Hematological adverse effects in HCV patients treated with pegylated interferon and ribavirin in a Tertiary Care Hospital Peshawar

To know the frequency of common hematological adverse effects during treatment of HCV. Comparative study. This study was carried out OPD of gastroenterology unit HMC Peshawar from November 2013 to August 2014. This study comprising of 42 patients. Patient age more than 17 years, both genders, previously treatment experienced patients with normal hematologic and radiological parameters were included in the study. Patients age more than 70 years, patients with uncontrolled depressive illness, pregnant ladies, treatment naive patients and decompensated cirrhotics were excluded from the study. Patients were evaluated for treatment with pegylated and ribavirin by history, clinical examination, routine laboratory investigations, ultrasound abdomen, HCV genotyping and upper GI endoscopy where considered necessary. Patient's who fulfilled the inclusion criteria were included in the study. Total of 42 patients, 24 [57.14%] male and 18 [42.85%] female were included in this study. The mean age was 39.05 +/- 8.54 with minimum age of 18 years and maximum age of 55 years. Genotype 3 was the most frequent genotype, present in 26 [61.90%] patients followed by untypeable genotype, present in 12 [28.57%] patients. Anemia was present in 18 [42.85%], thrombocytopenia in 10 [23.80%] patients. Leucopenia was present in 6 [12.28%] patients. Haematological abnormalities are common during treatment for HCV, so patients should be regularly followed to diagnose and treat the cytopenias in time

Comparability and validity of siriraj stroke score and allen stroke score in differentiation of acute ischemic and haemorrhagic stroke

To compare and validate Alien stroke score [ASS] and Siriraj stroke scores [SSS] in differentiating acute cerebral hemorrhage [CH] and cerebral infarction [CI]. This comparative, analytical study was conducted at Khyber Teaching Hospital Peshawar, Pakistan from July 2000 to February 2002. Study included 100 patients of acute ishemic or hemorrhagic stroke confirmed on CT scan brain after clinically evaluation. ASS and SSS were calculated for each patient and compared with the results of CT scan for comparability [Kappa Statistics] and validity by using SPSS 10. Out of 100 patients, 69 had CI and 31 had CH. The overall comparability of ASS and SSS was fair [Kappa=0.51]. ASS and SSS were uncertain in 27 and 18 cases respectively; with Kappa showing worst comparability in term of certain results [K= 0.23]. In 64 cases with both scores in the diagnostic range, the Kappa showing excellent comparability [K=0.91].The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of ASS was 38.70%, 91.30%, 66.67%, 76.82% respectively for CH and 71.1%, 80.64%, 89.09% and 55.56% respectively for CI, with overall predictive accuracy of 61%. The sensitivity, specificity, PPV and NPV of SSS was 67.74%, 94.2%, 84% and 86.67% respectively for CH and 78.26%, 90.32%, 94.73% and 65.11% respectively for CI, with overall predictive accuracy of 75%. Although, SSS being simple with more accuracy is better than ASS, both these scores lack sufficient validity to be used for exclusion of cerebral haemorrhage before offering antithrombotic or thrombolytic therapy

Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope

To evaluate the management of foreign bodies in the upper Gastrointestinal tract in a tertiary care hospital in Peshawar. In this descriptive study, conducted at Gastroenterology Department Hayatabad Medical Complex Peshawar from May 2002 to May 2009, a total of 40 consecutive patients presenting with history of foreign body ingestion were included. Radiological survey was made before endoscopy in all the patients. Flexible endoscope, esophageal over tube and other accessories were used for removal of the foreign bodies. Female to male ratio was 1.5:1. The mean age of the sample was 19.92 +/- 23.5. Dysphagia [n=18, 45%] was the most common symptom in the esophageal foreign bodies followed by retrosternal pain or discomfort [n=11, 27.5%]. The most common foreign body was coin ingestion [n=24, 60%]. Meat bolus and bone chip impaction was present in 9 [22.7%] patients. The success rate in case of esophageal foreign bodies was 93.75%. While in the case of gastric foreign bodies, it was 100%. There was a small perforation which occurred in only one patient with esophageal foreign body which was managed conservatively. In the case of gastric foreign bodies, no procedure related complications occurred. Flexible endoscopy was a safe and effective technique for the management of foreign bodies in the upper gastrointestinal tract in our study

