ABSTRACT
Background: Helicobacter Pylori is a common infection highly prevalent globally causing chronic gastritis, duodenal ulcer and gastric carcinoma. It is observed clinically that patients who underwent therapy for eradication of H Pylori developed weight gain. Objective of this study was to evaluate the association between weight gain and eradication of H pylori infection
Method: For this observational cross sectional study, 137 patients were studied after confirmation of diagnosis of H pylori. Base line data at the beginning of the study and comparison between pre- treatment and post treatment outcomes were assessed after 3 months of follow up
Result: After eradication therapy, a difference in body weight was evident from pre-treatment mean body weight of 61.7+/-12.3 kg to 62.5+/-11.2 Kg [P=0.011]. An increase in BMI was recorded from pretreatment BMI of 23.24 +/-2.1Kg/m[2] to 26.4+/-3.8 Kg/m[2] [P=0.028]. The assessment of symptoms was performed by applying Mann-Whitney U test of significance; score of symptoms showed a decline in intensity after eradication therapy. Mean score of dyspepsia decreased from 2.65 to 1.02 with a P value of 0.024, mean score of epigastric pain from 2.73 to 1.14 [P=0.041], mean upper abdomen fullness from 2.49 to 0.35[P=0.021]. A decrease in heart burn was noted 3.46 vs 0.92 [P=0.003] and loss of appetite was less severe; 2.89 vs 0.58 [P=0.011]
Conclusion: The eradication of H Pylori, after 3 months of treatment, is associated with mild weight gain
ABSTRACT
To assess the histological and serological parameters of patients with hepatitis delta virus [HDV] in active HBV versus inactive HBV carriers. An observational study. Medical Unit IV at Liaquat University Hospital, Jamshoro, Sindh, from June 2008 to September 2011. This study included 49 consecutive inactive HBV carriers who were HBsAg-positive, HBV DNA-negative, anti-D antibody-positive, and HDV RNA-positive, as well as 277 patients with active HBV who were HBsAg-positive, anti- HDV antibody-positive, HDV RNA-positive, and demonstrated > 20,000 IU/mL HBV DNA and > 2 [ULN] serum glutamic pyruvic transaminase [SGPT]. Informed consent was obtained from each patient. Liver biopsies were obtained and the staging of fibrosis was performed according to the METAVIR scoring system. Continuous variables such as age, SGPT, platelet count, and the HBV DNA level were computed as the mean +/- standard deviation. Categorical variables such as gender and stage of fibrosis are expressed as percentages. All data were processed using SPSS version 16. This study included 49 patients in an inactive HBV group. Fibrosis stage 0 was observed in 37 [75.5%] patients and 12 [24.5%] were stage 1. Among the 277 patients with active disease, fibrosis stage 0 was present in 7 [2.5%] patients, stage 1 in 31 [11.2%] patients, stage 2 in 172 [62.1%] patients, stage 3 in 44 [15.9%] patients and stage 4 in 23 [8.3%] patients. HDV in active HBV carriers is severe on its initial presentation and requires prompt treatment whereas in inactive HBV carriers demonstrates an indolent course
ABSTRACT
To determine the efficacy of peg-interferon-based therapy in patients refractory to previous conventional interferon-based treatment and factors predicting sustained viral response [SVR]. Analytical study. Medical Unit IV, Liaquat University Hospital, Jamshoro, from July 2009 to June 2011. This study included consecutive patients of hepatitis C who were previously treated with conventional interferon-based treatment for 6 months but were either non-responders, relapsed or had virologic breakthrough and stage >/= 2 with fibrosis on liver biopsy. All eligible patients were provided peg-interferon at the dosage of 180 micro g weekly with ribavirin thrice a day for 6 months. Sustained Viral Response [SVR] was defined as absence of HCV RNA at 24[th] week after treatment. All data was processed on SPSS version 16. Out of 450 patients enrolled in the study, 192 were excluded from the study on the basis of minimal fibrosis [stage 0 and 1]. Two hundred and fifty eight patients fulfilled the inclusion criteria and 247 completed the course of peg-interferon treatment. One hundred and sixty one [62.4%] were males and 97 [37.6%] were females. The mean age was 39.9 +/- 6.1 years, haemoglobin was 11.49 +/- 2.45 g/dl, platelet count was 127.2 +/- 50.6 10[3]/mm[3], ALT was 99 +/- 65 IU/L. SVR was achieved in 84 [32.6%]. The strong association was found between SVR and the pattern of response [p = 0. 001], degree of fibrosis and early viral response [p = 0.001]. Peg-interferon based treatment is an effective and safe treatment option for patients refractory to conventional interferon-based treatment
ABSTRACT
