To study the frequency of obesity among female students of nishtar medical college, multan

Objectives: 1. To find out obesity frequency among female students of Nishtar Medical College by measuring their Body Mass Index. 2-To create awareness about hazards of obesity among them

Study Design: Observational / Cross sectional study

Place and duration of study: This Study was carried out at Nishtar Medical College, Multan from October 2015 to December, 2015

Materials and Methods: A sample of 250 female students was taken by convenient sampling technique,50 students from each class were included in the study. After taking informed consent, all the desired in formations were collected by developing a structured questionnaire. Excel and SPSS software were used to analyze data

Results: Out of the total 250 students, 80[32%] were obese and 170[68%] were non-obese. Among the obese students, 24[30%] were from final year and 13[16.25%] were from first year MDBS class. There was very high percentage of obese students 59[73.75%] belonging to middle socioeconomic class. Most of the students 42[52.5%] were consuming 2100-2500 calories/day. Among the obese students, only 10[12.5%] were doing exercise daily. 22 [27.5%] students had positive family history of obesity. About 13[16.25%] students were consuming fast food once daily and 46[57.5%] were taking 2-3 times per week

Conclusion: Obesity is a significant problem among female medical students. The main risk factors identified were middle economic status, lack of exercise, overall sedentary life style, with high calories and fast food consumption

HDV seroprevalence in HBsAg positive patients

To find out the frequency of HDV seroprevalence and the demographic characteristics or HBsAg-HDV positive patients. Cross-sectional analytical study. Jinnah Postgraduate Medical Centre and Civil Hospital, Medical Unit-III, Karachi, from March 2007 to April 2011. Patients with positive HBsAg were included in the study. Those having co-infection with HCV or HIV, autoimmune hepatitis, alcoholic hepatitis, Wilson's disease and haemochromatosis were excluded. After detailed history and physical examination all the patients underwent laboratory workup including complete blood count, liver function test, viral profile [HAV, HCV, HIV and anti-HDV] and prothrombin time. While in selected patients, HBc [core] antibodies, ultrasound abdomen, serum iron profile, ANA and liver biopsy were also carried out whenever needed to establish a clinical stage of liver disease. There were 374 patients with 266 [71.1%] males and 108 [28.9%] females with overall mean age of 31.64 +/- 8.66 years. Overall frequency of anti-HDV antibodies positivity was found in 28.1% [n = 105] patients. HDV seropositivity was slightly more prevalent in males as compared to females [28.57% vs. 26.57%]. HDV seropositivity frequency was significantly higher in patients who presented with acute hepatitis/hepatic failure as compared to other clinical diagnoses [p = 0.027] and in those sub-sets of patients who had raised ALT levels [p = 0.012]. There was a high frequency of HDV seropositivity in the studied population particularly in males with acute hepatitis or hepatic failure, having raised ALT levels. The emphasis should be on preventive measures taken by other countries to reduce the prevalence of these treatment challenging infections

Idiopathic adult ileoileal and ileocolic intussusception in situs inversus totalis: a rare coincidence

Situs inversus totalis is a rare autosomal recessive congenital anomaly that is characterized by mirror image anatomy of the abdominal and thoracic organs. We report a case of a 28-year-old male with situs inversus totalis, who developed an idiopathic ileoileal and ileocolic intussusception, which was diagnosed on computed tomography scan. Patient underwent successfully ileal resection and side-to-side functional anastomosis of ileum 12 cms from ileocecal junction. Postoperative course was uneventful. To the best of our knowledge, this is the first case of idiopathic adult intussusception with situs inversus totalis in the literature

incidentally discovered asymptomatic para-aortic paraganglioma with peutz-jeghers syndrome

