Résumé
Hepatitis D virus [HDV] superinfection in patients with chronic hepatitis B leads to accelerated liver injury, early cirrhosis, and decompensation. It may be speculated that hepatocellular carcinoma [HCC] may differ in these patients from hepatitis B virus [HBV] monoinfection. The aim of this study was to compare clinical aspects of hepatocellular carcinoma in patients of hepatitis D with HBV monoinfection. A total of 92 consecutive HCC cases seropositive for antibody against HDV antigen [HDV group] were compared with 92 HBsAg-positive and anti-HDV-negative cases [HBV group]. The features including sex, body mass index, presence of ascites, serum biochemistry, gross tumor appearance, child class, barcelona cancer liver clinic and okuda stages were not significantly different between the 2 groups. Decreased liver size was noticed more in cases of HDV compared with HBV group where the liver size was normal or increased [P=0.000]. HDV patients had lower platelets [P=0.053] and larger varices on endoscopy [P=0.004]. Multifocal tumors and elevated alpha-fetoprotein level>1000 IU/mL were more common in HBV group [P=0.040 and P=0.061]. TNM classification showed more stage III-IV disease in HBV group [P=0.000]. Decreased liver size and indirect evidence of more severe portal hypertension and earlier TNM stage compared with HBV monoinfection indicate that HDV infection causes HCC in a different way, possibly indirectly by inducing inflammation and cirrhosis
Résumé
Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority [68%] of the audited medical records were of females. Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of 'excellent' or 'good' diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% [95% CI: 71.1-87.9] of cases. Physical activity advised/reinforced at every visit was least observed [27.3%; 95% CI: 18.0-36.6]. In addition, blood sugar control was reported in less than a quarter [23.9%] with 95% CI of 15.0-32.8. This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale