Is peripheral neuropathy a part and parcel of chronic hepatitis-c in south asian population?

Introduction: Management of chronic Hepatitis C and its complications is a major concern for physicians. Peripheral neuropathy is a disease affecting the nerves, and is one of the complications of Hepatitis C

Objective: The aim of this study is to determine the prevalence of peripheral neuropathy in chronic hepatitis-C patients. Study design and duration: The type of study is a cross-sectional study, which was conducted over a period of one month from 01-11-2015 to 30-11-2015

Setting: The study was conducted at a tertiary care hospital in Karachi, Pakistan

Sample size and procedure: The study population consisted of a random sample group of 139 Hepatitis C positive patients who presented to the Internal Medicine Department either via out-patient clinic or via emergency. After due informed consent, variable such as demographic data and type and degree of neuropathy were recorded. All the Hepatitis-C patients who presented to us during that time were evaluated clinically, serologically and electrophysiologically. Data Analysis: Data was analyzed using SPSS version 20

Results: Out of the total study population of n= 139 patients peripheral neuropathy was present in n= 77 [55.39%] of the patient population; n= 3 [2.15%] had sensory type of neuropathy, n=13 [9.35%] had motor neuropathy and n= 61 [43.88%] had mixed type of neuropathy

Conclusion: According to the results of our study there is a significant association of peripheral neuropathy with hepatitis C in patients in South Asian population as more than hald of the participants had some form of peripheral neuropathy.

Insulin resistance in non-diabetic patients of chronic hepatitis C

To determine insulin resistance in non-diabetic chronic hepatitis C patients using Homeostatic Model Assessment of Insulin Resistance [HOMA-IR]. Patients having anti-HCV positive were included in this study. Patients with diabetes mellitus, thyroid disease, hyperlipidemias, hypercortisolism and infective diseases other than hepatitis C were excluded. Age, weight, height and absence of diabetes were documented. Fasting blood glucose and fasting insulin levels were done. Body mass index and insulin resistance was calculated using the formulas. Patients having insulin resistance using formula HOMA-IR>2.5 were labeled as insulin resistant. Data was analyzed using SPSS-18. One hundred and fifty five patients according to sample size estimation were enrolled, in whom HOMA-IR was calculated, the mean value was found to be 2.47 +/- 1.30. A total of 79 [51%] of patients had HOMA-IR more than 2.5 showing insulin resistance. In a third world country like Pakistan, where there is a high prevalence of hepatitis C infection, the consequences of the disease are also very common. Insulin resistance was found in 51% of patients with chronic hepatitis C

Frequency of eosinophilic esophagitis in patients undergoing upper Gl endoscopy

To determine the frequency of Eosinophilic Esophagitis [EoE] in patients undergoing upper Gl endoscopy. Patients undergoing upper Gl endoscopy for any indication were subjected to additional esophageal biopsies for derrnination of eosinophilic esophagitis. The additional biopsy protocol was two each from proximal esophagus, distal esophagus, stomach and duodenum. Presence of >15 eosinophils in one high power field was criteria for diagnosis of EoE. Ninety four patients were included according to sample size estimations. Eosinophilic esophagitis was found in 7 [7.4%] of patients undergoing upper Gl endoscopies. Eosinophilic esophagitis should be considered as active diagnosis in presence of suggestive symptoms

Frequency and pattern of colonization of intravenous cannula in an ICU of public sector hospital

To determine the frequency of colonization of intravenous [IV] cannula by microorganism in patients admitted to intensive care unit [ICU] and to determine the frequency of common organisms involved in colonization of IV-cannula. A total of 369 patients of age more than 12 years, and meeting inclusion criteria of the study were included from in medical ICU after taking informed consent. Staff nurse introduced intravenous cannula of appropriate bore after proper disinfection of the insertion site with povidone iodine solution and alcohol. The cannula was removed for culture within 48 hours of insertion if clinical signs i.e. redness and swelling was present. Mean age was 41 [ +/- 16.7] years. Male to female ratio was 1.07:1. Presence of colonization in IV-cannula was seen in 31 [8.4%] cases. Coagulase-Negative Staphylococci was the most common microorganism seen in 24 [77.4%] patients. The incidence of IV cannula colonization is low in this study. Bacterial colonization occurs in the indwelling intra vascular cannula despite, adequate precautions. Coagulase-Negative Staphylococci and S. Aureus were the common organisms

Frequency of depression in chronic Hepatitis C naive patients

To determine frequency of depression in chronic hepatitis C na‹ve patients before interferon therapy using CES-D questionnaire. Patients testing positive antibodies to HCV by EIA of more than 6 months duration and who have not taken interferon therapy previously were included after taking informed consent. Patients who had co-infections such as hepatitis B and D virus or human immunodeficiency virus, or patients with other coexisting chronic liver disease like primary biliary cirrhosis, chronic autoimmune hepatitis and Wilson disease were excluded from study. Urdu version of CES-D a self-reporting questionnaire in public domain was administered. A score of >/= 10 was taken consistent with depression. Ninety-six patients were included and 59.4% were depressed. These included 57.9% males and 42.1% females. Highest frequency was seen in under-graduates and positive correlation was seen with duration of hepatitis C infection. This study showed that 59.4% of patients with hepatitis C have depression before initiation of therapy and this should be evaluated and treated if necessary before starting interferon therapy

