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

Role of serum procalcitonin in sepsis

Objective: Role of serum procalcitonin in sepsis

Study Design: Descriptive / Cross sectional study

Place and Duration of Study: This study was carried out at the Mamji Hospital Karachi from January 2013 to July 2014

Materials and Methods: The adult patients presented with short duration of fever, altered consciousness, bed sores, cough, increased frequency of urine, diarrhea and vomiting and abdominal pain. ESR, CRP and serum procalcitonin level were sent simultaneously with blood, sputum and urine cultures. The study was conducted in Mamji Hospital F. B. area, data was recorded in a preset proforma. The features like biodata, symptoms/signs, biochemical test and cultures reports were shown in tables. The data was analysed on SPSS version 15

Results: In this study total cases were 33. Males were 19[55%] and 14[45%] were females. The mean age was 47 +/- 19. With the age range from 28 to 68 years. Males were slightly more than females. The patients were divided into two groups according to the level of procalcitonin. Group I were those with raised procalcitonin level > 0.5 and group II were those with procalcitonin level < 0.5. The ESR and CRP were raised in every case. In Group I total number of cases were 27, pneumonias 06 cases, UTI06 cases, bacterial meningitis 05 cases, bacterial dysentery 05 cases, skin infection 04 cases and septic arthritis 01 cases. In group II total cases were 06, 02 cases were viral one is cytomegalovirus and other is Epstein-Barr virus, 01 cases was connective tissue disease and was diaganosed as systemic lupus erythematosus 01 case was wegner's granulomatosis, 01 case was bronchogenic carcinoma and 01 was peripartum cardiomyopathy. The culture report showed 08 cases were E coli, 6 cases were pseudomonas aeroginosa, 5 cases were staphylococcus aureus, 3 cases Enterobacter 03 cases and streptococcus pneumonia 02 cases

Conclusion: In cases with fever the early detection of high serum procalcitonin level will clearly differentiate between inflammatory conditions caused by bacterial rather non bacterial conditions

Beyond the liver! extra hepatic manifestations: assessment of frequency and risk factors among hepatitis b and c related chronic liver diseases

Objectives: The study aimed to determine the frequency and risk factors for Extra Hepatic Manifestations among patients with Hepatitis B and C related Chronic Liver Diseases

Study Design: Cross Sectional Study

Place and Duration of Study: This Study is conducted at the Department of Medicine [Both indoor and outdoor patients] of Civil Hospital, Karachi from 2012 to 2016

Materials and Methods: In this study of 548 patients, who were positive for HBV or HCV, fulfill the selection criteria and were suffering from Chronic Hepatitis, Cirrhosis or HCC were examined for Extra Hepatic Manifestations clinically and if required appropriate tests were done to confirm the diagnosis and finding. Frequency and risk factors were determined for extra hepatic manifestations. Test of statistical significance were applied where p value of <0.05 was considered to be statistically significant cut-off

Results: Majority of patients 432 [78.8%] were HCV Positive and 116 [21.2%] were found to be HBV positive. Overall frequency of extra hepatic manifestations was found to be 54.7 %. Patients with chronic hepatitis C and B. The Extra Hepatic Manifestations of 60.6 % in HCV and 32.8% in HBV respectively. Diabetes Mellitus [DM] is the most common extra hepatic manifestation found in both, chronic HCV [19.0%] and chronic HBV patients [5.2%] whereas hypertension is the second commonest extra hepatic manifestation among HBV patients [12.1%]. Disease duration > 5 years, age> 45 years, Viral PCR, Raised ALT and Hepatocellular Carcinoma associated with chronic HCV and HBV were found to be significant risk factors for extra hepatic manifestations

Conclusion: Extra Hepatic Manifestations are more common in HCV associated liver diseases than HBV. Diabetes and hypertension are the main extra hepatic manifestation among HBV and HCV positive patient. Disease duration > 5 years, age> 45 years, Viral PCR, Raised ALT and HCC associated with chronic HCV and HBV were found to be significant risk factors for Extra Hepatic Manifestation

Evaluation of upper right abdominal pain in patients of dengue fever

Objective: To Evaluate patients with upper Right abdominal pain in dengue fever

Study Design: Prospective descriptive study

Place and Duration of the Study: This study was conducted at Mamji Hospital Karachi between August 2012 to October 2014

Materials and Methods: The patients presented with confirmed dengue fever with upper right abdominal pain. The study was conducted in Mamji Hospital F.B area. The data was gathered and analysed on SPSS version 15

