Cervical lymphadenopathy: an audit of 116 cases

Objective: To find out the frequency of different pathologies causing enlarged cervical lymph nodes

Study Design: A Prospective observational study

Place and Duration: Study carried out from 1[st] Jan 2006 to 31[st] Dec 2006 at ENT Department of Khayber Teaching Hospital, Peshawar, Department of Pathology Kabeer Medical College, Peshawar and Department of Histopathology, Combined Military Hospital Peshawar Cantonment

Methodology: The patients presenting with cervical lymph node enlargement for more than one month duration were subjected to Fine Needle Aspiration. A Core Needle or open biopsy was performed when FNAC yielded a non diagnostic aspirate or when a histological confirmation of a malignant tumour was required

Results: A total of 116 patients, aged between 8-72 years with a mean age of 34.64 and male to female ratio of 1.23:1 were studied. Tuberculosis was the commonest cause of lymphadenopathy 36.2% [n=42], followed by metastatic disease 29.3% [n=34], reactive hyperplasia was the third commonest cause with 19.3% [n=22], followed by Lymphoma [both Non Hodgkin's and Hodgkin's] accounting for 13.8% of cases. A single case 0.86% of Kikuchi's or Necrotizing lymphadenitis was also found

Conclusion: Tuberculosis was the underlying cause in younger patients while metastatic disease was more commonly found in elderly patients

Frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites

To determine the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites. Descriptive study. The study was conducted at indoor and outpatient departments of Medicine, Military Hospital, Rawalpindi, Pakistan from 29[th] February 2008 to 28th August 2008. One hundred and ninety five patients of liver cirrhosis with ascites were selected. To standardize the study; patients of both genders over 18 years of age, diagnosed with liver cirrhosis and ascites were included in the study after obtaining their informed consent. Patients with abdominal tenderness and fever, hepatic encephalopathy, intra-abdominal surgically treatable cause, with any co-morbid disease [hypertension and diabetes mellitus] or refusing to give consent were excluded from the study. Strict inclusion/exclusion criteria were observed to control the confounding variables. Diagnosis of spontaneous bacterial peritonitis was based on increased ascitic fluid absolute polymorphonuclear leukocyte [PMN] count [> 250 cells / mm[3]] and/or positive bacterial culture. Out of 195 patients, 10 patients [5%] had neutrocytic ascites [absolute neutrophil count > 250 cell/mm[3]]. Out of these 195 patients, three patients [1.5%] were found to have positive ascitic fluid culture. In our study the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites turned out to be 5% which is low. Therefore, analysis of ascitic fluid through diagnostic paracentesis should be reserved for inpatient or outpatient with clinically apparent new onset ascities or in cirrhotic patients with ascities whose general condition deteriorates

Role of vitamin E and vitamin C as antioxidants in Parkinson's disease: a community based study in urban areas of Karachi

Pharmacological studies of vitamin E and vitamin C as antioxidants in patients with Parkinson's disease. Randomized, comparative and categorical study. This study was conducted in the Department of Pharmacology, Faculty of Pharmacy, University of Karachi in collaboration with Jinnah Post Graduate Medical College Hospital and Mamji Hospital from April 11, 2010 to August, 2010. On enrollment each patient received complete physical examination and laboratory tests were performed. All registered patients were advised to attend the respective outpatient department [OPDs] every week and at the end of 3[rd] month at a special counter allocated for the purpose of this study. Evaluation of the subjects was done on Patients Health Questionnaire and Unified Parkinson's disease Rating Scale [UPDRS]. Patients responded to this combination in a very energizing way making them more active, less depressed and motivated. In some patients who were younger around age of 43 [as compared to others

