compared with malaria and dengue negative patients. One hundred and fourteen patients were seen during the study period. Antibody titer [IgM] tested in all patients was found positive in 78 patients [69.64%]. Among those 78 patients, 26 [23.21%] were concomitantly positive for malarial parasite [Group A]. Plasmodium vivax was positive in 25 patients and falciparum in one patient. Fifty-two patients [46.42%] were dengue IgM positive and MP negative [Group B]. Thirty four [30.35%] patients were MP and dengue IgM negative [Group C] but were strongly suspected for DHF and malaria on clinical and hematological basis. The hemoglobin of 34.61% of patients of group A, 5.76% of group B and 14.7% of group C were low, hematocrit level was also low in group A[92.3%], group B [15.38%] and group C [70.58%] patients. The platelet count was markedly low in 84.61% of patients of group A, 57.69% of group B and 94.11% of group C. Leukopenia was found in 34.61% of patients of group A, 78.84% in group B and 29.411% in group C. The liver function tests were deranged in all groups. The frequency of dual dengue and malaria infection was 23.21%. The serology of the dengue and malaria showed negative results in 30.35%. The diagnosis of dual infections could be made on the basis of history, clinical examination supported by hematological results. It is recommended that all the patients suspected for dual infections should be treated concomitantly for dengue and malaria in malaria endemic areas

Thrombocytopenia in malaria

To determine the frequency of thrombocytopenia in Malarial Parasite [MP] positive patients. A cross-sectional study. Medical Unit-III, Ward-7, JPMC, Karachi, from June to October 2006. One hundred twenty four MP positive cases were included in the study. Infections with both Plasmodium falciparum and Plasmodium vivax species were included. Complete blood picture with platelet count was obtained in all patients. Thrombocytopenia was defined as platelets count of < 150.000/cmm. Among 124 patients of MP positive, 100 [80.6%] were found to have thrombocytopenia. Over all 64 patients had Plasmodium falciparum, while 60 patients were having Plasmodium vivax infection. The frequency of thrombocytopenia was 71.87% [n=46] in falciparum and 93.33% [n=56] in vivax infection. Thrombocytopenia was a common haematological finding in patients with Plasmodium infection particularly marked in vivax species infection

Hematological and biochemical indicators for the early diagnosis of dengue viral infection

To determine the haematological and biochemical indicators for the early diagnosis of dengue viral infection. A case series. At Medical Unit-III, Ward 7, Jinnah Postgraduate Medical Centre and referred cases from Faiz-e-Rehman Hospital, Metroville, Karachi from September to November 2007. Patients presenting with a fever of less than 2 weeks duration, generalized morbiliform rash and bleeding manifestations were included. Clinical history was recorded and patients were placed on fluid and haematological support. Diagnosis was established by Polymerase Chain Reaction [PCR] for dengue virus or detection of dengue virus specific IgM and IgG. Results: One hundred and four patients met the inclusion criteria during the study period. Sixty six patients had clinical and haematological features suggestive of grade I Dengue Hemorrhagic Fever [DHF]; 34 patients had grade II DHF and 4 had grade III DHF out of whom 3 progressed to grade IV DHF. All the patients presented with fever followed by generalized morbiliform rash [81.73%], vomiting [79.8%], abdominal pain [65.38%], backache [62.5%], depression [60.6%] and mucosal bleeding manifestations [34.6%]. Clinically, conjunctival infection was present in 93 patients [89.4%], hepatomegaly 59 [56.7%], lymphadenopathy in 17 [16.3%], splenomegaly in 13 [12.5%], pleural effusion in 11 [10.5%] and ascites in 8 [7.6%]. Common laboratory findings were thrombocytopenia in 100% patients, leucopenia in 55 [52.8%], raised hematocrit in 52 [50%], and elevated aminotransferases, gamma GT in 100 [96%] patients. The overall mortality was 2.88%. In this series clinical history and examination supported by the triad of thrombocytopenia, raised hematocrit and elevated liver enzymes was sufficient for the early diagnosis of dengue hemorrhagic fever without waiting for dengue serology

Prevalence of bacterascites

This is a Hospital based prospective study carried out in Medical Unit-I, Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi from June, 1993 to May, 1994, to find the prevalence of bacterascites in cirrhotic patients with ascites. 65 cirrhotic patients with ascites were selected. Aspiration of ascitic fluid of all patients was done. The fluid was sent for analysis, culture and sensitivity. The main laboratory indicators were polymorph count/mm3 and culture positive ascitic fluid. Patients with bacterascites were followed for 12 weeks. Prevalence of bacterascites was 8%. Twenty% patients of bacterascites developed spontaneous bacterial peritonitis [SBP] during 12 weeks follow up. Bacterascites does not require aggressive treatment. It usually resolves spontaneously