Patterns of acute poisoning and its outcome reported at civil hospital Karachi

To determine frequently used agents in acute poisoning, mode of poisoning, influencing factors, time interval between intoxication and hospital arrival outcome. The study was conducted in the department of Medicine, Civil Hospital Karachi in year 2006. It was a Descriptive and observational study. All cases of acute poisoning admitted in medical unit IV were included in this study. In all the cases a previously prepared Performa was filled, the Performa included patient's demographic patterns, agent used for poisoning, various influencing and precipitating factors of acute poisoning, route of poisoning, time interval between intake and arrival in hospital, past history of such episode, psychiatric history and outcome. Total of 118 cases of acute poisoning admitted during the study period. Sixty two [52.85%] were female and fifty six [47.15%] were males. Oral route was used in all cases. Mode of poisoning was suicidal [61.02%], deliberately self harm [22.03%], accidental [11%] and homicidal [5.08%]. Common reasons for poisoning in males were financial constraints [48%] and unemployment [40%]. Common reason for poisoning in females was family conflictions [68%]. Fifteen patients [12.54%] had previously attempted the poisoning as well. Previously known psychiatric illness was found in five [4.24%] of patients. Most of the patients [102] reached within eight hours, only six arrived within two hours. Eleven patients [9%] expired in which six were females and five were males. Organophosphorus compounds were found to be the commonest incriminating agent in poisoning. Family conflictions and financial constraints were the main reasons behind poisoning. Most of the patients are reaching late in hospital, Majority of the deaths are occurring immediately after arrival and within two days. Reattempt of poisoning was found in significant number of patients which were although preventable. Mortality in cases of poisoning is still high

Hyperglycemia: an unusual cause for hemichorea-hemiballism

Hemichorea - hemiballism is a rare neurologic disorder due to oxidative stress leading to neurodegeneration of the dentate nuclei and striata. It is rarely observed in diabetes. One such case occuring in an adult female diabetic is described

Unusual presentation of an unusual hepatitis

Autoimmune hepatitis is an uncommon cause of chronic hepatitis in Pakistan. One such case is described occurring in an adult female cirrhotic diagnosed on raised serum IgG and LKM-I

Corrlation of adjusted blood requirement index with treatment intervention and outcome in patients presenting with acute variceal bleeding

To determine the correlation of ABRI with treatment intervention and outcome as discharged or expired in patients of acute variceal bleed. Cross-sectional study Records of all the patients admitted in Medical Unit-IV, Civil Hospital Karachi with acute variceal bleeding during January 2004 to October 2006 were retrieved. Use of vasoactive agents [Terlipressin/Octreotide], endoscopic band ligation [EBL] and outcome [Discharged/Expired] were noted. ABRI was calculated by the following formula: ABRI= Blood Units Transfused/ [[Final Hematocrit - Initial Hematocrit] + 0.01] Mean ABRI were compared by Student's 't' test according to vasoactive therapy, EBL and outcome. Correlation of ABRI with the same variables was also studied by plotting Receiver Operative Curves [ROC]. Seventy six patients fulfilling inclusion criteria were selected. No statistically significant difference was observed in the mean ABRI scores when compared according to vasoactive drug administration, EBL and outcome. Significant correlation with mortality was seen on ROC plot with significantly larger area under the curve. ABRI correlated significantly with mortality in this study. Larger prospective studies with appropriate power are required to evaluate its association with other variables

Correlation of quality of life in patients of cirrhosis of liver with etiology and disease severity using disease-specific quality of life questionnaire

Quality of Life has an important status in patient management suffering from chronic disease like cirrhosis and health related quality of life has significant impact on patient management. This study was conducted to evaluate the correlation of health related quality of life with disease severity in patients of cirrhosis of liver. This cross-sectional study was conducted at Medical Unit-IV, Dow University of Health Sciences, Karachi, during the period January 2006 to October 2006. All patients of cirrhosis of liver admitted during the study period were selected. Patients with encephalopathy, hepatocellular carcinoma were excluded. The 29 item chronic liver disease questionnaire [CLDQ] was administered to the patients by a postgraduate trainee. Internal validity of responses was checked statistically and correlation of responses was done with disease severity by Child-Pughs Criteria. 109 patients were selected with 72 males and 37 females. Patient classification according to Child class A, B and C was 30, 38 and 41 respectively. The mean CLDQ score in the patients was 89.5 +/- 30.4. It correlated significantly with Child Class but did not correlate with the gender, age and etiology of cirrhosis. Health related CLDQ scores correlate with the severity of liver disease

Frequency and comparative analysis of hepatitis in patients seeking treatment for hepatitis B

To find the frequency of hepatitis 'D' in patients of hepatitis 'B' seeking treatment and to compare clinical and biochemical features in patients harboring HDV with those who are not. Cross-sectional study. Medical Unit-IV, Civil Hospital Karachi, Medical Unit-VI and Surgical Unit-VII, Lyari General Hospital, Dow University of Health Sciences, Karachi; from July 2003 to June 2005. HBsAg positive patients seeking treatment were enrolled in the study. Anti-HDV was done in all. Patients were split into two groups according to their anti-HDV status into HDV positive and HDV negative groups. Liver biochemistries and viral profile for HCV, anti-HBc IgM and HBeAg were done and compared between the two groups. A total of 246 patients were selected. HDV was positive in 66 [26.8%] patients. No significant difference was observed in the frequency and stages of cirrhosis between the two groups while significant differences were observed in the mean SGPT [95% CI: -381.09 to -110.74; P = 0.001] and albumin levels [95% CI: 1.87 to 7.73; P = 0.007] and in the frequency of HBeAg [P = 0.001], anti- HBc IgM [P = 0.02] and HBV DNA [P < 0.001]. HDV infection was common in patients with HBV in this cohort of patients. All patients of HBV should be screened for HDV before treatment decision for the former is taken