To compare the Model for End-Stage Liver Disease [MELD] and The King's College Hospital Criteria [KCH] as early clinical prognostic indicators in patients with Acute Liver Failure. This descriptive Case series study was conducted in emergency medical wards of Liaquat University Hospital Jamshoro and Hyderabad from February 2008 to July 2010. This study included 76 consecutive patients with ALF defined as onset of hepatic encephalopathy occurring within 12 weeks of onset of jaundice. The patients using sedatives, anticoagulants or if any evidence of chronic liver disease were excluded. Laboratory workup was done from laboratory of University. MELD score of >/= 33 and presence of positive criteria for KCH category were taken as a bad prognostic indicator. The primary end point was death during hospital stay. Continuous variables were computed as mean +/- standard deviation [SD] and categorical variables as frequency and percentage. Out of 76 patients 49 were male [64.47%] and 27 [35.53%] female. The mean age of patients was 24.62 +/- 10.3. Out of 76 patients a total of 59 patients [77.63%] died during the study period. The KCH criteria cut off point was reached in a total of 63 patients [out of 76] of which 50 patients died. The MELD criteria cut off point [MELD Score > 33] was reached in 49 patients [out of 76] of which 46 eventually died.KCH predicted outcome with the sensitivity of 80% and Positive predictive value [PPV] of 89% [p=0.001]. MELD predicted outcome with sensitivity of 82.4% and Positive predictive value [PPV] of 94% [p=0.001].Viral hepatitis B was the most common cause of Acute Liver Failure. Both criteria are good predictors of the outcome in acute liver failure
ABSTRACT
To study the frequency of mortality and evaluate the influence of various prognostic factors such as Glasgow Coma Scale [GCS] Score, volume of hematoma and age on the outcome of the patient admitted with intracereberal hemorrhage. This descriptive case series study was conducted at Liaquat University of Medical aHealth Sciences hospital from July 2006 to March 2008. It included 399 consecutive patients with a diagnosis of SICH wthin 24 hours of their first stroke onset. Patients excluded from study were with hemorrhage secondary to brain tumors, to trauma, to hemorrhagic transformation of cerebral infarct and with previous history of hemorrhagic stroke. The patients' data was collected in a well designed Proforma. The volume of hematoma was calculated according to ABC/2 formula. Quantitative variables were described as mean with +/- SD. While qualitative variables were described as frequency and percentages. Age, GCS score and volume of hematoma compared to the outcome of the patients by receiver operating characteristics [ROC]. The level of Significance was <0.05. This study included 399 patients of which 261 [65.4%] were male and 138 [34.6%] were female. The number of patients <65 years were 222 [55.6] whereas 177 [44.4%] patients were >65 years old. The number of patients who died during hospitalization were 122 [30.6%] and 277 [69.4%] patients remained alive. AUR comparing the volume of hematoma is 0.707 [p=0.001], GCS on admission 0.815 [p=0.001] and age had 0.552 [p=095]. This study showed elderly patients with decreased level of consciousness and hemorrhage > 60 ml have the worst outcome
Subject(s)
Humans , Male , Female , Prognosis , Stroke/complications , Prevalence , Mortality , Fatal Outcome , Brain Hemorrhage, Traumatic , Glasgow Coma Scale , Age Factors , Neurologic ManifestationsABSTRACT
To determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis. This Descriptive case series study was conducted in Medical Department of Liaquat University Hospital Jamshoro / Hyderabad from 3rd January 2009 to 16th June 2009.This study included 74 consecutive cases of cirrhosis of liver of either sex above 14 years of age. Firstly, resting ECG was done in all the patients. QTc values were calculated from lead II. QTc interval of > 0.44 sec were considered as prolonged. Systolic dysfunction was assessed by ejection fraction [value of >55% was considered as increased]. Diastolic dysfunction manifested by reduced E/A ratio [< 1 was considered as decreased]. Thirdly, all patients had determination of proBNP levels. The presence of cirrhotic cardiomyopathy was confirmed by abnormal ECG or echocardiography, along with proBNP abnormalities. Statistical package for social sciences [SPSS[TM]] version 16 was used for data processing purpose. Means +/- Standard Deviation of age and pro BNP levels were calculated. Frequency and percentage were computed for cirrhotic cardiomyopathy in cirrhosis patients. A total of 74 patients were selected for this study, out of which 41 [55.41%] were male and 33 [44.59%] were female. The mean age was 46.2 years [ +/- 10.8 SD]. Out of 74 patients 9 [12.2%] belonged to child Pugh A, 29[39.2%] to child-Pugh B and 36[48.6%] in child-Pugh C. Elevated pro BNP was present in 42[56.8%] cases, E/A ratio < 1 in 15 [20.3%] cases, prolong QT interval [>0.44sec] in 16 [21.6%], Ejection fraction [EF] >/= 0. 55 was present in 25 [33.8%] patients. Cirrhotic cardiomyopathy was present in 33[44.6%] cases. A strong relation was found between cardiomyopathy and severity of cirrhosis of liver [p=0.001], pr0-Bnp levels [p=0.003], QTc > 44 sec [0.004], Ejection fraction > 55% [0.004] and E/A ratio < 1 [p=0.005]. Cirrhotic cardiomyopathy was present in a sizeable proportion of cirrhotic patients, more so in the later stages of cirrhosis of liver
