Self expandable metallic stent endoscopic insertion in esophageal cancer

To determine the safety of self expandable metallic stent [SEMS] placement under endoscopic guidance without fluoroscopy. Quasi experimental study. Section of Gastroenterology and Hepatology, Departments of Medicine, Isra University Hospital and Liaquat University of Medical and Health Sciences [LUMHS], Hyderabad, from April 2006 to March 2009. In 80 patients with inoperable carcinoma of esophagus, SEMS made-up of nickel titanium alloy and mesh shaped with distal release system were placed without the use of fluoroscope under endoscopic guidance. Patients with proximal location of tumour in esophagus were excluded. They were followed at one week after deployment. All the complications were recorded. Dysphagia score was assessed before and after stent placement. Mean pre- and poststenting scores were compared using t-test. Fluoroscopy was needed in only 2 patients. In 75 patients the stent was successfully placed with endoscope control only, without fluoroscope. Dysphagia score improved significantly from 4.26 +/- 1.07 before stenting to 1.02 +/- 0.57 later, [p < 0.001]. Minor complications like retrosternal pain occurred in 30 [37.5%] patients and major complications in 8 [10.0%] patients amongst which 4 [5.0%] developed upper gastrointestinal bleeding and 4 patients [5.0%] had aspiration. Insertion of self expandable metallic stent in esophageal carcinoma without fluoroscope was safe and effective in relieving dysphagia at short term follow-up

Rising menace of multidrug resistant mycobacteria in pulmonary tuberculosis

Objective: the study was conducted to determine the rising menace of multidrug resistant mycobacteria in pulmonary tuberculosis

Subjects and methods: this prospective study was conducted in the Department of Medicine, Muhammad Medical College Mirpurkhas, from May 2007 to July 2008. Sixty cases of pulmonary tuberculosis were selected for multidrug resistant tuberculosis [MDR-TB] study that fulfilled the inclusion criteria. Pulmonary specimens consisted of 2-5 ml, early morning sputa and bronchial washings were sent for the ZN staining [AFB] and culture and drug sensitivity on culture-media. MDR-TB was defined as simultaneous resistance of an isolate to isoniazid and rifampicin

Results: drug culture and sensitivity revealed that 22 [36.66%] were sensitive to all the five first-line drugs, while 38 [63.33%] showed one or other type of drug resistance, including 7 [11.66%] resistant to single drug, 15 [25%] resistant to two drugs, 10 [16.66%] resistant to three drugs, while 6 [10%] were resistant to all the first-line drugs. Primary drug resistance was noted in 3 [5%]. Resistance to isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide was seen in 32 [53.33%], 28 [46.66%], 24[40%], 20 [33.33%], and 18 [30%] respectively

Conclusions: in view of this increasing level of drug resistance, more organized national strategy against tuberculosis is needed. MDR-TB was most commonly seen in chronic cases/ drug defaulters, and it is a major threat to the tuberculosis control measures

Frequency of hepatitis B and hepatitis C in patients with hepatocellular carcinoma at Hyderabad

Objective: to determine the frequency of hepatitis B and Hepatitis C in patients with hepatocellular carcinoma in two university hospitals of Hyderabad

Study design: descriptive observational study

Place and duration: this study was conducted at Liaquat University Hospital Hyderabad and Isra University Hospital Hyderabad from November 2005 to October 2008

Material and methods: clinically diagnosed hepatocellular carcinoma [HCC] cases were confirmed pathologically. Demographic and clinical information was recorded on a predesigned proforma. Serological assessment for hepatitis B, hepatitis C and delta virus was carried out through ELISA

Results: a total of 200 cases of hepatocellular carcinoma were included in this study. Hepatitis C antibody was present in 145 [72.5%] cases. HBsAg was present in 42 [21.0%] cases. Thirteen [6.5%] cases were infected by multiple viruses. Twenty-one [10.5%] cases were alcoholic as well as infected by hepatitis C and 1 case [0.5%] was only alcoholic. Twelve cases [6.0%] were neither alcoholic nor having any viral etiology

Conclusion: HCV alone was most frequent presentation in cases of HCC followed by HBV, emphasizing their etiological association

Frequency of peripheral arterial disease in diabetic foot

Objective: to determine the frequency of peripheral arterial disease in patients with diabetic foot

Study design: prospective descriptive study

Place and duration: this study was conducted at Medical Unit-IV Liaquat University Hospital, Jamshoro/Hyderabad from February 2007 to August 2008

Patients and methods: diabetic patients with non-healing foot ulcer, were selected for the study by non-probability purposive sampling technique. Ankle brachial index [ABI] was calculated; peripheral arterial disease [PAD] was diagnosed when ankle brachial index was less than 0.9 and further graded as mild, moderate and severe as per recommendations of American Diabetes Association. Frequencies with proportions in different grades were calculated

Results: a total of 67 diabetic foot patients were included, amongst which 51 [76.1%] were males and 16 [23.9%] were females. Peripheral arterial disease was found in 30 [44.78%] patients, among them 18 [60%] had mild, 12 [40%] had moderate and none had severe peripheral arterial disease

Conclusion: ankle brachial index [ABI] is a simple and cheap technique for the diagnosis of peripheral arterial disease [PAD]. The PAD is one of the major risk factors for diabetic foot, which can be prevented by monitoring ABI in at-risk patients

Hepatitis B vaccination status in health care workers of two university hospitals

Hepatitis B virus [HBV] infection is the leading cause of hepato-cellular carcinoma and acute liver failure in Asia. It usually transmits through parenteral routes. The health personnel are at high risk for acquiring HBV infection. This study was designed to determine the immunization status for HBV infection in healthcare workers [HCWs] of two university hospitals in Sindh, Pakistan. The healthcare workers of two university hospitals [Liaquat University Hospital, Jamshoro and Isra University Hospital, Hyderabad] were selected and divided into ten different groups. There were total 923 participants including 649 [70%] males and 274 [30%] females. The mean age of participants was 29.6 years. A total of 596 [64.6%] participants were immunized for HBV infection and 392 [66.2%] were inoculated three or more than three doses of vaccine. The pre vaccination HBSAg status was checked in 380 [41.2%] and it was positive in 18 [4.7%] participants. The frequency of immunization was highest in doctors [92.4%] and lowest in nursing assistants [18.9%]. A good number of HCWs is vaccinated against HBV infection in these two university hospitals of Sindh compared to general population of Pakistan. This study shows the need for a more aggressive approach to get HCWs vaccinated, because a significant percentage of them is not protected