Seasonal and demographic aspects of dengue outbreak of 2011 in northern Pakistan

Objective: To study the seasonal and demographic pattern of outbreak of dengue epidemic in Northern Pakistan during 2011. Patients and Methods: The study was conducted in the Virology department of Armed Forces institute of Pathology, Rawalpindi from 1st May to 31" December, 2011. This study included 2623 patients with critical suspicion of dengue fever. A venous blood sample of patients was drawn aseptically and tested for Dengue IgM antibodies by capture ELISA of Vircell, Spain. The test results obtained were positive, negative or equivocal. Those found equivocal an initial testing, were re-tested with fresh blood sample, after 3-4 days. I Results: The maximum number of the cases occurred during the months of September and October. 2011. Out of the total 2623 study subjects, 1923[73.3%] were males and 700[26.7%] were females. A total of 417[15.9%]patients tested positive for Dengue IgM antibodies out of which 318 [76.2%] were males and 99 [23.8%] were female, 28 [1%%] of patients. with equivocal results in initial testing for Dengue IgM were re-tested for the same tests after 3-4 days and 16 [57%] out of them confirmed positive or] repeat testing. Ages of patients ranged from 6 months to 90 years with a mean of 33.77 + 17.65 years. The maximum number of the positive cases was seen in the patients of age group of 76-30 years followed by 31-45 years. Conclusion: Dengue her epidemic was at its peak during Sep and Oct dung 2011. Itic psrtod 1rnmedi;rtcly atter the maximurn rains in the region. The dengue was diagnosed three limes more in male patients as corrlparerj tn temale patients. The dengue epidemic during 2011, affected people of all age groups and the most cases were diagnosed young adults followed by other age groups

Frequency of glucose-6-phosphate dehydrogenase [G6PD] deficiency in asymptomatic Pakistani population

To determine the frequency of G6PD deficiency in asymptomatic Pakistan population. Cross sectional study. This was carried out at Pakistan Air Force [PAF] Hospital at PAF Base Masroor Karachi between June 2004 - September 2007. Healthy young males and females between the ages of 13 to 28 years were tested for G6PD deficiency. None of the individuals had the findings of chronic hemolytic anemia. Their test was carried out on Trinity Biotech visual, qualitative, colorimetric procedure for determining G6PD deficiency using dichlorophenol indophenols as an indicator. During the study period 888 individuals, 804 males and 84 females were tested for G6PD deficiency. Forty [4.5%] individual had G6PD deficiency. All were otherwise healthy with normal general physical examination, complete blood count, blood glucose level, liver function tests, renal function tests, lipid profile, urine analysis, electrocardiogram and X- Ray chest .Out of 804 males 40[5.0%] had G6PD deficiency. None of the 84 females had the enzyme deficiency. G6PD deficiency is observed to be 4.5%. Our findings are in conformity with W.H.O data for geographic distribution of G6PD deficiency in Pakistan .It should be considered in the differential diagnosis of hemolytic anemia, especially following drug administration

Frequency of complications during hemodialysis in patients of chronic renal failure

To determine the frequency of various complications occurring during hemodialysis in patients of chronic renal failure undergoing maintenance hernodialysis. A descriptive prospective study. The study was conducted at Department of Nephrology, Military hospital Rawalpindi Pakistan, from 21st July 2005 to 21st Jan 2006 One hundred subjects fulfilling inclusion criteria [Patients suffering from chronic renal failure [CRF] who were on maintenance hemodialysis for at least 03 months] during the above-mentioned period were enrolled in this study with non-probability sampling technique after taking informed consent. One hundred patients of end stage renal disease of maintenance hemodialysis were studied The major causes of renal disease were diabetes mellitus [24.0%] and hypertension [22.0%] The most frequent complication was hypotension seen in 12% of dialectic treatment followed by muscular cramps [10%], chest pain [09%], vomiting [08%] and headache 06% of patients. Other complications like membrane hypersensitivity reactions, pruritis and complications of access route disequilibrium syndrome were uncommon. In the patients with chronic renal failure on maintenance hemodialysis, hypotension was the most frequent complication. So assessment of patient for hernodynamic status and general condition is important to reduce the incidence of complications

Comparison of frequency of heamaturia with rapid and slow decompression of urinary bladder in the management of chronic urinary retention

