Seroprevalence of measles igG antibodies in children of school going age

Background: Measles is highly contagious infectious disease and considered to be leading cause of death among young children. Although vaccination process of measles is well ascertained but still its associated morbidity and mortality is high among children of developing countries. This study was designed to see the level of measles IgG in children in District Bagh of Azad Jammu and Kashmir

Methods: Measles IgG antibodies were screened in total of 250 school going children [4-8 years] in the District Bagh, Azad Jammu and Kashmir were enrolled. The subjects were grouped on age basis; Group A had children of 4-5 years, Group B comprised of children of 5-6 years, Group C contained children of 6-7 years and Group D had age 7-8 years. A The collected samples were transferred to the Molecular Virology Laboratories at National Institute of Health [NIH], Islamabad for detection of measles IgG antibodies. Measles antibodies were estimated by using kits for Enzyme Linked Immunosorbant Assay

Results: There were 10 [4%] children in Group A, 18 [7.2%] were in Group B, 42 [16.8%] were in Group C, and 180 [72%] children were in Group D. Out of 250 children 61 [24.4%] were detected as unprotected and 13 [5.2%] were at borderline and 176 [70.4%] had protective antibody level against the measles virus

Conclusion: Significant number of children is under potential risk to develop measles infection. No significant relation could be established between disease, age, and gender

Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons

Objective: To determine within-rater and between-rater reliability of the universal goniometer [UG] for measuring active cervical range of motion [ACROM] in asymptomatic healthy subjects

Methods: Nineteen healthy subjects were tested in an identical seated position. Two raters used UG to measure active cervical movements of flexion, extension, right side flexion, left side flexion, right rotation and left rotation. Each motion was measured twice by each of the two raters and was re-measured all over again after one week. Data analysis was performed using the intraclass correlation coefficient [ICC]

Results: The results demonstrated excellent within-session [ICC2,1 = 0.83 to 0.98] and between-session [ICC2,2 = 0.79 to 0.97] intra-rater reliability and excellent inter-rater reliability [ICC2,2 = 0.79 to 0.92]

Conclusion: Considering above results it is concluded that UG is a reliable tool for assessing ACROM in a clinical setting for healthy subjects

Socio-economic determinants of the awareness and adoption of citrus production practices in Pakistan / Determinantes socioeconômicos da conscientização e adoção de práticas de produção de citros no Paquistão

Citrus is the leading fruit of Pakistan and famous worldwide especially kinnow cultivar because of its pleasant taste and remarkable quality. The yield of citrus per hectare in Pakistan is almost half of potential due to non-adoption of recommended horticultural practices by citrus growers. Adopting a decision regarding the improvement of practices is usually influenced by various factors including farmers' socio-economic attributes. In order to determine the relationship between socio-economic aspects and the awareness and adoption of recommended citrus production practices the present study was carried out in Sargodha district from central Punjab, Pakistan. The Study was based upon cross sectional survey research design due to availability of sampling frame, probability (random sampling) was applied for sample selection. Through random sampling, 120 citrus growers were selected as sample. Structured questionnaire administered through interview was used as a research instrument. Analysis of the data collected from the targeted citrus growers revealed a highly significant influence of education on awareness and adoption. Moreover, significant association was found between citrus cultivation area and awareness and adoption of improved practices. Age also showed significant association with awareness and adoption. Moreover, dominancy of middle aged farmers and illiteracyin the study area strongly point the need of provision of formal and non-formal education and training program for farmers. Young generation needs to be focused and reorientation of youth clubs may help in better way to gain the utmost outcome.

