Identification of Cryptosporidium parvum Oocysts among Hospitalized Children under-5years in Northeastern Nigeria

Cryptosporidium parvumis among the major pathogens causing diarrheal diseases in children. It is of major public health significance due to its low infectious dose and its oocysts are highly resistant to chlorination, common household disinfectants and survive long periods in the environment. This study was designed to evaluate the occurrence of Cryptosporidium parvum oocysts in stool of hospitalized children under-5years. One hundred and fifty (150) stool samples were collected from one hundred and fifty children (Male:Female= 1:1.08, Mean Age±S.D=22.08 months ± 21.02) and were processed using the modified Ziehl-Nelson method for identification of protozoan oocysts. Out of the one hundred and fifty (150) stool samples analyzed, 16 tested positive to oocysts of C. parvum, which gives a parasite prevalence rate of 10.7%. This was observed to be higher among male patients (52.0%) and children between the age 32-41months (31.3%). Parasite prevalence in relation to age of patients was statistically not significant (X2=0.105, DF=1, P-value= 0.74591, p<0.05). Other intestinal protozoan parasites identified include Entamoeba histolytica(1.33%) and Giardia lamblia (2.60%

Effect of Leaf Extract of Senna alata on Biochemical Indices of Wistar Rats Infected with Trypanosoma brucei brucei

This study was aimed at determining the effect of leaves of Senna alata extract on biochemical indices of Wistar rats infected with Trypanosoma brucei brucei . Phytochemical screening revealed the absence of steroids in all extracts, absence of saponins in chloroform extracts and the presence of free anthraquinones only in chloroform extract. Post - infection treatment of animals stirred the emergence of parasitaemia by Day 3. Only animals receiving 200 mg/kg b.wt. of chloroform extract survived by day 16. A significant (P<0.05) decrease in ALT for groups receiving methanol (400 mg/kg b.wt.), chloroform and aqueous extracts and significant (P<0.05) increase in unconjugated bilir ubin in the group receiving methanol extract (200 mg/kg b.wt.) compared to infected not treated rats. Significant (P<0.05) decrease in potassium concentration in groups receiving methanol and chloroform, and a significant (P<0.05) increase in sodium concen tration in the group receiving 400 mg/kg b.wt. of aqueous extract compared to the infected not treated rats. These results thereby demonstrate the ameliorative potential of Senna alata leaves against T. brucei brucei .

Smokeless tobacco consumption in a multi-ethnic community in Pakistan: a cross-sectional study

Smokeless tobacco is commonly used in south Asia. In addition to causing oral and pharyngeal cancers, its harmful effects are comparable to smoking tobacco. A cross-sectional survey with systematic sampling was conducted in 2010-2011 to investigate smokeless tobacco use in a multi-ethnic, semi-urban population in Islamabad, Pakistan [n = 2030]. The prevalence of smokeless tobacco use was 16.0% [21.6% among males and 8.8% among females]; 51.7% of smokeless tobacco users were also cigarette smokers. The rate of smokeless tobacco use was comparatively high among Pakhtun males [38.2%] and Sindhi females [22.4%]. The associations between smokeless tobacco use and ethnicity, age group, income level and cigarette smoking were statistically significant among male smokeless tobacco users. Of the sample 41.4% [840/2030] had inadequate knowledge about the health problems associated with smokeless tobacco. Appropriate interventions are needed to raise awareness of the health risks and to prevent smokeless tobacco use

Sero-prevalence of HBV and HCV in tuberculous patients at Sheikh Zayed hospital Rahim Yar Khan, Pakistan

Infections due Hepatitis B and C with co-infection tuberculosis are important health issues all over the world. In TB patients, viral hepatitis infection increases risk of drug related hepatotoxicity up to three to five times more than TB patients which do not have viral infection. The study was designed to determine the frequency of Hepatitis B and C among the tuberculous patients admitted at Sheikh Zayed Hospital, Rahim Yar Khan. This is descriptive and cross sectional study which was conducted at Sheikh Zayed Hospital Rahim Yar Khan from September 2011 to April 2012.Blood samples were collected from TB patients aseptically from Pulmonology Department Sheikh Zayed Hospital Rahim Yar Khan. HBsAg and anti HCV antibodies were detected using ICT and ELISA techniques according to SOP of the kit manual. Among the 110 TB positive patients,5.5% were positive for HBsAg and 9.1% were positive for anti HCV antibodies using ELISA technique. Whereas, 5.5% HBsAg and 10% anti HCV antibodies were positive using ICT. The transmission of HBV and HCV was expected to have occurred were mostly found in barber shop and during ear nose piercing [30%], blood transfusion [20%], visit to quack [10%] as indicated from the history. Detection rate of HCV using ELISA is greater than ICT method. Male to female ratio 1:1 and age mean was 42 with standard deviation 18.2. We found a relatively increased frequency of HBV and HCV among TB patient. Therefore TB patients should also be screened for HBV and HCV for better management of the conditions

Molecular genetics of beta-thalassaemia syndrome in Pakistan

This molecular genetics study was conducted in Karachi, Pakistan from 2004 to 2006 to provide guidelines for prenatal diagnosis programmes in the country. Blood samples of patients with beta-thalassaemia minor [n = 200] and beta-thalassaemia major [n = 150] were collected from hospitals, transfusion centres and diagnostic laboratories from different districts of Karachi, representing 5 major ethnic groups. Molecular analysis revealed 11 genetic mutations of the beta-thalassaemia gene, among which 5 mutations accounted for 88% of the total beta-thalassaemia genes identified [IVS-1-5 [G-C], Fr 8/9 [+G], Fr 41/42 [-TTCT], IVS-1-1 [G-T] and Del 619]. Other mutations identified were: CAP+1, IVS-II-1 [G-A], Cd 5 [-CT], Cd 15 [G-A], Cd 16 and Cd 30

Bacteriological analysis of drinking water from 100 families of Lahore by membrane filtration technique and chromagar

Water borne diseases are caused by pathogenic microorganisms. In Pakistan, the availability of safe water is only 40% to 60%. Therefore it becomes imperative to determine the bacteriological status of drinking water. A few laboratories perform such an evaluation and, that too, by the old method technique i.e Most Probable Number [MPN]. We evaluated 100 samples of drinking water from some areas of Lahore by the Metnbrane Filtration Technique [MFT] using CHRO-Magar. Using this technique in one step a much large volume of water can be evaluated quantitatively in a short time and with ease. Use of CHROMagar straightaway confirms the presence of Escherichia coli which is accepted universally as the indicator of fecal contamination. It was a cross sectional study. A volume of 100 ml water was filtered under the vacuum pressure through Millipore membrane filters. After filtration, membrane filters were placed on CHRO Magar and incubated at 35°C for 24 hr. Escherichia coli appeared as blue coloured colonies while coliforms yielded colonies of pink colour. Escherichia coli were further identified by API 2OE and confirmed by Eijkman test. Escherichia coli was grown from 42% samples [all Eijkman positive]. Coliform organisms were grown from 54% specimens. It was alarming that 59% of drinking water was unsatisfactory for human consumption

quantitative analysis for the toxic pesticide residues in marketed fruits and vegetables in Lahore, Pakistan

This study was an attempt to assess the health hazards faced by the consumers through possible ingestion of toxic chemicals contained in the fruits and vegetables. In this cross sectional analytical study, tomato, apple and cucumber samples were collected from four main markets of Lahore and were analysed separately for the levels of nine pesticide residues using Liquid Chromatography- Mass Spectrometry system. The levels were compared with the maximum residue limits set by the WHO for every pesticide in respective items. The results showed that most of the samples did not contain any residues of the nine selected pesticides and only two samples of tomato had detectable residues of one pesticide Imidacloprid, which were within the limits set by the WHO. So it was concluded that the analysed fruit and vegetable samples did not pose a serious threat to the health of the consumers

rare case of thiamine-responsive megaloblastic anaemia syndrome: a disorder of high-affinity thiamine transport

A three years old boy presented with sensory neural hearing loss since birth, Diabetes mellitus and anaemia. On investigation he was found to be suffering from Thiamine Responsive Megaloblastic Anaemia [TRMA] a very rare condition diagnosed in our settings

Kartagener syndrome

12 year old boy presented in ENT OPD with rhinorrhoea, nasal obstruction and chronic cough since childhood. He had hypertelorism and his nose was filled with watery and mucoid secretion with extensive nasal polyps bilaterally. Otoscopy revealed secretary otitis media confirmed on tympanometery and myringotomy. Suspicion of Kartagener syndrome came from dextrocardia and was confirmed on electron microscope that revealed missing dynin arms on quantitative estimation of cilia

Circumcision - a comparative study

This quasi-experimental study was conducted in department of surgery in Military Hospital Rawalpindi from September 2003 to January 2004 with the aim to compare the results of one of the most commonly performed surgical procedure, circumcision, by open and bone-cutter method in terms of complications such as trauma to glans, bleeding and infection alongwith cosmetic outcome. Total 200 patients were selected from Out Patients Department on the basis of non-probability convenient sampling. After careful history taking and physical examination, patients fulfilling the criteria were identified into two equal groups, one underwent open method circumcision and the other bone cutter circumcision. Parents were instructed to follow up in the surgical OPD after seven days for assessment and earlier in case of any complication. There was insignificant different in terms of bleeding, superficial infection, cosmetic appearance and trauma to glans [P-value > 0.05]. Both methods proved to be safe and effective techniques with reproducible results but it is important to emphasize that trauma to glans; a well known and catastrophic complication is more common with bone cutter circumcision especially in the hands of an inexperienced operator

Occult metastasis in carcinoma of oral cavity

To determine the frequency of occult neck node metastasis in squamous cell carcinoma of oral cavity, in particular relation to the subsite and histopathological grading, and of involvement of the level of lymph nodes in the neck in oral cavity carcinoma. Descriptive study. Pakistan Institute of Medical Sciences, Islamabad and Wah Medical College, POP Hospital, Wah Cantt. from June 2000 to August 2006. Inclusion criteria were untreated carcinoma of oral cavity, not crossing midline, having NO neck. The tumors size more than T4 were excluded. All patients had ipsilateral type III modified radical [functional] neck dissection and lymph node groups were subjected to histopathology. Occult metastasis were found in 12 out of 37 cases [32.4%]. Metastasis in tongue carcinoma was 5/14, lower afveofar ridge carcinoma metastasized in 5/18, floor of mouth carcinoma was 2/4 and buccal mucosa carcinoma was 0/1.The percentage of occult metastasis in well-differentiated carcinoma [WDSCC], moderately differentiated carcinoma [MDSCC], and poorly differentiated carcinoma [PDSCC] were 22.2, 25% and 54.6% respectively. The levels of lymph nodes involved were level I [16.7%], level II [83.3%], level III [75.5%] and level IV [16.7%]. Oral cavity is a favourable site for metastasis to lymphatics even with small tumors. Occult metastasis is so frequent even with early carcinomas that neck should be treated with primary site. It is also important to remove level IV lymph nodes along with level I, II and III

Assessment of severity of cirrhosis in hospitalized patients

Background: To assess the severity of cirrhosis at the time of presentation to hospital and to seek association between sociocultural, demographic and geographic variables and severity of chronic liver disease

Materials and Methods: One hundred consecutive cases of cirrhosis of liver admitted in Nishtar Hospital, Multan were included in this study. After history, physical examination and relevant investigations, patients were segregated into Child grade A, B and C depending upon the severity of liver disease

Results: Among 100 cases studied, 48 were male and 52 female; the mean age was 47 years [range 20 to 80 years]. Majority of the patients were from low socio economic group. Out of 100 cases 72% were from rural areas and 28% were from urban areas. It was found that most of the patients [92%] presented to hospital when their liver disease was advanced [46 patients of Child grade B and 46 patients of Child grade C] while only 8 patients had mild liver disease [Child Grade A]. Rural population had more severe disease at the time of presentation as compared to urban population. Poor and middle socioeconomic group had more severe and advanced chronic liver disease as compared to rich class [p=0.0306]. It was found that female had more severe disease at the time of presentation [P=0.0346]. Frequency of cirrhosis was found to be more above 40 years of age