The objective of this study was to compare frequency of haematuria after slow decompression and rapid decompression of urinary bladder in the management of chronic urinary retention. Quasi experimental study. This study was carried out in Combined Military Hospital Quetta from May 2007 to Nov 2007. Sixty patients fulfilling the inclusion criteria were randomly assigned to two equal groups. Group A was subjected to intermittent clamping of Foley catheter and group B was subjected to no clamping of Foley catheter. On insertion of Foley catheter sample of urine was taken in a test tube and saved. A second sample was also taken in another test tube after one hour of complete decompression of either group and compared with original sample for occurrence of haematuria. Frequency of haematuria was calculated after both the procedures and recorded. confounding variables were traumatic catheterization and patients who were taking anticoagulants or having bleeding disorders. These were controlled by including only those cases where catheter was passed atraumatically by registrar surgery. The frequency of haematuria was found to be equal in both groups. Rapid decompression of the urinary bladder in cases of chronic urinary retention is a safe and convenient method of decompressing the urinary bladder in patients of chronic urinary retention, without any increase in frequency of haematuria

Role of ultrasound in rotator cuff injury

To determine the role of ultrasound [US] in Rotator cuff pathologies and to correlate the accuracy of Ultrasonography [USG] findings in rotator cuff pathologies with b Magnetic Resonance Imaging. It was a Descriptive study. Study was conducted in Department of Radiology, PNS Shifa Karachi, where Grey Scale as well as Color Doppler USG and Fluoroscopy was available. However the facilities of MRI were utilized from other Radiology departments in Karachi; namely, National Medical Centre [NMC], Advanced Radiology Clinic [ARC] and Agha Khan University Hospital [AKUH] on referral basis. The study involved 50 patients of both sexes between 15-60 years of age who presented with shoulder pain and stiffness, in out-patient departments or admitted in surgical/orthopedic wards. They were referred to the Radiology department PNS Shifa for X-Rays and US shoulder. All of them were followed by Magnetic Resonance Imaging. Patients were 32 males and 18 females of more than 15 years of age. Rotator cuff tears were suggested on US by finding thinning or absence of cuff, by hyper or hypo echoic areas in cuff and by criteria of the abnormal cuff-bursa interface. Out of 50 patients 35 patients were diagnosed on US, as having rotator cuff tears while 15 patients were reported normal. 21 out of 35 patients were having full thickness tear while 14 had partial thickness tears. When MRI was conducted in these patients, it showed 39 rotator cuff tears out of 50 patients while 11 patient

ere diagnosed as normal. 26 out of 39 patients were having full thickness tears while 13 had partial thickness tears. Ultrasound had high sensitivity, specificity, positive predictive values and accuracy. We conclude that MRI and US are both sensitive in detection of abnormalities of the rotator cuff. In our set up; Ultrasound is an accurate, non invasive and economic mode of investigation for diagnosing rotator cuff pathologies

Comparison of diagnostic accuracy of non-invasive tests for helicobacter pylori infection in children

To compare urea breath and stool antigen in children, with hisotological diagnosis for helicobacter pylori [H.pylori] infection. Cross-sectional study. From June 2005 to December 2005 carried out at KRL Hospital, Islamabad and Children Hospital, PIMS, Islamabad. Children between 3 and 15 years of age reporting in pediatric outpatient department with upper gastrointestinal symptoms were included. All the participating children underwent an upper gastrointestinal endoscopy and 3 tests namely: histopathological identification of H.pylori [the traditional gold standard], urea breath test and stool antigen test were carried out on each child. The sensitivity, specificity, and positive predictive values were calculated for each noninvasive test used in the study. A total of 54 patients completed the study with a mean age of 8.2 years. On histological examination, 725 [39] were positive for H.pylori infection. On gross endoscopic examination, only 9 patients had signs of gastritis as compared to 39 histological positives. The sensitivity, specificity and positive predictive value of stool antigen test were: 77%, 73% and 89% respectively whereas the same for urea breath test: 79%, 80% and 91% respectively. Both the noninvasive tests were found to be sensitive and specific as compared with histological identification, for the diagnosis of H.pylori in our pediatric population. The accuracy of urea breath test was better than the stool antigen test but later was easier to perform and could fulfill the criteria for a rapid bedside diagnostic test

Accuracy of ultrasonography in detection of severe liver fibrosis/cirrhosis in chronic liver disease

