Fulminant hepatic failure in multan: five years experience

Four hundred sixteen patients of fulminant hepatic failure [FHF] with a prevalence of 31.39% out of AVH patients were studied, who were admitted in Medical Unit II, Nishtar Hospital, Multan during January, 1987 to December, 1991. There were 323 male [77.64%] and 93 [22.36%] female patients. A progressive rise in number of FHF patients were noted during this period. Mean age was 40.31 +/- 16.84 years, male pts. Higher than female patients [42.33 +/- 17.18 and 35.35 +/- 15.51 years respectively]. In FHF patients hospital stay was shorter [6.18 +/- 6.06 V 7.95 +/- 1.65 days], disease was more acute [16.71 +/- 13.05 V 23.45 +/- 14.54 days], temperature higher [99.02 +/- 1.52 V 98.63 +/- 1.15 F], vomiting less frequent [12.73% V 17.82%], HbsAg positive rate higher [76.36% V 69.31%], serum bilirubin higher [9.67 +/- 5.87 V 5.7 +/- 4.83mg/dl], SALT higher [439.16 +/- 377.91 V 192.55 +/- 172.66 u/l], prothrombin time more prolonged [26.2 +/- 11.43 V 21.03 +/- 7.34sec.] and serum potassium lower [3.73 +/- 0.75 V 4.05 +/- 0.57 mmol/l] than in Non-FHF patients. Complications like ascites, hepatorenal syndrome and hypoprothrombinemia were more common in FHF [P<0.001]. Extremes of age [female<30years, P<0.001; male>60 years, P<0.01], short hospital stay [P<0.001] acute illness [P<0.001], higher temperature [P<0.001], serum bilirubin >10mg/dl [P<0.001], SALT>400u/l [P<0.01 in male, P<0.001 in female], were associated more frequently with FHF patients than Non-FHF patients. Overall mortality rate in FHF patients was very high [in total 61.3 V 4.5%, in male 53.5% V 6.9%, in female 88.2% V zero] as compared to Non-FHF patients. In male patients older age, short hospital stay, acute illness [all with P<0.001], high serum alkaline phosphatase, hypoglycemia, hypokalemia, prolonged prothrombin time and coma grade V [all with P<0.01] were associated with higher mortality and can be considered as poor prognostic factors. While coma grade I in both sexes [P<0.001] was associated with better survival. Such prognostic factors were of no value in female patients

Acute hepatitis B in adults 5-years experience

Total 946 patients were HBs Ag positive, out of 1325 patients admitted with Acute Viral Hepatitis, in Medical Unit II, Nishtar Hospital, Multan during Jan. 1987 to Dec. 1991, with an incidence of 71.4%. There were 632 males [66.8%] and 314 females [32.2%] patients. Mean age was 40.73 +/- 15.49 years, with male of slightly older age than female patients [41.29 +/- 15.50 and 38.93 +/- 15.68 years]. Clinical and laboratory features were unable to differentiate between HbsAg positive and negative patients. Serum bilirubin [7.31 +/- 5.71 V 6.77 +/- 5.00] SGPT [285.51 +/- 203.97 V 263.11 +/- 202.55], serum alkaline phosphatase [262.37 +/- 167.06 V 244.39 +/- 149.55] and fasting blood sugar [100.35 +/- 56.09 V 95.09 +/- 35.09] were slightly higher in HbsAg positive as compared to HbsAg negative patients. Various complications noted like bleeding [P<0.0001] ascites [P<0.0001 in males P<0.001 in females], hepatorenal syndrome [P<0.001] in males and deaths [P<0.0001 in females] were significantly more common in HbsAg positive patients. Hepatic encephalopathy was more common in female patients [P<0.01] only. Similarly extremes of ages, high temperature, small liver, very high s. bilirubin and enzymes, hypoglycemia, hypokalemia and prolonged prothrombin time [P<0.01 to <0.0001] were commonly seen in female patients. While high temperature, high serum enzymes hypokalemia and prolonged prothrombin time [P<0.01 to P<0.0001] were more common in male HbsAg positive patients. There were total 19.13% deaths, while in male patients death rate was 22.15% and in female HbsAg positive patients deaths were 13.05%. Excluding patients with hepatic encephalopathy, total death rate was just 3.80% and in male HbsAg positive patients death rate was 6.22%. There was no death in female HbsAg positive non-comatosed patients. Overall death rate was higher in HbsAg negative [30.34%] patients as compared to HBs Ag positive [19.13%] patients

Acute viral hepatitis in pregnancy

Total 91 pregnant women with AVH were admitted in Medical Unit II, Nishtar Hospital, Multan from January 1987 to December 1991. Incidence of female AVH patients was 22.3%, while hospital-based frequency was1: 3540. Mean age was 27.5 +/- 5.01 in pregnant women in contrast to 43.07 +/- 15.43 years in non-pregnant females. Younger age, short hospital stay brief illness, high temperature, high serum bilirubin, high serum ALT, hypoglycemia, hypokalemia [all with P<0.0001], high serum phosphatase [P<0.001], and small liver [P<0.01], were significantly more requent in pregnant women than in non-pregnant women. Bleeding from GIT [P<0.001] and ascites [P<0.001] were significantly more common in non-pregnant patients. While higher death rate, prolonged prothrombin time and hepatic encephalopathy [all with P<0.0001] were more frequently noted in pregnant AVH patients. The death rate in pregnant AVH patients was 58.24% in contrast to 9.15% in non-pregnant AVH patients. Out of pregnant AVH patients pregnancy was associated with 68% death rate and abortion / delivery was associated with 32% death rate. Poor prognosis was associated with short hospital stay [P<0.01], small liver [P<0.02], HBsAg positive [P<0.02], high serum alkaline phosphatase [P<0.001], pregnant AVH patients

Pseudo-Hypo-Parathyroidism [PHP] and Albright's Hereditary Osteodystrophy[AHO], review and two case reports

Pseudo-hypo-parathyroidism and Albright's hereditary osteodystrophy are rare but important diseases as they represent the only human disease states in which G protein function is disrupted. Decreased function of Gs alpha of adenylate cyclase results in receptor resistance to not only to PTH but to some other hormones as well. Case reports of two young females are reported. One had PHP-Ia along with a rare manifestation of the oligomenorrhea; while the other has PPHP with spinal cord compression, again a rare complication