Citrus é fruto líder do Paquistão e famoso no mundo inteiro, especialmente Kinnow, cultivado por causa do sabor agradável e de qualidade notável. Por hectare, o rendimento de citrus no Paquistão é quase metade do potencial, devido à não-adoção de práticas de horticultura recomendadas por citricultores. A adoção da decisão sobre práticas melhoradas geralmente é influenciada por vários fatores, incluindo atributos socioeconômicos dos agricultores. A fim de determinar a relação entre os aspectos socioeconômicos e a consciência e adoção de práticas de produção de citros recomendadas presentes, este estudo foi realizado no distrito de Sargodha do centro de Punjab, Paquistão. O estudo foi baseado em projeto de pesquisa do estudo transversal e, devido à disponibilidade de amostragem, amostragem quadro probabilidade (amostragem aleatória) foi aplicada para a seleção da amostra. Por meio de amostragem aleatória, 120 citricultores foram selecionados como amostra. Questionário estruturado, aplicado por meio de entrevista, foi utilizado como um instrumento de pesquisa. A análise dos dados coletados dos citricultores direcionados revelou uma influência altamente significativa da educação sobre a conscientização e adoção. Além disso, foi encontrada associação significativa entre a área de cultivo de citrinos e conscientização e adoção de práticas melhoradas. A idade dos produtores também mostrou associação significativa com a conscientização e adoção. Além disso, a dominância dos agricultores de meia idade e a falta de conhecimento na área de estudo apontam fortemente para a necessidade de oferta de educação formal e não-formal e de formação para os agricultores. Necessidades de geração de jovens a ser focado e reorientação dos clubes de jovens pode contribuir para melhor maneira de ganhar o máximo resultado.

Short and long term follow up results of [the versatile] reverse sural artery flap

This study was designed to see the long and short term outcome of the reverse sural artery flap.Case series. From January 2009 to December 2011, data was collected and analyzed for this study. Eighty nine patients with wounds on the ankle, heel, sole, distal leg, and foot were included in the study.they were followed up at 01 week, 02 weeks, and then 4 weekly for 06 months and at one year time from operation. They were examined for necrosis, congestion, surgical site infection, dehiscence of suture line, epidermolysis, donor site infection and functional outcome. Most of the flaps healed nicely but two [2.25%] failed completely. Six flaps were delayed. However early follow up [within 04 weeks] revealed that there was partial loss of the distal 1-1.5 cm of flap in 04 patients [4.50%]. Two patients [2.25%] developed superficial surgical site infection. Six patients [6.74%] developed venous congestion of the flaps which recovered within two weeks. Other minor complications included dehiscence of suture line in 3 patients [3.37%], and superficial Epidermolysis in four [4.50%] [Table-2]. Twenty two patients [24.72%] returned to their work in 12-16 weeks, 31 [34.83%] in 16-20 weeks and 36 [40.45%] in 20-24 weeks. Long term follow-up to 06 months revealed hypertrophic scars at the donor site in three patients [4.91%] and recurrence of ulcer in 2 patients [3.27%]. The sural fasciocutaneous flap provides reliable supple and durable most single-stage coverage of wounds of the distal third of the leg, heel, and foot with the results comparable to free-tissue transfer

Cancer types; correlation of renal and liver function tests

This study attempts to highlight the relation of various types of cancers to abnormalities in liver and renal function tests. Correlation of deranged renal and liver function tests to different types of cancers in industrial workers who are exposed to industrial chemicals and carcinogens. This non-interventional study included 100 hundred confirmed cases of cancer were selected and studied from July 2011 to December 2011. The study was conducted at Fatima Memorial Hospital/College of Medicine and Dentistry, Lahore. Out of these 100 patients, 21 had CA lung, 19 had lymphoma, 14 had sarcoma, 13 had CA breast, 6 had CA prostate, 4 had CA liver, 3 had CA colon, 3 had CA ovary, 3 had CA testis, 2 had leukemia, 2 had multiple myeloma, 2 had CA gall bladder, 2 had CA stomach, 1 had CA esophagus, 1had CA tongue, 1had CA parotid, 1 had CA rectum, 1 had CA cervix and 1 had CA larynx. Among lymphoma, non-Hodgkin lymphoma was more than Hodgkin lymphoma [out of 19 patients, 13 had non-Hodgkin and 6 had Hodgkin lymphoma]. Out of 14 patients of sarcomas, 5 had Ewing sarcoma, 4 had chondrosarcoma, 3 had fibrosarcoma and 2 had liposarcoma. Similarly the serum bilirubin levels in liver cancer, ovarian cancer, multiple myeloma, stomach and gall bladder cancer were 1.50 +/- 0.31, 1.17 +/- 0.10, 1.46 +/- 0.15 and 1.40 +/- 0.50 mg% were 32.38 +/- 18.81, 37.73 +/- 4.35, 34.43 +/- 4.35, 45.00 +/- 46.17, 31.33 +/- 44.70, 65.25 +/- 31.14, 33.67 +/- 80.90, 99.00 +/- 73.08, 50.00 +/- 98.49, 33.50 +/- 75.0, 36.50 +/- 85.0 and 49.0 +/- 11.0 micro /l respectively which were statistically significantly higher [p<0.05] then control individuals. respectively which were significantly higher [p<0.05] than the control individuals Similarly the ALT levels in lung cancer, lymphoma, sarcoma, breast cancer, prostate cancer, liver cancer, leukemia, ovarian cancer, cancer of colon, multiple myeloma, cancer of testis and stomach. The mean serum creatinine levels in lung cancer, liver cancer and cancer of colon were 0.89 +/- 0.05, 0.90 +/- 0.16 mg% respectively which were significantly higher than the control individuals [p<0.05]. The renal and liver function tests should be frequently monitored in cancer patients from industrial back grounds