To determine the accuracy of three ultrasonographic [US] signs; liver surface nodularity, caudate lobe hypertrophy and hepatic vein flow pattern on Doppler ultrasound, in detecting severe liver fibrosis in chronic liver disease. Descriptive study. Department of Diagnostic Radiology, PNS Shifa Karachi. Duration of the study was 6 months -SEPTEMBER 2005 TO MARCH 2006. The study included 50 patients of both sexes [20-60 yrs], presenting with chronic liver disease to department of Ultrasound. TOSHIBA [NEMIO- 20] Doppler Ultrasound Machine with Doppler 3.5 and 5.0MHz probes was used to look for liver surface nodularity, caudate lobe hypertrophy and pattern of hepatic vein flow. After performing US, liver biopsy on these patients was performed under US guidance and sent for histopathology findings; taken as gold standard. On US, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were highest for liver surface nodularity in detecting severe liver fibrosis. However, the above-mentioned values were relatively higher when the three ultrasound signs were collectively considered; compared to single US sign. US determination of liver surface nodularity is a significantly accurate method for identifying severe liver fibrosis or cirrhosis. The accuracy of ultrasound further increases when hepatic vein flow pattern and caudate lobe hypertrophy are also taken into account

Ossicular changes in chronic suppurative otitis media, atticoantral disease

Chronic suppurative otitis media is chronic inflammation of the middle ear characterized by ear discharge and hearing impairment. This hearing impairment is usually due to ossicular involvement and tympanic membrane perforation. The purpose of this study is to document the pattern of ossicular damage in chronic suppurative otitis media atticoantral type Sixty patients with chronic suppurative otitis media atticoantral type were selected and admitted in ENT-I Department. Ears were examined under microscope. Mastoid exploration was done in all cases. Per-operative ossicular chain status was noted. The sequence of damage to ossicles was documented and compared with other studies. Our conclusion was that in 57[95%] patients the ossicular chain was found damaged. Whole of the ossicular chain was involved in majority of the cases 25[42%]. Incus was the most vulnerable bone and was found necrosed in 20% isolated cases and in 46% along with other ossicles

Hormonal changes in male-type androgenetic alopecia

Androgens play an important role in the pathogenesis of androgenetic alopecia. Conflicating data has since been reported with regards to gonadotropin and androgen levels in androgenetic alopecia. A case control study was planned to evaluate androgens and gonadotropins in hyperandrogenaemia of males for their role in androgenetic alopecia. Patients of androgenetic alopecia [n=22] were men with fronto-occipital baldness, aged 20-30 years. Healthy controls [n=20] were age matched males without alopecia. The individuals with clinical evidence of any systemic or localised scalp disease were excluded. Levels of FSH, LH, Prolactin and Testosterone were higher in patients of androgenetic alopecia when compared with normal controls but the difference was not significant statistically. Serum SHBG was lower while DHEA-S and androstenedione levels were significantly higher in patients of androgenetic alopecia [p < 0.05]. Testosterone/SHBG ratio as an index of free testosterone was significantly higher [p < 0.01] in patients of androgenetic alopecia as compared to healthy controls. The results support the hypothesis that androgenetic alopecia in males is associated with hyperandrogenaemia

Seroprevalence of HBsAg and HCV antibodies in hospital workers compared to aged matched healthy blood donors

