Chronic hepatitis C; "APRI score a noninvasive marker, its predictive value for determination of hepatic fibrosis and liver cirrhosis at tertiary care hospital Hyderabad/ Jamshoro"

ABSTRACT: The major causative factor of hepatic cirrhosis and its complications in chronic hepatitis C is due to presence of liver fibrosis. To assess prognosis and management related decisions, the exact staging of liver fibrosis is of greatest importance. Now, liver biopsy is the inexact gold standard for this purpose. APRI or AST to platelet ratio Index is the best noninvasive marker which can predict presence of fibrosis in majority of chronic hepatitis C patients without the need of biopsy. It is also cost effective and only depends on routine testing [Platelet count and serum AST]

Objectives: To determine the positive predictive value of APRI Score for the prediction of fibrosis and cirrhosis in chronic hepatitis C patients. Study design: Cross sectional study. Setting: Medical wards and Out Patient Medicine Department of Liaquat University Hospital Hyderabad / Jamshoro. Period: 6 months

Methodology: A total of 51 patients of either gender, age >14 years presenting to Medical wards and OPD for the evaluation of chronic hepatitis were enrolled in this research study after giving preference and avoiding criteria. Clinical data was collected at the time of liver biopsy and blood samples for liver function tests, blood glucose and complete blood picture with platelet count were collected before the biopsy [only AST and platelet count are needed for APRI score] a core biopsy needle of 14 gauge was used and the procedure was conducted under ultrasound guidance. Fibrosis stage was determined according to the METAVIR group scoring system. The patients were examined in a very comfortable manner and all the information collected from the patients was kept confidential and entered in the predesigned proforma

Results: A total of 51 patients were selected for this study. Out of these 31 [60.78%] were male and 20[39.22%] were female. The mean age was 42.53 years [ +/- 11.2 SD]. The positive predictive value for APRI score between 0.5 to 1.0 was 58.82% whereas the positive predictive values for APRI score 1.1-1.5 was 70.58%

Conclusion: The positive predictive values of APRI score in the ranges of 0.5 to 1.5 were not indicative of the presence of significant liver fibrosis in this research study. However, additional data are required to authenticate or disprove the usefulness of APRI score for the prediction of significant hepatic fibrosis in chronic hepatitis C patients

Incidence of right ventricular infarction in patients with acute inferior wall infarction

Objectives: to find out the frequency of right ventricular infarction [RVI] in patients with acute inferior wall myocardial infarction and also to see its clinical correlation and prognostic value

Methods: 198 consecutive patients with acute inferior wall myocardial infarction [MI] were enrolled. Elevated ST segments in V4R or V3R to V6R were used to diagnose RVI. We assessed the incidence of ST-segment elevation in these leads and their correlation on clinical ground

Result: in 96 patients [48.5%], RVI was present. Clinical correlation showed that raised JVP was present in 58.5% and raised JVP with hypotension in 34.5% of patients. Normal JVP was present in 41.5% of patients in which 22% of patients were with hypotension and 20% of patients were without clinical findings. Hypotension observed in 53% of patients. Complications were higher in patients with elevated ST segments in V4R [51%] in contrast to those without RVI [21%]. In-hospital mortality was more than double in RVI Group

Conclusion: RVI in acute inferior MI is common. Elevated ST segments in V4R or V3R to V6R can be used to diagnose RVI. Clinical correlation can help but may not be diagnostic and it has higher mortality compared to inferior MI alone

Chronic kidney disease; study on patterns of anemia in relation to glomerular filtration rate [GFR] in patients

Chronic kidney disease is usually related with anemia and the level of anemia correlates with the severity of renal failure. A chronic kidney disease is complicated by anemia and anemia may contribute to adverse clinical outcomes. No large-scale population data are available for patients with chronic kidney disease regarding prevalence of anemia, subpopulations at risk, and relationships between anemia and renal dysfunction