Reconstruction of non-melanotic facial tumours with local flaps; replacing like with like

To assess the outcome of early skin tumour excision and reconstruction with regards to tumour margin clearance, recurrence and aesthetic results of reconstruction. Quasi experimental. This study was carried in the department of Plastic and Reconstructive Surgery Combined Military Hospital [CMH] Rawalpindi, Pakistan from January 2010 to December 2012. All patients having tumours of the cheek, upper and lower lips, nose and forehead, who underwent primary surgical excision and reconstruction with local flaps, were included in the study. Patients with nodal or distant metastasis were excluded. Tumours were excised with safe margins and defects reconstructed with local facial flaps. Patients were regularly followed up as per protocol for basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]. Eighty nine patients aged between 37-86 years with a mean age of 59.4 years [SD +/- 9.24] were included in the study. There were 58 [65%] cases of basal cell carcinoma [BCC] and 31 [35%] of squamous cell carcinoma [SCC]. Recurrence was seen in 3 [5.2%] cases of BCC and 2 [6.4%] cases of SCC. There was 1 [1.1%] complete and 4 [4.5%] partial flap losses. The follow-up period ranged from 4 months to 3 years with average of 16 months. Local flaps give a simple option for facial reconstruction for postoncological resection defects giving good aesthetic match due to local tissue

Emerging human health pertinent to modern agriculture. Critical review

In developing countries week and dispersed link has been shown between agriculture and human diseases. In this regard present review was conducted and revealed several examples that there exist strong link between agriculture and diseases. Review categorized the major disease into zoonotic, vector borne and food associated. Zoonotic diseases were found to be transmitted by the livestock. Some of these diseases are also associates with vectors that were found to be transmitted by the agriculture. Mosquito is the major vector transferring malaria, cholera and skin diseases. Agricultural intensification is the major source of their climate change through increased emission of green house gases. Agricultural intensification, ecological disturbance and inadequate agricultural managements are the dominant reason revealed. Rate of future agricultural diseases such as zoonotic diseases emergence or reemergence will be closely linked to the evolution of the agriculture-environment nexus. Meanwhile, the available research is not enough to address these issues. Agriculture sector is for peace and sustainability and to strengthen this sustainability there is dire need of Convergence is needed between integrated pest management strategies and integrated vector management strategies to help farmers improve their agricultural practices while minimizing environmental risks to health. In addition, further research by the medical scientists and agricultural scientists is needed to explore the epidemiology of various diseases caused by the agricultural activities through promotion of vector

Diabetes mellitus; incidence of chronic hepatitis C patients

Hepatitis C virus [HCV] is a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma [HCC]. HCV infection and type 2 diabetes are two common disorders with a high impact on health worldwide. There is growing evidence to support the concept that HCV infection is a risk factor for developing type 2 Diabetes Mellitus. Both insulin resistance and diabetes can adversely affect the course of chronic hepatitis C, and lead to poor response to antiviral therapy and increased incidence of Hepatocellular carcinoma. The objective of the study was to assess the frequency of type 2 Diabetes mellitus in newly diagnosed chronic hepatitis C patients presenting in Allied hospital Medical unit II during six month period. Cross sectional study. Medical unit-II, Allied Hospital, Faisalabad. 01-08-2009 to 28-02-2010. All newly diagnosed patients of chronic hepatitis C on the basis of PCR for HCV-RNA were included in the study. Fasting and two hours postprandial blood sample were tested. Diabetes Mellitus was labeled as per slandered. Out of 180 patients with CHC 19 [10.6%] were found to have Diabetes mellitus while 161[89.4%] were non-diabetics. There is close association in the development of type 2 diabetes mellitus in patients with chronic hepatitis C

Management of war injuries - experience at CMH Rawalpindi during 2008 - 2010

To see the changing mode of injury from firearm to blast, pattern of injury with modern body armor and improved surgical options with results of different procedures done. Descriptive study. Department of Plastic Surgery Combined Military Hospital Rawalpindi between Jan 2008 and Dec 2010. All victims of low intensity conflict whether civilian or military personnel from all age groups without sex discrimination were included. Data was collected from history, transferring notes from the forward medical facility to this hospital, case record documents in this hospital and `patients follow up proforma. All these cases were managed in collaboration with other concerned specialties including orthopedic surgery, general surgery, otolaryngyology, maxillofacial surgery and vascular surgery. Plastic surgery department managed 212 patients over last three years i.e. 2008-2010. Age range was 14-58 years and male to female ratio was 71:1. Primary surgical wound management was done at field military hospitals in majority of cases and few were air evacuated directly to CMH Rawalpindi. Majority of injuries were caused by explosions followed by firearms. Simultaneous injuries were 68.9% and isolated injuries were 31.1%. Decision of wound closure was usually dependent on level of tissue damage, contamination and infection. Concept of reconstructive ladder was followed. Majority of wounds were closed in delayed primary setting. Infection was the most common complication followed by partial or complete graft or flap loss. Minimum complication rate was encountered in the wounds which were closed in delayed primary setting. All war wounds are primarily contaminated. If these wounds are closed in delayed primary setting after 2-3 debridements, best results can be achieved. Although infected wounds, wounds with severely damaged structures and injuries associated with tendon or nerve injuries or bone loss will require secondary reconstructive procedures.

Assessment of knowledge, attitude and practices pattern of hand washing in some major public sector hospitals of Pakistan [a multi-center study]

To assess knowledge, attitude and practices of hand washing in major Public sector Hospitals of Pakistan and see the differences in practices in different levels of health care workers. Cross sectional hospital based survey conducted in all provinces of Pakistan in major tertiary care hospitals. A Cross sectional hospital based survey was conducted on knowledge, attitude and practices of hand washing in doctors, nurses and paramedical staff. From each hospital 10 OPD's and 10 wards i.e. 2 medical, 2 Surgical, Gynae, Peads, Dermatology, Eye, ENT, and Causality/ICU were selected and from each unit. Four doctors, four nurses and two paramedical staff were interviewed. A total of 3243 respondents were interviewed. Of these 87.3% had knowledge of hand washing. Hand washing facilities were available at 75% places and 69% respondents practiced hand hygiene, but only 58.8% washed their hands for more than 20 seconds. Majority used antibacterial soap bought by them. Rush of the patients, shortage of time, non availability of soap and water and lack of encouragement by seniors were the major causes for low hand hygiene practice. Almost 25% sites in major public sector tertiary hospitals did not have hand washing facilities but where available most health care providers were using them. Majority despite having knowledge, need motivation and continuous education of hand hygiene. Facilities of hand hygiene should be made available

Diversity of presentations in decompensated chronic liver disease due to HCV

Background: An estimated 170 million people worldwide suffer from HCV infection. Chronic hepatitis C virus [HCV] infection is often a clinically silent infection presenting many years after with complications related to decompensation, so

Objective: To emphasize the role of early detection and intervention in preventing complications of HCV related chronic liver disease