As study was planned to document the seroprevalence of HBsAg and HCV antibodies in hospital workers compared to age-matched volunteer healthy blood donors. The study was conducted at PNS Shifa Hospital Karachi from November 2001 to October 2003. Study group comprised of 305 voluntary hospital workers including 60 doctors, 101 female nurses and attendants, 116 male nurses and attendants and 18 sweepers. Control group comprised of 300 aged matched volunteer blood donors, 90 males and 30 females. A performa was designed to record various findings. Sera of subjects were tested by a standard method for the presence of HBsAg and HCV antibodies. Study group comprised 70 [23%] doctors, 60 males and 10 females. HBsAg was positive in 1[1.43%] and HCV antibodies in 2[2.85%]. Among 101[33%] of the female nurses and attendants, HBsAg was positive in 03 [3%] and HCV antibodies in 8[8%]. Among 116 [38%] male nurses and attendants, 04 [3.44%] were HBsAg positive and 07 [6.03%] HCV antibodies positive. Among 18[6%] khakrobs and sweepers 1[5.56%] was HBsAg positive and 2[11.11%] were HCV antibodies positive. In total 10[3.27%] hospital workers were found positive for HBsAg and 18 [5.90%] positive for HCV antibodies. In voluntary blood donors, HBsAg was detected in 2.4% and HCV antibodies in 3.2%. It is conduced that the seroprevalence of HBsAg is marginally higher in hospital workers while seroprevalence of HCV antibodies is reasonably higher in hospital workers compared to general healthy population

Correlation of viremia and alanine aminotransferase in sera of HCV infected patients

A descriptive, semi-interventional and analytical study was planned to evaluate the usefulness of serum alanine aminotransferase [ALT] testing as compared with Hepatitis C Virus [HCV] RNA testing by Polymerase Chain Reaction [PCR] in different clinical settings of HCV infection. The study was carried out from Dec 2003 to Feb 2004 at Virology department, Armed Forces Institute of Pathology, Rawalpindi. The patients referred to AFIP for blood test for Hepatitis C Virus RNA by PCR were included in the study. The demographic information like age and sex of the patient was noted down. Blood samples were collected and sera were separated. Two hundred and fifty microlitres [ul] of serum was transferred to plastic aliquots that were stored at -80°C in a retrievable fashion until utilized for HCV RNA. The remaining part of serum was stored at -20°C until tested for ALT level. The HCV RNA test was carried out with a commercial kit [Acugen, USA] using automated equipment [Robomaster] based on Real Time PCR. The serum ALT was evaluated with commercial kit of GPT [ALT] IFCC mod. liq UV Humazyme Test [Human-Germany]. Out of the 199 cases, 135 [67.8%] had detectable HCV and thus declared positive for PCR while the remaining 64 had no detectable virus in their sera and were called negative for HCV RNA PCR. ALT was raised in 133/135 [98.5%] PCR positive patients and 08/56[14.2%] PCR negative patients. It is concluded that raised ALT level has good sensitivity in predicting the positivity for HCV RNA in sera of HCV infected individuals and, therefore, can be used with a fair degree of confidence for assessment of degree of liver damage in HCV infected individuals without cirrhosis and hepatocellular carcinoma

Control of burkholderia [pseudomonas] bacteraemia in the intensive care and paediatric units

Investigation and control of nosocomial bacteraemia caused by Burkholderia [Pseudomonas] cepacia in the Intensive Care and Paediatric Units of a general care hospital. Design: A cross-sectional analytical study. Place and Duration of Study: Departments of Pathology, Intensive Care and Paediatrics, Kahota Research Laboratory Hospital, Islamabad from January 1998 to June 2002. Subjects and Blood cultures from patients admitted to Intensive Care Unit and Paediatric Ward were inoculated into brain heart infusion broth and incubated for upto 10 days. Any Gram-negative rods isolated were characterized by API-20E. Environmental samples were inoculated on blood and MacConkey's agars and isolates, if any, were identified as above. Intensive intervention in the form of hand washing, strict adherence to aseptic practices and standard sterilization techniques were adopted and then cultures were again carried out with similar methodology. Cultures yielded 58 strains of Burkholderia cepacia, 52 from blood cultures and 6 from hospital environment, including 1 from the washbasin of the ICU. Thirty- four of these were isolated before intervention measures were adopted, mainly during 1998. Findings suggested a strong probability of nosocomial transmission, with washbasin as the common source. After a lapse of about a year, B. cepacia infection re-emerged in a sporadic form but remaining confined to paediatric unit. Only 18 isolates were yielded over the next two and-a-half years. The intervention measures for Burkholderia bacteraemia within the hospital, proved effective in stopping the nosocomial transmission leading to disappearance of B. cepacia from blood cultures. We emphasize the crucial role of hand hygienic practices in the hospital setting, especially in critical care units