Objectives: The objective of this study is to determine the frequency of different patterns of anemia in relation to glomerular filtration rate in patients suffering from chronic kidney disease stage II and above Patients

Material and Methods: Study Design: Cross sectional study

Setting: Medical and Nephrology wards of Liaquat University Hospital Hyderabad / Jamshoro

Period: 20[th] January 2013 to 19[th] December 2013

Results: During the study period, total 339 patients of chronic kidney disease with stage II and above patients were enrolled. The mean age +/- Standard Deviation and range] of patients was 50.65 +/- 11.86 [16 to 80 years, n = 339]. 211[62.2%] were male and 128[37.8%] were female. [Male to Female Ratio 1: 6]. Mean Hemoglobin +/- SD was 7.16 +/- 3.89 [3.0 to 17.0 g/dL]. The frequency of anemia was present in 285[84.1%] patients with mean Hb +/- SD 6.02 +/- 2.1 [g/dL]. The mean weight +/- SD was 56.50 +/- 9.84 [40 to 81 kg]. The mean serum creatinine +/- SD was 5.63 +/- 2.48 [0.9 to 12.0 mg/dL] and we observed that most frequent pattern of anemia was normocytic-normochromic anemia in 216[77.0%] patients, hypochromic-microcytic in 61[18.0%] and macroyctic in 17[5.0%] patients. We also found that as anemia increased progressively with declining GFR with mean hemoglobin concentration of 11.78 +/- 2.8 g/dL in CKD stage 2, 10.14 +/- 3.6 g/dL in CKD stage 3, 6.8 +/- 3.6 g/dL in CKD stage 4, 7.44 +/- 4.0 g/dL in CKD stage 5

Conclusion: Frequency of anemia increases with the progression of stage of chronic kidney disease [decreased GFR] and anemia was most common in stage 5 patients of chronic kidney disease. Most frequent pattern of anemia is normocytic normochromic anemia

Essential hypertension; [evaluation of serum uric acid at tertiary care hospital hyderabad/jaivishoro]

Little and sparse information is present in our population on association between serum uric acid and essential hypertension .Increased serum uric acid is related with elevated blood pressure in different research studies. The relationship between serum uric acid level and high blood pressure can be difficult to assess because drugs for high blood pressure usually affect uric acid level. The objective of our study is to evaluate the association of serum uric acid to severity and duration of essential hypertension at Liaquat University Hospital [tertiary care] Hyderabad / Jamshoro. Case control and prospective study. Medical wards and Out Patient Medicine Department of Liaquat University Hospital Hyderabad /Jamshoro. One year i.e. from 20[th] March 2013 to 19[th] February 2014. A total of 75 high blood pressure subjects aged 35 years and above were included as cases with same number[75] of age and sex matched normal blood pressure subjects as controls after excluding, Secondary hypertension, metabolic syndrome ,Diabetes Mellitus, age <40 ;>70 years, hypothyroidism, hyperparathyroidism, Ischemic heart disease, congestive cardiac failure, Alcohol abuse, Renal Insufficiency, glomerulonephritis, pyelonephritis, hereditary nephropathy, patients on drugs -, ethambutol levodopa pyrazinamide, low dose asprin, Cytotoxic drugs, nicotinic acid ,thiazide diuretics.. Qualitative and quantitative data were evaluated in SPSS version 16.0. The mean serum uric acid level was 6.3 +/- 1.4 mg/dl vs 4.5 +/- 1.2 mg/dl in case [n = 75] and control patients [n = 75] respectively. A total of 23 [30.6%, n = 75] patients in cases and 8 [10.6%] subjects in control had high serum uric acid [Odds Ratio 2.13, p <0.05]. Therefore, the frequency of increased serum uric acid level subjects and mean serum uric acid level were significantly greater in hypertensive cases, as compared to those of healthy normal blood pressure Controls. Serum uric acid correlated positively with both systolic blood pressure [r=0.132, p<0.01] and diastolic blood pressure [r=0.214; p<0.01]. High serum uric acid is frequent in our populace with essential hypertension and there is relationship between serum uric acid level and blood pressure. Further large scale research studies on the pathophysiologic significance of high serum uric acid in these high blood pressure patients are in further need

