Clinical presentation in an outbreak of hepatitis E

In many cases of acute hepatitis, hepatitis E virus [HEV] is a common cause. Hepatitis E is a self limiting disease which shares many epidemiological, clinical and morphological similarities with hepatitis A. Both are enterically transmitted. The purpose of this study was to evaluate the clinical presentation of hepatitis E during an epidemic and correlate the clinical features with liver function tests [LFTs]. It is a cross sectional retrospective study. The study was conducted at Army Medical College [National University of Sciences and Technology] and Military hospitals Rawalpindi from July to December 2009. One hundred patients admitted to the hospital with clinical features of acute hepatitis including anorexia, nausea, vomiting, pain epigastrium, jaundice, raised serum total bilirubin [TBil] and serum aminotransferase [ALT] were included in the study. Hepatitis E in these patients was confirmed by detecting the presence of anti HEV IgM. The patients were monitored during their stay in the hospital and changes in their clinical condition were correlated with liver function tests [LFTs]. The most prominent symptoms in all patients were fatigue, nausea, anorexia, jaundice and dark urine, followed by pain epigastrium [50%], low grade fever [48%] and hiccups [2-3%]. Jaundice developed when mean total bilirubin was 127micromol/L, mean ALT was 1527 U/L and mean ALP 127 U/L. Serum bilirubin correlates with the development of jaundice. Hepatitis E presents with varying clinical features. The presentation is acute with marked anorexia, nausea and fatigue coupled with sharp rise in LFTs. Any adult presenting with acute onset of these symptoms should be investigated for LFTs and anti HEV IgM

Frequency and clinical outcome in conduction defects in acute myocardial infarction

Conduction defects complicating acute myocardial infarction [MI] are frequent and associated with increased mortality and complications. Common conduction defects after acute MI are atrioventricular nodal blocks [1[st], 2[nd] and 3[rd] degree] and intraventricular conduction defects [right or left bundle branch blocks and hemiblocks]. In myocardial infarction occlusion of coronary arteries at different levels affects the conduction system of heart leading to various types of blocks. Conduction defects usually reflect extensive damage to the myocardium. In this descriptive case series with non-probability purposive sampling, 345 cases of acute ST elevation myocardial Infarction were studied at Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi from May 2007 to May 2008. ECG was continuously observed in CCU and daily ECGs were done. Conduction defects whether transient or persistent were recorded in pre-designed proforma in addition to other clinical features and associated complications during hospital stay. Out of 345 patients. 251 [72.8%] patients received thrombolytic therapy and 61 [17.6%] developed various types of conduction defects [Group A] and 284 had no significant conduction defects [Group B]. Isolated complete atrioventricular block [AVB] at the node level occurred in 28 patients [8.1%] mainly in inferior MI. Bundle branches Blocks occurred in 32 [9.2%] patients mostly in Anterior MI. One patient [0.6%] had complete heart block at bundle branch level. All patients with complete atrioventricular block reverted to sinus rhythm except one who required permanent pacemaker. Mortality rate and clinical complications were higher in group A as compared to group B. Conduction defects are common even in this thrombolytic era. Patients with conduction defects are at high risk of inhospital complications and mortality. They need close monitoring and optimum clinical care to reduce mortality and morbidity

Balneology: a concept of public health-bath houses in Arabian life

Although Hippocrates was famous for corpus, Aphorismi, de aere, aquis including balneology and Romans were practicing public health with the development of baths. Arabs have been given credit for the implementation of preventotherapeutic application of public bath houses in their life. This paper will put stress on preventive and therapeutic value of balneology, model of public health-bath houses in Arabs and role of bather and bathmen in regimental therapy and recommended advises related to bath

Indicators of early outcome in neonatal sepsis

The purpose of this study was to evaluate different parameters predicting outcome of neonatal sepsis. It was carried out at the neonatal unit of Ghurki Trust Teaching Hospital, Lahore from February 2004 to May 2005. This was an analytical comparative study performed prospectively. A total of 100 culture proven cases of neonatal sepsis were included. Complete data including birth weight and time interval between onset of symptoms and arrival at hospital was recorded. Complete blood counts and arterial blood gas analysis were performed in all cases. Overall mortality was 37%. Among the total of 100 cases 51% [n=51] were low birth weight [LBW] while 49% [n=49] were of normal birth weight, 40.7% [n=24] expired from LBW group, while 26.5% [n=13] from those with normal birth weight. Mortality was higher [P<0.05] in LBW babies. Among them 29.03% [n=18] expired from those who reached within 24 hrs of onset of symptoms [n=62] whereas 50% [n=19] expired from those who reached after 24 hrs [n=38]. This difference was also significant [P<0.05]. Hypothermia affected 39% of the cases. Mortality was significantly higher [P<0.05] in cases who developed hypothermia. Among laboratory parameters, leukopaenia, thrombocytopaenia, and acidosis were individually associated with high mortality [P<0.05], while leukocytosis was not significantly [P>0.05] associated with neonatal mortality. It was concluded that neonatal sepsis has high mortality. Some of the clinical and laboratory parameters are useful to recognize high-risk cases. Early referral can reduce mortality. Long-term follow-up of the survivors is indicated