ABSTRACT
Objective: To determine the frequency of different sexual dysfuctions in type 2 diabetic males attending Diabetic OPD of Isra University Hospital and in private setup at Hyderabad
Design: Observational study
Duration of Study: March 2008 to August 2008
Methods: One-hundred type 2 diabetic males were enrolled by purposive sampling technique after obtaining a well informed consent. The different sexual dysfunctions were explained in the language best understood by the subject. Inclusion criteria was type 2 diabetic males of 35-65 years in age taking oral hypoglycemic agents for at least 5-years with HbA1c <9%. Patients with hypertensions, and any other endocrine disease like hypogonadism, thyroid and marked renal or hepatic insufficiency were excluded from the study. Frequencies, proportions and means with standard deviations are calculated for respective types of data
Results: Erectile dysfunction was most frequent, which was present in 55 patients, premature ejaculationin 20, hypoactive sexual desire disorder in 15 and retrograde ejaculation in 10 patients
Conclusion: Diabetes is associated with different sexual dysfunctions and most common is erectile dysfunction
ABSTRACT
To compare the predictive value of MELD [Model of end stage liver disease] and Child-Pugh [CP] scores in patients with decompensated cirrhosis of liver. Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007. This study included 110 consecutive patients with decompensated cirrhosis of liver diagnosed either clinically or radiologically were followed-up during hospital stay. Studied variables included demographic data, cirrhosis related complications and investigations. Patients were classified according to original CP classification into A, B and C. MELD score was estimated from serum bilirubin, serum creatinine and INR [International normalized ratio] of the patients. Duration of hospitalization and in-hospital mortality were made as the end points of the study. T-test and Chi-square test were done for continuous and categorical data. Original CP and MELD score were compared by the ROC curve. 0.05 was kept as the level of significance. There were 110 patients with decompensated cirrhosis of liver. Mean age was 46.76 +/- 12.93 years. There were 72 [65%] male and 38 [35%] females patients. Hepatitis C was the most prevalent cause of cirrhosis of liver present in 60/110 [60%] cases. Ascites was present in 93/110 [83%] patients. The mean MELD scores were 2.23 +/- 0.712 [95% CI 2.09-2.36] and for CTP 2.52 +/- 0.586 [95%; CI 2.41-2.63]. The outcome of the patients were 12 deaths [11%]; 54 [49%] remained hospitalized for up to 14 days and 44 [40%] for>14 days. The majority of deaths and prolong hospitalization were found in patients with MELD score>15 as well as with Child-Pugh grade C. The c-statistic was 0.726 [p=0.001] for CP score, and 0.642 for MELD score [p=0.021]. The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study
Subject(s)
Humans , Male , Female , Chi-Square Distribution , Hepatitis C , Hepatitis BABSTRACT
To study the frequency of steatosis and observe the relation between steatosis and grade of fibrosis in patients with hepatitis C. This descriptive case series study was undertaken at liaquat University of Medical and Health Sciences hospital from July 2005 to November 2007. It included 158 PCR-positive hepatitis C cases with genotype 3. Patients demographic data was enrolled in welt designed proforma BMI was calculated and history of diabetes metlitus was obtained. Liver biopsy was done after written consent and was sent for grading of fibrosis and steatosis. T-test was applied for continuous variables whereas stage of fibrosis was compared with grade of steatosis, BMI and age by chi-square test. 0.05 was made a level of Significance. This study included 158 patients out of which 109 [69%] were male and 49[31%] were female. The mean age of the patient was 36.8 +/- 9.8.The BMI was <25 in 86[54.4%] whereas BMI 25-30 was present inS3 [33.5%] and BMI >30 in 19 [12%] of cases. The steatosis was found in 71[45%] of cases. Mild [<30% of hepatocytes involved] 33[21%], moderate [30-60% hepatocytes involved] in 26 [16.5%] and severe [>60% hepatocytes involved] steatosis in 12[7.5%] cases. A strong correlation between steatosis score and fibrosis stage was observed in our study [P= < 0.001] whereas no relationship was observed between BMI [P = 0.67] or age [P =0.39] with stage of steatosis. This study showed that increased steatosis is associated with worsening fibrosis suggesting a possible role for steatosis in the acceleration of Liver disease in HCV Patients and efforts to control steatosis may therefore have an important role in halting HCV liver disease progression
