Relative changes in hepatitis-C virus RNA titre and serum ALT levels before, during and after treatment with interferon and ribavirin

Hepatitis C is commonly treated with Interferon and Ribavirin combination therapy. The aim of this study was to find the relative change in the Hepatitis C virus [HCV] RNA titre and serum alamine aminotransferase [ALT] levels before, during and after completion of treatment with Interferon [IFN] and Ribavirin therapy in HCV positive patients. This cross- sectional descriptive study was conducted from May 2010 to August 2010. Seventy hepatitis C patients reporting to the Laboratory of Army Medical College, Rawalpindi, were included in the study. Blood samples were first subjected to centrifugation and stored at -20[degree sign] C till tested. HCV RNA titre was determined by Real Time PCR while ALT estimation on serum samples was done on Selectra-E by kinetic method. The age, gender and treatment status of the patients was also recorded. In a total of 70 patients, 30% were females while 70% were males. The mean age of patients was 38 +/- 11 yrs. On applying, analysis of variance [ANOVA], we found that the change in serum ALT level was significant [F = 6.044 and p = 0.004] while it was not significant in case of HCV RNA [F = 1.93 and p = 0.153] treatment with Inj. IFN and Ribavirin. There is a definite decreasing trend in the serum ALT levels while no definite relationship of the HCV RNA level to the treatment with combination therapy with IFN and Ribavirin

Biochemical pattern of liver function tests in hepatitis E epidemic

To evaluate the biochemical pattern of liver function tests in acute hepatitis E epidemic. Cross sectional descriptive study. Department of Pathology Army Medical College, Rawalpindi from June '09 to Dec '09. A total of 81 patients of acute hepatitis of all age groups, both male and female were included in the study. Patients who reported with symptoms of acute hepatitis and tested positive for hepatitis E IgM antibody were included. Detailed history, clinical examination and serial liver function tests [LFTs] were carried out. Weekly data of LFTs was arranged serially up to 4 weeks. The results were analyzed on SPSS version 17. The patients' age ranged from 17-59 years. Serum Alanine Transaminase [ALT] values were highest in the first 2 weeks reaching 100 times the upper limit of normal [ULN]. Similarly serum total bilirubin [TBil] reached up to 8 times ULN in the 1st week. The increase in serum alkaline phosphatase [ALP] was 2 times ULN and then returned to within the reference range in the 3rd and 4th weeks before other variables. Serum albumin levels remained unchanged. Prothrombin time [PT] was found to be prolonged. Two cases ended up fatally. Rest recovered fully and became symptom free. Hepatitis E is a serious clinical condition. LFTs play an important role in its diagnosis. There is marked derangement of LFTs. Sharp rise in serum ALT up to 100 times ULN is a significant feature and should raise the suspicion of acute Hepatitis E

need and rationale of thyroid function tests in a tertiary care laboratory

To find out the outcome of thyroid function tests in a tertiary care laboratory and to assess the rationality of thyroid function tests advice. It was a descriptive study which was carried out in a tertiary care laboratory of Rawalpindi. Patient's demographic data and clinical details were recorded. Blood samples were obtained and analysis was done. Results were analyzed on SPSS version 17. One hundred twenty seven samples of both sexes with age range 15-80 years were selected for study and non probability random sampling was done. There were 94 [74%] females and 33 [26%] males. Age range of the patients was 38.8 +/- 14.4 years. Majority of the patients were found to be euthyroid 76.38%. On basis of history, the most common symptom for which thyroid testing was advised was lethargy. For non-specific symptoms, full thyroid profile should not be advised, rather Thyroid Stimulating Hormone [TSH] should be used as a first line screening test. Full thyroid profile is an expensive test and has financial implications on both patients as well as the laboratory, so rational use o thyroid function tests is recommended

Correlation between glycated haemoglobin and random plasma glucose levels for the screening of diabetes mellitus

