Serum hyaluronic acid level does not reliably differentiate minimal and significant liver disease in chronic hepatitis C

To evaluate the predictive value of hyaluronic acid [HA] for the assessment of liver fibrosis and inflammation in chronic hepatitis C [CHC]. This cross-sectional study was conducted at Ziauddin University, Karachi, Pakistan from June 2006 to July 2010. Ninety-eight CHC patients, 52 [53%] males, and 46 [47%] females, with an age range of 20-60 years [mean 36.0 +/- 10.5] were recruited. Liver fibrosis was staged on a 5-point scale, F0 to F4, and inflammation was graded on a 4-point scale, A0 to A3. Patients were divided into minimal [F<2 and A<2] and significant [F >/= 2 or A >/= 2] overall disease groups. The HA was measured in the serum by ELISA. Diagnostic value was assessed through receiver operating characteristic [ROC] curve. Significant liver disease was present in 46 [47%] patients. Mean serum HA was significantly different among severity groups [p=0.001]. Area under ROC curve for overall disease was 0.716. Negative predictive value [NPV] for significant overall disease remained 71% at a low HA level of 20 ng/mL. Positive predictive value [PPV] of 85% was obtained at 60 ng/mL and 100% at 120 ng/mL. Those high levels were present in 15% and 10% of the patients. Serum HA levels showed a low NPV for significant liver disease. An acceptable PPV was found only in a small proportion of the patients. Hyaluronic acid may not be regarded as a reliable marker for making treatment decisions

Drinking water: a major source of lead exposure in Karachi, Pakistan

Excess lead in drinking water is a neglected source of lead toxicity in Pakistan. A cross-sectional survey in 2007/08 was made of water samples from drinking water sources in Karachi, a large industrial city. This study aimed to compare lead levels between untreated ground water and treated surface [tap] water in 18 different districts. Of 216 ground and surface water samples collected, 86% had lead levels higher than the World Health Organization maximum acceptable concentration of 10 ppb. Mean lead concentration in ground water [146 [SD 119] ppb] was significantly higher than in surface water [77.1 [SD 54] ppb]. None of the 18 districts had a mean lead level of ground or surface water below the WHO cut-off and ground water sources in 9 districts had a severe level of contamination [> 150 ppb]. Urgent action is needed to eliminate sources of contamination

Sonographic fetal biometry charts for a Pakistani cohort

This study aimed to develop growth centiles at different gestational weeks for fetal biparietal diameter, abdominal circumference, femur length and head circumference in a Pakistani cohort. Data were collected at a tertiary referral hospital from pregnant women at gestational ages 13-40 weeks referred for obstetric ultrasound as a part of routine antenatal care. A total of 1599 fetal sonographic biometric measurements were collected after screening for the inclusion criteria. For each measurement, separate regression models were derived to estimate the mean, standard deviation and reference percentiles at each week of gestational age for this cohort. The best fitting model for each variable was selected. These charts will help radiologists and clinicians in predicting dates of delivery, assessing fetal growth and identifying intrauterine fetal insufficiency in the Pakistani population

Risk factors associated with childhood asthma

To identify the risk factors associated with childhood asthma, in children attending Isra University Hospital, Hyderabad. Case-control study. Isra University Hospital between September 2005 to August 2006. The study included 398 age-matched children [200 asthmatic and 198 non-asthmatic]. Information was collected concerning their familial history of atopy, birth weight, environment, breastfeeding, disease and treatment history. Odds ratio was calculated for determining the risk. The children were aged between 12 months and 8 years and 60% were male. The asthmatic children were hospitalized more frequently than the non-asthmatic children [p < 0.0001]. Most of the asthmatic children lived in the urban areas of Hyderabad [odd ratio [OR] = 16.7, 95% CI = 3.1-14.6, p < 0.0001], had a parental history of asthma [OR = 26.8, 95% CI = 10.8-68.2, p < 0.0001] or allergic rhinitis [OR = 4, 95% CI = 1.2-13.4, p= 0.01], 38.5% had at least one person who smoked, and were weaned earlier than the non-asthmatic children [OR =12.4, 95% CI = 1.3-4.4, p < 0.01]. Childhood asthma was strongly associated with a family history of asthma and allergic rhinitis, the urban place of residence, having smokers as parents and early weaning from maternal breast milk. The results highlight the need to educate the parents about the risk of smoking and early weaning in the development of asthma

Oesophageal atresia and tracheo-oesophageal fistula: an experience from a developing country