Materials And Methods: Newly diagnosed decompensated chronic liver disease [CLD] due to HCV infection presenting to respective hospitals during 2010

Study design: observational multicentre study

Results: Out of 340 new cases of decompensated chronic liver disease due to hepatitis C virus. 190 [56%] were females and 150 [54%] were male. In terms of presentation, patients were having overlapping symptoms and signs like ascites, jaundice, upper GI bleed and encephalopathy. 220 [64.7%] had clinical ascites, 70 [20.5%] had spontaneous bacterial peritonitis, 130[38.2%] had altered conscious level and150 [44.1%] had upper GI bleed. It was inferred from history that 170[50%] patients with Hepatitis C were detected while being investigated for complaints other than liver disease. Other presentations included jaundice in 10[2.9%] 50 [14.7%] with previous upper GI bleed, 80 [23.5%] with CLD, 10 [2.9%] with epigastric discomfort and 20 [5.8%] had altered conscious level. 235 [69.1%] with Child's Score B and 105[30.4%] with Child's Score C

Conclusion: Majority of patients become aware only when complications set in. Early detection and interventions should be stressed because the available treatment options for the complications are beyond the reach of majority of patients and don't have a permanent solution

Metabolic syndrome frequency in patients presenting with acute myocardial infarction

To determine the frequency of metabolic syndrome in patients presenting with acute myocardial infarction [MI]. Cross -sectional, observational, multi center study. Allied Hospital Faisalabad from 01-01-2009 to 30-06-2010. Any patient fulfilling the criteria of acute myocardial infarction were admitted and enrolled in the study during the study period. Demographic details, history and clinical examination of the patients were recorded on prescribed performa after securing an informed consent. Blood Pressure was recorded in lying posture from right arm and waist circumference measured at umbilical level in lying position. Blood sample was collected in fasting state for estimation of plasma glucose, serum HDL-cholesterol and serum triglycerides levels. Out of 690 patients, 420[60.86%] were male and 270[39.14%] were females with average age 55.90 +/- 10.19. 40% males and 44% females had metabolic syndrome and incidence increased with age. Waist circumference was increased in 46.85% participants followed by increased fasting blood sugar [42%] levels. Frequency of metabolic syndrome was high among the patients with acute myocardial infarction. It supports the potential for preventive efforts in persons with high risk for acute myocardial infarction

Morbidity of mesh repair in inguinal hernias

Hernia is protrusion of any viscous or part of viscous from its proper cavity. Inguinal hernias are the commonest variety amongst all ages and both genders. The most widely practiced operation for inguinal hernia is Lichtenstein tension free mesh repair. Mesh repair, although is best known technique, it still has got morbidity in form of postoperative pain at operation site, urinary retention, scrotal hematoma, wound infection, testicular atrophy and recurrence. In experienced hands, however, this morbidity is significantly reduced. Bring to light the morbidity in our setup and then compare it with other studies available from eastern setup. We studied a total of 200 male patients having inguinal hernias, in CMH Kharian, from Mar 2005 to Mar 2007. Unilateral Lichtenstien tension free mesh repair was performed under general aneasthesia as indoor case. All patients were followed up in OPD, upto one year, to see any complication. 69 patients had mild pain, 113 patients had moderate pain and 18 patients had severe post op pain. Wound infection occurred in 03 patients. Scrotal hematoma formed in 05 patients. Urinary retention occurred in 07 patients, Testicular atrophy occurred in 01 patient. Chronic scar pain was reported by 02 patients. We came to the conclusion that mesh repair is the safest procedure having minimal morbidity

Seroprevalence of measles antibodies in children at school going age in Islamabad, Pakistan

