Chronic hepatitis "C" a dermatologic outlook

OBJECTIVE: To determine the cutaneous manifestations of hepatitis [C] virus infection at tertiary care hospital

METHODOLOGY: This descriptive study was performed in Department of medicine, Khyber Teaching Hospital Peshawar. Study was performed in the outpatient and inpatient medical units of Khyber Teaching Hospital Peshawar from 1stJanuary 2009 to 30 June 2010. 325 patients met the inclusion criteria. Hepatitis C patients of age >15 years and either gender were examined. All hepatitis C patients, diagnosed by third generation ELISA and/or polymerase chain reaction were allowed to participate. Subjected to detailed history, careful clinical examination of skin by dematologist to recognize and diagnose the cutaneous condition. Data was entered in a prestructured Performa. For data interpretation SPSS 14 was used. Descriptive statistics were used. Mean + standard deviation was sorted for age. Frequencies and percentages for various variables were calculated

RESULTS: Of all 325 HCV +ve patients were included in this descriptive study. Male patients were 61% and female 39%. Mean age was 43 [SD+10 years], ranging from 15 to 78 years. About one-fourth of patients [23%] were using anti-viral therapy the rest 77% were with out antiviral therapy. About 41% had one or more cutaneous lesion

Pruritis was the leading manifestation found in 11%. Lichen planus [oral and cutaneous] was next found in 6.7% patients. Hyperpigmentation was seen in 5.5% patients. Urticaria [acute and chronic] was next counting 5.23%. Jaundice, alopecia and vitiligo were seen in 4.9% each. Dry skin and interferon injection site erythema was observed in 4.6% patients each. Cutaneous vasculitis was noticed in 3.6% each. While Reynaud's Phenomenon photosensitivity and psoriasis were seen in 1.5%1.8% 2.5% patients respectively

CONCLUSION: Skin lesions are common in patients with anti-HCV patients. Dermatologic lesion may be the initial clue of HCV positivity. Screening studies are needed to find the exact prevalence of skin manifestations of chronic HCV and its treatment

Role of high resolution computed tomographic scan in diagnosis of interstitial lung diseases in local population

The objective of this study was to find the role of High Resolution Computed Topographic [HRCT] scan of the chest in the diagnosis of Interstitial Lung Diseases [ILD] in our local population. A prospective study of fifty patients already diagnosed as ILD on transbronchial or open lung biopsy was performed in the Medical B Unit of the Department of Medicine Khyber Teaching Hospital, Peshawar from January, 2008 to December, 2008. Both male and female admitted patients above 15 years of age were included in this study. Of the fifty patients meeting the inclusive criteria 18 were male and 32 were female. The commonest affected age was 40-60 years. The commonest symptoms were shortness of breath and cough respectively. Inspiratory crepts and wheezes were the most common physical findings followed by clubbing, raised jugular venous pressure and edema feet. HRCT Scan revealed ILD in 88% with sensitivity of 95% and specificity of 75% having 95% positive predictive value and 75% negative predictive value. HRCT Scan of chest is the most sensitive non invasive test in the diagnosis of ILD compared to chest X ray, pulomary faction tests and can abate the need of lung biopsy in many cases

Effectiveness and safety of narrowband ultraviolet b therapy in chronic plaque psoriasis

To determine the effectiveness and safety of narrow band ultraviolet B in chronic plaque Psoriasis. This descriptive case series study was carried out at skin unit Lady Reading Hospital Peshawar from June 2009 to Dec 2010. Sixty patients suffering from chronic plaque psoriasis, between the ages of 12 and 70 years were included in the study. Minimum erythema dose was determined in every patient according to skin types [1-6]. All the patients were exposed to narrow band ultraviolet B. At zero, fourth, eighth weeks and sixteen weeks, Psoriasis Area Severity Index [PASI] was determined and decision was made to increase or decrease the dose according to response of patient. Out of sixty patients fifty eight patients showed response showing effectiveness of 97.1%. Two patients showed poor response. Four patients suffered from moderate erythema itching and vesicles. Narrowband ultraviolet B is a safe and effective therapy for chronic plaque psoriasis but long term follow up is needed to determine its carcinogenic effects

