Yield of closed pleural biopsy and cytology in exudative pleural effusion

Objective: To determine diagnostic yield of Closed Pleural Biopsy [CPB] and Cytology in Exudative Pleural Effusion [PE]

Methods: This prospective comparative study was conducted at Chest Unit-II and Medical Unit-IV of Dow University of Health Sciences, Karachi Pakistan from January 2011 till December 2014

Results: Ninety-four patients with exudative PE were finally included. The mean age [SD] was 44.0 [13.8] years. Overall Specific Diagnosis was reached in 76/94 patients; 46 Tuberculosis PE [TPE] and 30 Malignant PE [MPE]. CPB diagnosed all TPE patients alone and 28/30 of MPE. Cytology diagnosed only 10/30 patients of MPE with 8 patients having both CPB and Cytology positive for malignancy whereas in the remaining two cases only Cytology positive. The sensitivity of CPB in detecting TPE and MPE was 93.9% and 82.4% respectively whereas specificity for both was 100%. The diagnostic yield of cytology in detecting MPE is only [33.3%]. The diagnostic yield of CPB for TPE and MPE is 100% and 93.3% respectively. The overall specific diagnostic yield of CPB is 78.7%

Conclusion: CPB is better than pleural fluid cytology alone with the later adding little to diagnostic yield when both combined in distinguishing TPE from MPE, the two main differential of exudative PE in a TBEndemic country

Frequency of minimal hepatic encepalopathy inilleterate patients with compensated cirrhosis

Objective: To determine frequency of Minimal Hepatic Encephalopathy in illiterate patients with compensated cirrhosis

Methods: Illiterate patients with compensated cirrhosis with F4 Score on Shear-wave Elastography were selected for study after informed consent. Sample size was estimated at 106. Selected patients were subjected to two tests for detection of MHE, Number Connection Test A and Block Design Test. Patients taking ? 30 seconds were labelled as Positive for MHE

Result: Out of 110 selected patients 10.9% were alcoholics and in 8.2% of patients no hepatic virus infection was detected. HCV was positive in 48.2% patients while HBV was positive in 13.6% of patients. MHE was detected in 72 [65.5%] of patients. Major differences were found in MHE Stage II and III by two tests. Over all BDT detected more cases and gave higher Staging in Stage II and III as compared to NCT-A test

Conclusion: Minimal Hepatic Encephalopathy [MHE] could be detected in illiterate patients using NCT-A and BDT Tests

Asthma and Myths: an online survey

To determine the information about myths regarding asthma among internet users. An open access internet based close ended survey was hosted on a website which included questions related to common myths regarding asthma. Data was entered automatically into a database at the hosting servers. The survey invitations were sent by email by the authors with request to forward to the contact lists of recipients. After closure of survey, data from responses were recoded into new variables as correct and incorrect using the key made by the authors. Frequencies of correct responses were reported and analyzed on the basis of gender, educational status and profession. A total of 782 complete responses were submitted out of which 498 [63.7%] were submitted by males and 284 [36.3%] by females. Majority of the participants were graduate [36.1%] and postgraduates [44.8%], while the most common profession of the participants was doctor [49.9%] followed by non-medical students [17.1%]. Frequency of correct responses was better in males. Lowest correct responses were given by unemployed and best responses were given by doctors. Self-employed persons fared better than bankers and people associated with education.Surprisingly non-medical students fared better than medical students. There is a need to increase public awareness regarding asthma, as the status of relatively educated internet users is also inadequate

Frequency of acute hepatitis C after needle stick injury and its treatment outcome

To determine the frequency of acute HCV infection after needle stick injury and its treatment outcome. Patients with HCV positive needle stick injury and reporting within 72 hours of incident were selected. Co-infections with HBV, HDV, HIV, hematological disorders and depression were excluded. Anti-HCV was done at presentation and those testing positive were excluded. HCV RNA was done after two weeks or anti-HCV after six weeks of incident. Those testing positive were kept under observation for 16 weeks for spontaneous resolution. After this period HCV RNA and Genotype were done and therapy with Peg-interferon was started. Rapid, early and sustained virological responses were checked. Two hundred eight patients with HCV positive needle stick injury were selected, 10 [4.8%] developed acute HCV infection out of them one [10%] had spontaneous recovery during the observation period of 16 weeks. seven [77.8%] achieved rapid virological response and eight [88.9%] achieved sustained virological response. Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks

Appraisal of the knowledge of internet users of Pakistan regarding hepatitis using on line survey

Hepatitis B and hepatitis C are global health care problems causing morbidity and mortality. Much of it could be prevented by better education of the masses regarding its spread. The study was conducted to assess the knowledge base of internet users of Pakistan to help in formulating education strategies. A survey questionnaire consisting of 20 close ended questions was designed and hosted on a website. The responses submitted at the website were auto-emailed to the author. A total of 1024 complete responses were included. The survey shows increased level of awareness according to the educational status. The knowledge status of lowest education level was also adequate possibly due to access to internet to these respondents. Internet users in Pakistan have adequate core knowledge regarding hepatitis

Frequency of rectal varices in patients with cirrhosis

To document the frequency of rectal varices in patients with cirrhosis of liver and compare it with that of oesophageal varices in liver and to compare the frequency of rectal varices with non-cirrhotic controls. Design: A cross-sectional analytical survey. Place and Duration of Study: The study was conducted in the medical wards of Civil Hospital, Karachi from August 2000 to July 2001. Patients and All patients of confirmed cirrhosis of liver, presenting during the study period, were selected for initial workup. On the basis of upper gastrointestinal [GI] endoscopy, patients were segregated into those with oesophageal varices [Group-A] and those without them [Group-B]. A matched control group [Group-C] was added, which consisted of patients of irritable bowel syndrome [IBS] who underwent sigmoidoscopic/colonoscopic examination during the study period. Fiberoptic sigmoidoscopy was done in all selected patients. Statistical analysis for continuous variables was done by student's 't' test while non-continuous variables were analyzed by Mann-Whitney-U test. A total of 104 patients [males 61; females 43] were included. Hepatic encephalopathy grade was significantly lower in Group-B [p < 0.0001]. Grade-I varices were seen in 13 patients, Grade-II in 38 and Grade-III in 33 patients of Group-A. Rectal varices were present in 59.9% of patients in Group-A as compared to Group-B in which no one had them [p<0.0001]. Rectal varices are common in patients of portal hypertention