Injection sclerotherapy of bleeding gastric varices using absolute alcohol

To evaluate the effectiveness of absolute alcohol injection in the management of bleeding gastric varices. This descriptive study was conducted in the department of Gastroenterology, Hayatabad Medical Complex Peshawar from September 2006 to September 2009. Twenty Seven patients with portal hypertension fulfilling the inclusion criteria and consenting were included in the study. Endoscopy was arranged within 12 hours of admission to the hospital. The gastric varices were injected with 5-10 ml of absolute alcohol depending upon the size of the varices. Both intravariceal and paravariceal techniques were used. Subsequent endoscopy sessions were arranged at 2 weeks intervals. The outcomes assessed were variceal eradication, rebleed and death. Findings were noted and entered into a structured proforma. Data was analyzed using SPSSv.10. Fifteen [55.56%] patients were male and 12 [44.44%] were female with a mean age of 47.52 +/- 15.09 years. Twenty one [77.78%] patients had cirrhosis due to chronic hepatitis C, 4 [14.81%] were HBV related while 2 [7.40%] had alcoholic liver disease. Majority [70.73%] had child's class C followed by B and A [18.51% and 11.11% respectively]. Variceal eradication was achieved in 19[70.37%] patients. Three were lost to follow up while 5 died due to uncontrolled bleeding. Post sclerotheraphy ulceration was the most common complication [64%] followed by pyrexia [28%], Retrosternal/epigastric pain [16%] and dysphagia [8%]. Sclerotherapy with absolute alcohol may be effective in achieving hemostasis in bleeding gastric varices but with exceptionally high rate of complications

Frequency of Brugada-type ECG pattern [Brugada sign] in an apparently healthy young population

To determine the frequency and demographic features of subjects with Brugada-Type ECG pattern in apparently healthy young population. Cross sectional descriptive study. This study was conducted at School of Nursing Hayatabad Medical Complex, Public Health School, Post Graduate College of Nursing, Qurtaba College, Brain's Post Graduate College and Gandhara Institute of Science and Technology Hayatabad Peshawar from June 2006 to May 2007. A total of one thousand one hundred [1100] subjects, 712 males and 388 females, were included in the study. A prospective analysis of the eleven hundred electrocardiograms [ECG] of healthy young subjects in the above institutions were included in this study. Brugada-Type ECG pattern frequency was 0.8% [nine out of one thousand one hundred healthy subjects]. Five cases [0.45%] were observed between 16 to 20 years of age and four cases [0.36%] were observed in 21 years and above. Out of total of nine cases of Brugada-Type ECG pattern [Brugada Sign], seven were males [0.6%] and two were females [0.2%]. Frequency of Brugada-Type ECG pattern was 0.8% in the apparently healthy young students in Hayatabad Peshawar

Glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 patients of type 2 diabetes mellitus

To assess the glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 type 2 diabetes mellitus patients. Material and This descriptive observational study was carried out at Medical A Unit, Khyber Teaching Hospital Peshawar. A total of 100 type 2 diabetic patients were included through non-probability sampling. Glycosylated hemoglobin of each patient was determined and questions were asked about income, self-monitoring of glycemic status, education and compliance of the patients. Majority of the patients [78%] had poorly controlled diabetic mellitus. Most of the patients [42%] were poor and their monthly income was less than 5000 rupees. Only 57% of the patients monitored their blood sugar once a month. No patient was using glycosylated hemoglobin for assessment of his or her glycemic status. Majority of the patients [82%] were illiterate. Oral hypoglycemic agents were used by 81% of the patients. Most of the patients had poorly controlled diabetes mellitus. Majority of the patients were poor and illiterate and there was poor self-monitoring. Most of the patients were using oral hypoglycemic drugs