To determine the seroprevalence of IgG antibodies against measles in school going children [age 4 to7.5 years] and to assess need of a booster dose. A serological study was carried out in different schools of urban and rural areas of Islamabad during 2006-2007. A total of 510 school going children aged between 4 to 7.5 years, were studied. The study included the consents from parents and principals of schools for collection of blood samples for measles antibody titer. Serum IgG antibodies against measles were measured by enzyme-linked immunosorbent assay. The protective IgG antibody for measles was found in 186 [86.9%] males and 248 [83.8%] females, respectively [P-value=0.327]. While among children of 4 to 7.5 years, 28 [13.1%] males and 16.2% females had non-protective antibody level against measles. Although, a majority of children between 5.5 years and 7.5 years had shown to have high protective antibody against measles [92.3% and 93.1%, respectively. No significant difference was observed in antibody positivity according to gender [p>0.05]. The study showed that significant number of children remain unprotected against measles in childhood may be due to primary vaccine failure or inappropriate vaccination age. Expanded programme of immunization can review strategies for measels immunization

Role of chelating agents in thalassaemia major patients

To evaluate current chelation in thalassaemia major patients. It is a retrospective study. This study was conducted at Sundus Foundation, Shadman, Lahore Pakistan from March 2006 to August 2006. One hundred and seventy patients with transfusion dependent thalassaemia major were evaluated for chelation practice and iron overload. 98.2% were found to be either non-chelators or inadequate chelators whereas 82.3% patients had serum ferritin levels above 2500 ng/ml. Growth failure and hepatosplenomegaly were also common. Survival appears to be limited as only 6 patients were older than 20 years. Patients face risks and complications during treatment of thalassaemia major. Urgent and effective measures should be taken to remove the obstacles for improvement in quality of life in these patients. Involvement of physicians about current concepts in treatment of thalassaemia major can produce promising results

Biliary leakage following cholecystectomy and its outcome

To find out the causes and outcome of management in cases of bile leakage following cholecystectomy. Prospective descriptive study from April 2005 to December 2006. Surgical Unit five of Civil Hospital, Karachi. A total of 140 patients who were operated for symptomatic gall stones. Detailed information regarding the patients was collected. Initially due to non-availability of ERCP as well as high cost in the private sector, all patients with biliary leakage underwent open surgery. Later on all patients underwent ERCP due to its availability in the unit; operative intervention was only undertaken when the ERCP was not therapeutic or failed. Ultrasound studies were done in patients who were suspected to have bile collections but no discharge from the drains or the operative wounds. Out of 140 patients, two patients were noticed to have biliary leakage during surgery and 10 post-operatively. The former cases underwent repair on the spot, while in the latter group five underwent re-exploration and four ERCP; one patient expired without intervention and another from the re-exploration group. In three patients ERCP was successful and sphincterotomy with stenting was done while in one patient there was failure of cannulation, resulting in open exploration

Effect of smoking on erthrocyte sedimentation rate [ESR] and lipid profile in adults

The study was designed to find out changes in ESR and serum lipid profile in adult smokers and non-smokers and risk of development of atherosclerosis. It is a comparative and non-interventional study. 1st October to 31st October, 2005 Study was carried out in Department of Pathology, Punjab Postgraduate Medical Institute, Lahore. A total of 100 males of adult age [18-65 years] were selected, out of which 50 were smokers and 50 were non-smokers. ESR was done by modified Westergren method and lipid profile was done by chemistry analyzer [Microlab 300 MERCK]. A significant increase in ESR, serum total cholesterol [TC], low density lipoprotein cholesterol [LDL-c] and mean serum triglyceride [TG] levels were observed in smokers as compared with nonsmokers. While levels of serum high density lipoprotein cholesterol [HDL-c] were significantly lower in smokers as compared with non-smokers. Smoking produces adverse effect on lipid profile and ESR thus enhancing the risk of atherosclerosis

Alloxan induced diabetes in rabbits

Alloxan monohydrate is a common drug used for developing experimental diabetes in animals, as streptozotocin, though less toxic than alloxan is considerably costlier. This study aimed to provide an exact and detailed account of alloxan induced diabetes in rabbits as none was available in both local and international literature and in Pharmacology textbooks. This resulted in extremely high mortality in experimental animals i.e., rabbits, leading to inevitably wasted research time and effort for a researcher.Twenty-four healthy rabbits of a local strain weighing 1000 to 1800 g were obtained and kept at the animal house of the Department of Pharmacology Shaikh Zayed Hospital, Lahore. They were injected with varying doses of Alloxan monohydrate [from 75mg -1 l0mg]/ kg body weight in order to induce diabetes. The blood glucose RBS levels were estimated 8 days after injecting the alloxan and subsequently randomly at intervals of five to ten days till the rabbits became diabetic. These doses were found to lower the rabbit mortality by 25% as compared to [upto 75%] that was encountered with a single standardized dose of 160mg/kg body weight suggested by Akhtar et al. [1982] or 80mg/kg body weight [Puri and Prabhu 2002]. It was therefore concluded that our proposed regime may be beneficial for future researchers aiming to develop a similar animal model

