Hepatitis B surface antigen carrier rate in unvaccinated and vaccinated children with thalassaemia major at Bahawal Victoria Hospital, Bahawalpur, Pakistan

Screening of blood reduces but does not eliminate the risk of hepatitis B virus [HBV] infection in multi-transfused thalassaemia patients. This study was done to evaluate efficacy of HBV vaccination on hepatitis B virus surface antigen [HBsAg] carrier rate in children with thalassaemia major receiving multiple blood transfusions. In a cohort study conducted at a hospital in Bahawalpur, Pakistan, during 2009-10, children with thalassaemia major aged < 60 months who received more than 24 blood transfusions and were HBsAg negative at the time of first blood transfusion were included. Of 196 unvaccinated children, the seropositive rate was 12.2%; while among 218 children vaccinated during the first year of life via the Pakistan Expanded Programme on Immunization, the seropositive rate was only 0,9%. The HBV vaccine was highly effective in reducing the HBsAg carrier rate in children with thalassaemia aged < 5 years

Testicular abscess caused by salmonella para-typhi

This case is the first report of a bacteriologically proven testicular abscess in a child caused by Salmonella paratyphi 'A' in Pakistan that clinically simulates a testicular tumour. The case also emphasises that a course of 2 weeks antibiotic is sufficient for testicular abscess if complete surgical debridement is done. Keywords: Salmonella paratyphi 'A', Testicular Abscess, Tumour

Intussusceptions in adults: clinical features and operative proce

To determine the clinical presentation and treatment outcomes of adult patients with intussusceptions. Case series. The Aga Khan University Hospital, Karachi, from January 1988 to December 2008. Medical records of patients with diagnosis of intussusceptions in adults [above 15 years of age] from January 1988 to December 2008 were retrieved through ICD 9 coding system. Patients with complete records were included in the study and those with incomplete medical record or under 30 days follow-up were excluded. Data was analyzed on SPSS version 16. The treatment outcomes were hospital stay, 30 days-morbidity, mortality and recurrence of intussusceptions during follow-up period. The mean age of the 19 patients was 37 years with male predominance. Most patients presented with acute bowel obstruction. In 14 patients, small bowel were involved. CT scan diagnosed intussusception in 10 out of 12 patients. Benign lead point were found in 80% cases. Eighteen patients were treated surgically. Fourteen [70%] patients underwent resection with primary anastomosis while in 4 patients only reduction was done. In resection group, 11 patients had resection after reduction and in 3 patients only resection was done. There was no recurrence in resection group. One recurrence was noticed in the reduction group and one patient died of advanced gastrointestinal malignancy in the non-operative group. Intussusception is a rare cause of acute intestinal obstruction in adult population. CT scan is a promising diagnostic tool to establish pre-operative diagnosis. Early surgical resection could achieve optimal outcome. Small bowel intussusception could be reduced before resection if there is no doubt about bowel viability. In most of the patients the lead point could be benign disease

Impact of rural medical care in remote mountainous region of Pakistan: challenges and opportunities

To share the experience of developing rural medical care and the impact on the health indicators of the population. The clinical data was collected prospectively using ICD-9 coding and data base was developed on a desk top computer. Information about the operative procedures and outcome were separately collected on a excel work sheet. The data from January 1998 to December 2001 were retrieved and descriptive analysis was done on epi info-6. Thirty one thousand seven hundred eighty two [31,782] patients were seen during this period, 53% were medical, 24% surgical, 16% obstetric and 7% with psychiatric illness. Out of 1990 surgical operations 32% were general surgery, 31% orthopedic, 21% pediatric, 12% obstetric and 4% urological cases. There were 21 surgical mortality including 6 operative deaths, 15 non operative deaths and 89% of the mortalities were unavoidable. The crude in hospital mortality decreased significantly from 5.5% in 1992 to 1.1% in 2001 and the contributing factors were improved structure and process of care. The impact of secondary care rural medical centre [AKMC] is obvious from the clinical audit including accessibility, sustainability and quality of care. This could be a model of care in rural Pakistan where accessibility, affordability and quality of care is lacking

