Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Hepatitis E virus [HEV] is endemic in Pakistan. Although otherwise asymptomatic, HEV infection becomes fatal in pregnancy, with considerable maternal and fetal morbidity and mortality. We conducted a descriptive study from April to October 2015 in 10 tertiary care hospitals throughout Pakistan to determine maternal and fetal morbidity and mortality in HEV-positive pregnant women with acute jaundice or raised liver function tests. Twenty-one of 135 women were HEV positive and in 3rd trimester except for 1 in 1st trimester. Overall prevalence of HEV in pregnancy was 0.19%. Ten women were artificially induced, 3 had premature labour, 4 delivered spontaneously [full term], 3 died and there was 1 intrauterine death. One woman had a home abortion before coming to hospital. There were 7 perinatal infant deaths: 4 intrauterine, 3 stillbirths and 1 abortion. Maternal mortality was significantly associated with delivery, as 17 mothers who lived went into labour spontaneously or were artificially induced, whereas 3 women who continued their pregnancy and did not deliver, died. Case fatality rate of HEV infection in pregnancy was 14.2%

Frequency of hepatitis C and D super infection in patients with hepatitis B related complex liver disorders

To determine the frequency of super infection of hepatitis C and D in patients with hepatitis B related complex liver disorders and the distribution of HBV genotypes in these patients. Descriptive study. The Gastroenterology Unit of PMRC in JPMC, Karachi, from July 2006 to June 2007. All patients registered for HBV associated infections were selected. Blood was drawn from 180 patients who fulfilled the inclusion criteria. Those with an incomplete test profile were excluded. All clinical conditions were investigated through liver function tests, coagulation profile, and findings at abdominal ultrasonography, upper gastrointestinal endoscopy and liver biopsy. Liver cirrhosis and hepatocellular carcinoma [HCC] were diagnosed either on the basis of histology, or on a combination of radiological, endoscopic and laboratory data. Hepatitis B virus DNA was extracted from serum, and subjected to a nested PCR using the type specific primers for HBV genotype. Descriptive statistics were used for frequency and mean determination. The 129 patients finally selected for statistical analysis included 108 [84%] males and 21 [16%] females. The age ranged from 6- 68 years [mean=31.5 +/- 12.39 years]. There were 70 [54.2%] patients of non-cirrhotic, chronic hepatitis [CLD], 38 [29.4%] carriers, 12 [9.3%] cirrhotics and 9 [6.9%] HCC patients. Among the 129 patients, 45 [34.9%] were positive for double infection with HDV. These included 35 CLD cases, 7 cirrhotic and 3 carriers, 4 [3.1%] patients were positive for double infection with HCV including one with CLD, 2 with cirrhosis and one with HCC. Triple infection with HBV/HDV/HCV was present in 4 [3.1%] patients who had CLD. Approximately 59% [n=76] patients were not coinfected, though 9 had developed HCC. The genotype distribution of HBV was observed as D in 98 [76%] patients, A in 24 [18.6%], and AD mix in 7 [5.4%]. Genotypes B, C, E or F were not found. Accordingly, genotype D strains were the predominant strains among all categories. The frequency of super infection of hepatitis C and D was found to be highest in HBV cirrhosis patients compared to patients having chronic liver disease [non-cirrhotics] and carriers. Genotype D of hepatitis B virus was found dominant in all hepatitis B related complex liver disorders

Management of parapharyngeal space tumours

To determine the role of clinical features, fine needle aspiration cytology [FNAC] and computed tomography [CT] scan in diagnosing parapharyngeal space [PPS] tumors and treatment options. A descriptive study. From July 2000 to July 2002 at Pakistan Institute of Medical Sciences, Islamabad. Patients diagnosed as having PPS tumors were studied. The medical record of patients was reviewed for their age, gender, clinical features, investigations [FNAC and CT scan] and treatment. The mean age, percentage of different clinical features and the sensitivity and specificity of FNAC was determined. The mean age of patients presenting with PPS tumours was 33.6 years. The most common clinical features were neck mass [93%] and bulge in lateral pharyngeal wall [80%]. The CT scan showed exact location and extent of tumour in 11 out of 15 cases. The sensitivity and specificity of FNAC was 70% and 85% respectively. The most common tumours were neurogenic tumours [6] and salivary gland tumours [4]. Surgery was performed in all except 2 patients with lymphoma in whom radiation and chemotherapy was recommended. This study indicates that PPS tumours are usually benign neurogenous and salivary gland tumours presenting with neck mass and bulge in oropharynx. FNAC and CT scan are important in diagnostic work up and treatment planning. Surgery has the best results in most cases