Peutz-Jeghers syndrome [PJS] is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal [GI] tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extra GI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers. We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was noted. An abdominal computed tomography scan [CT] revealed multiple polyps in small bowel loops. Gastroscopy revealed multiple dimunitive polyps in stomach and pedunculated polyp in duodenum. Colonoscopy revealed multiple colonic polyps. Pathological examination of the polyps confirmed hamartomas with smooth muscle arborization, compatible with Peutz-Jeghers polyps. CT scan guided left para-aortic lymph node biopsy revealed the characteristic features of extra-adrenal para-aortic paraganglioma. Although cases of various GI and extra GI malignancies in PJS patients has been reported, the present case appears to be the first in literature in which the PJS syndrome was associated with asymptomatic extraadrenal para-aortic paraganglioma. Patients with PJS should be treated by endoscopic or surgical resection and need whole-body screening

Frequency of portal hypertensive gastropathy and its relationship with biochemical, haematological and endoscopic features in cirrhosis

To determine the frequency of portal hypertensive gastropathy [PHG] and its relation with biochemical, haematological and endoscopic findings in cirrhotic patients. Cross-sectional analytical study. Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7, from June 2009 to December 2010. Patients with diagnosis of cirrhosis and either undergoing screening upper gastrointestinal [GI] endoscopy or presented with acute upper GI bleeding were included in the study. Portal hypertensive gastropathy and oesophageal varices were classified using Baveno scoring system. The severity of cirrhosis was classified according to the Child-Pugh criteria. Hypersplenism was assessed by the reduction of haemoglobin, leucocytes and platelets. Out of 217 patients, 148 were males [68.2%] and 69 were females [31.8%] with ages ranging from 15-85 years, [mean 48.06 years]. There were 144 HCV +ve patients [66.4%], 36 HBV +ve patients [16.6%], 15 HCV/HBV co-infected patients [6.9%] and only 1 [0.5%] had co-infection of HBV/HDV. Twenty-one patients [9.7%] were classified as having cryptogenic cirrhosis. Out of 172 patients [79.27%], 56 patients [25.8%] had mild and 116 patients [53.5%] were suffering from severe PHG. Significant positive correlation was found between esophageal variceal grade and PHG [r=0.46, p < 0.001] but not with etiology [r=0.05, p=0.41] or hypersplenism [r=0.08, p=0.22]. The frequency of PHG was 79.27% in the studied group. The grade of oesophageal varices had significant relation with PHG that is the severity of PHG increased with the grade of oesophageal varices, suggesting common pathophysiology of both entities

Hepatocellular carcinoma: a clinicopathological study

To describe the clinico-pathological and radiological profile of hepatocellular carcinoma. A case series. Medical Unit-III Ward-7, Jinnah Postgraduate Medical Centre, Karachi, from January to December 2008. All consecutive patients suspected of having hepatocellular carcinoma [HCC], were admitted and included in this study. Diagnosis of HCC was established by clinical, biochemical, ultrasonographic and histopathologic findings. Patients with primary carcinoma elsewhere in the body, metastatic in the liver, fibrolamellar carcinoma and benign tumours were excluded from the study. At ultrasonography, the details of tumour size and number, portal vein thrombosis and presence of ascites were recorded. Patients were staged according to Okuda staging system. Results were described in mean and percentage values. There were 82 patients with hepatocellular carcinoma including 58 males and 24 females, with male to female ratio of 2.8:1. The mean age of patients was 56.24 +/- 13.65 years. Right hypochondrial pain was the main symptom in 52 [63.4%] patients. The duration of symptoms varied from 1 month to 2 years. Tumour size was larger than 50% of liver size in 42 [51.2%] with portal vein thrombosis in 10 [12.19%]. Anti HCV was positive in 44 [53.7%], HBsAg in 26 [31.7%] and both were found positive in 2 [2.44%] patients. Ten patients [12.2/%] found negative both for anti-HCV and HBsAg. According to Okuda staging system 18 patients had stage 1, 50 had stage 2 and 14 had stage 3 hepatocellular carcinoma. The mean age of presentation of hepatocellular carcinoma was younger as compared to western countries with potentially large non-resectable lesions. Chronic hepatitis C and B was found to be the major known factors. Patients with chronic hepatitis C and B should undergo vigorous HCC surveillance to detect early, potentially respectable HCC

Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients

To determine the severity of thrombocytopenia in different grades of esophageal varices. Cross-sectional analytical study. Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January to December 2008. Subjects were eligible if they had a diagnosis of cirrhosis. Patient with advanced cirrhosis [Child-Pugh class C], human immunodeficiency virus [HIV] infection, hepatocellular carcinoma, portal vein thrombosis, parenteral drug addiction, current alcohol abuse and previous or current treatment with beta-blockers, diuretics and other vasoactive drugs were excluded from the study. All patients under went upper gastrointestinal endoscopy after consent. On the basis of platelet count patients were divided into four groups; Group I with platelets 20000/mm 3, Group II with values of 21000-50000/mm 3, Group III with count of 51000-99000/mm 3 and Group IV with count of 100000-150000/mm 3. Correlation of severity of thrombocytopenia with the grading of esophageal varices was assessed using Spearman's correlation with r-values of 0.01 considered significant. One hundred and two patients with thrombocytopenia and esophageal varices were included in the study. There were 62 [60.8%] males and 40 [39.2%] females. The mean age of onset of the disease in these patients was 49.49 +/- 14.3 years with range of 11-85 years. Major causes of cirrhosis were hepatitis C [n=79, 77.5%], hepatitis B [n=12, 11.8%], mixed hepatitis B and C infection [n=8, 7.8%] and Wilson's disease [n=3,2.9%]. Seven patients had esophageal grade I, 24 had grade II, 35 had grade III, and 36 had grade IV. Gastric varices were detected in 2 patients. Portal hypertensive gastropathy were detected in 87 patients. There was an inverse correlation of platelet count with grading of esophageal varices [r=-0.321, p<0.001]. The severity of thrombocytopenia increased as the grading of esophageal varices increased. Thrombocyte count was significantly and inversely correlated with the grade of esophageal varices

Clinical features, diagnostic techniques and management of dual dengue and malaria infection

To find out clinical features, diagnostic techniques and management outcome of patients having dual dengue and malaria infection. A case series. Medical Unit-III, Ward- 7, Jinnah Postgraduate Medical Centre, Karachi, from September 2007 to January 2008. Patients presented with fever of less than or equal to 10 days duration, severe body aches, rash and bleeding manifestations were included. Patients with obvious features of other diseases like typhoid, hereditary bleeding diathesis and hematological malignancies and only malarial parasite positive with high grade intermittent fever without rash and myalgia were excluded from the study. Diagnosis of dengue and malaria was based on history, clinical features, laboratory parameters and malarial parasite test by thin and thick films. Serological evaluation was done by dengue IgM and IgG by ELISA test kit. Patients were divided into three groups. Group A was dengue IgM positive plus MP positive, group B was dengue IgM positive and MP negative and group C was dengue IgM negative and were clinically suspected dengue and malaria. The clinical manifestations and laboratory parameters of dual dengue and malaria positive patients were compared with malaria and dengue negative patients. One hundred and fourteen patients were seen during the study period. Antibody titer [IgM] tested in all patients was found positive in 78 patients [69.64%]. Among those 78 patients, 26 [23.21%] were concomitantly positive for malarial parasite [Group A]. Plasmodium vivax was positive in 25 patients and falciparum in one patient. Fifty-two patients [46.42%] were dengue IgM positive and MP negative [Group B]. Thirty four [30.35%] patients were MP and dengue IgM negative [Group C] but were strongly suspected for DHF and malaria on clinical and hematological basis. The hemoglobin of 34.61% of patients of group A, 5.76% of group B and 14.7% of group C were low, hematocrit level was also low in group A[92.3%], group B [15.38%] and group C [70.58%] patients. The platelet count was markedly low in 84.61% of patients of group A, 57.69% of group B and 94.11% of group C. Leukopenia was found in 34.61% of patients of group A, 78.84% in group B and 29.411% in group C. The liver function tests were deranged in all groups. The frequency of dual dengue and malaria infection was 23.21%. The serology of the dengue and malaria showed negative results in 30.35%. The diagnosis of dual infections could be made on the basis of history, clinical examination supported by hematological results. It is recommended that all the patients suspected for dual infections should be treated concomitantly for dengue and malaria in malaria endemic areas