Frequency of cutaneous diseases in geriatric population of type IV and V skin

To determine the frequency of common cutaneous diseases in geriatric population of type IV and V skin. This Cross-sectional Survey was conducted at Skin outdoor department in May Hospital, Lahore. Two hundred and seventy patients of either sex aged sixty years and above were included in the study. Frequency of common dermatoses was noted. The data were analyzed according to age, sex and skin type. Two hundred and seventy patients were included in the study. The mean age of the patients in the study was 66.85 [ +/- 8.1: range 60-105] years. Eczemas were found in [40%] of geriatric population, scabies [25.2%], fungal infection [14.8%], pruritus [9.6%], viral [8.1%] and bacterial [2.2%] infections. Regarding miscellaneous diseases, significantly greater number of patients aged 80 years or more were diagnosed to have malignant skin disorders. Eczemas were the most common dermatoses. Scabies was more prevalent in females as compared to males. The chances of skin cancer like BCC increases as the age advances

Frequency of hepatocellular carcinoma in cirrhosis

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

Tuberculous meningitis

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

Postpartum haemorrhage; a preventable complication of Labour

To determine the frequency, risk factors and existing practice for the management of massive primary postpartum hemorrhage [PPH]. Retrospective cross-sectional study. Department of Obstetrics and Gynaecology at Kuwait Teaching Hospital, Peshawar. this study was performed from June 2008 to June 2010. Women who developed massive primary PPH after admission or were admitted with it, were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum hemorrhage, supportive medical and surgical intervention. Data was entered in the pre-structured proforma. Estimates of blood loss were made on history, visual parameters and patient's condition. All the data was analyzed by using statistical computer soft ware SPSS 6. During the study period total number of obstetrical admissions were 2944. Forty nine out of 2769 [1.76%] deliveries, developed massive primary PPH. The highest frequency of massive primary PPH was observed in grand multiparous patients. Uterine atony was the most common cause of the complication. Birth attendants other than doctor and delivery outside the study unit were significantly associated with the adverse outcome in these patients. Seventy five percent patients,[36/49] who had massive PPH, delivered vaginally. High dependency unit [HDU] was required in 12% [6/49] of women. Only one caesarian hysterectomy was done. There was one maternal mortality. Blood transfusions were required in 82% [40/49] of the patients. Postpartum hemorrhage can be a preventable condition if early identification and timely management of this complication and its risk factors is observed. Uterine atony is the leading cause of immediate PPH. The main risk factors for PPH due to uterine atony are high parity, a large fetus, multiple fetuses, hydramnios, or past history of PPH. Determining the frequency, risk factors and management of primary postpartum hemorrhage will help design stepwise protocols for prevention and management of primary PPH in our setup

Aetiology of pancytopenia

Pancytopenia is a reduction in the number of each type of peripheral blood cell. Therefore the role of bone marrow examintion in diagnosis of pancytopenia is important to know etiology of pancytopenia. The objective of the study was to know the aetiology of pancytopenia. This descriptive [Cross sectional] study was carried out in Khyber teaching hospital. Fifty patients with pancytopenia were included in the study from 1[st] January 2008 to 30[th] October 2008. Full blood counts, bone marrow examinations and trephine biopsies were performed according to standard methods. Statistical packages for social science [SPSS.11] was used to analyze data. Out of 50 patients, 36% were of aplastic anaemia, 16% megaloblastic anaemia, 14% myelodysplastic syndrome and 12% acute lymphoblastic leukemia [ALL], Hypersplenism in 10%, 4% non Hodgkin lymphoma [NHL] and 4% multiple myeloma, 2% each of acute myeloblastic leukemia and chronic myelocytic leukemia. All of these disorders were common in male as compared to female. Aplastic anaemia was the commonest cause of pancytopenia followed by megaloblastic anemia and myelodysplastic syndrome in our study

Diabetic foot risk classification in a tertiary care teaching hospital of Peshawar

To find out diabetic foot risk classification in patients admitted with diabetes mellitus at a tertiary care teaching hospital. The hospital record of one hundred and twenty seven patients of diabetes mellitus, admitted to the medicine department, Khyber teaching hospital Peshawar from 1st October 2005 to 31st March 2006 were evaluated against the Royal College of Physicians, London; Clinical Guidelines for Type 2 diabetes: prevention and management of foot problems. Both male and female indoor patients above 15 years of age were included in the study. An audit of 127 diabetes mellitus patient revealed that 25 [19.68%] patients were having low current risk, 21 [16.53%] were classified as having risk foot, 6 [4.72%] were categorized as high risk patients, 16 [12.59%] were admitted with ulcerated foot and 5 [3.39%] were having diabetic foot emergency according to Royal College of Physicians, London; Clinical Guidelines for Type 2 diabetes: prevention and management of foot problems. The main reason for poor diabetic foot outcomes in the tertiary care teaching hospital is the absence of classification of majority of diabetic patients into different risk groups for the appropriate treatment. This lack of risk classification results in ensuing gaps in the management and an overall increase in morbidity