Frequency and common risk factors Leading to Hepatitis C Virus Infection in patients with type 2 Diabetes Mellitus

Objective: To determine the frequency of hepatitis C virus infection in patients with type 2 diabetes mellitus and to look for the common risk factors leading to this infection in diabetics

Study Design: Descriptive cross sectional study design

Place and Duration of Study: Department of Medicine, Combined Military Hospital [CMH] Kharian, from Jan 2015 to Jun 2015

Patients and Methods: This study was conducted in the department of Medicine, Combined Military Hospital Kharian. Through a descriptive cross sectional study design, a total of 140 patients with type 2 diabetes mellitus, admitted through casualty, OPD or private clinics were selected and tested for Hepatitis C virus infection. The common risk factors leading to such infection among positive cases were also scrutinized

Results: The mean age of patients was 48.82 +/- 10.14 with 60.7 percent female gender predominating the overall sample of diabetics. Using 3rd generation ELISA method, hepatitis C virus was found in 45 [32.1 percent] of patients with 41-50 years of age group most commonly affected age group [34.7 percent] and female [57.8 percent] commonly affected gender. The distribution of risk factors leading to hepatitis C virus in diabetics are: 21 [46.7 percent] had history of surgery in the past, 13 [28.9 percent] had history of blood transfusion in the past, 7 [15.55 percent] had history of hemodialysis while only 4 [8.9 percent] had history of tattooing in the past

Conclusion: Hepatitis C virus infection is still a common problem in diabetic patients of our local population and we recommend further research work over its risk factors so that the guidelines for its control may be formulated

Sideroblastic anaemia as a diagnostic filch point of melas [myoencephalopathy, lactic acidosis and stroke like episodes]

Sideroblastic anaemia includes a heterogeneous group of conditions characterized by decreased heme synthesis and mitochondrial iron overload. It is diagnosed by the presence of ringed sideroblasts in the bone marrow aspirate and association of this form of anemia with various mitochondrial dysfunction disorders can be a catch point to reach an ultimate diagnosis in these disorders as reported in this case of myoencephalopathy, lactic acidosis, and stroke-like episodes [MELAS] syndrome

Post esophageal variceal band ligation pain, another insult to injury

Objective: To measure and characterize pain in post esophageal variceal band ligation patients

Study Design: Cross sectional observational study

Place and Duration of Study: This study was carried out in Combined Military Hospital Kharian which is a tertiary care hospital, from Dec 2014 to Aug 2015

Material and Methods: All patients of esophageal varices due to any underlying pathology requiring esophageal variceal band ligation [EVBL] were included in this study. Patients unwilling for EVBL were excluded from the study

Their EVBL was done with the help of Upper Gastrointestinal Pentax High definition 90i series Video Endoscope and subsequently they were inquired about the details of pain till next session of banding

Results: Out of 86 patients 63 [73%] were males and 23 [27%] were females. Their mean age was 54 years with SD +/- 12. Pain was present in 47 [54%] patients and 39 [46%] were pain free. It was severe in 3 [7%], moderate in 34 [72%] and mild in 10 [21%] patients. Out of post EVBL pain group 30 [65%] patients experienced pain after first EVBL session, 12 [25%] in subsequent and 5 [10%] after all the sessions

Conclusion: Post EVBL pain is a common complication. Mostly it is mild to moderate in intensity and needs attention in almost half of the patients to relief the suffering

Hepatitis B leading to megaloblastic anemia and catastrophic peripheral thrombocytopenia