Results: Total cases were 113.Males were 62 [55%] and 51[45%] were females. The mean age was 27 +/- 9. With the range from 18 to 36 years. Males were slightly more than females. The causes of abdominal pain were acalculuscholicystitis in 57 cases[50%], hepatitis in 17 cases[15%], pancreatitis in 5 cases[4.4%] and no cause was detected in 34 cases[30%].Total leukocyte count was not high and thrombocytes were low in every case. SGPT was mildly[Less than 100]raised in 71 cases [63%], moderately raise [more than 200] in 27 cases [23%] and severely raised in 12 cases [10.6%][more than300] and in 03 cases [3%] the SGPT was normal. Ultrasound finding of acute acalculus cholecystitis were enlarged gallbladder with thickened wall in 57 cases [50%] while 9 cases [8%] had gall stones without inflammatory signs. Perihepatic fluid in 35 cases [31%]. Swollen pancreas were noted in 5 cases [4.4%].Amylase were raised in 13 cases [11.5%] and serum lipase were raised in 5 cases [4.6%]

Conclusion: The acalculuscholecyctitis is one of the commonest cause of upper abdominal pain in denguefever. It is also consider as an early sign of severeinfection

To see the synergistic effect of PP1 and itopride in functional dyspepsia

To see the synergistic effect of PPI and Itopride in functional dyspepsia. Prospective descriptive study. The study was conducted in a tertiary care hospital, Al-Tibri Medical College and Hospital, a three hundred bedded hospital from Feb 2011 to Dec 2011. The patients reported in the OPD were included in this study and they were screened according to inclusion criteria with complained of upper abdominal pain, fullness, chest burning and bloating. All the data were recorded in a preset performa and result were analyzed by SPSS version 15. A total of 54 cases were included. Male were 25 and females were 29. All the patients were presented to OPD with upper abdominal pain 51 cases, chest burn 49 cases, abdominal fullness43 cases and bloating in 37 cases. The symptoms were persistent for more than two weeks. The entire patients were inquired about the comorbids, like hypertension, diabetes mellitus, ischemic heart disease, rheumatism, or on steroids and that all excluded from the study. All the patients had negative H Pylori status and had undergone upper gastrointestinal endoscopies. All the patients were started on PPI and itopride in low and high dose regime according to the symptoms. Improvement of the symptoms was accessed at the end of fifth day. Nearly 82 % of the patients had improved on the fifth day of the therapy while the other the rest of the patients were started with a higher dose and additional 10 % were benefited at the end of 2[nd] week. All the patients were treated for four week and then they were followed for next four week for the recurrence of the symptoms. In the first follow-up of four weeks 44% of the patients had sustained complete response in their symptoms. The combination of PPI and Itopride has synergistic effect in functional dyspepsia. Further studies are required to prove their efficacy

Role of pregablin in neuropathic pain

To evaluate the role of pregablin in neuropathic pain. Prospective descriptive study. This study was conducted in the department of medicine of Al-Tibri Medical College and Hospital from Jan. 2011 to Jan 2012. A prospective study conducted in a private hospital of Karachi from Jan 2011 to Jan 2012. A total 107 cases were enrolled. All patients are adult above 18 years of age. The neuropathic pain was analyzed by Leeds Assessment of Neuropathic symptoms and sign [LANSS]. The pain was assessed by numeric pain rating scale. The data was recorded on a preset performa. Primary disease was also controlled and all the patients were given pregablin 50-150mg/day for two-six weeks. The symptoms were re assess by numeric pain scale. The SPSS 16 used to analysed. Total number of patients were 107. Male were 52 while female were 55. The patients were grouped according to pathology. The most common pathology was Diabetes in 49 cases [45.79%] followed by hypertension in 35 cases [32.71%] and herpes zoster in 27 cases [25.23%]. The age ranges from 42-72 years with mean age is 56.66 +/- 16. The dose ranges from 50-150 mg per day and the duration of treatment were two- six weeks. The pregablin was superior in relieving pain and sleep in patient with diabetic neuropathy and post herpetic neuralgias. The adverse effects noted were somnolence, lethargy and ataxia. Two of the cases were stopped treatment due to somnolence. The result of adding pregablin in the treatment of a patient with neuropathic pain was very successful and it is improving the quality of life and sleep