Conclusion: Results of this study indicated that cases of cirrhosis of liver are referred to tertiary care units when their disease is advanced with serious complications. Moreover there is a significant association between geographic and socioeconomic status of the patients and severity of cirrhosis. It is recommended that health care personnel should be properly trained for health education and early recognition and referral of the patients of chronic liver disease to tertiary care units. This will prevent complications and with help to decrease the morbidity and mortality

Pattern of ABO and Rh blood groups in Multan region

The discovery of various blood group systems has an immense importance in transfusion medicine and medico legal field. The association of certain blood groups with various diseases like peptic ulcer is well established. ABO and Rh blood groups are the main systems to cause blood transfusion reactions. An individual blood group today, is as important as national identity card. In cases of emergency blood transfusion, the blood group data of a population is very much important. The frequency of ABO and Rh blood groups vary throughout the world. It has been observed that group B diminishes in frequency from East to West. ABO and Rh blood group data is well established in Karachi and Lahore areas, but the data is not available from Multan region. In this study six thousands young healthy voluntary blood donors of either sex belonging to Multan region comprising of 5476 males and 524 females were included from "Blood Transfusion Center Nishtar Hospital Multan" and "Fatmid Blood Transfusion Center Multan". The commonest blood group observed in this study was "B" with frequency of 36.95%. The next common was group "0" with frequency of 33.8% followed by group "A" with frequency of 21.92% and group "AB" 7.33%. The frequency distribution of Rh blood group shows that 92.17% of the subjects are Rh-+ve and 7.83% are Rh--ve

Hematologic and cytogenetic findings in eleven chronic myelogenous leukemia patients treated with imatinib mesylate at a Tertiary care hospital

Objective: To evaluate the response of Imatinib mesylate in patients with myeloid leukemia in chronic, accelerated and blast phase

Material and Methods: Eleven patients with established diagnosis of chronic myeloid leukemia were treated with Imatinib mesylate. Adverse events were documented with regular follow ups. Hematological and cytogenetic responses were assessed according to established criteria. Patients with zero percent Philadelphia positive metaphases were labeled as complete cytogenetic response while patients with 1% to 35% Philadelphia positive metaphases were termed as partial responders

Results: Of 11 cases there were 7 males and 4 females with a mean age of 39.5 years and median age 51 years [range 21-69]. Male to female ratio was 7:4. Median follow-up was 34 weeks [range 8-78]. Four patients were in blast crisis, 1 in accelerated phase and remaining six patients were in chronic phase. All patients achieved hematological response. Cytogenetic response was present in six patients, 3 were responders and the remaining were non responders. Two patients achieved complete cytogenetic response and one patient had partial cytogenetic response. Both patients with complete cytogenetic response relapsed in twelve weeks time

Conclusion: Imatinib mesylate is a drug with curative potential and can be used as a first line drug in the management of CML, however at present the cure rate is unknown

role of magnetic resonance cholangiopancreatography [MRCP] in obstructive jaundice

To evaluate the diagnostic value of MRCP in studying the sites and cause of obstructive jaundice in comparison with other imaging modalities at the Department of Radiology, Aga Khan University Hospital, from January 1999 to May 2001. Forty nine consecutive patients included 19 men and 30 women, suspected of obstructive jaundice. Patients underwent ultrasound [n=49], CT [n=11], ERCP [n=25] and biliary surgery [n=17]. Final diagnosis was established by surgical exploration, endoscopic sphincterectomy, cytology and clinical follow up. Of the 49 patients 17 had choledocholithiasis. Twenty five patients had malignant strictures, out of which 11 had non-specific malignant strictures, 7 had pancreatic carcinoma, 3 had Klatskin tumors, 3 had periampullary carcinoma and 1 had gallbladder carcinoma. Six patients had benign strictures and 1 patient had choledochal cyst. Overall, MRCP was sensitive [88%] and specific [96.8%] in detecting choledocholithiasis. MRCP sensitivity and specificity in detecting benign main bile duct stricture was equal to 83.3% and 97.6% respectively, and 92% and 100% for malignant stricture. Our prospective study confirms that MRCP, a noninvasive and well tolerated imaging technique is of value in the diagnosis of obstructive jaundice