To find out a correlation between Glycated hemoglobin [HbA1c] and random plasma glucose levels for the screening of diabetes mellitus. Analytical cross-sectional study. This study was conducted in the Department of Pathology, Army Medical College, National University of Sciences and Technology, Rawalpindi, from January 2010 to April 2010. Three hundred and fifteen patients were included in the study. HbA1c was estimated using Ion Exchange Resin separation kit of Globe Diagnostics, as per guidelines. The Plasma samples received were analyzed on fully automated chemical pathology analyzer Selectra E for random glucose estimation by Glucose Oxidase method. The gender distribution and the relationship of age with HbA1c and random plasma glucose levels were also determined. The results were interpreted using Statistical Package for The Social Sciences [SPSS] version 17. There was a direct correlation between glycated hemoglobin and random plasma glucose levels while there was no correlation between age of the patients and the HbA1c or the age and the random plasma glucose levels. We also found that for every 1% rise in HbA1c, plasma glucose level rose by 2.3mmol/L. Glycated haemoglobin can be used as a reliable, feasible and fairly accurate tool for screening of diabetes mellitus

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

Rational thyroid screening by thyroid stimulating hormone assay

Serum thyroid stimulating hormone [TSH] estimation is an ideal investigation for thyroid disease. It gives most comprehensive information about whether a patient has a thyroid disease and what is the cause. It has been frequently observed in clinical settings that complete profile of thyroid function tests is advised for screening and vague symptoms. Aims and objectives of current study were to assess the usefulness of TSH alone as a screening tool of thyroid disease. It also evaluated the extra information generated by analysing fT3 and fT4 during screening. It was a prospective comparative cross sectional study. Adult patients referred for routine thyroid disease were selected for study. Their history was taken and detailed clinical examination was carried out. FT3, fT4 and TSH were analysed by chemiluminescence immunoassay. Results revealed that in 100% cases with normal TSH, fT3 and fT4 remained normal. Likewise in 107 cases with normal fT3 and fT4, TSH was abnormal leading to the diagnosis of sub-clinical hypothyroidism in 82 cases and sub-clinical hyperthyroidism in 25 cases. In a total of 213 abnormal TSH cases fT3 was abnormal 19 and fT4 was abnormal in 87. It was concluded that in cases with normal TSH levels there is no need of fT3 and fT4. Only patients with abnormal TSH merit detailed evaluation

Perceptions and practices of mothers regarding child feeding

Perceptions and practices of mothers regarding child feeding vary depending upon their education, socioeconomic and cultural background. The objective of current study was to see the perceptions and practices of nutrition in mothers of malnourished children. It was also aimed to ascertain malnutrition due to poverty versus ignorance. It was a retrospective study. A total 200 malnourished children from children OPD, aged 6 months to 3 years were included in this study. History was taken regarding breast feeding, weaning, ORS preparation and care of children. Physical examination was carried out to assess the nutritional status and grade of malnutrition. Weaning age at enrollment of 18 [9%] children was 4 months, 9 [4.5%] children was 5 months, 105 [52.5%] children was 6 months, 34 [17%] children was 7 months while weaning age of 34 [17%] children was 8 months. Children being inadequately fed on food were 178 [89%]. Hundred percent children had history of an illness in the past. One hundred and sixty three [81.5%] of the mothers had heard about ORS but did not know how to prepare it. Only37 [18.5%] of the mothers had full knowledge about preparation of ORS. It was concluded that poverty alone is not the only factor in causing malnutrition. Ignorance is an important factor in child malnutrition. Nutritional education should be given to the mothers to eradicate malnutrition in the children

Treatment of pulmonary alveolar microlithiasis with alendronate sodium

Pulmonary alveolar microlithiasis [PAM] is a rare disorder with only about 200 cases having been BEEN reporting worldwide. No effective treatment has been evolved as yet and the disease is fatal. Allendronate Sodium has been reported to he effective in some cases. However each dosage, duration of treatment and clinical parameters in evaluating the patient response are not specifically given in available literature. Aims and objectives of the current study were to see the effect of allendronate sodium on the treatment of PAM This is a prospective interventional study. Cases reporting to Medical OPD with symptoms of PAM were selected for study. Patients with shortness of breath, blue discoloration of lips and failure to thrive since childhood were included in the study. Twelve cases were initially short-listed with the suspician of PAM based on history, clinical examination and preliminary investigations including X-Ray chest. They were subjected to lung biopsy, CT scan and pulmonary function tests. Cases finally diagnosed as pulmonary alveolar microlithiasis were subjected to one year treatment with Allendronate Sodium. They had significant improvement clinically as well as in pulmonary function tests. However, there is no improvement in X-Ray of the chest