Frequency of Hepatitis B, C and Human Immunodeficiency virus in blood donors at Shaikh Zayed Hospital, Lahore

To find out the frequency of hepatitis B, C and human immunodeficiency virus [HIV] in blood donors at Shaikh Zayed Hospital, Lahore. Design: This is a non-interventional study. Study Period: Period of this study is from 1-1-2005 to 30-6-2005. Study was conducted at the Blood Bank of Shaikh Zayed Hospital, Lahore. Subjects and Methods: In this study 18216 young healthy voluntary blood donors [age 16-50 years] comprising of 16611 males and 1605 females were included and tested for HBsAg, Anti-HCV and HIV by Accu check one step test [chromatographic immunoassay] in serum. Results: Frequency of hepatitis B, C and HIV infection was 3.36%, 4.16% and 0% respectively. We can get representative prevalence values of HBV, HCV and HIV infection in general population by collecting data from all blood transfusion centers of Pakistan. This is also helpful to create public awareness regarding hepatitis and HIV transmission through blood transfusion

Exertional dyspnea in patients with diabetes mellitus: evaluation by myocardial perfusion scintigraphy

Coronary Artery disease is a major cause of morbidity and mortality in patients with diabetes mellitus. They have high incidence of silent ischemia as pain perception is blunt in such patients. As a result many of them present with atypical symptoms like exertional dyspnea, instead of classical chest pain as their chief presenting complaint. We evaluated incidence of myocardial perfusion scintigraphic [MPS] evidence of coronary artery disease [CAD] in patients with type II diabetes mellitus without known CAD presenting with exertional dyspnea as chief presenting complaint. We conducted stress-redistribution SPECT MPS with intravenous injection of 93-130 MBq [2.5-3.5 mCi] 201T1-thallous chloride in 290 subjects with type II diabetes mellitus having exertional dyspnea [SOB] as study group [151 male and 139 female, age range 20 to 76 years]. 138 asymptomatic subjects with type II diabetes mellitus also underwent same procedure as control group [56 male and 82 female, age range 29 to 65 years]. Upon the bases of clinical history, study groups were further divided into three categories, Esob=exertional SOB [n=54], AcpD= atypical chest pain with dyspnea [n=114] and TcpD=typical chest pain with dyspnea [n=122]. We conducted visual analysis on reconstructed tomographic slices. CAD was present in 34.78% control [ischemia 23.91%, myocardial infarction 10.87%] and in 66.9% study group subjects [ischemia 49.31%, myocardial infarction 17.87%]. Incidence of CAD was high in Esob group than control [48.15% vs. 34.78%], AcpD group than Esob [64.91% vs. 48.15%] and TcpD group than AcpD [77.05% vs. 64.91%]. Stress induced ischemia [SII] was more frequent in Esob group than control [37.04% vs. 23.91%] and AcpD group than Esob [50% vs. 37.04%]. However, its occurrence was almost similar in TcpD and AcpD groups [54.1% vs. 50%]. Observed frequency of myocardial infarction was almost same in control [10.87%] and Esob [11.11%] group. Incidence of myocardial infarction was higher in AcpD group than control [14.91% vs. 10.87%] and TcpD group than AcpD [22.95% vs. 14.91%]. Our study concludes that incidence of myocardial ischemia and infarction is quite high in patients with type-II diabetes mellitus presenting with exertional dyspnea. Presence of chest pain further increases the likelihood of CAD in these patients. We should perform MPS in all patients with type II diabetes mellitus who present with exertional dyspnea, even if they have no chest pain