Knowledge, attitude and practices of dentists about hepatitis B and C infection in Lahore

To assess the knowledge, attitude and practices of dentists of public and private sector in Lahore about Hepatitis B and C infection. This cross-sectional analytical study was conducted on private dental practitioners and public sector dental surgeons working in hospitals of Lahore. Private sector dentists of Lahore working in Shahdara, Badami Bagh, Mughalpura, Baghbanpura, Gulberg, Shadman, Mozang, Feroz pur Road, Model Town, Multan Road, Johar Town and Tohkher Niaz Baig were selected for the study. In the public sector hospitals, dental surgeons were selected from Demont Morency Dental College and Hospital, Mayo Hospital, Services Hospital, Govt. Mozang Hospital, Jinnah Hospital, Lahore General Hospital, Mian Munshi Hospital, Sheikh Zaid Hospital, Railway Hospital, Wapda Hospital and Combined Military Hospital by using convenient sampling technique. A self-administered, close- ended questionnaire was used and information was gathered about their knowledge, attitude and practices for HBV/HCV infection and its prevention. Data was entered in the SPSS-13 computer program. Frequency and percentages were calculated for different segments and comparison between the two groups was performed by using z-test for proportion. p-value

Prevalence of dyslipidemia in patients with type-2 diabetes mellitus

The dyslipidaemia associated with type-2 diabetes is associated with raised plasma triglycerides, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels and is a risk factor of cardiovascular disease. To assess the lipid abnormalities in patients with type-2 diabetes. A cohort study carried out at Diabetic Clinic of PMRC Research Centre, FJMC, Lahore, Pakistan. Eight years case records of type-2 diabetic patients seen at the research centre from 1999-2006 were reviewed. The research centre is a specialized centre for diagnosing and treating diabetes mellitus. All the patients were recruited for their follow up check up and laboratory investigations for dislipidemia. Adult treatment panel III guidelines for dyslipidaemia were followed. A 12 hours fasting blood sample was collected from each patient for serum total cholesterol, triglycerides, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and glucose as well as glycosylated hemoglobin [HbA1c] by using standard methods at Biochemistry laboratory of the research centre. LDL-C/ HDL-C ratios, Very low-density lipoprotein cholesterol [VLDL-C] and body mass index was calculated after anthropometery body mass index [BMI] >/= 25 was considered as overweight while >/= 30 obese. HbA1c<6.1 was considered as poor glycemic control. Data was analyzed by using statistical software SPSS-15. a total of 1200 type-2 diabetes were seen in 8 years. There was poor glycemic control, in 87.5% subjects judged on blood HbA1c levels. These patients had higher total cholesterol, LDL-C and low HDL-C levels in blood. The percentage of patients with high, borderline and near optimal risk LDL-C was 62.7, 26.9 and 10.4% respectively, while HDL-C >40mg/dl were seen in 67%. Raised VLDL-C [above 40 mg/dl] was seen in 32.9% cases. The group with high LDL and VLDL is at risk of developing cardiovascular disease. Hypertriglyceridaemia was found in 55% and hypercholesterolaemia in 45.4% cases. Obesity as indicated by body mass index was found in 53.7% patients. Statistically significant association of hypercholesterolemia, hypertriglyceridemia, hypo HDL cholesterolemia and VLDL-C was found with advancing age while only hypertriglyceridemia and VLDL-C showed a positive association with duration of diabetes. A significant association of hyperglycemia [raised HbA1c] was seen with hypertriglyceridemia and high LDL-C along with high body mass index i.e. obesity. Hypertriglyceridemia, high LDL-C and VLDL-C, low HDL-C levels and obesity were the pattern of dyslipidemia found in our diabetic population

Detection of peripheral arterial disease [PAD] in diabetics using ankle brachial index [ABI]

To evaluate the Ankle Brachial Index [ABI] in the detection of peripheral arterial disease [PAD] among diabetic patients. Diabetic clinic of PMRC Research Centre, Fatima Jinnah Medical College, Lahore. Cross sectional descriptive. This pilot study included 95 diabetic patients with ages 40 years or above and duration of the disease was more than 5 years. Detailed history including treatment was documented. During examination systolic blood pressure in the right and left arms [Brachial Pressure] was measured and documented. Systolic Blood Pressure in both ankles was measured using ultrasound Doppler probe [Huntleigh Super Doppler - II]. Left and right ABI were obtained by dividing brachial systolic pressure with ankle systolic pressure. A ratio of 0.9 or above was taken as normal. The study included 95 patients [15 males and 80 females] with mean age 51.90 +/- 9.49 years and mean duration of diabetes 13.23 +/- 5.83 years. Smoking was observed in 53.30%, hypertension in 57.89% and 71.57% had dyslipidemia. ABI ratio was mildly abnormal in 52.68%, moderately abnormal in 7.38% while it was normal in 38.94% cases. Duration of thedisease was negatively correlated [r = - 0.650 and 0.937] with ABI and correlation was highly significant [p < 0.047 and 0.008]. Blood sugar and lipid levels were not significantly correlated with ABI. The results conclude the detection of high percentage [60.08] of abnormal ABI in this group of patients. Ankle brachial index, a non-invasive and simple technique, may be used to screen the detection of PAD and diabetic foot