To evaluate the various factors influencing the survival of neonates with oesophageal atresia with distal tracheo-oesophageal fistula [EA with TEF]. A descriptive case series. Department of Paediatric Surgery. National Institute of Child Health, Karachi from January 2003 to December 2003. A descriptive case series spanned over one year was conducted at the Department of Paediatric Surgery, National Institute of Child Health, Karachi. The baby's condition was classified according to Waterston's classification. All patients who survived were discharged when they were stable and fit for nursing at home. A routine follow up was advised, initially monthly and later at greater intervals. During one year period 45 patients of aesophageal atresia with distal tracheo-oesohageal fistula were managed. Among these twenty seven [60%] were male and eighteen [40%] female babies. The age at presentation ranged between 3 hours to 20 days with a median age 4 days. The weight at presentation ranged between 1.2 kg to 3.5 kg with a mean of 2.3 +/- 0.5. According to Waterston classification nine [20%] of these were in group-A, twenty-four [53%] in group-B and twelve [27%] in group-C. Six [13%] died preoperatively. In nine patients circular myotomy was done due to long gap. Postoperatively five patients needed ventilatory support. Postoperative course was uneventful in fifteen patients. Twenty four [61%] patients developed minor and major complications. Postoperatively thirteen [28.8%] patients died. Cause of death was mainly sepsis. The over all mortality was 42.2%. A high overall mortality is of concern but post operative survival of about 66.6% [overall 57.8%] is encouraging. Early referral seems to be an important preventable factor for which awareness program at primary health care level is to be stressed

Estrogen receptors in human thyroid gland. an immunohistochemical study

Thyroid diseases affect women approximately 3 times more frequently than men. It has been suggested that the female sex steroids stimulate thyroid growth such as in the breast. Seventeen beta-estradiol, the major estrogen in the body acts via estrogen receptors [ER] present in the nucleus of the cell. The aim of the study is to determine the ER status in the thyroid gland tissues. Our study was based on immunohistochemical staining for ER. Fifty previously diagnosed cases of various thyroid lesions were selected from the Surgical Pathology Records of Pathology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center, Karachi, Pakistan between March and August 2000. The staining was performed on formalin-fixed paraffin embedded tissues using monoclonal anti-ER antibody [clone 1D5]. Out of 50 cases, 8 were nodular goiter, 9 cases of adenoma, 19 papillary carcinoma, 10 follicular and 4 cases were of medullary carcinoma. Surrounding normal tissue was available in 25 [50%] cases, 4 non-neoplastic and 21 neoplastic lesions. Out of 50 cases, 10 [20%] were males and 40 [80%] were females, the youngest patient was a 14-year-old female and the eldest patient was a 56-year-old male. Despite the availability of normal thyroid tissue and a wide range of lesions, none of our cases showed positive staining. In contrary to many earlier reports by immunohistochemical method using monoclonal antibody [clone 1D5] on formalin-fixed paraffin-embedded thyroid tissues, the ER are not detectable. The effect of estrogen on thyroid gland may be indirect one

One year study of cases of severe pneumonia treated with chloramphenicol

All cases, aged 2 months to 5 years diagnosed as severe pneumonia according to A.R.I. programme during study year March 1995 to March 1996 were included in the study. The purpose was to determine a] clinical features on presentation, b] correlation between clinical and radiological diagnosis and c] response to treatment with chloramphenicol. Among total admissions of 1623 cases, 24.32% were admitted with respiratory complaints. 71 cases were classified as severe pneumonia according to ARI programme, and treated with chloramphenicol, 3 cases were excluded from the study as they left within 48 hrs. Out of remaining 68 children, 41 [60.29%] were below I year, 15 were 1-3 yrs and 12 cases were 3-5 yrs old. MY ratio was 1.7: I. In 45.6% of cases the duration of complaints was less than 48 hrs, while in 48.6% it was 35 days. Only 25 cases i.e. 36.76% had radiological changes consistent with pneumonia out of which 7 [10.29%] had lobar pneumonia. 61/68 cases i.e. 89.70% responded to treatment with chloramphenicol with clinical response within 48 hrs but 22/61 cases needed treatment for 7 days due to persistent clinical signs. One child expired within 24 hrs, [mortality of 1.47%] and treatment was changed in 6 cases [8.82%] due to lack of response in 48 hrs. This study confirms that chloramphenical is an effective treatment for most cases of severe pneumonia