Diagnostic significance of serum protein electrophoresis

Serum protein electrophoresis is a simple, reliable and specific method of separating different protein fractions. A study was carried out in 1556 symptomatic cases reported to Department of Chemical Pathology, Army Medical College fbr serum protein electrophoresis. Aims and objectives were to see the diagnostic significance of protein electrophoresis especially in comparison to other related investigations like serum protein estimation and albumin: globulin [A: G] ratio etc. Deluxe electrophoresis chamber and sample applicator were used. Gelman DCD-16 digital computing densitometer was used for quantification. Results revealed that protein electrophoresis was essential for diseases like paraproteinaemia, immunodeficiencies and a-antitrypsin deficiency. It is helpful along with other investigations in liver disease, nephrotic syndrome, collagen disease and malignancy. Three hundred and sixty five cases had subacute/ chronic infection, 340 had normal electrophoretic pattern, 250 cases were of congestive cardiac failure, 152 cases of nephrotic syndrome, 90 cases of hepatic cirrhosis, 53 cases of chronic renal failure and 25 cases of paraproteinaemia were identified Its sensitivity and specificity were more than serum protein estimation by dye methods. It is recommended that full use of this diagnostic technique should be made for better diagnostic sensitivity and specificity

Comparison of 24 hour urine albumin and spot urine albumin to creatinine rattio as a predictor of diabetic nephropathy

Twenty four hours urine albumin is frequently used for prediction of the extent of nephropathy. Spot urine albumin to creatinine ratio has been recently introduced as an alternative to 24 hours urine albumin. Aims and objectives of the current study were to compare and contrast 24 hours urine albumin and spot urine albumin to creatinine ratio as a predictor of nephropathy. Two hundred cases of diabetes were selected for 24 hours urine albumin and spot urine albumin to creatinine ratio. Urine samples containing RBC 's or pus cells were excluded from the study. Twenty four hours urine albumin was estimated by pyrogallol method. First morning urine specimen was used for albumin to creatinine ratio. Creatinine was estimated by Jaffe reaction on semi-automated analyzer. Results revealed that mean 24 hours urine albumin was 693 mg/24 hours [reference range < 30 mg/24 hours], while mean albumin to creatinine ratio was 22.7 mg/mmol [reference range < 3 mg/mmol]. Fifty seven cases were having microalbuminuria, 103 cases had macroalbuminuria whereas 40 cases had normal urine albumin. Forty eight cases showed albumin to creatinine ratio in the normal range, 88 cases in microalbuminuria range while 64 cases had albumin to creatinine ratio in macroalbuminuric range. Correlation of 24 hours urine albumin versus urine albumin to creatinine ratio was 0.97, p value < 0.01. It was concluded that there was no significant difference between 24 hours urine albumin and spot urine albumin to creatinine ratio as a predictor of nephropathy, besides yielding immediate results and spot convenient sampling. It is recommended that spot urine albumin to creatinine ratio is a simple, clear, attractive and right predictor of nephropathy and can safely replace 24 hours urine sample for convenience of the patient, pathologist as well as the physician

Diabetic nephropathy in relation to duration and severity of diabetes mellitus

This paper presents a retrospective interventional study on 200 patients having diabetes mellitus for 5-15 years. Their histories were taken and clinical examination carried out. They were investigated for plasma glucose fasting and 2 hours after 75g glucose, glycated haemoglobin, blood urea, creatinine, creatinine clearance, 24 hour urinary protein and spot urine albumin to creatinine ratio. Data analysis was performed on SPSS computer software. In these 200 cases, 120 [60%] were males and 80 [40%] were females. Age ranged between 37 and 74 years. Ninety six [48%] cases showed accompanied hypertension. Normal albumin excretion [< 30 mg/24 hours] was present in 40 [20%] diabetics, microalbuminuria [30-300 mg/24 hours] was present in 57 [28.5%] cases while macroalbuminuria [> 300 mg /24 hours] was present in 103 [51.5%] cases. There was a direct relation of albuminuria with diabetes duration [correlation 0.749, p value < 0.01] and glycated haemoglobin [correlation 0.78, p value < 0.01]. Creatinine clearance varied inversely with duration of diabetes, glycated haemoglobin and albuminuria. The purpose of the study was to observe diabetic nephropathy and to correlate it with duration and severity of diabetes. It was observe that nephropathy was the most important complication of diabetes. It varied directly with the duration and severity of diabetes. Microalbuminuria is an early indication and every diabetic should follow a regular screening programme