Polycythemia vera and idiopathic eryhrocytosis: comparison of clinical and laboratory parameters

To evaluate the various clinical and laboratory parameters of Polycythemia vera and idiopathic erythrocytosis in order to differentiate between two entities at the Aga Khan University Hospital. Twenty six patients of polycythemia vera and 34 patients of idiopathic erythrocytosis were analyzed with respect to clinical features and laboratory findings. Patients with idiopathic erythrocytosis were males with a mean age of 41 years and no splenomegaly. Patients with polycythemia were older males and females with splenomegaly, red cell count of mor than 6.5 million/cmm, haematocrit 55%, leucocytosis, thrombocytosis and low erythropoietin level. Based on the above-mentioned findings, we suggest that polycythemia vera and idiopathic erythrocytosis are separate entities and the diagnosis of these can be made on the basis of clinical and laboratory parameters

Increased expression of HLA DR2 in acquired aplastic anemia and its impact on response to immunosuppressive therapy

To study the frequency of HLA DR2 status of patients with aplastic anemia and their response to immunosuppressive therapy at a tertiary care hospital. Thirty eight consecutive patients of acquired aplastic anemia were evaluated with respect to demographic features, severity of HLA DR2 status and response outcome to immunosuppressive therapy. The mean age of the patients was 24.6 years + 16.4 with a male to female ratio of 2.8:1. Positivity of HLA DR2 was markedly high in acquired aplastic anemia patients. Twenty four [65%] out of 38 patients as compared to 45 [15%] of 300 healthy controls [p<0.0001] were positive for HLA DR2. Response to immunosuppressive therapy, which included antilymphocyte globulin, cyclosporin and methylprednisolone, was available in sixteen HLA DR2 positive patients and was found satisfactory in 12/16 [75%] patients. HLA DR2 was significantly higher in patients with acquired aplastic anemia and favourable response to immunosuppressive therapy was also associated with HLA DR2 positivity

Prevalence of hepatitis C virus and its serotypes in Bahawalpur divison

To find the prevalence of hepatitis C virus serotypes in Bahawalpur division Design: It was a prospective study to asses the frequency of HCV serotyping Settings All the patients coming for the treatment of liver disease from Jan 2000-Dec 2002 in the departments of medicine and consultants in BVH Bahawalpur Subjects and Methods 125 patients of chronic liver disease, with persistently raised SGPT and positive anti HCV and HCV RNA, were included in this study. All these sera were serotyped using Murex Serotyping 1-6 assay system. Of 125 patients sera 105 [84%] were typable and 20 were [16%] untypable, no multiple serotypes were seen. Serotype 3 were 69.6% and serotype 1 [6%]. Serotype 2,4,6 were also detected 4.8%, 2.4% and 0.8 respectively, No serotype 6 was seen. The disease state was compared to different HCV serotypes by and more cirrhosis was observed in serotype 1 as compared to serotype 3. Cirrhosis was also observed in non-typable cases. Risk factors identified from data were transfusions [29%], parentral therapy [20%], Health workers 25[20%], sharing blades, Homosexuality 10 patients [08%], Intravenous drug abusers [04%], previous surgery [6.8%], dentists [7.2%]. No vertical group was seen in this study. Few other miscellaneous risk factors were pricking for ears and noses tattooing [in female groups]. One patient returned from USA, developed cirrhosis due to serotype 1 gave the history of out of family sex contact. No significant difference was noted in different groups of serotypes for HCV. HCV serotypes 3 were more common and serotype 1 was related to more sever disease. Risk factors are more important to control the spread of HCV