Risk factors for syphilis and HIV infection in pregnant women attending a tertiary care public sector hospital

Syphilis, a sexually transmitted disease which seemed to have disappeared or had been controlled over the years, has now been re-emerged as a major public health problem in many communities. It can complicate the pregnancies with serious consequences. Appropriate treatment of pregnant women often prevents such complications. To study the frequency of syphilis in pregnant women attending a tertiary care public sector hospital, and see the positivity for HIV/AIDS among syphilis positive women. This cross sectional and interventional study was conducted among pregnant women attending Sir Ganga Ram hospital for antenatal care at PMRC Research Centre, Fatima Jinnah Medical College, Lahore. Blood samples from 2000 women were collected after taking consent. The blood was tested for syphilis by Treponema Pallidum Haemagglutination.History of the subjects for risks factors was also taken. Syphilis positive women were further screened for human immunodeficiency virus positivity. The treponemal antibodies were detected in less than one percent [9] pregnant women. The highest positivity was observed among age group of 21-26 years. Women in third trimester were significantly more infected with syphilis. Risk factors included husband's history with frequent traveling and drug abuse. All husbands of syphilis positive women were also positive. All syphilis positive women and their husbands were negative for Human immunodeficiency virus /Acquired immune deficiency syndrome. Less than 1% of pregnant women were infected with syphilis, and most of the spouses of these positive women were either travelers or drug addicts. Screening for syphilis should continue in pregnant cases and high risk individuals

Insulin resistance, liver enzymes and the metabolic syndrome

The objective of the study was to test the hypothesis that enzymes conventionally associated with liver dysfunction [alkaline phosphatase, aspartate aminotransferase, alanine arninotransferase] may predict diabetes. Three hundred type-2 diabetics were selected from Diabetic clinic and one hundred and fifty non-diabetes control from population. Biochemical testing of fasting and 2 hours serum insulin, renal, liver functions and protein was measured by using standard method and instruments. Insulin resistance was calculated using the homeostasis model assessment for insulin resistance [HOMA-IR] method. Statistical analysis of samples and control subjects were done by using SPSS-13. At baseline all three enzymes were related to most of the features of the metabolic syndrome. Serum alkaline phosphatase levels as well as serum transaminases also showed a statistical significant difference at P<0.05. The HOMA-IR in the type-2 diabetic group was significantly greater than that of the control group [mean +/- SD 3.84 +/- 2.3 vs. 1.62 +/- 0.79 units [P<0.05]. Serum total proteins and albumin significantly reduced in type-2 diabetic subjects. Mild elevations in liver enzymes and decreased levels in serum proteins are associated with features of the metabolic syndrome

C-reactive protein levels in type-2 diabetes mellitus amongst the local population

The objective of this study was to assess the levels of C-reactive protein in type-2 diabetes mellitus patients in the local population. Serum samples of patients of sixty type-2 diabetes mellitus and thirty healthy subjects acting as control of same age and sex matched were included from the general community, ensuring similarities of their basic confounding factors. Duration of type-2 diabetes of these subjects was also recorded. Sera were stored at-80°C till analysis. Estimation of CRP was done by a microplate immunoenzymometric assay. HbAlc levels in blood were done by using a commercial kit. Baseline values for HbAlc and CRP were assayed in the diabetic as well as control samples. CRP levels in serum were significantly higher among diabetic participants compared to the control subjects [P<0.05]. Among diabetic participants, higher levels of HbAlc were associated with higher level of CRP. CRP levels during different duration of type-2 diabetes were 3.4 +/- 1.35 micro g/ml in type-2 diabetics and 1.37 +/- 1.10 micro g/ml in control subjects having duration less than one year [P<0.05] similarly, 1-5 years 6-10 years and 11-15 years of duration had levels 4.90 +/- 1.57 micro g/ml, 4.60 +/- 1.90 micro g/ml and 4.42 +/- 1.20 micro g/ml respectively in type-2 diabetics and control subjects had 1.85 +/- 1 .20 micro g/ml, 1.40 +/- 1 .70 micro g/ml and 1.22 +/- 1.10 micro g/ml respectively. Diabetes having 16-20 years duration showed a non significant behavior. Our findings show that patients having type 2 diabetes had higher CRP levels in serum compared to the control subjects. Duration of disease and HbAlc levels showed statistical significant differences