To evaluate different features of pyogenic liver abscess

To evaluate different features of pyogenic liver abscess. Prospective descriptive study. This study was conducted in the Medical Department of Al Tibri Medical College and Hospital, Karachi from Jan 2011 to Jan 2013. Patient presented with upper abdominal pain and fever of more than two weeks duration. All patients undergone ultrasound of abdomen reported at Al Tibri Medical College and hospital were enrolled in the study. All data was recorded in a preset proforma and features like biodata, symptoms, sign, biochemical test, ultrasonographic finding, culture and sensitivity of pus were assessed. The data were analyzed on SPSS version 15. Total cases were 67. Male were 47 and female were 20. The mean age was 47 +/- 18. With range from 29 to 65 years. Male were more as compared with females. The commonest symptoms were abdominal pain in 43 cases [64%], fever was in 39 cases [58%], anorexia was in 39 cases [58%], Jaundice was in 29 cases [43%], weight loss in 24 cases [37%], raised ESR was in 42 cases [62%], raised leukocyte count was in 57 cases [86%], raised bilirubin in 46 cases [69%] ALT was raised in 27cases [40%] and alkaline phosphatase was raised in 20 cases [29%], ultrasound abdomen showing single abscess in 55 cases [83%] and multiple in 12 cases [17%], right lobe involvement in 53 cases [79%], left lobe involvement in 14 cases [21%], 37 cases [55%] were under gone therapeutic percutaneous ultrasound guided aspiration of the abscess . Culture were positive in 49 cases [73%], in which Klebsella pneumonia was the commonest organism found in 22 cases [45%], Enterococcus supp were in 11 cases [23%], E-coli were in 9 cases [18%], While the culture is negative in 18 cases [27%]. No mortality were recorded. The pyogenic liver abscess is one of the common cause of upper abdominal pain and fever of longer duration

Frequency of hepatitis B and C in patients reported at Al-Tibri medical college and hospital

The aim of this study is to determine the frequency of hepatitis B and C in the residents of Malir district who reported to Al Tibri Medical College and Hospital. A Cross Section Prospective study. The study was conducted in the Department of Medicine and Pathology of Al Tibri Medical College and Hospital from May 2010 to April 2011. This study was based on the data of patients who reported to the hospital in a year. Pakistan is a developing country. On one side we have a population burden and on the other side communicable diseases. Viral Hepatitis is one of them. In general population the frequency of hepatitis B and C viral infection ranges from 8-15%. Rapid Chromatography immunoassay and ELISA were the methods for the tests. The data was collected in a preset Performa and analyzed on SPSS version 16. Total of 2093 specimen were reported. Both hepatitis B surface antigen and anti HCV antibody were checked. Total number of persons screened were 2093. Out of them male were 963 and female were 1130. HBV were 124 positive cases while 426 were anti HCV positive. This showed that HBs antigen were 5.9% while Anti HCV antibody were 20.35%. Among HBs Antigen positive cases 61% were males while 39% were females and in Anti HCV antibody positive cases the females were 67% while 33% were males. Hence combined infection were 2.7%. Cases were divided into five groups according to their ages. The group of ages between 25 to 45 had maximum positivity. The frequency of HBV and HCV in this particular area of our great province is quite high. This is the time to educate the general population of area so as to prevent the disease

Endoscopic Findings of Patients Reporting With Upper Gastrointestinal Symptoms - A Study of 1493 Cases

OBJECTIVE: Endoscopic findings of patients reporting with upper gastrointestinal symptoms

STUDY DESIGN: A retrospective observational study

PLACE AND DURATION: Shaukat Omar Memorial Fauji Foundation Hospital, Karachi and Khan Diagnostic Laboratories, Malir Karachi from January 2001 to May 2010

METHODS: All the consecutive cases that underwent upper gastrointestinal endoscopic examination during January 2001 to May 2010 were included in the study. The computerised data of these cases was retrieved from hospital record. The cases were thoroughly reviewed regarding their history, examination, investigations and findings of the endoscopy. Patients with known gall bladder and pancreatic diseases and advanced malignancies were excluded. Results were compiled and statistically analysed using SPSS v.16

RESULTS: A total of 1493 patient were included. Male to female ratio was 1.4:1. Mean age was 44.38+13.52 years. The common indications were dyspepsia, dysphagia and haemtemesis. Four hundred and thirteen [27.7%] endoscopies were normal. The common pathological findings were Oesophagitis 25%, duodenal ulcer 12.9%, Gastritis 11.7%, gastric ulcer 8.4%, esophageal malignancies 4.5%, gastric malignancies 4.3% others i.e. less common findings [oesophageal web, oesophageal stricture, oesophageal varices, oesphageal candidiasis, achalasia etc] were 5.5%