Hepatitis B virus [HBV] typically causes chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is associated with a variety of extrahepatic complications. We herein, present a rare extrahepatic complication of HBV infection. A 32-year man presented with melena, bleeding from gums and fever. Peripheral blood examination revealed anemia, macrocytosis and severe thrombocytopenia. His hepatitis B surface antigen [HBsAg] was positive but deoxyribonucleic acid [HBV DNA] by polymerase chain reaction [PCR] was negative. Other hepatitis, human immune deficiency virus [HIV], dengue, and autoimmune serology were negative. Bone marrow examination revealed megaloblastic erythropoiesis. There was mild to moderate reduction of megakaryocytes in bone marrow, which was not compatible with severe peripheral thrombocytopenia. His response to cyanocobalamin and folic acid was remarkable for myeloid cell lines and moderate for erythroid cell lines, but poor to platelet counts. Platelet counts gradually improved to safe limits with eltrombopag, likely reflecting autoimmune pathogenesis for thrombocytopenia. This case report highlights multiple targets of HBV infection with associated multiple pathogenetic mechanisms

Opinion of Pakistani physiotherapists/students about anatomy as a subject and method of teaching anatomy: a cross sectional survey

To recognise and identify the importance of Anatomy as a subject for physiotherapists/students. The cross-sectional descriptive study was conducted from January to October 2011 at Riphah International University, Lahore, and comprised physiotherapists registered with Pakistan Physical Therapy Association and students pursuing undergraduate physiotherapy studies at the University. A survey proforma consisting of six questions was used for data collection which was analysed using SPSS 17. Of the 500 questionnaires distributed among physiotherapists and students, 286[57.2%] were collected back duly filled. Overall, 280[97.9%] respondents said Anatomy was important in physical therapy, 179[62.58%] said Anatomy was a difficult subject to retain knowledge of, 155[54.38%] were of the view that only Clinical Anatomy should be studied, 204[71.32%] were in favour of performing dissection, 259[90.55%] found that teaching videos were essential for the study of Anatomy, and 89[31.11%] believed Anatomy could be memorised by multiple readings. Despite being a difficult subject, Anatomy is an essential subject for medical professionals

Gfr estimation using 99mTc dtpa gates method for assessment of early diabetic nephropathy - a comparison with 24-hour creatinine clearance

To correlate Gates glomerular filtration rate [GGFR] using technetium-99m diethylene triaminepentacetic acid [99mTc DTPA] with 24-hour creatinine clearance [CRCL] and to establish relationship with duration of diabetes in patients with early diabetic nephropathy. A cross-sectional comparative study carried out in Nuclear Medical Centre from Aug 2009 to Jan 2010 at Armed Forces Institute of Pathology [AFIP], Rawalpindi, Pakistan. A total of eighty three subjects were enrolled, who were divided into three groups; group 1 comprised 31 normotensive diabetics, group 2 had 37 hypertensive diabetics while group 3 had 15 normal subjects. The DTPA GFR and creatinine clearance in healthy subjects as well as diabetic patients were compared using the unpaired student's t-test. The linear association between GFR, creatinine clearance and disease duration was expressed by Pearson's correlation coefficient V along with their significance levels. Gates GFR showed hyperfiltration in normotensive diabetics [96.6 +/- 3.3 ml/min/1.73 m[2]], significantly [p<0.05] higher than controls [85.5 +/- 5 ml/min/1.73 m[2]], whereas hypertensive diabetics had a significantly lower [p<0.05] Gates GFR [76.8 +/- 3.7] than that of controls. Significant degree of correlation existed between GGFR and CRCL in hypertensive diabetics [p<0.05, r=0.716] and controls [r=0.546]. Gates GFR also showed good correlation with duration of diabetes in both diabetic groups as compared to that of CRCL. GGFR also correlated well with duration of hypertension 0.37 [0.31-0.43] as compared to CRCL 0.155 [0.15-0.16] in all groups. The 99mTc-DTPA clearance correlates significantly with 24-hour creatinine clearance as well as with disease duration and can provide a simple and convenient index of kidney function in patients of early diabetic nephropathy

IgA nephropathy - its seasonal variation and clinico pathological profile in local patients

To study the frequency of IgA nephropathy in relation to seasonal variation and its clinico-pathological profile at Military Hospital Rawalpindi. A descriptive study. Military Hospital, Rawalpindi, Pakistan from Jan 2010 to Mar 2012. The study was conducted at Military Hospital Rawalpindi on 289 consecutive renal biopsy specimens. Ultrasound