Hypokolemic paralysis and megaloblastic anaemia in laurence-moon-bardet-biedl syndrome

Laurence-Moon-Bardet-Biedl syndrome is a rare, genetically heterogeneous autosomal recessive disorder, characterized by progressive retinal dystrophy, polydactyly, obesity, hypogonadism, mental retardation, and renal dysfunction. Other manifestations include diabetes mellitus, heart disease, hepatic fibrosis and neurological features. Herein, 2 patients with Laurence-Moon-Bardet-Biedl syndrome are described, who had features of persistent hypokalemia and megaloblastic anemia

Hematological and biochemical indicators for the early diagnosis of dengue viral infection

To determine the haematological and biochemical indicators for the early diagnosis of dengue viral infection. A case series. At Medical Unit-III, Ward 7, Jinnah Postgraduate Medical Centre and referred cases from Faiz-e-Rehman Hospital, Metroville, Karachi from September to November 2007. Patients presenting with a fever of less than 2 weeks duration, generalized morbiliform rash and bleeding manifestations were included. Clinical history was recorded and patients were placed on fluid and haematological support. Diagnosis was established by Polymerase Chain Reaction [PCR] for dengue virus or detection of dengue virus specific IgM and IgG. Results: One hundred and four patients met the inclusion criteria during the study period. Sixty six patients had clinical and haematological features suggestive of grade I Dengue Hemorrhagic Fever [DHF]; 34 patients had grade II DHF and 4 had grade III DHF out of whom 3 progressed to grade IV DHF. All the patients presented with fever followed by generalized morbiliform rash [81.73%], vomiting [79.8%], abdominal pain [65.38%], backache [62.5%], depression [60.6%] and mucosal bleeding manifestations [34.6%]. Clinically, conjunctival infection was present in 93 patients [89.4%], hepatomegaly 59 [56.7%], lymphadenopathy in 17 [16.3%], splenomegaly in 13 [12.5%], pleural effusion in 11 [10.5%] and ascites in 8 [7.6%]. Common laboratory findings were thrombocytopenia in 100% patients, leucopenia in 55 [52.8%], raised hematocrit in 52 [50%], and elevated aminotransferases, gamma GT in 100 [96%] patients. The overall mortality was 2.88%. In this series clinical history and examination supported by the triad of thrombocytopenia, raised hematocrit and elevated liver enzymes was sufficient for the early diagnosis of dengue hemorrhagic fever without waiting for dengue serology

Nitroglycerine ointment for anal fissure

To determine long term effectiveness of glyceryl trinitrate [GTN] for treatment of anal fissure and to find out its side effects. This study was done on patients who presented with symptoms of anal fissure in colorectal clinic surgical ward 2 JPMC. Total 498 patients were included out of which 237 had acute anal fissure while 261 patients had chronic fissure. All patients received 8 weeks treatment with 0.2% GTN ointment three times daily applied over perianal area. Those patients who developed side effects i.e. headache were offered treatment with 2% diltiazem. After 8 weeks treatment 228 patients of acute anal fissure had complete healing and 9 patients had partial response. In chronic anal fissure, 229 patients completely healed after 8 weeks of treatment while 32 patients were advised further 4 weeks treatment of GTN due to partial healing and out of them 22 patients had complete healing. Thirteen patients had to undergo lateral sphincterotomy. Five patients complained of headache that settled after shifting to treatment with diltiazem ointment. Ten patients developed recurrence of symptoms. GTN proved to be good first line treatment for most of patients with anal fissure. Small group of patients experience recurrence of symptoms and most of them respond to prolong duration of treatment