Syphilis screening: outcome and interventions at an antenatal clinic

Syphilis, a sexually transmitted disease which seemed to had been controlled over the years, has now been re-emerged as a major public health problem in many communities. It can complicate the pregnancies with serious consequences. While appropriate treatment of pregnant women often prevents such complications. To study the frequency of syphilis in pregnant women coming to a public sector hospital and see the pregnancy outcome of positive mothers and disease transmission in neonates. This cross sectional and interventional study was conducted at PMRC Research Centre, Fatima Jinnaha Medical College, Lahore among pregnant women attending Sir Ganga Ram hospital for antenatal care. Blood samples from 2000 women were collected after taking consent from them. The blood was tested for syphilis by using Treponema pallidum haemagglutination assay. Infected mothers were administered intramuscularly with 2.4 million units of benzathine benzylpenicillin [penicillin G] after testing for hypersensitivity and followed for delivery outcomes such as abortion, miscarriage, intrauterine growth restriction, low birth weight, preterm delivery and still birth. Neonates born to infected women were examined for signs of congenital syphilis including non immune hydrops, jaundice, skin rash, pseudo paralysis and running nose along with blood test for either infection. Medical and reproductive histories were also obtained from women and recorded on a proforma. The treponemal antibodies were detected in 9[0.45%] pregnant women. The highest positivity was obtained among age group of 21-26 years. There was no statistically significant difference of acquiring infection among women of different age, education, and socioeconomic backgrounds. Women in third trimester were significantly more infected with syphilis. Out of 9 couples 3 refused treatment, 1 received only one dose of penicillin, 2 received two doses while only three couples completed all doses. Delivery outcome included one abortion, two preterm deliveries and none of the neonate had sign of congenital syphilis. Only one couple consented for blood sampling of their neonate which was positive for syphilis and was referred to pediatrician. Only 9[0.45%] of pregnant women were infected with syphilis, which can seriously complicate pregnancy and result in spontaneous abortion, and preterm delivery. Screening for syphilis in pregnant women is recommended to detect infected woman who requires treatment to prevent further transmission of this disease to new born

audit of clinicopathological indications of abdominal hysterectomy

To determine clinical indications of abdominal hysterectomy and compare these with histopathological diagnosis. A descriptive study. Case records of all the women that underwent major gynaecological operations in one calendar year period i.e. January to December, 2005 were reviewed. The cases that underwent total abdominal hysterectomy were selected and studied for the indications. All the patients had been admitted through the out patient department [OPD] for the complaints of irregular vaginal bleeding with or without pain and mass in lower abdomen. A total of 306 major gynaecological operations were carried out, of which 180 [58.81%] were abdominal hysterectomies. Majority of the women [65%] were between 35-45 years of age. The most frequent presenting symptom was pain and irregular vaginal bleeding [57.5%], irregular vaginal bleeding [25%] and mass in lower abdomen [7.2%]. Disparity was found between clinical and histopathological diagnosis in cases of leiomyoma [36% clinical and 38.3% histopathological] and adenoma [11.1% clinical and 27.2% histothological]. Clinical diagnosis of dysfunctional uterine bleeding was made in [26.1%] of which only 20% were confirmed histopathologicaly. There was a disparity of 6 - 16% between clinical and histopathological diagnosis especially in cases of adenomas, dysfunctional uterine bleeding and leiomyoma. Therefore, accurate clinical assessment of cases should be the main stay of diagnosis and categorization for different indications of hysterectomy

Antenatal screening of women for hepatitis B and C in an out-patient department

To determine frequency of hepatitis B virus [HBV] and hepatitis C virus [HCV] and its clinical manifestation in pregnant women. A cross-sectional descriptive study. Pregnant women visiting the Gynaecology and Obstetrics out patient's department of Sir Ganga Ram Hospital Lahore for antenatal check-ups from October 2006 to March 2007 were screened for hepatitis B and C. Immune- chromatography was used for initial screening and diagnosis was confirmed by ELISA technique. Data collection included maternal age, parity, symptoms or past history of jaundice, fatigue, tiredness, insomnia, depression, dyspepsia, fever, anorexia and pale stool. Risk factors investigated include past history of some surgical procedures, the dental visit, blood transfusion, tattooing, hospitalization and history of injection. Among the screened population, 7.3% out of 2439 ladies were positive for anti HCV and 2.2% for HBsAg while dual infection with HBV and HCV was observed in 0.08%. Symptoms observed in hepatitis B patients were fatigue [90%], depression and pale stool [70%], anorexia [60%], jaundice [57.2%], fever [56.4%] and dyspepsia [51.2%]. In hepatitis C antibody positive patients fatigue was the main symptom [95.7%] followed by pale stool [84.5%] and depression [80.2%]; 63.3% had insomnia, 59.1% had anorexia, 50.7% had fever, 50.7% had jaundice and 43.6% had dyspepsia. Past history of blood transfusion was reported by 32.3% patients, surgery by 42.2% and tattooing was observed in 0.70%. One or more tooth extraction was reported by 50.2% subjects, and 49.25% had history of repeated injections. The frequency of sero-positivity for HBsAg and HCV among pregnant women is alarming. These sero-positive mothers are not only predisposed to chronic consequences of hepatitis, but also are a continuous threat to their off springs and care providers. Hence, there is a direct need for further epidemiological studies and to take measures for prevention and control of the disease