Comparison of Self-Assessment with Peer and Student Assessment in Evaluating the Overall Performance of the Faculty

To evaluate the overall faculty performance by comparison of Self-assessment with peer and student assessment. A comparative cross sectional survey. Study was conducted from January to June 2012 in Riphah College of Rehabilitation Sciences, Riphah International University Islamabad. This research study was conducted among students of Doctor of physical therapy [DPT], post-professional Doctor of physical Therapy [PPDPT], and Master of Science in speech language pathology [MS-SLP], and faculty members at Riphah College of Rehabilitation Science [RCRS], Riphah International University Islamabad. The total sample size was 730, including 700 students and 30 faculty members. A questionnaire was developed according to likert scale, and after a pilot study on 20 student and 10 faculty member to determine the reliability. The questionnaire was circulated among all the 30 faculty members and 700 students, including 500 undergraduate and 200 post graduate students of all the 3 programs. The data was analyzed and Wilcoxon [Kruskal-Wallis] was applied at 95% level of significance for all the 3 groups. The group [A] included assessment of the performance of the faculty members done by the students, group [B] done by other faculty members, and group [C] included self assessment done by faculty members. The averages were calculated to determine the overall performance of the faculty members as assessed by themselves, other faculty members, and the by students as well, afterwards the averages of 3 groups were compared. the overall performance of the faculty members was graded as 71% [P=0.015] as evaluated by the students, 77% [P=0.009] as evaluated by other faculty members, and 73% [P=0.011] as evaluated by the faculty members through self assessment. It is concluded that there was no significant difference in the performance of the faculty members, as assessed themselves, by the students and the other faculty members

Histological features of ligamentum venosum at different ages

To study the histological features of ligamentum venosum at different ages. An observational study. The study was conducted in Anatomy department at Islamic International Medical College Rawalpindi from June 2008 to June 2009. The study was based on 6 post- mortem specimens. The livers were dissected from cadavers at ages 5, 35, and 65 years. The ligamentum venosum was dissected and fixed in 10% formalin solution for 24 hours. After fixation and processing, the slides were stained with haematoxylin and Eosin stain. At the age of five years the lumen was completely obliterated towards the portal extremity whereas it was patent near the caval extremity. At the age of 35 years the lumen was patent; the ligamentum venosum had got an intima without an endothelium. At the age of 65 years the lumen was patent; the ligamentum venosum had gotanintima without an end othe lium. The study concludes that ligamentum venosum shows different histological features at different ages. The presence of internal elastic lamina at the age of sixty five years is a unique feature of this study

Diseases causing acute renal failure in a tertiary care hospital

This study was done to evaluate frequency of acute renal failure [ARF], its causes and out come of the patients. Descriptive analytic study. March to Dec 2007 at Combined Military Hospital Lahore. All patients, admitted in different wards of the hospital, who developed acute renal failure [doubling of serum creatinine measured on two occasions 12 hours apart], were included in this study. A total of 39 patients were included in the study. Males were 19 [48.71%] and 20 [51.28%] were female. Mean age of patients was 40.2 years [SD=18.0]. The major cause was acute Gastroenteritis seen in 23 [58.97%] cases. Others developed ARF due to, Abruptio Placentae 5 [12.82%], Postoperative 5 [12.82%], Eclampsia 3 [7.69%] and Drug induced 3 [7.69%]. Oliguric phase developed in 28 [71.79%] patients and lasted for 8.45 +/- 4.16 days. Of these 17 [60.71%] patients had acute gastroenteritis. Gastroenteritis is the most common and important cause of ARF though gynaecological and surgical etiologies must be kept in mind. It is evident that the gynaecological and surgical patients need critical peri-partum and peri-operative monitoring to prevent development of ARF. Early institution of therapy will prevent subsequent morbidity associated with this disease