Subject(s)
Humans , Male , Female , Body Mass Index , Fibrosis , Liver Cirrhosis , Hepatitis C , Polymerase Chain Reaction , Diabetes Mellitus , Liver , Biopsy , Hepatocytes , Disease Progression , Fatty Liver/virologyABSTRACT
To compare various biochemical markers i.e. APRI [AST to platelet ratio index], aspartate aminotransferase [AST] alanine aminotransferase [ALT] ratio, FIB-4 [AST, platelet, AST and age] with biopsy for assessing the severity of hepatic fibrosis in patients with hepatitis C. Study Design: Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2005 to March 2007. Consecutive hepatitis C virus RNA positive and previously untreated patients were studied. Liver biopsy with histological evaluation and AST/ALT ratio, AST to platelet ratio index and FIB-4 were assessed in all patients. Receiver operative curves were developed. There were 158 patients [109 males, 49 females]. On histological grounds non-advanced fibrosis [F0-1] was present in 74 [46.5%] of cases, whereas 84 [53.5%] patients had advanced [F2-4] fibrosis. The area under the receiver operating characteristic curves of APRI < 0.05-1 and FIB-4 < 1.45 were 0.7 and 0.74 respectively, which means that APRI < 1 and FIB-4 < 1.45 will exclude advanced fibrosis in 70% and 74% of patients respectively. An APRI of > 1 and FIB-4 will predict advanced fibrosis in 87% and 98% of patients respectively. AST/ALT ratio was inferior to both of these biomarkers. Both APRI and FIB-4 not only exclude minimal fibrosis but can predict advanced fibrosis in the majority of the patients. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy
Subject(s)
Humans , Male , Female , Hepatitis, Chronic , Hepatitis C , Biopsy , Biomarkers , Liver Cirrhosis , Alanine Transaminase , Aspartate AminotransferasesABSTRACT
Objective: to study clinical localization of stroke and correlate with findings on C-T Scan of Brain
Design: observational study
Place and Duration of study: the study was conducted at the Medical Department of Liaquat University Hospital Hyderabad/Jamshoro from January 2006 to December 2006
Material and Methods: total 110 patients with features of stroke were included in this study. These patients were further evaluated for clinical correlation with findings on CT scan brain, done within 24 hours after the development of focal neurological deficit. Brain tumor, meningitis, viral or bacterial encephalitis, multiple sclerosis and metabolic derangements that could explain focal neurological deficit e.g hypoglycemia were` the exclusion parameters
Results: total of 110 patients, 60 [54.5%] were males and 50 [45.5%] were females. Age of patients ranged 22-84 years with mean +/- SD age of 53 +/- 5 years. On clinical ground cerebral infarction was suspected in 89 [80.9%] and cerebral hemorrhage in 21 [19.1%] patients. In 74 [83%] patients infarction was confirmed by CT scan brain, whereas cerebral hemorrhage was proved in 10 [47.6%] out of a total of 21 patients. These patients were further evaluated for clinical localization of area of stroke. Clinically left parietal / temporo parietal lobe infarction was suspected in 43 patients and right parietal / temporo parietal lobe in 25 patients. Left frontal lobe infarction in 7 patients right frontal lobe infarction in 8 patients, left internal capsule infarction in 2 patients and right internal capsule infarction in 4 patients. Comparing with the CT scan brain findings: left parietal / temporo parietal lobe infarction was confirmed in 41 [95.34%] patients, right parietal / temporo parietal lobe in 19 [76%], left frontal lobe in 5 [71.4%], right frontal lobe in 4 [50%], left internal capsule in 2 [100%] and right internal capsule in 3 [75%] patients. Left middle cerebral artery territory involvement was observed in 43 [58%] patients and right middle cerebral artery territory in 22[30%] patients. No Significant difference was observed in other cerebral artery territories
Conclusion: it was concluded from the study that cerebral infarction was more common than hemorrhage and middle cerebral artery territory infarction of both sides was more common than other cerebral artery territories. Localization of stroke on clinical basis is not always easy. Confident diagnosis requires careful case history taking, extensive neurological assessment and with the help of focal neurological deficit of a particular area
Category: internal Medicine