Immune thrombocytopenia in children with reference to low income countries

Immune thrombocytopenia is a benign and self-limiting disorder. Data about the condition and its incidence from low-income countries is limited. This paper reviews the research about immune thrombocytopenia, comparing low- and high-income countries. Diagnosis is usually based on complete blood count and peripheral smear and, in selected cases, bone marrow aspiration. The disease has a high remission rate both in high- and low-income countries and intracranial haemorrhage is rare. The recommended treatment is simply observation of cases, especially when the platelet count is > 10 000 /mm[3]. If drug therapy is required, oral steroids are the most economical choice

unique variant of intestinal tuberculosis

Duodenum is a rare site of involvement in intestinal tuberculosis. We report a 19 years old boy who presented with non-bilious vomiting and weight loss. His workup showed stricture in ascending colon, multiple liver abscesses with pneumobilia on CT scan. Upper GI endoscopy revealed stricture in 2[nd] part of duodenum distally. He was operated and duodenojejunostomy with limited right hemicolectomy [for stricture in this part of gut] were done. Biopsy report was suggestive of tuberculosis. Antituberculous treatment was started. He responded well and gained 20 kg weight at 3 months follow-up

Study on the effect of oral hypoglycaemic agents on arterial stiffness among Malays with type II diabetes mellitus

To determine the effect of two regimens of oral hypoglycaemic agents: sulphonylurea monotherapy and metformin in combination with sulphonylurea on arterial stiffness. A case control study was conducted at the Family Medicine and Diabetic Clinic, HUSM from May 2004 until May 2005. Sixty subjects receiving sulphonylurea alone and ninety subjects on combination therapy with metformin participated in this study. A simple random sampling method using a draw lot was used to select 51 subjects for each group. Augmentation index [AI] was measured using the Sphygmocor apparatus and all measurements were performed by the investigators after an earlier validation study. The mean augmentation index measurements were analyzed. The mean AI values of diabetic subjects treated with sulphonylurea monotherapy and a combination with metformin were 140.51 +/- 11.42 vs 140.14 +/- 12.86, p= 0.877. AI values were significantly higher in females compared with males [143.23 +/- 10.60 vs 135.82 +/- 13.01, 95% CI: -12.07, -2.73, p = 0.002]. Duration of diabetes [in years] was significantly less [3.46 +/- 3.16 vs 5.41 +/- 3.66, p = 0.005] for sulphonylurea monotherapy patients compared with combination therapy patients. This study shows that sulphonylurea monotherapy and metformin in combination with sulphonylurea have similar effects on arterial stiffness in type 2 diabetes subjects. Diabetes is associated with a greater arterial stiffness in women compared with men

Road traffic injuries in the third trimester of pregnancy

Road traffic accident third trimester of pregnancy present with dual problem the one is the injury to mother and others to the foetus. There were 9 women in the third trimester of pregnancy who were severely injured in road traffic accidents. Three cases were in accelerated labours and half the babies died. Immediate obstetric interference was often impractical and did not improve fetal survival. Note war thy injuries of the central nervous .system were associated with very high fetal mortality. Fractures of the pelvic were not disastrous. The first consideration in management should he the well being of the severely inured mother. Since the injuries that would kill the, fetus are not likely to be amenable to surgery. The only, justification for intervention for the sake of the fetus that survives the moment of impact is to salvage it from its dying mother's body

Renal cell carcinoma metastatic to great toe

Metastasis in the bone are quite common, and Renal Cell Carcinoma remains an important cause. When metastases occur in bone, they usually involve the vertebrae, ribs, pelvis, clavicles, mandibles and proximal portions of major long bones. We are reporting a case with metastases to great toe, an unusual presentation

Late repair of the tendon achilles

The results of untreated ruptures of the tendon achilles are widely accepted as poor. Surgical or conservative treatment is fruitful in ruptures presenting early, but in ruptures presenting late only surgical treatment is possible because the proximal end of the tendon retracts. A prospective and retrospective study of 5 patients of Late Repair of the Tendon Achilles was carried out at Liaquat Medical College Hospital, Jamshoro / Hyderabad from July 1996 to June 1998. The average age for the series was 43 years. Sex incidence finale to female ratio was 4:1 patients. Delay between injury and time of operation had been from one month to an year. All cases were operated upon. Direct suturing method was used. Follow up of the patient varied from 4 months to 12 months. The results shown by direct Suturing in the Achilles tendon is comparable to any other form of treatment

Pattern of renal disease in children

In 1992 a total of 1298 patients with renal diseases were seen in the medical outpatients department. Eight hundred and forty-seven [65.2%] had urinary tract infection and 265 [20.5%] had nephrotic syndrome. Two hundred and twenty patients required inpatient care, which constituted 3.3% of total number of patients admitted to medical wards. Sixty-four [29%] of admitted patients with renal disease had nephrotic syndrome, 29 [13.1%] had acute renal failure due to various causes including haemolytic uraemic syndrome. The average stay was 5.8 days per patient and mean bed occupancy was 3.4 beds per day. Various renal diseases in children together form an important group of disorders often requiring long term care and this should be taken into account when planning provision of child health services particularly at tertiary care level