CONCLUSION: Upper GI endoscopy is an important diagnostic tool for patients of upper GI symptoms to differentiate pathological from non-ulcer dyspepsia. Upper GI endoscopy is recommended in all cases of dyspepsia to evaluate the actual pathology

Vitamin D status in young female reported with backache

To evaluate the Vitamin D status in young females who reported with the complaint of backache. This study was conducted in a private hospital in Karachi from Aug. 2010 to Dec.2011. A descriptive prospective study. This study was conducted in two private hospitals Memon Medical Complex and Mamji Hospital from Aug 2010 to Dec. 2011. In this study 113 adults females were taken. The age range between 21-35 with mean age 27.2 +/- 4.6 years. They attended the hospital with complaint of backache. The patients were enrolled through a Proforma with an inclusion and exclusion criteria. The Proforma recorded the basic information i.e. age, marital status, pregnancies, occupation, work load, duration of sun exposure, area of skin exposed, veiled, type of residence and dietary habits. The serum vitamin D level and simultaneously the serum calcium, phosphorus and alkaline phosphatase. X-ray Lumbo/Sacral spine and pelvis were taken. All these tests were got done from a well reputed laboratory. Total of 113 cases, age ranging from 21-35 years with mean 27.2 +/- 4.6. All were females. Subjects were predominantly married 84 [74.33%], 54 [64.28%] had multiple pregnancies, 29 [25.66%] were house wives, 84 [74.33%] were working women, 34 [30.08%] were doing heavy work, sun exposure was almost negligible, 80 [70.79%] were veiled, 30[26.54%] had opened face, 11[9.73%] had opened face and forearm, 97[85.84%] were lived in flats, dietary habits were poor, black burqa were using outside. Vitamin D was deficient in 83 [73.45%] cases, insufficient in 21 [18.58%] cases and near normal in 9 cases[7.96%]. Inspite most of them belonged to middle class socio-economic status. The calcium was low in 90 cases [79.64%] while phorphorus was low in 83 cases [73.45%] and alkaline phosphate was not correlated positively. The X-ray of L/S spine and pelvis showed straightening of the spine and osteopenia. Vitamin D deficiency was the main reason of back pain of the young females

Clinical presentation and evaluation of histopathological patterns of hospital-based frequency of thyroidectomic biopsies

The aim of this study is to evaluate the clinical presentation of different histophathological pattern of hospital-based surgical thyroidectomic specimens. Multicentre, Prospective Study. This study was conducted at the department of Pathology, Isra University Hyderabad; Liaquat University of Medical and Health Sciences, Jamshoro; Memon Hospital, Hyderabad and Al-Tibri Medical College and Hospital, Isra University Karachi Campus from July 2009 to December 2011. In the present 358 thyroidectomic specimens were collected from four different hospitals of Sindh. Specimen of thyroid tissue was taken after the end of thyroidectomy. The tissues were fixed in buffered neutral formalin and after processing embedded in paraffin to form tissue blocks. A 5 micro m thick sections were cut by microtome and the sections were then stained with Hematoxylin and Eosin [H and E] strain. Special stain like PAS were also used for confiring specific diagnosis. The histopathalogical examination was then carried out for any morphological changes. The results showed that hospital-based frequency of throidectomy specimens was found to be 4.1%, indicating that the thyroid diseases are common in plain areas of Sindh. Multinodular goiter was the most common histopathological pattern in 202 cases and usually presents as asymptomatic lump in the neck. Thyroid neoplasms were found to be the second most common disease in 94 cases specially in the follicular adenoma and papillary carcinoma. The mean +/- SD age of the patients in 358 thyroidectomy specimen was 32.65 +/- 10.66 years. The persons having age ranges between 10 to 70 years were considered. The youngest patient included in our study was 10 years old female with colloid adenoma. The female to male ratio was 2.5:1. Thyroid diseases are common in plain areas. Multinodular goiter is the most prevalent thyroid disease. Follicular adenoma and papillary carcinoma are the most frequent thyroid neoplasms. It is therefore concluded that multinodular goiter and thyroid neoplasm are the most common pattern in thyroid diseases in these ares