Endoscopic dilatation for caustic esophageal strictures

To determine the outcome of esophageal dilatation in caustic esophageal strictures in our Patients. This descriptive study was conducted in the department of Gastroenterology and Hepatology Hayatabad medical complex from 1999 to 2007. Patients with caustic esophageal strictures and above 03 years of age were included. Patient with caustic stricture and fistulae or diverticulae, peptic stricture and malignant stricture were excluded. Patients were initially evaluated with barium swallow and meal. Consenting patient were asked to come in the morning after over night fasting. Guide wire was positioned across the strictures with the help of the endoscope [GIF-140/GIF-N130]. SavouryGilliard plastic dilators of increasing sizing were employed. Repeated sessions were performed fortnightly till a 15mm [45Fr] lumen size was achieved. Follow up session were arranged whenever dysphagia developed. Out of 20 patients, 11 patients [55%] were more than 12 years of age. Mean age is 19.25 ranging from 3 years to 65 years. There were ten males [50%] and ten females [50%]. Total dilatations were 442. Successful dilatation up to a lumen size of 15mm could be achieved in twelve patients [60%]. In six patients [30%] satisfactory dilatation could not be achieved and were referred for surgery. Two patients [10%] had perforation with an incidence rate of 0.45%. Caustic Stricture is more common in adolescent and adults in our population. Endoscopic dilatation is modestly effective in achieving adequate dilatation and relieving dysphagia

Cutaneous manifestations of chronic liver disease

Hepatobiliary diseases are frequently associated with abnormalities of the skin, nails and hair. This study was undertaken to determine the cutaneous manifestations of chronic liver disease [CLD] and particular pattern associated with aetiology of disease. Patients suffering from chronic liver disease of any aetiology presenting to department of gastroenterology Hayatabad Medical Complex, Peshawar from 1st December 2004 to 30th April 2005 were enrolled in the study. All the relevant details regarding history and clinical examination were recorded on a specially designed pro forma. A total of fifty patients, 32 males and 18 females were included. Thirty [60%] patients were suffering from chronic hepatitis C virus infection, 14 patients were suffering from Chronic hepatitis B virus infection and 2 patients each were suffering from primary biliary cirrhosis and Wilson's disease. In two cases the aetiology could not be ascertained. Different manifestations included pigmentation [82%], Terry's nails [80%], xerosis and excoriations [72%], nonscarring hair loss from axilla and pubic region [64%], and spider naevi and palmar erythema [36%]. Lichen planus was seen in 4%, vitiligo and hepatocutaneous syndrome in [2%] of patients each. Cutaneous manifestations in chronic liver disease are non-specific and do not point towards specific aetiology. Physicians caring for patients with chronic liver disease should pay attention to its multisystemic nature

Hypertension in acute ischemic and haemorrhagic stroke

To know the pattern of systolic and diastolic blood pressure in hypertensive patients with acute ischemic and hemorrhagic stroke. Material and This study was conducted on 100 patients with acute stroke, admitted in Khyber Teaching Hospital from July 2000 onward. Hypertensive patients were finally selected for analysis. BP was recorded at arrival and 24 hours after admission. Out of 100 patients with stroke, hypertension was present in 72 cases. Out of these 72 patients, 44 cases [61.1%] had cerebral infarction [CI] and 28 cases [38.9%] had cerebral haemorrhage [CH]. Overall mean systolic BP at arrival [SBP-A] was 163 [ +/- 35.606] mm Hg. Mean SBP-A in patients with CI was 152.3 [ +/- 34.397] mm Hg and in patients with CH was 181.25 [ +/- 30.357] mm Hg. Overall 68% of hypertensive stroke patients had uncontrolled systolic BP at arrival. Overall mean diastolic BP at arrival [DBP-A] was 95. 97 [ +/- 20.733] mm Hg. Mean DBP-A in CI was 88.75[ +/- 17.854] mm Hg and in CH was 107.32[ +/- 20.115] mm Hg. The mean difference of DBP-A in CH and CI was 18.57mm Hg. Mean systolic BP and Mean diastolic BP, 24 hours after admission were 157.85 mm Hg and 92.08 mm Hg respectively. Majority of hypertensive stroke patients have uncontrolled blood pressure. Hypertension is a risk factor for both ischemic and hemorrhagic stroke. More elevation of blood pressure is more frequently associated with cerebral hemorrhage than cerebral infarction