Insulin resistance and cardiovascular risks in type-2 diabetic population

To determine the presence of diabetes mellitus and other conventional coronary heart disease risk factors such as hypertension, hyperlipidemia and sedentary lifestyles in patients with acute coronary events in Pakistani population. This study included 300 type-2 diabetic patients selected from diabetic clinic of PMRC Research Centre Fatima Jinnah Medical College and Sir Ganga Ram Hospital Lahore with insulin resistant type-2 diabetics, unstable angina or myocardial infarction [MI]. One hundred and fifty control subjects without diabetes, myocardial or other coronary artery disease were also included in this study. Out of all patients 41.66% were female while 58.34% males and duration of diabetes was 0-3 years in 8% cases. Frequency of cardiovascular complications in type-2 diabetics were noted in 40.66% having hypertension, angina pectoris in 12.33%, congestive cardiac failure in 2% and MI in 2% cases. Location and extension of MI and myocardial enzymes did not differ between diabetics and non-diabetic patients. Age, duration of diabetes and HbA1c levels, did not differ between diabetic patients with or without MI. Hypertension and current smoking was significantly higher in patients with MI compared to patients with unstable angina [P< 0.05]. Serum TG, HDL-C, LDL-C and total cholesterol level did not differ between patients with MI and unstable angina. In this study insulin resistant type-2 diabetic patients have at least one of conventional cardiac risk factors. Diabetes and hypertension are leading risk factors, which may directly or indirectly interfere and predict more serious complications of coronary heart disease

PAP smear screening in hospital based population

To reduce the mortality rate in women due to cervical cancer by early detection. To calculate magnitude pattern and proportion of PAP positive cases among high risk population and associate variables to PAP positive cases. Descriptive, cross-sectional Gynaecology and Obstetrics out patient department of Shaikh Zayed Medical Complex and Sir Ganga Ram Hospital Lahore from June 2005 to May 2006 The smears were analysed in Histopathology department of Shaikh Zayed Medical Complex. A total of 1500 smears were taken, 511 [34.1%] from Sir Ganga Ram Hospital and 989 [64.9%] from Shaikh Zayed Medical Complex. The mean age was 42 +/- 8 years with a range of 35-80 years. Prevalence of positive cases was 3.9% with majority of [2.5%] falling in the age group 35-40 yrs. Cases with positive cervical intraepithelial neoplasia [CIN] had strong association with family history of cancer [p-<0.002, OR=3.284,CI: 1.497-7.2203]. On examination cervix bled to touch in 25 cases [p-<0.0001.0R=2.721,Cl: 1.595-4.645], it was suspicious looking in 8 cases [p-<0.0001,OR=8.714,CI:3.758-20.21] and 5 cases had post menopausal bleeding [p-<0.006. OR=3.582,CI: 1.354-9.481]. However no association was found with smoking, hormonal intake or post coital bleeding. PAP smear should be used as a routine test for every woman aged 35 or above coming to the gynaecology department for symptoms of abnormal vaginal discharge, bleeding, or low backache for early detection of cervical cancer

Microalbuminuria as an indicator of kidney function among diabetics

To find out the role of microalbuminuria as an indicator of kidney function among diabetics. Comparative study. Diabetes control clinic of Shaikh Zayed Hospital, Lahore, a tertiary care hospital, was the venue. The study was conducted during March 2002 to August 2003. Timed overnight urine samples were collected from all subjects and albumin was estimated using Radioimmunoassay [RIA] method. Albumin excretion rate [AER] was assessed in three groups including normals, Type 1 and Type 2 diabetics. AER over 30 mg/min was considered as significant. A significantly higher proportion of AER was observed in both types of diabetes. A higher proportion of increased AER was observed in females of Type 2 diabetics. The study has indicated that irrespective of the duration and type of diabetes the damage to the kidney can be avoided if good glycemic control is achieved