Realty or myth hyponatremia is common in admitted patients in medical wards lumhs Hyderabad

OBJECTIVE: To see the frequency of hyponatremia in hospitalized patients of medical wards at Liaquat university hospital Hyderabad

METHODOLOGY: In this Descriptive Cross-sectional Study we included 200 patients admitted in medical wards of Liaquat University Hospital Hyderabad from 1st July to31 august 2013, Serum sodium level of these patients was sent and results were recorded on a preformed profarma. We included all patients admitted in ward through emergency or out patients department

Inclusion Criteria: In this study patients attending emergency and OPD were included in between age of 12 years to 80 years

Exclusion Criteria: In this study we excluded all patients with acute myocardial infarction ,angina ,and traumatic emergency

RESULTS: Among 200 patients, we found 44%[88] patients having hyponatremia with 36%[72] patients with mild to moderate hyponatremia and 8% [16] patients have moderate to severe hyponatremia

Males have increased frequency of hyponatremia then females. Study concludes that frequency of hyponatremia is more frequent with increasing age

CONCLUSION: Hyponatremia is common problem seen in admitted patients in male wards

Adolescent males and young females in Tehran: differing perspectives, behaviors and needs for reproductive health and implications for gender sensitive interventions

Despite cultural and religious prohibitions against premarital heterosexual rela-tionships and intimacy, some recent evidence suggests some rise in premarital heterosexual interactions and relationships among young people. On the other hand, although HIV in Iran is a concentrated epidemic and mainly reported among high risk groups such as injecting drug users [IDUs], but there are evidences that the mode of transmission is shifting towards sexual contacts. This trend has caused concern among health policy makers in terms of prevention of STDs and HIV/AIDS particularly, among young people. This paper was prepared with the aim of high-lighting how gender contributes to variation in reproductive health needs and conduct of young people in Iran. Method: This paper is based on a secondary analysis and compares comparable reproductive beliefs and conducts of women and men based on the data of two surveys conducted in Tehran in 2002 and 2005. A survey among 1385 adolescent males and another survey among 1743 female undergraduate students in four multidisciplinary universities in Tehran. Both surveys used anonymous self-administered questionnaires. To make the two samples comparable, the data of unmarried female university undergraduate students who resided in Tehran were merged with the data of adolescent male students who intended to pursue higher education. Common variables of the two surveys were identified, homogenized, merged and analysed. Reproductive health knowledge among male adolescents was poor compared to that of their female peers. Although premarital friendships were moderately acceptable from view points of both males and females, the majority were against premarital sex, particularly among female participants. There were evidences of gender-based double standards in perceptions of premarital sexuality among both males and females; particularly, it was stronger among males than females. Male adolescents reported earlier and greater experiences of premarital hetero-sexual intimacy and sexual contact than females. Multiple partners were also more common among males than females. Females had a tendency to regret first sexual contact more than males, which reflects that first sex is more likely to be unplanned and unwanted among females compared to males. Significant gender based double standards prevailed current sexual attitudes and conduct of young people in Iran. Gender norms which encourage unmarried men to practice pre-marital sex lead to an earlier transition of men to sexual relations and multiple sexual partners. Due to poor knowledge and various misconceptions about sexual health and lack of consistent contraceptive and condom use among adolescents and young people in Iran, both young men and women are susceptible to sexual and reproductive health hazards such as sexually transmitted infections [STIs], HIV/AIDS, pregnancy and unsafe abortion. Changing gender norms associated with sexuality may lead to promotion of safer sexual behaviors particularly among young people. Current reproductive health and HIV prevention programs should take into account gender-based double standards among young people and their unmet reproductive health needs