RESUMEN
To determine the etiology, clinical manifestation, management [medical and surgical] and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan. Descriptive, analytical study. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010. Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight [kg] and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated. Among the 112 patients, 59 [53%] were younger than 5 years of age. Males [n=83, 74%] were predominant. Fifty [45%] children were admitted in winter. Thirty [27%] children found unvaccinated and one fourth [n=27; 24%] were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six [59%] were on some antibiotics prior to admission. Staphylococcus aureus [n=13] and Streptococcus pneumoniae [n=5] were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention [n=86]. Surgically managed children were younger [p=0.01]; had less weight [p=0.01] and prolonged fever [p=0.02]; and stayed longer in hospital [p < 0.001] as compared to medically managed children. Requiring readmission [n=8], subcutaneous emphysema [n=5] and recollection of pus [n=5] were the major complications. Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management
RESUMEN
OBJECTIVE: Type 2 Diabetes mellitus is more common among chronic hepatitis C patients$4Various risk factors that predisposes chronic hepatitis C patients' to develop Type 2 Diabetes, includes age, sex, BMI and positive family history of diabetes mellitus. The objective of present study is to determine the frequency of Type 2 Diabetes mellitus in chronic hepatitis C virus infection and to compare the clinico-demographic features of hepatitis C cases with or without diabetes mellitus
METHODS: This cross sectional study was done in medical wards of Liaquat University Hospital Hyderabad / Jamshoro from August 15, 2010 to February 15, 2011.Hundred consecutive patients of chronic hepatitis C virus infection were enrolled after getting informed consent. Baseline patient's data was collected with the help of a self-administered questionnaire which includes patient's history and physical examination. Patients were especially asked about family history of Diabetes mellitus and their body mass index [BMI] and blood pressure were recorded. Blood samples were drawn after twelve hours of fasting for fasting blood sugar and after two hours of taking meal for post prandial blood sugar. Liver function test, ultrasound abdomen and serological tests for hepatitis such as hepatitis B surface antigen [HBsAg] and anti hepatitis C antibody [antiHCV] were done in every patient. Patients with Type 1 Diabetes mellitus and those having positive results for both HBsAg and anti HCV antibody simultaneously were not included in the study. The data was analyzed by SPSS [statistical package for social science] version 10.0. For statistical data analysis, Chi square test was applied. A p value of 0.05 was considered as statistically significant
RESULTS: Hundred patients of chronic hepatitis C were included in the study. Sixty were males [60%] and forty [40%] were females. The age range of patients was 35-74 years and the mean age was 47.25+/- 11.02 [SD]. Out of hundred patients, twenty seven [27%] had positive family history of diabetes mellitus and twenty eight [28%] had diabetes mellitus themselves. The BMI range of patients was 21-37 kg/m2 and the mean BMI was 26.03kg/m2 +/- 4.30 [SD]. Correlation of age [p = 0.001], BMI [p = 0.009] and family history of diabetes mellitus[p = 0.001] with the frequency of type 2 Diabetes mellitus in HCV +ve patients was statistically significant while comparison of gender with T2DM in HCV patient was not statistically significant [p = 0.413]
CONCLUSION: Type 2 Diabetes mellitus is more common among patients with chronic hepatitis C than those without hepatitis C. Increasing age, positive family history of diabetes mellitus and raised BMI are the risk factors for its development